CLINICAL RESEARCH: HEART FAILURE TREATMENT
Benefits of Cardiac Resynchronization Therapy for Heart Failure Patients With Narrow QRS Complexes and Coexisting Systolic Asynchrony by Echocardiography
Cheuk-Man Yu, MD, FRCP*,*,
Yat-Sun Chan, FHKAM*,
Qing Zhang, MM*,
Gabriel W.K. Yip, MRCP*,
Chi-Kin Chan, FHKAM ,
Leo C.C. Kum, MRCP*,
LiWen Wu, BM*,
Alex Pui-Wai Lee, MRCP*,
Yat-Yin Lam, MRCP* and
Jeffrey Wing-Hong Fung, FHKAM*
* Division of Cardiology, S. H. Ho Cardiovascular and Stroke Centre, Institute of Vascular Medicine, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China.
Manuscript received May 8, 2006;
revised manuscript received July 14, 2006,
accepted July 17, 2006.
* Reprint requests and correspondence: Prof. Cheuk-Man Yu, Division of Cardiology, S. H. Ho Cardiovascular and Stroke Centre, Institute of Vascular Medicine, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong, China. (Email: cmyu{at}cuhk.edu.hk).
OBJECTIVES: This study was designed to evaluate the role of cardiac resynchronization therapy (CRT) in heart failure (HF) patients with narrow QRS complexes (<120 ms) and echocardiographic evidence of mechanical asynchrony.
BACKGROUND: Cardiac resynchronization therapy is currently recommended to advanced HF patients with prolonged QRS duration. Echocardiographic assessment of systolic mechanical asynchrony has been proven useful to predict a favorable response after CRT.
METHODS: A total of 102 HF patients with New York Heart Association (NYHA) functional class III or IV were enrolled. Among them, 51 had wide QRS (>120 ms) and 51 had narrow QRS (<120 ms). Tissue Doppler imaging (TDI) was employed to select patients with systolic asynchrony (increased asynchrony index) in the narrow-QRS group. Clinical and echocardiographic assessments were performed at baseline and 3 months after CRT.
RESULTS: There was a significant reduction of left ventricular (LV) end-systolic volume in both narrow (122 ± 42 cc vs. 103 ± 47 cc, p < 0.001) and wide (148 ± 74 cc vs. 112 ± 64 cc, p < 0.001) QRS groups. Improvement of NYHA functional class (both p < 0.001), maximal exercise capacity (both p < 0.05), 6-min hall-walk distance (both p < 0.01), ejection fraction (both p < 0.001), and mitral regurgitation (both p < 0.005) was also observed. In both groups, the degree of baseline mechanical asynchrony determined LV reverse remodeling to a similar extent, as shown by the superimposed regression lines. Withholding CRT for 4 weeks resulted in loss of echocardiographic benefits.
CONCLUSIONS: Cardiac resynchronization therapy for HF patients with narrow QRS complexes and coexisting mechanical asynchrony by TDI results in LV reverse remodeling and improvement of clinical status. The amplitude of benefit is similar to the wide-QRS group provided that similar extent of systolic asynchrony is selected.
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Abbreviations and Acronyms
| | CRT = cardiac resynchronization therapy | | HF = heart failure | | LV = left ventricular | | NYHA = New York Heart Association | | ROC = receiver-operating characteristic | | TDI = tissue Doppler imaging |
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|
|
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A. E. Weyman
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|
|
|
|
|
|
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|
|
|
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|
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|
S. J. Cazeau, J-C. Daubert, L. Tavazzi, G. Frohlig, and V. Paul
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|
|
|
|
|
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|
|
|
|
|
|
|
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51(1):
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|
|
|
|
|
|
|
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|
|
|
|
|
|
|
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|
|
|
|
|
|
|
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|
|
|
|
|
|
|
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October 1, 2007;
9(10):
959 - 998.
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|
|
|
|
|
|
|
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September 2, 2007;
28(18):
2256 - 2295.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C.-M. Yu, Q. Zhang, and J. W.-H. Fung
Reply
J. Am. Coll. Cardiol.,
May 8, 2007;
49(18):
1900 - 1900.
[Full Text]
[PDF]
|
|
|
|
|
|
|
O.-A. Breithardt
Cardiac Resynchronization Therapy
J. Am. Coll. Cardiol.,
May 8, 2007;
49(18):
1899 - 1899.
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. B. Bleeker, M. J. Schalij, and J. J. Bax
Reply
J. Am. Coll. Cardiol.,
May 8, 2007;
49(18):
1899 - 1900.
[Full Text]
[PDF]
|
|
|
|
|
|
|
Does Echo Have a Role in Predicting Benefit from CRT?
Journal Watch Cardiology,
January 10, 2007;
2007(110):
3 - 3.
[Full Text]
|
|
|
|
