The relationship between ventricular electrical delay and left ventricular remodelling with cardiac resynchronization therapy

Michael R Gold, Ulrika Birgersdotter-Green, Jagmeet P Singh, Kenneth A Ellenbogen, Yinghong Yu, Timothy E Meyer, Milan Seth, Patrick J Tchou, Michael R Gold, Ulrika Birgersdotter-Green, Jagmeet P Singh, Kenneth A Ellenbogen, Yinghong Yu, Timothy E Meyer, Milan Seth, Patrick J Tchou

Abstract

Aims: The aim of the present study was to evaluate the relationship between left ventricular (LV) electrical delay, as measured by the QLV interval, and outcomes in a prospectively designed substudy of the SMART-AV Trial.

Methods and results: This was a multicentre study of patients with advanced heart failure undergoing cardiac resynchronization therapy (CRT) defibrillator implantation. In 426 subjects, QLV was measured as the interval from the onset of the QRS from the surface ECG to the first large peak of the LV electrogram. Left ventricular volumes were measured by echocardiography at baseline and after 6 months of CRT by a blinded core laboratory. Quality of life (QOL) was assessed by a standardized questionnaire. When separated by quartiles based on QLV duration, reverse remodelling response rates (>15% reduction in LV end systolic volume) increased progressively from 38.7 to 68.4% and QOL response rate (>10 points reduction) increased from 50 to 72%. Patients in the highest quartile of QLV had a 3.21-fold increase (1.58-6.50, P = 0.001) in their odds of a reverse remodelling response after correcting for QRS duration, bundle branch block type, and clinical characteristics by multivariate logistic regression analysis.

Conclusion: Electrical dyssynchrony, as measured by QLV, was strongly and independently associated with reverse remodelling and QOL with CRT. Acute measurements of QLV may be useful to guide LV lead placement.

Figures

Figure 1
Figure 1
Two examples of QLV measurements. The calipers are aligned with the onset of QRS and peak of the left venticular electrogram. The QLV was calculated as 90 ms for the patient in (A) and 165 ms for the patient in (B).
Figure 2
Figure 2
Comparisons of the changes in left ventricular end-systolic volume, left ventricular end-diastolic volume, ejection fraction, and quality of life from implant baseline to 6 months for the two QLV groups separated by the median value. The data were presented as median ± inter-quartile range.
Figure 3
Figure 3
Comparisons of the changes in left ventricular end-systolic volume, left ventricular end-diastolic volume, ejection fraction, and quality of life from implant baseline to 6 months for the QLV quartiles. The data were presented as median ± inter-quartile range (box).
Figure 4
Figure 4
Univariate logistic regression results for left ventricular end-systolic volume (A) and quality of life (B) by subgroups.

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