Interaction of left ventricular size with the outcome of cardiac resynchronization therapy in Japanese patients

IF 4.6 Q2 MATERIALS SCIENCE, BIOMATERIALS ACS Applied Bio Materials Pub Date : 2024-04-15 DOI:10.1002/clc.24267

Ryo Ito MD, PhD, Yusuke Kondo MD, PhD, FESC, Masahiro Nakano MD, PhD, Takatsugu Kajiyama MD, PhD, Miyo Nakano MD, PhD, Mari Kitagawa MD, PhD, Masafumi Sugawara MD, Toshinori Chiba MD, Yoshio Kobayashi MD, PhD

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Abstract

Background

We analyzed the influence of the QRS duration (QRSd) to LV end-diastolic volume (LVEDV) ratio on cardiac resynchronization therapy (CRT) outcomes in heart failure patients classified as III/IV per the New York Heart Association (NYHA) and with small body size.

Hypothesis

We proposed the hypothesis that the QRSd/LV size ratio is a better index of the CRT substrate.

Methods

We enrolled 114 patients with advanced heart failure (NYHA class III/IV, and LV ejection fraction >35%) who received a CRT device, including those with left bundle branch block (LBBB) and QRSd ≥120 milliseconds (n = 60), non-LBBB and QRSd ≥150 milliseconds (n = 30) and non-LBBB and QRSd of 120−149 milliseconds (n = 24).

Results

Over a mean follow-up period of 65 ± 58 months, the incidence of the primary endpoint, a composite of all-cause death and hospitalization for heart failure, showed no significant intergroup difference (43.3% vs. 50.0% vs. 37.5%, respectively, p = .72). Similarly, among 104 patients with QRSd/LVEDV ≥ 0.67 (n = 54) and QRSd/LVEDV < 0.67 (n = 52), no significant differences were observed in the incidence of the primary endpoint (35.1% vs. 51.9%, p = .49). Nevertheless, patients with QRSd/LVEDV ≥ 0.67 showed better survival than those with QRSd/LVEDV < 0.67 (14.8% vs. 34.6%, p = .0024).

Conclusion

Advanced HF patients with a higher QRSd/LVEDV ratio showed better survival in this small-body–size population. Thus, the risk is concentrated among those with a larger QRSd, and patients with a relatively smaller left ventricular size appeared to benefit from CRT.

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日本患者左心室大小与心脏再同步化疗法结果的相互作用

背景我们分析了QRS持续时间（QRSd）与左心室舒张末期容积（LVEDV）之比对纽约心脏病协会（NYHA）分级为III/IV级且体型较小的心衰患者心脏再同步化治疗（CRT）结果的影响。假设我们提出的假设是 QRSd/LV 大小比是 CRT 基底面的更好指标。方法我们招募了 114 名接受 CRT 设备治疗的晚期心衰患者（NYHA III/IV 级，左心室射血分数为 35%），包括左束支传导阻滞（LBBB）且 QRSd≥120 毫秒（60 人）、非 LBBB 且 QRSd≥150 毫秒（30 人）和非 LBBB 且 QRSd 为 120-149 毫秒（24 人）的患者。结果在平均 65 ± 58 个月的随访期间，主要终点（全因死亡和心衰住院的复合终点）的发生率在组间无显著差异（分别为 43.3% vs. 50.0% vs. 37.5%，p = .72）。同样，在104例QRSd/LVEDV≥0.67（n = 54）和QRSd/LVEDV < 0.67（n = 52）的患者中，主要终点的发生率也没有观察到显著差异（35.1% vs. 51.9%，p = .49）。然而，QRSd/LVEDV ≥ 0.67 的患者比 QRSd/LVEDV < 0.67 的患者生存率更高（14.8% 对 34.6%，P = .0024）。结论在这个小体型人群中，QRSd/LVEDV 比率较高的晚期 HF 患者生存率较高。因此，风险集中在 QRSd 较大的患者，而左心室尺寸相对较小的患者似乎能从 CRT 中获益。

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