Zhisheng Chen, Jianmin Chu, Jing Wang, Chi Cai, Xilie Lu, Manshu Song, Lois Balmer, Wei Wang, Xuerui Tan
{"title":"水平 QRS 轴预测左束支传导阻滞的心力衰竭患者对心脏再同步化疗法的反应","authors":"Zhisheng Chen, Jianmin Chu, Jing Wang, Chi Cai, Xilie Lu, Manshu Song, Lois Balmer, Wei Wang, Xuerui Tan","doi":"10.1016/j.hrthm.2024.11.011","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Electrocardiogram criteria for left bundle branch block (LBBB) inadequately predict left ventricular electrical dyssynchrony, complicating cardiac resynchronization therapy (CRT) candidate selection.</p><p><strong>Objective: </strong>To investigate the predictive value of the horizontal QRS axis for CRT response in heart failure (HF) patients with LBBB patterns.</p><p><strong>Methods: </strong>The direction and magnitude of the horizontal QRS axis were calculated using the net amplitudes in leads V<sub>2</sub> and V<sub>6</sub>. CRT response was defined as a ≥10% increase in left ventricular ejection fraction (LVEF) and at least one New York Heart Association (NYHA) class reduction one-year post-CRT implantation. The composite endpoint included HF hospitalization or all-cause mortality.</p><p><strong>Results: </strong>Among 244 consecutive CRT recipients, 156 (63.9%) responded favorably, while 88 (36.1%) were non-responders. The horizontal QRS axis demonstrated significant backward deviation [-75.5° (-79.7°, -69.0°) vs. -65.0° (-73.0°, -46.5°), P <0.001] and larger magnitude (35.5±10.9 mm vs. 25.5±10.5 mm, P <0.001) in CRT responders compared to non-responders. The direction and magnitude independently predicted CRT response with an area under the curve (AUC) of 0.778 (95% CI: 0.717, 0.839) and 0.749 (95% CI: 0.685, 0.814), respectively. Combining both parameters increased the AUC to 0.814 (95% CI: 0.760, 0.868). Moreover, the direction and magnitude of the horizontal QRS axis, or their combination, predicted the composite endpoint of HF hospitalization or all-cause mortality, with hazard ratios (HR) of 0.36 (95% CI: 0.22, 0.60), 0.41 (95% CI: 0.25, 0.67), and 0.25 (95% CI: 0.15, 0.41), respectively.</p><p><strong>Conclusion: </strong>Horizontal QRS axis accurately predicts CRT response and prognosis in HF patients with LBBB.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6000,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Horizontal QRS Axis Predicts Response to Cardiac Resynchronization Therapy in Heart Failure Patients with Left Bundle Branch Block.\",\"authors\":\"Zhisheng Chen, Jianmin Chu, Jing Wang, Chi Cai, Xilie Lu, Manshu Song, Lois Balmer, Wei Wang, Xuerui Tan\",\"doi\":\"10.1016/j.hrthm.2024.11.011\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Electrocardiogram criteria for left bundle branch block (LBBB) inadequately predict left ventricular electrical dyssynchrony, complicating cardiac resynchronization therapy (CRT) candidate selection.</p><p><strong>Objective: </strong>To investigate the predictive value of the horizontal QRS axis for CRT response in heart failure (HF) patients with LBBB patterns.</p><p><strong>Methods: </strong>The direction and magnitude of the horizontal QRS axis were calculated using the net amplitudes in leads V<sub>2</sub> and V<sub>6</sub>. CRT response was defined as a ≥10% increase in left ventricular ejection fraction (LVEF) and at least one New York Heart Association (NYHA) class reduction one-year post-CRT implantation. The composite endpoint included HF hospitalization or all-cause mortality.</p><p><strong>Results: </strong>Among 244 consecutive CRT recipients, 156 (63.9%) responded favorably, while 88 (36.1%) were non-responders. The horizontal QRS axis demonstrated significant backward deviation [-75.5° (-79.7°, -69.0°) vs. -65.0° (-73.0°, -46.5°), P <0.001] and larger magnitude (35.5±10.9 mm vs. 25.5±10.5 mm, P <0.001) in CRT responders compared to non-responders. The direction and magnitude independently predicted CRT response with an area under the curve (AUC) of 0.778 (95% CI: 0.717, 0.839) and 0.749 (95% CI: 0.685, 0.814), respectively. Combining both parameters increased the AUC to 0.814 (95% CI: 0.760, 0.868). Moreover, the direction and magnitude of the horizontal QRS axis, or their combination, predicted the composite endpoint of HF hospitalization or all-cause mortality, with hazard ratios (HR) of 0.36 (95% CI: 0.22, 0.60), 0.41 (95% CI: 0.25, 0.67), and 0.25 (95% CI: 0.15, 0.41), respectively.</p><p><strong>Conclusion: </strong>Horizontal QRS axis accurately predicts CRT response and prognosis in HF patients with LBBB.</p>\",\"PeriodicalId\":12886,\"journal\":{\"name\":\"Heart rhythm\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":5.6000,\"publicationDate\":\"2024-11-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Heart rhythm\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.hrthm.2024.11.011\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Heart rhythm","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.hrthm.2024.11.011","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Horizontal QRS Axis Predicts Response to Cardiac Resynchronization Therapy in Heart Failure Patients with Left Bundle Branch Block.
Background: Electrocardiogram criteria for left bundle branch block (LBBB) inadequately predict left ventricular electrical dyssynchrony, complicating cardiac resynchronization therapy (CRT) candidate selection.
Objective: To investigate the predictive value of the horizontal QRS axis for CRT response in heart failure (HF) patients with LBBB patterns.
Methods: The direction and magnitude of the horizontal QRS axis were calculated using the net amplitudes in leads V2 and V6. CRT response was defined as a ≥10% increase in left ventricular ejection fraction (LVEF) and at least one New York Heart Association (NYHA) class reduction one-year post-CRT implantation. The composite endpoint included HF hospitalization or all-cause mortality.
Results: Among 244 consecutive CRT recipients, 156 (63.9%) responded favorably, while 88 (36.1%) were non-responders. The horizontal QRS axis demonstrated significant backward deviation [-75.5° (-79.7°, -69.0°) vs. -65.0° (-73.0°, -46.5°), P <0.001] and larger magnitude (35.5±10.9 mm vs. 25.5±10.5 mm, P <0.001) in CRT responders compared to non-responders. The direction and magnitude independently predicted CRT response with an area under the curve (AUC) of 0.778 (95% CI: 0.717, 0.839) and 0.749 (95% CI: 0.685, 0.814), respectively. Combining both parameters increased the AUC to 0.814 (95% CI: 0.760, 0.868). Moreover, the direction and magnitude of the horizontal QRS axis, or their combination, predicted the composite endpoint of HF hospitalization or all-cause mortality, with hazard ratios (HR) of 0.36 (95% CI: 0.22, 0.60), 0.41 (95% CI: 0.25, 0.67), and 0.25 (95% CI: 0.15, 0.41), respectively.
Conclusion: Horizontal QRS axis accurately predicts CRT response and prognosis in HF patients with LBBB.
期刊介绍：
HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability.
HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community.
The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.
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