Value Of R/S Ratio In ECG Lead V1 In Predicting The Effect Of Cardiac Resynchronization Therapy

Purpose: To investigate the effect of cardiac resynchronization therapy(CRT)in patients with chronic heart failure(CHF)and to evaluate the value of R/S ratio of V1 lead in the first electrocardiogram after the therapy.Method: The study was retrospectively analyzed.Sixty-two patients with heart failure undergoing cardiac resynchronization therapy(CRT-D / P)were enrolled in the Department of Cardiology,Anhui Provincial Hospital from 2015 to 2017.They were divided into two groups: CRT responder group(39 cases)and CRT non-responder group(23 cases).The baseline data of patients and clinical data,electrocardiogram and echocardiography of 6 months after CRT were retrospectively analyzed.The left ventricular ejection fraction(LVEF)increasing?5% was defined as CRT response;The left ventricular ejection fraction(LVEF)increasing<5% was defined as CRT non-response.The first R / S ratio of lead V1 or the lead R/S ratio of less than 1 in lead V1 was defined as R/S ratio positive after the first electrocardiogram.Result: 1)Baseline data: A total of 62 patients,mean age 61.63 ± 8.89 years,with 39 males(63%)and 23 females(37%).Including 53 cases of dilated cardiomyopathy(85.5%),8 cases of ischemic cardiomyopathy(12.9%),11 cases of ventricular premature beats(17.7%),2 cases after percutaneous radiofrequency ablation(0.03%).17 cases of hypertension(27.4%),2 cases of diabetes(0.03%)and 3 cases of cerebral infarction(0.05%).Among the selected cases,preoperative NYHA level ?6 cases(9.7%),level 51 cases(82.3%)? and level 5 cases(8.0%).?2)Baseline data comparison of the two groups: the proportion of female and LBBB in responder group was significantly higher than that in non-responder group(P=0.014).There was no significant difference in age and underlying disease between the two groups(all P> 0.05).Patients with NYHA level II were 2(5.1%)and 4(17.4%)(P = 0.12),level III were 33(84.6%)and 17(73.9% %)(P = 0.19),level IV were 4(10.3%)and 2(8.7%)(P = 0.89).The level of serum N-terminal B-type brain natriuretic peptide(NT-pro BNP)was significantly higher in non-responder group(P <0.01),while the left ventricular end diastolic volume(LVEDD)and pulmonary hypertension(SPAP)were lower(P <0.01)than in responder group.There was no significant difference between the two groups in the optimization of left ventricular parameters and placement of lead electrodes(P> 0.05).3)Comparison of follow-up results between two groups: NYHA heart function level,P wave duration,QRS duration,LVEDD and SPAP were significantly improved in responder group(P<0.05).There were 31 cases(79.5%)of the positive R/S ratio in responder group and 12 cases(52.2%)in non-response group(X2 =6.637,P=0.01).In 42 cases with positive R/S ratio,the average LVEF was improved to 11.78% while the rate in anotherwas 4.31%(P <0.05).4)Predicting value:The positive rate of R/S ratio was found to be a independent predictor of CRT response(OR=4.43,95% CI 1.06-18.5,P = 0.041),while Women with preoperative LBBB can not predict CRT response independently.Conclusions: 1)Female,preoperative LBBB patients respond well to CRT.2)Patients with higher preoperative SPAP response to CRT worse,postoperative decrease in SPAP and cardiac function after CRT related improvements.3)CRT postoperative electrocardiogram V1 lead R/S ratio ? 1 or lead R/S ratio ?? 1 suggests that effective left ventricular pacing is an independent predictor of CRT good response,CRT efficacy evaluation can become an effective standard.