To Evaluate The Predictive Value Of QRS Duration Shortening In Response To Cardiac Resynchronization Therapy Under Different Criteria

Objective: Cardiac resynchronization therapy(CRT)is one of the important therapies for patients with reduced left ventricular ejection fraction and electrical dyssynchrony in heart failure.However,some CRT recipients do not respond to CRT.When CRT is implanted,better methods are needed to predict who will benefit from this treatment.The aim of this study is to explore the predictive value of QRS duration on the response to CRT and the consistency of different response criteria by grouping the patients with different quartiles of Delta QRS duration(△QRSd)before and after CRT implantation.Methods: Patients admitted to Northern Jiangsu People’s Hospital due to heart failure from January 2019 to December 2021 were enrolled and met the latest criteria for CRT implantation.The baseline data of the patients were collected and grouped according to the interquartile range of △QRSd(△QRSd=△QRSd pre-operation-△QRSd postoperation).The follow-up data were collected for 12 months.Echocardiographic parameters included Left Ventricular Ejection Fraction(LVEF),Left Ventricular EndSystolic Dimension(LVESD),Left Ventricular end-diastolic Dimension(LVEDD),Left Ventricular End Systolic Volume(LVESV),and Left Ventricular End-Diastolic Volume(LVEDV);New York Heart Association(NYHA)classification;Clinical Composite Score(CCS);Time of first HF readmission.An absolute increase of LVEF ≥ 5% at 12 months after CRT was defined as response.The differences of LVEF before and 12 months after CRT among different △QRSd groups were compared,and the differences of response distribution among different △QRSd groups were compared.COX regression analysis was used to analyze the difference of cumulative HF rehospitalization risk among different △QRSd groups.Cohen’s kappa consistency test was used to compare different CRT response criteria(absolute LVEF increase > 5%;LVEDV decreased by more than 15%;LVESV was reduced by > 15%.NYHA grade decreased ≥1 grade;CCS as "improvement"),and the predictive value of different △QRSd groups when different response criteria were used.Results: 1.Baseline analysisA total of 128 patients were finally included in the analysis.The range of △QRSd fluctuation was 9ms-80 ms,28 patients were in the △QRSd < 18 ms group,36 patients were in the 18ms≤△QRSd < 31 ms group,and 30 patients were in the 31ms≤△QRSd < 42 ms group.There were 34 patients in the △QRSd≥42ms group.There was a significant difference among the four groups [4(14.3)vs 18(50.0)vs 16(53.3)vs 6(17.6),P=0.031].The preoperative QRSd width was significantly different among the four groups(155.43ms±13.71 ms vs 158.72ms±10.37 ms vs 166.13ms±11.16 ms vs 169.52ms±15.98 ms,P=0.015).2.Comparison of indexes before and 12 months after operation in different △QRSd groupsThe absolute value of LVEF(LVEF postoperation-LVEF preoperation)was significantly improved in different △QRSd groups(P < 0.05),and the △QRSd < 18 ms group was the smallest(6.29%±7.98%).Compared with 31ms≤△QRSd < 42 ms group and △QRSd≥42ms group,the difference was statistically significant(P < 0.05).3.Evaluation of CRT response in different △QRSd groupsTaking LVEF absolute increase ≥ 5% as the response standard,univariate analysis and multivariate Logistic regression analysis showed that △QRSd was the influencing factor of response after CRT.In the group of 31ms≤△QRSd < 42ms(OR=6.058 95%CI 1.066-34.430,P=0.042)and △QRSd≥42ms(OR=7.599 95%CI 1.385-41.694,P=0.042),the difference was statistically significant.Ischemic cardiomyopathy was a risk factor for CRT response(OR=0.344 95%CI 0.090-0.842,P=0.048).The CRT response rate was different among different △QRSd groups(64.3% vs 80.6% vs 93.3% vs 94.1%),and the difference was statistically significant(P=0.007).The response rate of △QRSd < 18 ms group was significantly higher than that of 31ms≤△QRSd < 42 ms group and △QRSd≥42ms group(P < 0.05).During the 12-month follow-up,20 of 128 patients were rehospitalized for heart failure,and there were no deaths.Univariate COX regression analysis and multivariate COX regression analysis adjusted for confounding factors such as gender and preoperative QRSd,compared with the △QRSd < 18 ms group,the △ QRSD < 18 ms group was significantly higher than the △ QRSD < 18 ms group.The patients with 31ms≤△QRSd < 42ms(HR=0.192 95%CI 0.038-0.962,P=0.045)and △QRSd≥42ms(HR=0.200 95%CI 0.049-0.809,P=0.024)had a lower risk of rehospitalization for heart failure.The difference was statistically significant.4.The consistency of different CRT response criteria and the predictive value of △QRSdA total of 122 patients(95.3%)met the criteria for response to either CRT.The response rate varied according to different response criteria,ranging from 51.6% to 84.4%.Kappa consistency test showed that there were some differences among the five response criteria,and △QRSd can be used as a predictor of CRT response in the NYHA classification criteria.Conclusion: △QRSd is an independent predictor of CRT response.Compared with patients with △QRSd < 18 ms,patients with △QRSd≥31ms had significantly improved left ventricular ejection fraction and were more likely to have a response to CRT.△QRSd has predictive value for heart failure readmission.Compared with △QRSd < 18 ms group,△QRSd≥31ms group has a lower risk of heart failure readmission.There are some differences between echocardiography and clinical criteria in evaluating CRT response,among which LVEF and NYHA are better correlated with △QRSd.