TY - JOUR
T1 - Prognostic Impact of QRS Axis Deviation in Patients Treated with Cardiac Resynchronization Therapy
AU - Perrotta, Laura
AU - Kandala, Jagdesh
AU - Di Biase, Luigi
AU - Valleggi, Alessandro
AU - Michelotti, Federica
AU - Pieragnoli, Paolo
AU - Ricciardi, Giuseppe
AU - Mascioli, Giosuè
AU - Lakkireddy, Dhanunjaya
AU - Pillarisetti, Jayasree
AU - Emdin, Michele
AU - Natale, Andrea
AU - Singh, Jagmeet P.
AU - Padeletti, Luigi
N1 - Publisher Copyright:
© 2015 Wiley Periodicals, Inc.
PY - 2016/3/1
Y1 - 2016/3/1
N2 - Prognosis of QRS Axis Deviation in CRT-D Introduction QRS duration and morphology are currently recognized as recommended criteria for the selection of CRT candidates. It has recently been shown that patients with left bundle branch block (LBBB) derive substantial clinical benefit from CRT. The aim of this study is to investigate the prognostic impact of QRS axis deviation (AD) in HF patients with LBBB undergoing CRT. Methods and Results We retrospectively evaluated 707 HF patients with LBBB who underwent CRT at five centers. Baseline QRS axis was defined as normal (NA: -30° to 90°), right axis deviation (RAD: 90° to 180°) and left axis deviation (LAD: <-30°). The primary endpoint was a composite of all cause death/HF hospitalization. The risk of endpoint by AD was evaluated with both Kaplan-Meier and Cox proportional hazard analysis. Among 707 patients (73% M, median age: 71 [62,77] years), 323 (46%) had NA, 359 (51%) LAD, and 25 (3.5%) RAD. Baseline clinical characteristics were similar between the three groups. Over a mean follow-up of 32 ± 25 months, 141 deaths occurred (21%) and 36% (n = 255) met with the composite endpoint. A significantly higher proportion of RAD patients (52%) reached the endpoint (LAD 40%, NA 30%). KM analysis showed that RAD and LAD patients had worse event free survival and in multivariate analysis both LAD (HR: 1.40; 95% CI: 1.05-1.86; P = 0.021) and RAD (HR: 2.49; 95% CI: 1.31-4.74; P = 0.005) were independently associated with worse clinical outcome. Conclusions Right or left axis deviation in the presence of LBBB in HF patients undergoing CRT are independent predictors of poor prognosis.
AB - Prognosis of QRS Axis Deviation in CRT-D Introduction QRS duration and morphology are currently recognized as recommended criteria for the selection of CRT candidates. It has recently been shown that patients with left bundle branch block (LBBB) derive substantial clinical benefit from CRT. The aim of this study is to investigate the prognostic impact of QRS axis deviation (AD) in HF patients with LBBB undergoing CRT. Methods and Results We retrospectively evaluated 707 HF patients with LBBB who underwent CRT at five centers. Baseline QRS axis was defined as normal (NA: -30° to 90°), right axis deviation (RAD: 90° to 180°) and left axis deviation (LAD: <-30°). The primary endpoint was a composite of all cause death/HF hospitalization. The risk of endpoint by AD was evaluated with both Kaplan-Meier and Cox proportional hazard analysis. Among 707 patients (73% M, median age: 71 [62,77] years), 323 (46%) had NA, 359 (51%) LAD, and 25 (3.5%) RAD. Baseline clinical characteristics were similar between the three groups. Over a mean follow-up of 32 ± 25 months, 141 deaths occurred (21%) and 36% (n = 255) met with the composite endpoint. A significantly higher proportion of RAD patients (52%) reached the endpoint (LAD 40%, NA 30%). KM analysis showed that RAD and LAD patients had worse event free survival and in multivariate analysis both LAD (HR: 1.40; 95% CI: 1.05-1.86; P = 0.021) and RAD (HR: 2.49; 95% CI: 1.31-4.74; P = 0.005) were independently associated with worse clinical outcome. Conclusions Right or left axis deviation in the presence of LBBB in HF patients undergoing CRT are independent predictors of poor prognosis.
KW - QRS axis deviation
KW - cardiac resynchronization therapy
KW - heart failure
KW - left bundle branch block
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U2 - 10.1111/jce.12887
DO - 10.1111/jce.12887
M3 - Article
C2 - 26640084
AN - SCOPUS:84960804293
SN - 1045-3873
VL - 27
SP - 315
EP - 320
JO - Journal of cardiovascular electrophysiology
JF - Journal of cardiovascular electrophysiology
IS - 3
ER -