Usefulness of the Sum Absolute QRST Integral to Predict Outcomes in Patients Receiving Cardiac Resynchronization Therapy

Jonatan Jacobsson, Rasmus Borgquist, Christian Reitan, Elyar Ghafoori, Neal A. Chatterjee, Muammar Kabir, Pyotr G. Platonov, Jonas Carlson, Jagmeet P. Singh, Larisa Tereshchenko

    Research output: Contribution to journalArticle

    8 Citations (Scopus)

    Abstract

    Cardiac resynchronization therapy (CRT) reduces mortality and morbidity in selected patients with heart failure (HF), but up to 1/3 of patients are nonresponders. Sum absolute QRST integral (SAI QRST) recently showed association with mechanical response on CRT. However, it is unknown whether SAI QRST is associated with all-cause mortality and HF hospitalizations in patients undergoing CRT. The study population included 496 patients undergoing CRT (mean age 69 ± 10 years, 84% men, 65% left bundle branch block [LBBB], left ventricular ejection fraction 23 ± 6%, 63% ischemic cardiomyopathy). Preimplant digital 12-lead electrocardiogram was transformed into orthogonal XYZ electrocardiogram. SAI QRST was measured as an arithmetic sum of areas under the QRST curve on XYZ leads and was dichotomized based on the median value (302 mV ms). All-cause mortality served as the primary end point. A composite of 2-year all-cause mortality, heart transplant, and HF hospitalization was a secondary end point. Cox regression models were adjusted for known predictors of CRT response. Patients with preimplant low mean SAI QRST had an increased risk of both the primary (hazard ratio [HR] 1.8, 95% CI 1.01 to 3.2) and secondary (HR 1.6, 95% CI 1.1 to 2.2) end points after multivariate adjustment. SAI QRST was associated with secondary outcome in subgroups of patients with LBBB (HR 2.1, 95% CI 1.5 to 3.0) and with non-LBBB (HR 1.7, 95% CI 1.0 to 2.6). In patients undergoing CRT, preimplant SAI QRST

    Original languageEnglish (US)
    JournalAmerican Journal of Cardiology
    DOIs
    StateAccepted/In press - Feb 23 2016

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    Cardiac Resynchronization Therapy
    Bundle-Branch Block
    Heart Failure
    Mortality
    Electrocardiography
    Hospitalization
    Cardiomyopathies
    Proportional Hazards Models
    Stroke Volume
    Area Under Curve
    Morbidity
    Transplants
    Population

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine

    Cite this

    Usefulness of the Sum Absolute QRST Integral to Predict Outcomes in Patients Receiving Cardiac Resynchronization Therapy. / Jacobsson, Jonatan; Borgquist, Rasmus; Reitan, Christian; Ghafoori, Elyar; Chatterjee, Neal A.; Kabir, Muammar; Platonov, Pyotr G.; Carlson, Jonas; Singh, Jagmeet P.; Tereshchenko, Larisa.

    In: American Journal of Cardiology, 23.02.2016.

    Research output: Contribution to journalArticle

    Jacobsson, Jonatan ; Borgquist, Rasmus ; Reitan, Christian ; Ghafoori, Elyar ; Chatterjee, Neal A. ; Kabir, Muammar ; Platonov, Pyotr G. ; Carlson, Jonas ; Singh, Jagmeet P. ; Tereshchenko, Larisa. / Usefulness of the Sum Absolute QRST Integral to Predict Outcomes in Patients Receiving Cardiac Resynchronization Therapy. In: American Journal of Cardiology. 2016.
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    abstract = "Cardiac resynchronization therapy (CRT) reduces mortality and morbidity in selected patients with heart failure (HF), but up to 1/3 of patients are nonresponders. Sum absolute QRST integral (SAI QRST) recently showed association with mechanical response on CRT. However, it is unknown whether SAI QRST is associated with all-cause mortality and HF hospitalizations in patients undergoing CRT. The study population included 496 patients undergoing CRT (mean age 69 ± 10 years, 84{\%} men, 65{\%} left bundle branch block [LBBB], left ventricular ejection fraction 23 ± 6{\%}, 63{\%} ischemic cardiomyopathy). Preimplant digital 12-lead electrocardiogram was transformed into orthogonal XYZ electrocardiogram. SAI QRST was measured as an arithmetic sum of areas under the QRST curve on XYZ leads and was dichotomized based on the median value (302 mV ms). All-cause mortality served as the primary end point. A composite of 2-year all-cause mortality, heart transplant, and HF hospitalization was a secondary end point. Cox regression models were adjusted for known predictors of CRT response. Patients with preimplant low mean SAI QRST had an increased risk of both the primary (hazard ratio [HR] 1.8, 95{\%} CI 1.01 to 3.2) and secondary (HR 1.6, 95{\%} CI 1.1 to 2.2) end points after multivariate adjustment. SAI QRST was associated with secondary outcome in subgroups of patients with LBBB (HR 2.1, 95{\%} CI 1.5 to 3.0) and with non-LBBB (HR 1.7, 95{\%} CI 1.0 to 2.6). In patients undergoing CRT, preimplant SAI QRST",
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    AU - Chatterjee, Neal A.

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