Novel electrocardiographic dyssynchrony criteria improve patient selection for cardiac resynchronization therapy

András Vereckei, Zsuzsanna Szelenyi, Valentina Kutyifa, E. Zima, G. Szénási, Melinda Kiss, Gábor Katona, I. Karádi, B. Merkely

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

We hypothesized that the greater the intra-or interventricular dyssynchrony (intraD, interD), the more effective cardiac resynchronization therapy (CRT) is. We sought to improve patient selection for CRT by using novel ECG dyssynchrony criteria. Left ventricular (LV) intraD was estimated by the absolute time difference between the intrinsicoid deflections (ID) in leads aVL and aVF divided by the QRS duration (QRSd): [aVLID aVFID]/QRSd (%). InterD was estimated from the formula: [V5ID-V1ID]/QRSd (%). Their>25% value indicated electrical dyssynchrony present (ED\+) and 25% value electrical dyssynchrony absent (ED-) diagnoses. Using the intraD\+interD criteria (intra\+interDC) together, if at least one of them indicated ED\+diagnosis, a final ED\+diagnosis, if both indicated ED-diagnosis, a final ED-diagnosis was made. Two authors, blinded to CRT response, retrospectively analysed pre-CRT ECGs of 124 patients with known CRT outcome. CRT response was defined as improvement of 1 NYHA class, being alive and having no hospitalizations for heart failure during 6 months of follow-up. 35/124 (28%) patients were non-responders (NRs), using the traditional criteria (TC) correct diagnosis was made in the remaining 89/124 (72%) responder (R) cases. The test accuracy (TA) of intra\+interDC\+TC [100/124 (81%), P<0.001] was superior to that of TC [89/124 (72%)] due to its superior TA [36/43 (84%) vs. 29/43 (67%), respectively, P1/40.0156] in the non-specific intra-ventricular conduction disturbance (NICD) subgroup [43/124 (35%)]. In the left bundle branch block subgroup [70/124 (56%)] there was no between-criteria difference in TA. The intra\+interDC\+TC predicts clinical response after CRT more accurately than TC alone, due to greater TA in the NICD subgroup.

Original languageEnglish
Pages (from-to)97-103
Number of pages7
JournalEuropace
Volume20
Issue number1
DOIs
Publication statusPublished - Jan 1 2018

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Cardiac Resynchronization Therapy
Patient Selection
Electrocardiography
Bundle-Branch Block
Hospitalization
Heart Failure

Keywords

  • CRT
  • Electrocardiology
  • Heart failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Novel electrocardiographic dyssynchrony criteria improve patient selection for cardiac resynchronization therapy. / Vereckei, András; Szelenyi, Zsuzsanna; Kutyifa, Valentina; Zima, E.; Szénási, G.; Kiss, Melinda; Katona, Gábor; Karádi, I.; Merkely, B.

In: Europace, Vol. 20, No. 1, 01.01.2018, p. 97-103.

Research output: Contribution to journalArticle

Vereckei, András ; Szelenyi, Zsuzsanna ; Kutyifa, Valentina ; Zima, E. ; Szénási, G. ; Kiss, Melinda ; Katona, Gábor ; Karádi, I. ; Merkely, B. / Novel electrocardiographic dyssynchrony criteria improve patient selection for cardiac resynchronization therapy. In: Europace. 2018 ; Vol. 20, No. 1. pp. 97-103.
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AU - Szénási, G.

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