T-wave area as biomarker of clinical response to cardiac resynchronization therapy

Eszter M. Végh, Elien B. Engels, Caroline J M Van Deursen, B. Merkely, Kevin Vernooy, Jagmeet P. Singh, Frits W. Prinzen

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Abstract

Aims: There is increasing evidence that left bundle branch block (LBBB) morphology on the electrocardiogram is a positive predictor for response to cardiac resynchronization therapy (CRT). We previously demonstrated that the vectorcardiography (VCG)-derived T-wave area predicts echocardiographic CRT response in LBBB patients. In the present study, we investigate whether the T-wave area also predicts long-term clinical outcome to CRT. Methods and results: This is a retrospective study consisting of 335 CRT recipients. Primary endpoint were the composite of heart failure (HF) hospitalization, heart transplantation, left ventricular assist device implantation or death during a 3-year follow-up period. HF hospitalization and death alone were secondary endpoints. The patient subgroup with a large T-wave area and LBBB 36% reached the primary endpoint, which was considerably less (P < 0.01) than for patients with LBBB and a small T-wave area or non-LBBB patients with a small or large T-wave area (48, 57, and 51%, respectively). Similar differences were observed for the secondary endpoints, HF hospitalization (31 vs. 51, 51, and 38%, respectively, P < 0.01) and death (19 vs. 42, 34, and 42%, respectively, P < 0.01). In multivariate analysis, a large T-wave area and LBBB were the only independent predictors of the combined endpoint besides high creatinine levels and use of diuretics. Conclusion: T-wave area may be useful as an additional biomarker to stratify CRT candidates and improve selection of those most likely to benefit from CRT. A large T-wave area may derive its predictive value from reflecting good intrinsic myocardial properties and a substrate for CRT.

Original languageEnglish
Pages (from-to)1077-1085
Number of pages9
JournalEuropace
Volume18
Issue number7
DOIs
Publication statusPublished - 2016

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Keywords

  • Cardiac resynchronization therapy
  • Left bundle branch block
  • Long-term clinical outcome
  • T wave area
  • Vectorcardiography

ASJC Scopus subject areas

  • Medicine(all)
  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Végh, E. M., Engels, E. B., Van Deursen, C. J. M., Merkely, B., Vernooy, K., Singh, J. P., & Prinzen, F. W. (2016). T-wave area as biomarker of clinical response to cardiac resynchronization therapy. Europace, 18(7), 1077-1085. https://doi.org/10.1093/europace/euv259