Document Detail


Relationship between QRS complex notch and ventricular dyssynchrony in patients with heart failure and prolonged QRS duration.
MedLine Citation:
PMID:  18698544     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Cardiac resynchronization therapy (CRT) has been accepted as an established therapy for advanced systolic heart failure. Electrical and mechanical dyssynchrony are usually evaluated to increase the percentage of CRT responders. We postulated that QRS notch can increase mechanical LV dyssynchrony independently of other known predictors such as left ventricular ejection fraction and QRS duration. METHODS: A total of 87 consecutive patients with advanced systolic heart failure and QRS duration more than 120 ms with an LBBB-like pattern in V1 were prospectively evaluated. Twelve-lead electrocardiogram was used for detection of QRS notch. Complete echocardiographic examination including tissue Doppler imaging, pulse wave Doppler and M-mode echocardiography were done for all patients. RESULTS: Eighty-seven patients, 65 male (75%) and 22 female (25%), with mean (SD) age of 56.7 (12.3) years were enrolled the study. Ischemic cardiomyopathy was the underlying heart disease in 58% of the subjects, and in the others it was idiopathic. Patients had a mean (SD) QRS duration of 155.13 (23.34) ms. QRS notch was seen in 49.4% of the patients in any of two precordial or limb leads. Interventricular mechanical delay was the only mechanical dyssynchrony index that was significantly longer in the group of patients with QRS notch. Multivariate analysis revealed that the observed association was actually caused by the effect of QRS duration, rather than the presence of notch per se. CONCLUSIONS: QRS notch was not an independent predictor of higher mechanical dyssynchrony indices in patients with wide QRS complex and symptomatic systolic heart failure; however, there was a borderline association between QRS notch and interventricular delay.
Authors:
Amir Farjam Fazelifar; Hamid Reza Bonakdar; Keivan Alizadeh; Hosein Azarnik; Majid Haghjoo; Hooman Bakhshandeh Abkenar; Niloufar Samiei; Mohammad Ali Sadr-Ameli
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Cardiology journal     Volume:  15     ISSN:  1897-5593     ISO Abbreviation:  -     Publication Date:  2008  
Date Detail:
Created Date:  2008-08-13     Completed Date:  2008-11-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101392712     Medline TA:  Cardiol J     Country:  Poland    
Other Details:
Languages:  eng     Pagination:  351-6     Citation Subset:  IM    
Affiliation:
Department of Pacemaker and Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Teheran, Iran. fazelifar@gmail.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Cardiac Pacing, Artificial / methods*
Echocardiography, Doppler, Pulsed / methods
Electrocardiography / methods*
Female
Heart Failure, Systolic / diagnosis*,  etiology,  therapy*
Heart Ventricles / physiopathology
Humans
Male
Middle Aged
Multivariate Analysis
Myocardial Ischemia / complications,  diagnosis
Predictive Value of Tests
Prognosis
Prospective Studies
Risk Assessment
Sensitivity and Specificity
Severity of Illness Index
Stroke Volume / physiology

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