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T-wave Area Predicts Response to Cardiac Resynchronization Therapy in Patients with Left Bundle Branch Block.
MedLine Citation:
PMID:  25230363     Owner:  NLM     Status:  Publisher    
INTRODUCTION: Chronic heart failure patients with a left ventricular (LV) conduction delay, mostly due to left bundle branch block (LBBB), generally derive benefit from cardiac resynchronization therapy (CRT). However, 30%-50% of patients do not show a clear response to CRT. We investigated whether T-wave analysis of the ECG can improve patient selection.
METHODS AND RESULTS: The study population comprised 244 CRT recipients with baseline 12-lead electrocardiogram recordings. Echocardiographic response after 6-months CRT was defined as a ≥5% increase in LV ejection fraction (LVEF). Vectorcardiograms (VCGs) were constructed from the measured 12-lead ECGs using an adapted Kors algorithm on digitized ECGs. Logistic regression models indicated repolarization variables as good predictors of CRT response. The VCG-derived T-wave area predicted CRT response (odds ratio (OR) per 10 μVs increase 1.172 (p < 0.001)), even better than QRS-wave area (OR = 1.116 (p = 0.001)). T-wave area had especially predictive value in the LBBB patient group (OR = 2.77 in LBBB vs. 1.09 in non-LBBB). This predictive value persisted after adjustment of multiple covariates, such as gender, ischemia, age, hypertension, coronary artery bypass graft and the usage of diuretics and beta-blockers. In LBBB patients the increase in LVEF was 6.1 ± 9.7% and 11.3 ± 9.1% in patients with T-wave area below and above the median value, respectively (p < 0.01).
CONCLUSION: In patients with LBBB morphology of the QRS complex, a larger baseline T-wave area is an important independent predictor of LVEF increase following CRT. This article is protected by copyright. All rights reserved.
Elien B Engels; Eszter M Végh; Caroline J M VAN Deursen; Kevin Vernooy; Jagmeet P Singh; Frits W Prinzen
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-9-17
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  -     ISSN:  1540-8167     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2014 Sep 
Date Detail:
Created Date:  2014-9-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
This article is protected by copyright. All rights reserved.
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