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The Evaluation Of The Response To Cardiac Resynchronization Therapy In Patients With Dilated Cardiomyopathy By Using Fragmented QRS

Year 2022, Volume: 3 Issue: 2, 110 - 116, 01.08.2022

Abstract

Introduction: Cardiac resynchronization therapy (CRT) is an effective treatment in heart failure however; identifying the suitable patients is difficult. Fragmented QRS (fQRS) complex is a myocardial conduction abnormality that indicates myocardial scar. This study was conducted to find out the response of non-ischemic dilated cardiomyopathy (NCMP) to CRT by using fQRS. Methods: 56 patients were enrolled. 32 patients had fQRS (57.1%) and 24 had no fQRS (46.9%) on electrocardiography (ECG). All patients were suitable for CRT treatment. The two groups (fQRS and no fQRS) were evaluated before and after (1 year) CRT by using clinical status, ECG, and echocardiographic parameters. Continuous parameters were compared with Paired Samples T-test. Results: During the follow-up period; comparison of QRS (p=0.46, p=0.61), and NYHA class (p=0.29, p=0.57) were not statistically significant before and after CRT, respectively (fQRS and no fQRS). In addition, the change in left ventricular ejection fraction is not statistically significant (p=0.12). Conclusion: fQRS presence is not associated with CRT response in patients with NCMP.

References

  • 1. Bleeker GB, Schalij MJ, Nihoyannopoulos P, Steendijk P, Molhoek SG, van Erven L, et al. Left ventricular dyssynchrony predicts right ventricular remodeling after cardiac resynchronization therapy. Journal of the American College of Cardiology. 2005;46(12):2264-9.
  • 2. Yu CM, Zhang Q, Fung JW, Chan HC, Chan YS, Yip GW, et al. A novel tool to assess systolic asynchrony and identify responders of cardiac resynchronization therapy by tissue synchronization imaging. Journal of the American College of Cardiology. 2005;45(5):677-84.
  • 3. Bax JJ, Bleeker GB, Marwick TH, Molhoek SG, Boersma E, Steendijk P, et al. Left ventricular dyssynchrony predicts response and prognosis after cardiac resynchronization therapy. Journal of the American College of Cardiology. 2004;44(9):1834-40.
  • 4. Bleeker GB, Schalij MJ, Molhoek SG, Verwey HF, Holman ER, Boersma E, et al. Relationship between QRS duration and left ventricular dyssynchrony in patients with end-stage heart failure. Journal of cardiovascular electrophysiology. 2004;15(5):544-9.
  • 5. Stewart S, Jenkins A, Buchan S, McGuire A, Capewell S, McMurray JJ. The current cost of heart failure to the National Health Service in the UK. European journal of heart failure. 2002;4(3):361-71.
  • 6. Das MK, Zipes DP. Fragmented QRS: a predictor of mortality and sudden cardiac death. Heart rhythm. 2009;6(3 Suppl):S8-14.
  • 7. Homsi M, Alsayed L, Safadi B, Mahenthiran J, Das MK. Fragmented QRS complexes on 12-lead ECG: a marker of cardiac sarcoidosis as detected by gadolinium cardiac magnetic resonance imaging. Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc. 2009;14(4):319-26.
  • 8. Bleeker GB, Kaandorp TA, Lamb HJ, Boersma E, Steendijk P, de Roos A, et al. Effect of posterolateral scar tissue on clinical and echocardiographic improvement after cardiac resynchronization therapy. Circulation. 2006;113(7):969-76.
  • 9. Adelstein EC, Saba S. Scar burden by myocardial perfusion imaging predicts echocardiographic response to cardiac resynchronization therapy in ischemic cardiomyopathy. American heart journal. 2007;153(1):105-12.
  • 10. Das MK, Suradi H, Maskoun W, Michael MA, Shen C, Peng J, et al. Fragmented wide QRS on a 12-lead ECG: a sign of myocardial scar and poor prognosis. Circulation Arrhythmia and electrophysiology. 2008;1(4):258-68.
  • 11. Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R, Feigenbaum H, et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography. 1989;2(5):358-67.
  • 12. Thomas JD. How leaky is that mitral valve? Simplified Doppler methods to measure regurgitant orifice area. Circulation. 1997;95(3):548-50.
  • 13. Breithardt OA, Stellbrink C, Franke A, Balta O, Diem BH, Bakker P, et al. Acute effects of cardiac resynchronization therapy on left ventricular Doppler indices in patients with congestive heart failure. American heart journal. 2002;143(1):34-44.
  • 14. Bhatia V, Bhatia R, Dhindsa S, Virk A. Cardiac resynchronization therapy in heart failure: recent advances and new insights. Indian pacing and electrophysiology journal. 2003;3(3):129-42.
  • 15. Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L, et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. The New England journal of medicine. 2005;352(15):1539-49.
  • 16. Gorcsan J, 3rd. Finding pieces of the puzzle of nonresponse to cardiac resynchronization therapy. Circulation. 2011;123(1):10-2.
  • 17. Das MK, Maskoun W, Shen C, Michael MA, Suradi H, Desai M, et al. Fragmented QRS on twelve-lead electrocardiogram predicts arrhythmic events in patients with ischemic and nonischemic cardiomyopathy. Heart rhythm. 2010;7(1):74-80.
  • 18. Das MK, El Masry H. Fragmented QRS and other depolarization abnormalities as a predictor of mortality and sudden cardiac death. Current opinion in cardiology. 2010;25(1):59-64.
  • 19. Celikyurt U, Agacdiken A, Sahin T, Al N, Vural A, Ural D. Relationship between fragmented QRS and response to cardiac resynchronization therapy. Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing. 2012;35(3):337-42; discussion 42.
  • 20. Pranata R, Yonas E. Fragmented QRS is associated with intraventricular dyssynchrony and independently predicts nonresponse to cardiac resynchronization therapy-Systematic review and meta-analysis. 2020;25(4):e12750.
  • 21. Liu X, Hu Y, Hua W. A Predictive Model for Super-Response to Cardiac Resynchronization Therapy: The QQ-LAE Score. 2020;2020:3856294.
  • 22. Assadian Rad M, Tabarzan Baboli N, Barzigar A, Keirkhah J, Soltanipour S, Bonakdar HR, et al. The role of the fragmented QRS complexes on a routine 12-lead ECG in predicting non-responsiveness to cardiac resynchronization therapy. Anatolian journal of cardiology. 2015;15(3):204-8.
  • 23. Rickard J, Zardkoohi O, Popovic Z, Verhaert D, Sraow D, Baranowski B, et al. QRS fragmentation is not associated with poor response to cardiac resynchronization therapy. Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc. 2011;16(2):165-71.
  • 24. Morita H, Kusano KF, Miura D, Nagase S, Nakamura K, Morita ST, et al. Fragmented QRS as a marker of conduction abnormality and a predictor of prognosis of Brugada syndrome. Circulation. 2008;118(17):1697-704.
  • 25. Sinha SK, Bhagat K, Asif M, Singh K, Sachan M, Mishra V, et al. Fragmented QRS as a Marker of Electrical Dyssynchrony to Predict Inter-Ventricular Conduction Defect by Subsequent Echocardiographic Assessment in Symptomatic Patients of Non-Ischemic Dilated Cardiomyopathy. Cardiology research. 2016;7(4):140-5.
  • 26. Tigen K, Karaahmet T, Gurel E, Cevik C, Nugent K, Pala S, et al. The utility of fragmented QRS complexes to predict significant intraventricular dyssynchrony in nonischemic dilated cardiomyopathy patients with a narrow QRS interval. The Canadian journal of cardiology. 2009;25(9):517-22.

Non-İskemik Dilate Kardiyomyopati Hastalarında Fragmante QRS’in Bi-ventrikuler Pacemaker Tedavisine Etkisi

Year 2022, Volume: 3 Issue: 2, 110 - 116, 01.08.2022

Abstract

Giriş: Kardiyak resenkronizasyon tedavisi (KRT) kalp yetmezliğinde etkili bir tedavidir ancak; uygun hastaları belirlemek zordur. Fragmente QRS (fQRS) kompleksi, miyokardial skarı gösteren iletim anormalliğidir. Bu çalışma, non-iskemik dilate kardiyomiyopatili (NKMP) hastalarda fQRS’in KRT yanıtına etkisini değerlendirmek için yapılmıştır Yöntemler: Çalışmaya prospektif olarak 56 hasta alındı. Elektrokardiyografide (EKG) 32 hastada fQRS (%57.1) mevcuttu. KRT tedavisine uygun olmayan hastalar çalışma dışı bırakıldı. Klinik durum, EKG ve ekokardiyografik parametreler kullanılarak KRT öncesi ve sonrası (1 yıl) iki grup (fQRS ve fQRS yok) arasındaki farklılık değerlendirildi. Sürekli parametreler Paired Samples T-testi ile karşılaştırıldı. Bulgular: Takip döneminde; fQRS olan ve olmayan grup arasında QRS süresi (p=0.46, p=0.61) ve NYHA fonksiyonel sınıfı açısından (p=0.29, p=0.57) KRT öncesi ve sonrası istatistiksel olarak anlamlı değildi. Ayrıca sol ventrikül ejeksiyon fraksiyonundaki değişim açısından istatistiksel anlamlılık saptanmadı (p=0.12). Sonuç: NKMP'li hastalarda fQRS varlığı KRT yanıtı ile ilişkili değildir.

References

  • 1. Bleeker GB, Schalij MJ, Nihoyannopoulos P, Steendijk P, Molhoek SG, van Erven L, et al. Left ventricular dyssynchrony predicts right ventricular remodeling after cardiac resynchronization therapy. Journal of the American College of Cardiology. 2005;46(12):2264-9.
  • 2. Yu CM, Zhang Q, Fung JW, Chan HC, Chan YS, Yip GW, et al. A novel tool to assess systolic asynchrony and identify responders of cardiac resynchronization therapy by tissue synchronization imaging. Journal of the American College of Cardiology. 2005;45(5):677-84.
  • 3. Bax JJ, Bleeker GB, Marwick TH, Molhoek SG, Boersma E, Steendijk P, et al. Left ventricular dyssynchrony predicts response and prognosis after cardiac resynchronization therapy. Journal of the American College of Cardiology. 2004;44(9):1834-40.
  • 4. Bleeker GB, Schalij MJ, Molhoek SG, Verwey HF, Holman ER, Boersma E, et al. Relationship between QRS duration and left ventricular dyssynchrony in patients with end-stage heart failure. Journal of cardiovascular electrophysiology. 2004;15(5):544-9.
  • 5. Stewart S, Jenkins A, Buchan S, McGuire A, Capewell S, McMurray JJ. The current cost of heart failure to the National Health Service in the UK. European journal of heart failure. 2002;4(3):361-71.
  • 6. Das MK, Zipes DP. Fragmented QRS: a predictor of mortality and sudden cardiac death. Heart rhythm. 2009;6(3 Suppl):S8-14.
  • 7. Homsi M, Alsayed L, Safadi B, Mahenthiran J, Das MK. Fragmented QRS complexes on 12-lead ECG: a marker of cardiac sarcoidosis as detected by gadolinium cardiac magnetic resonance imaging. Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc. 2009;14(4):319-26.
  • 8. Bleeker GB, Kaandorp TA, Lamb HJ, Boersma E, Steendijk P, de Roos A, et al. Effect of posterolateral scar tissue on clinical and echocardiographic improvement after cardiac resynchronization therapy. Circulation. 2006;113(7):969-76.
  • 9. Adelstein EC, Saba S. Scar burden by myocardial perfusion imaging predicts echocardiographic response to cardiac resynchronization therapy in ischemic cardiomyopathy. American heart journal. 2007;153(1):105-12.
  • 10. Das MK, Suradi H, Maskoun W, Michael MA, Shen C, Peng J, et al. Fragmented wide QRS on a 12-lead ECG: a sign of myocardial scar and poor prognosis. Circulation Arrhythmia and electrophysiology. 2008;1(4):258-68.
  • 11. Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R, Feigenbaum H, et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography. 1989;2(5):358-67.
  • 12. Thomas JD. How leaky is that mitral valve? Simplified Doppler methods to measure regurgitant orifice area. Circulation. 1997;95(3):548-50.
  • 13. Breithardt OA, Stellbrink C, Franke A, Balta O, Diem BH, Bakker P, et al. Acute effects of cardiac resynchronization therapy on left ventricular Doppler indices in patients with congestive heart failure. American heart journal. 2002;143(1):34-44.
  • 14. Bhatia V, Bhatia R, Dhindsa S, Virk A. Cardiac resynchronization therapy in heart failure: recent advances and new insights. Indian pacing and electrophysiology journal. 2003;3(3):129-42.
  • 15. Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L, et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. The New England journal of medicine. 2005;352(15):1539-49.
  • 16. Gorcsan J, 3rd. Finding pieces of the puzzle of nonresponse to cardiac resynchronization therapy. Circulation. 2011;123(1):10-2.
  • 17. Das MK, Maskoun W, Shen C, Michael MA, Suradi H, Desai M, et al. Fragmented QRS on twelve-lead electrocardiogram predicts arrhythmic events in patients with ischemic and nonischemic cardiomyopathy. Heart rhythm. 2010;7(1):74-80.
  • 18. Das MK, El Masry H. Fragmented QRS and other depolarization abnormalities as a predictor of mortality and sudden cardiac death. Current opinion in cardiology. 2010;25(1):59-64.
  • 19. Celikyurt U, Agacdiken A, Sahin T, Al N, Vural A, Ural D. Relationship between fragmented QRS and response to cardiac resynchronization therapy. Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing. 2012;35(3):337-42; discussion 42.
  • 20. Pranata R, Yonas E. Fragmented QRS is associated with intraventricular dyssynchrony and independently predicts nonresponse to cardiac resynchronization therapy-Systematic review and meta-analysis. 2020;25(4):e12750.
  • 21. Liu X, Hu Y, Hua W. A Predictive Model for Super-Response to Cardiac Resynchronization Therapy: The QQ-LAE Score. 2020;2020:3856294.
  • 22. Assadian Rad M, Tabarzan Baboli N, Barzigar A, Keirkhah J, Soltanipour S, Bonakdar HR, et al. The role of the fragmented QRS complexes on a routine 12-lead ECG in predicting non-responsiveness to cardiac resynchronization therapy. Anatolian journal of cardiology. 2015;15(3):204-8.
  • 23. Rickard J, Zardkoohi O, Popovic Z, Verhaert D, Sraow D, Baranowski B, et al. QRS fragmentation is not associated with poor response to cardiac resynchronization therapy. Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc. 2011;16(2):165-71.
  • 24. Morita H, Kusano KF, Miura D, Nagase S, Nakamura K, Morita ST, et al. Fragmented QRS as a marker of conduction abnormality and a predictor of prognosis of Brugada syndrome. Circulation. 2008;118(17):1697-704.
  • 25. Sinha SK, Bhagat K, Asif M, Singh K, Sachan M, Mishra V, et al. Fragmented QRS as a Marker of Electrical Dyssynchrony to Predict Inter-Ventricular Conduction Defect by Subsequent Echocardiographic Assessment in Symptomatic Patients of Non-Ischemic Dilated Cardiomyopathy. Cardiology research. 2016;7(4):140-5.
  • 26. Tigen K, Karaahmet T, Gurel E, Cevik C, Nugent K, Pala S, et al. The utility of fragmented QRS complexes to predict significant intraventricular dyssynchrony in nonischemic dilated cardiomyopathy patients with a narrow QRS interval. The Canadian journal of cardiology. 2009;25(9):517-22.
There are 26 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Research Articles
Authors

Ayhan Küp 0000-0003-1977-069X

Mehmet Çelik 0000-0003-0364-2239

Şeyhmus Külahçıoğlu 0000-0002-6435-7821

Abdulkadi Uslu 0000-0002-3022-2734

Mert Evlıce 0000-0003-4733-6348

Mehmet Muhsin Türkmen 0000-0002-8588-4583

Ramazan Kargın 0000-0003-0866-8462

Publication Date August 1, 2022
Published in Issue Year 2022 Volume: 3 Issue: 2

Cite

APA Küp, A., Çelik, M., Külahçıoğlu, Ş., Uslu, A., et al. (2022). The Evaluation Of The Response To Cardiac Resynchronization Therapy In Patients With Dilated Cardiomyopathy By Using Fragmented QRS. Eskisehir Medical Journal, 3(2), 110-116.
AMA Küp A, Çelik M, Külahçıoğlu Ş, Uslu A, Evlıce M, Türkmen MM, Kargın R. The Evaluation Of The Response To Cardiac Resynchronization Therapy In Patients With Dilated Cardiomyopathy By Using Fragmented QRS. Eskisehir Med J. August 2022;3(2):110-116.
Chicago Küp, Ayhan, Mehmet Çelik, Şeyhmus Külahçıoğlu, Abdulkadi Uslu, Mert Evlıce, Mehmet Muhsin Türkmen, and Ramazan Kargın. “The Evaluation Of The Response To Cardiac Resynchronization Therapy In Patients With Dilated Cardiomyopathy By Using Fragmented QRS”. Eskisehir Medical Journal 3, no. 2 (August 2022): 110-16.
EndNote Küp A, Çelik M, Külahçıoğlu Ş, Uslu A, Evlıce M, Türkmen MM, Kargın R (August 1, 2022) The Evaluation Of The Response To Cardiac Resynchronization Therapy In Patients With Dilated Cardiomyopathy By Using Fragmented QRS. Eskisehir Medical Journal 3 2 110–116.
IEEE A. Küp, M. Çelik, Ş. Külahçıoğlu, A. Uslu, M. Evlıce, M. M. Türkmen, and R. Kargın, “The Evaluation Of The Response To Cardiac Resynchronization Therapy In Patients With Dilated Cardiomyopathy By Using Fragmented QRS”, Eskisehir Med J, vol. 3, no. 2, pp. 110–116, 2022.
ISNAD Küp, Ayhan et al. “The Evaluation Of The Response To Cardiac Resynchronization Therapy In Patients With Dilated Cardiomyopathy By Using Fragmented QRS”. Eskisehir Medical Journal 3/2 (August 2022), 110-116.
JAMA Küp A, Çelik M, Külahçıoğlu Ş, Uslu A, Evlıce M, Türkmen MM, Kargın R. The Evaluation Of The Response To Cardiac Resynchronization Therapy In Patients With Dilated Cardiomyopathy By Using Fragmented QRS. Eskisehir Med J. 2022;3:110–116.
MLA Küp, Ayhan et al. “The Evaluation Of The Response To Cardiac Resynchronization Therapy In Patients With Dilated Cardiomyopathy By Using Fragmented QRS”. Eskisehir Medical Journal, vol. 3, no. 2, 2022, pp. 110-6.
Vancouver Küp A, Çelik M, Külahçıoğlu Ş, Uslu A, Evlıce M, Türkmen MM, Kargın R. The Evaluation Of The Response To Cardiac Resynchronization Therapy In Patients With Dilated Cardiomyopathy By Using Fragmented QRS. Eskisehir Med J. 2022;3(2):110-6.