Abstract:Objective: To evaluate the predictive value of changes in QRS duration (ΔQRSd) after cardiac resynchronization therapy (CRT) in allcause mortality and sudden cardiac death. Methods: Patients underwent CRT between March 2011 and December 2020 in Wuxi People′s Hospital Affiliated to Nanjing Medical University were enrolled. The clinical data including 12lead electrocardiography were obtained. QRS durations derived from pre and postimplantation electrocardiography were measured. Predictors for allcause mortality and sudden cardiac death were evaluated using Cox regression analysis. Xtile software was used to analyze the cutoff of ΔQRSd for predicting allcause mortality and sudden cardiac death. ΔQRSd was assessed in relation to allcause mortality and sudden cardiac death by KaplanMeier survival analysis. Results: Sixtysix patients were enrolled with a median followup time of 72 months, 15 died and 16 suffered from sudden cardiac death. ΔQRSd was a predictor for allcause mortality in multiple Cox regression analysis(HR=1.019, 95% CI:1.004-1.035,P=0.014). Both ΔQRSd(HR=1.016, 95% CI:1.002-1.031, P=0.024) and complete left bundle branch block(HR=0.211, 95% CI:0.065-0.682, P=0.009) were predictors for sudden cardiac death. The cutoff of ΔQRSd for predicting allcause mortality and sudden cardiac death was 0 ms. The preimplantation left ventricular enddiastolic diameter in the ΔQRSd> 0 ms group was significantly higher than that in the ΔQRSd ≤ 0 ms group (P<0.001), and the preimplantation QRS duration was significantly lower than that in the ΔQRSd ≤ 0 ms group (P=0.001). KaplanMeier survival analysis revealed that ΔQRSd> 0 ms was a predictor of allcause mortality, sudden cardiac death, 5year survival rate, and 5year sudden cardiac death rate after CRT (P<0.001, <0.001, 0.01 and <0.001, respectively). Conclusion: A postimplantation widening in QRS duration is an independent predictor of allcause mortality and sudden cardiac death after CRT.
承燕, 张常莹, 李宗斌,等.. QRS时限变化对心脏再同步化治疗后全因死亡及心源性猝死的预测价值[J]. 江苏大学学报:医学版, 2022, 32(05): 415-421.
CHENG Yan, ZHANG Changying, LI Zongbin, ZHAO Xiaoxi, WANG Ruxing. The predictive value of changes in QRS duration after cardiac resynchronization therapy in all-cause mortality and sudden cardiac death. Journal of Jiangsu University(Medicine Edition), 2022, 32(05): 415-421.
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