Skip to main content

Advertisement

SpringerLink
Log in

Cardiac resynchronization therapy in patients with a narrow QRS

  • Published:
Current Heart Failure Reports Aims and scope Submit manuscript

Abstract

Although cardiac resynchronization therapy (CRT) is indicated in patients with moderate to severe heart failure with a wide QRS complex (> 120 ms), current guidelines exclude many heart failure patients with a narrow QRS. Detecting mechanical dyssynchrony on echocardiography has become a promising tool in selecting patients with a narrow QRS who may respond to CRT. Several small single-center studies identified patients with a narrow QRS (using echocardiography-based dyssynchrony criteria) who responded favorably to CRT; however, the results of two recent pilot studies remain elusive. The results of the RethinQ study do not provide necessary evidence for making clinical treatment decisions in this population. The lack of definitive evidence is the strongest rationale for conducting an adequately powered, long-term, end point-driven, randomized controlled trial to investigate whether CRT therapy can improve morbidity and mortality outcomes in heart failure patients with a narrow QRS. Such a trial, the EchoCRT trial, has recently been launched.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. CDC: Heart failure fact sheet. Available at http://www.cdc.gov/dhdsp/library/pdfs/fs_heart_failure.pdf. Accessed December 2008.

  2. Cleland JG, Daubert JC, Erdmann E, et al.: The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med 2005, 352:1539–1549.

    Article  PubMed  CAS  Google Scholar 

  3. Bristow MR, Saxon LA, Boehmer J, et al.: Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 2004, 350:2140–2150.

    Article  PubMed  CAS  Google Scholar 

  4. Abraham WT, Fisher WG, Smith AL, et al.: Cardiac resynchronization in chronic heart failure. N Engl J Med 2002, 346:1845–1853.

    Article  PubMed  Google Scholar 

  5. Kashani A, Barold SS: Significance of QRS complex duration in patients with heart failure. J Am Coll Cardiol 2005, 46:2183–2192.

    Article  PubMed  Google Scholar 

  6. Khan NK, Goode KM, Cleland JG, et al.: Prevalence of ECG abnormalities in an international survey of patients with suspected or confirmed heart failure at death or discharge. Eur J Heart Fail 2007, 9:491–501.

    Article  PubMed  Google Scholar 

  7. Abraham J, Abraham TP: Echocardiography is useful before cardiac resynchronization therapy if QRS duration is available. Circ Cardiovasc Imaging 2008, 1:79–85.

    Article  Google Scholar 

  8. Mollema SA, Bleeker GB, van der Wall EE, et al.: Usefulness of QRS duration to predict response to cardiac resynchronization therapy in patients with end-stage heart failure. Am J Cardiol 2007, 100:1665–1670.

    Article  PubMed  Google Scholar 

  9. Pitzalis MV, Iacoviello M, Romito R, et al.: Role of septal to posterior wall motion delay in cardiac resynchronization therapy. J Am Coll Cardiol 2006, 48:596–597.

    Article  PubMed  Google Scholar 

  10. Gorcsan J 3rd, Abraham T, Agler DA, et al.: Echocardiography for cardiac resynchronization therapy: recommendations for performance and reporting-a report from the American Society of Echocardiography Dyssynchrony Writing Group endorsed by the Heart Rhythm Society. J Am Soc Echocardiogr 2008, 21:191–213.

    Article  PubMed  Google Scholar 

  11. Bax JJ, Bleeker GB, Marwick TH, et al.: Left ventricular dyssynchrony predicts response and prognosis after cardiac resynchronization therapy. J Am Coll Cardiol 2004, 44:1834–1840.

    Article  PubMed  Google Scholar 

  12. Yu CM, Fung WH, Lin H, et al.: Predictors of left ventricular reverse remodeling after cardiac resynchronization therapy for heart failure secondary to idiopathic dilated or ischemic cardiomyopathy. Am J Cardiol 2003, 91:684–688.

    Article  PubMed  Google Scholar 

  13. Bleeker GB, Schalij MJ, Molhoek SG, et al.: Frequency of left ventricular dyssynchrony in patients with heart failure and a narrow QRS complex. Am J Cardiol 2005, 95:140–142.

    Article  PubMed  Google Scholar 

  14. Yu CM, Lin H, Zhang Q, Sanderson JE: High prevalence of left ventricular systolic and diastolic asynchrony in patients with congestive heart failure and normal QRS duration. Heart 2003, 89:54–60.

    Article  PubMed  Google Scholar 

  15. Bleeker GB, Holman ER, Steendijk P, et al.: Cardiac resynchronization therapy in patients with a narrow QRS complex. J Am Coll Cardiol 2006, 48:2243–2250.

    Article  PubMed  Google Scholar 

  16. Yu CM, Chan YS, Zhang Q, et al.: Benefits of cardiac resynchronization therapy for heart failure patients with narrow QRS complexes and coexisting systolic asynchrony by echocardiography. J Am Coll Cardiol 2006, 48:2251–2257.

    Article  PubMed  Google Scholar 

  17. Suffoletto MS, Dohi K, Cannesson M, et al.: Novel speckle-tracking radial strain from routine black-and-white echocardiographic images to quantify dyssynchrony and predict response to cardiac resynchronization therapy. Circulation 2006, 113:960–968.

    Article  PubMed  Google Scholar 

  18. Dohi K, Suffoletto MS, Schwartzman D, et al.: Utility of echocardiographic radial strain imaging to quantify left ventricular dyssynchrony and predict acute response to cardiac resynchronization therapy. Am J Cardiol 2005, 96:112–116.

    Article  PubMed  Google Scholar 

  19. Gorcsan J 3rd, Tanabe M, Bleeker GB, et al.: Combined longitudinal and radial dyssynchrony predicts ventricular response after resynchronization therapy. J Am Coll Cardiol 2007, 50:1476–1483.

    Article  PubMed  Google Scholar 

  20. Delgado V, Ypenburg C, van Bommel RJ, et al.: Assessment of left ventricular dyssynchrony by speckle tracking strain imaging comparison between longitudinal, circumferential, and radial strain in cardiac resynchronization therapy. J Am Coll Cardiol 2008, 51:1944–1952.

    Article  PubMed  Google Scholar 

  21. Lim P, Buakhamsri A, Popovic ZB, et al.: Longitudinal strain delay index by speckle tracking imaging: a new marker of response to cardiac resynchronization therapy. Circulation 2008, 118:1130–1137.

    Article  PubMed  Google Scholar 

  22. Kapetanakis S, Kearney MT, Siva A, et al.: Real-time three-dimensional echocardiography: a novel technique to quantify global left ventricular mechanical dyssynchrony. Circulation 2005, 112:992–1000.

    Article  PubMed  CAS  Google Scholar 

  23. Marsan NA, Bleeker GB, Ypenburg C, et al.: Real-time three-dimensional echocardiography permits quantification of left ventricular mechanical dyssynchrony and predicts acute response to cardiac resynchronization therapy. J Cardiovasc Electrophysiol 2008, 19:392–399.

    Article  PubMed  Google Scholar 

  24. Helm RH, Lardo AC: Cardiac magnetic resonance assessment of mechanical dyssynchrony. Curr Opin Cardiol 2008, 23:440–446.

    Article  PubMed  Google Scholar 

  25. Lardo AC, Abraham TP, Kass DA: Magnetic resonance imaging assessment of ventricular dyssynchrony: current and emerging concepts. J Am Coll Cardiol 2005, 46:2223–2228.

    Article  PubMed  Google Scholar 

  26. Trimble MA, Borges-Neto S, Honeycutt EF, et al.: Evaluation of mechanical dyssynchrony and myocardial perfusion using phase analysis of gated SPECT imaging in patients with left ventricular dysfunction. J Nucl Cardiol 2008, 15:663–670.

    Article  PubMed  Google Scholar 

  27. Chen J, Garcia EV, Lerakis S, et al.: Left ventricular mechanical dyssynchrony as assessed by phase analysis of ECG-gated SPECT myocardial perfusion imaging. Echocardiography 2008, 25:1186–1194.

    PubMed  Google Scholar 

  28. Nagueh SF: Mechanical dyssynchrony in congestive heart failure: diagnostic and therapeutic implications. J Am Coll Cardiol 2008, 51:18–22.

    Article  PubMed  Google Scholar 

  29. Achilli A, Sassara M, Ficili S, et al.: Long-term effectiveness of cardiac resynchronization therapy in patients with refractory heart failure and “narrow” QRS. J Am Coll Cardiol 2003, 42:2117–2124.

    Article  PubMed  Google Scholar 

  30. Jeevanantham V, Zareba W, Navaneethan S, et al.: Metaanalysis on effects of cardiac resynchronization therapy in heart failure patients with narrow QRS complex. Cardiol J 2008, 15:230–236.

    PubMed  Google Scholar 

  31. Beshai JF, Grimm RA, Nagueh SF, et al.: Cardiac-resynchronization therapy in heart failure with narrow QRS complexes. N Engl J Med 2007, 357:2461–2471.

    Article  PubMed  CAS  Google Scholar 

  32. Leon AR, Niazi I, Herrman K, et al.: Chronic evaluation of CRT in narrow QRS patients with mechanical dyssynchrony from a multicenter study: ESTEEMCRT. Heart Rhythm 2008, 5:S23–S24.

    Google Scholar 

  33. Chung ES, Leon AR, Tavazzi L, et al.: Results of the Predictors of Response to CRT (PROSPECT) trial. Circulation 2008, 117:2608–2616.

    Article  PubMed  Google Scholar 

  34. Bleeker GB, Kaandorp TA, Lamb HJ, et al.: Effect of posterolateral scar tissue on clinical and echocardiographic improvement after cardiac resynchronization therapy. Circulation 2006, 113:969–976.

    Article  PubMed  Google Scholar 

  35. Ypenburg C, Schalij MJ, Bleeker GB, et al.: Impact of viability and scar tissue on response to cardiac resynchronization therapy in ischaemic heart failure patients. Eur Heart J 2007, 28:33–41.

    Article  PubMed  Google Scholar 

  36. Butter C, Auricchio A, Stellbrink C, et al.: Effect of resynchronization therapy stimulation site on the systolic function of heart failure patients. Circulation 2001, 104:3026–3029.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Cardiovascular Center, University Hospital Zurich, Rämistrasse 100, CH-8091, Zurich, Switzerland

    Johannes Holzmeister

Authors
  1. Johannes Holzmeister
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David Hürlimann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jan Steffel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Frank Ruschitzka
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Johannes Holzmeister.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Holzmeister, J., Hürlimann, D., Steffel, J. et al. Cardiac resynchronization therapy in patients with a narrow QRS. Curr Heart Fail Rep 6, 49–56 (2009). https://doi.org/10.1007/s11897-009-0009-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11897-009-0009-5

Keywords

Search

Navigation