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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorBORTOLOTTO, Alexandre L.
dc.contributor.authorVERRIER, Richard L.
dc.contributor.authorNEARING, Bruce D.
dc.contributor.authorMARUM, Alexandre A.
dc.contributor.authorSILVA, Bruna Araujo
dc.contributor.authorPEDREIRA, Giovanna C.
dc.contributor.authorSILVA, Fernanda Tessarolo
dc.contributor.authorMEDEIROS, Sofia A.
dc.contributor.authorSROUBEK, Jakub
dc.contributor.authorZIMETBAUM, Peter J.
dc.contributor.authorCHANG, James D.
dc.identifier.citationHEART RHYTHM, v.17, n.11, p.1887-1896, 2020
dc.description.abstractBACKGROUND Reliable quantitative preimplantation predictors of response to cardiac resynchronization therapy (CRT) are needed. OBJECTIVE We tested the utility of preimplantation R-wave and T-wave heterogeneity (RWH and TWH, respectively) compared to standard QRS complex duration in identifying mechanical super-responders to CRT and mortality risk. METHODS We analyzed resting 12-lead electrocardiographic recordings from all 155 patients who received CRT devices between 2006 and 2018 at our institution and met class I and IIA American College of Cardiology/American Heart Association/Heart Rhythm Society guidelines with echocardiograms before and after implantation. Super-responders (n=35, 23%) had >= 20% increase in left ventricular ejection fraction and/or >= 20% decrease in left ventricular end-systolic diameter and were compared with non-super-responders (n=120, 77%), who did not meet these criteria. RWH and TWH were measured using second central moment analysis. RESULTS Among patients with non-left bundle branch block (LBBB), preimplantation RWH was significantly lower in super-responders than in non-super-responders in 3 of 4 lead sets ( P=.001 to P=.038) and TWH in 2 lead sets (both, P=.05), with the corresponding areas under the curve (RWH: 0.810-0.891, P<.001; TWH: 0.759-0.810, P <=.005). No differences were observed in the LBBB group. Preimplantation QRS complex duration also did not differ between super-responders and non-super-responders among patients with ( P=.856) or without ( P=.724) LBBB; the areas under the curve were nonsignificant (both, P=.69). RWH V1-3LILII >= 420 mu V predicted 3-year all-cause mortality in the entire cohort ( P=.037), with a hazard ratio of 7.440 (95% confidence interval 1.015-54.527; P=.048); QRS complex duration >= 150 ms did not predict mortality ( P=.27). CONCLUSION Preimplantation interlead electrocardiographic heterogeneity but not QRS complex duration predicts mechanical super-response to CRT in patients with non-LBBB.eng
dc.relation.ispartofHeart Rhythm
dc.subjectCardiac resynchronization therapyeng
dc.subjectHeart failureeng
dc.subjectR-wave heterogeneityeng
dc.subjectT-wave heterogeneityeng
dc.subject.othert-wave morphologyeng
dc.subject.otherventricular repolarizationeng
dc.subject.othertransmural dispersioneng
dc.subject.otherqt intervaleng
dc.titlePreimplantation interlead ECG heterogeneity is superior to QRS complex duration in predicting mechanical super-response in patients with non-left bundle branch block receiving cardiac resynchronization therapyeng
dc.rights.holderCopyright ELSEVIER SCIENCE INCeng
dc.subject.wosCardiac & Cardiovascular Systemseng
dc.type.categoryoriginal articleeng
dc.type.versionpublishedVersioneng, Richard L.:Beth Israel Deaconess Med Ctr, Dept Med, Boston, MA 02215 USA; Harvard Med Sch, Boston, MA 02115 USA, Bruce D.:Beth Israel Deaconess Med Ctr, Dept Med, Boston, MA 02215 USA; Harvard Med Sch, Boston, MA 02115 USA, Jakub:Beth Israel Deaconess Med Ctr, Dept Med, Boston, MA 02215 USA; Harvard Med Sch, Boston, MA 02115 USA, Peter J.:Beth Israel Deaconess Med Ctr, Dept Med, Boston, MA 02215 USA; Harvard Med Sch, Boston, MA 02115 USA, James D.:Beth Israel Deaconess Med Ctr, Dept Med, Boston, MA 02215 USA; Harvard Med Sch, Boston, MA 02115 USA
hcfmusp.publisher.cityNEW YORKeng
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Artigos e Materiais de Revistas Científicas - FM/Outros
Outros departamentos - FM/Outros

Artigos e Materiais de Revistas Científicas - LIM/04
LIM/04 - Laboratório de Microcirurgia

Artigos e Materiais de Revistas Científicas - LIM/11
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação

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