Increases in repolarization heterogeneity predict left ventricular systolic dysfunction and response to cardiac resynchronization therapy in patients with left bundle branch block
Introduction This study aimed to investigate the association between T‐wave morphology and impaired left ventricular ejection fraction (LVEF) in patients with complete left bundle branch block (cLBBB), and the predictive value of T‐wave morphology for response to cardiac resynchronization therapy (C...
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| Veröffentlicht in: | Journal of cardiovascular electrophysiology 2020-07, Vol.31 (7), p.1770-1778 |
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| container_title | Journal of cardiovascular electrophysiology |
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| creator | Huang, Hui‐Chun Chien, Kuo‐Liong Chang, Yi‐Chung Lin, Lian‐Yu Wang, Jui Liu, Yen‐Bin |
| description | Introduction
This study aimed to investigate the association between T‐wave morphology and impaired left ventricular ejection fraction (LVEF) in patients with complete left bundle branch block (cLBBB), and the predictive value of T‐wave morphology for response to cardiac resynchronization therapy (CRT).
Methods and Results
We enrolled 189 patients with cLBBB on electrocardiogram performed between January 2007 and December 2011 who underwent standard echocardiography. Repolarization parameters, including the QRS‐to‐T angle (TCRT), T‐wave morphology dispersion (TMD), T‐wave loop area (PL), and T‐wave residuum (TWR), were reconstructed from digital standard 12‐lead electrocardiograms by T‐wave morphology analysis. CRT response was defined as ≥15% reduction in left ventricular end‐systolic volume at 12 months after CRT implantation. The clinical outcome endpoint was a composite of heart failure hospitalization, heart transplantation, or death during follow up (mean, 5.8 years). On logistic regression, a higher heart rate, longer QRS duration, increased TMD, and larger TWR were all independently associated with LVEF |
| doi_str_mv | 10.1111/jce.14488 |
| format | Article |
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This study aimed to investigate the association between T‐wave morphology and impaired left ventricular ejection fraction (LVEF) in patients with complete left bundle branch block (cLBBB), and the predictive value of T‐wave morphology for response to cardiac resynchronization therapy (CRT).
Methods and Results
We enrolled 189 patients with cLBBB on electrocardiogram performed between January 2007 and December 2011 who underwent standard echocardiography. Repolarization parameters, including the QRS‐to‐T angle (TCRT), T‐wave morphology dispersion (TMD), T‐wave loop area (PL), and T‐wave residuum (TWR), were reconstructed from digital standard 12‐lead electrocardiograms by T‐wave morphology analysis. CRT response was defined as ≥15% reduction in left ventricular end‐systolic volume at 12 months after CRT implantation. The clinical outcome endpoint was a composite of heart failure hospitalization, heart transplantation, or death during follow up (mean, 5.8 years). On logistic regression, a higher heart rate, longer QRS duration, increased TMD, and larger TWR were all independently associated with LVEF < 40%. Among 40 patients who underwent CRT, those with a larger TMD (P = .007), larger PL (P = .025), and more negative TCRT (P = .015) had better response to CRT. A large TMD (P = .018) and large PL (P = .003) were also independent predictors of the clinical outcome endpoint.
Conclusions
Increases in repolarization heterogeneity in patients with cLBBB are associated with impaired LVEF. A large TMD and large PL may be useful as additional predictors of response to CRT, improving patient selection for CRT.</description><identifier>ISSN: 1045-3873</identifier><identifier>EISSN: 1540-8167</identifier><identifier>DOI: 10.1111/jce.14488</identifier><identifier>PMID: 32275338</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>cardiac resynchronization therapy ; Congestive heart failure ; Echocardiography ; EKG ; electrocardiography ; Heart rate ; Heart transplantation ; left bundle branch block ; Morphology ; T‐wave loop area ; T‐wave morphology ; Ventricle</subject><ispartof>Journal of cardiovascular electrophysiology, 2020-07, Vol.31 (7), p.1770-1778</ispartof><rights>2020 Wiley Periodicals, Inc.</rights><rights>2020 Wiley Periodicals LLC</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3538-14567e1ac65ce5c0dea7809f06b58876d4bfae461940e14bd4def62de7a4dd693</citedby><cites>FETCH-LOGICAL-c3538-14567e1ac65ce5c0dea7809f06b58876d4bfae461940e14bd4def62de7a4dd693</cites><orcidid>0000-0003-1743-7850</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fjce.14488$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fjce.14488$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32275338$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Huang, Hui‐Chun</creatorcontrib><creatorcontrib>Chien, Kuo‐Liong</creatorcontrib><creatorcontrib>Chang, Yi‐Chung</creatorcontrib><creatorcontrib>Lin, Lian‐Yu</creatorcontrib><creatorcontrib>Wang, Jui</creatorcontrib><creatorcontrib>Liu, Yen‐Bin</creatorcontrib><title>Increases in repolarization heterogeneity predict left ventricular systolic dysfunction and response to cardiac resynchronization therapy in patients with left bundle branch block</title><title>Journal of cardiovascular electrophysiology</title><addtitle>J Cardiovasc Electrophysiol</addtitle><description>Introduction
This study aimed to investigate the association between T‐wave morphology and impaired left ventricular ejection fraction (LVEF) in patients with complete left bundle branch block (cLBBB), and the predictive value of T‐wave morphology for response to cardiac resynchronization therapy (CRT).
Methods and Results
We enrolled 189 patients with cLBBB on electrocardiogram performed between January 2007 and December 2011 who underwent standard echocardiography. Repolarization parameters, including the QRS‐to‐T angle (TCRT), T‐wave morphology dispersion (TMD), T‐wave loop area (PL), and T‐wave residuum (TWR), were reconstructed from digital standard 12‐lead electrocardiograms by T‐wave morphology analysis. CRT response was defined as ≥15% reduction in left ventricular end‐systolic volume at 12 months after CRT implantation. The clinical outcome endpoint was a composite of heart failure hospitalization, heart transplantation, or death during follow up (mean, 5.8 years). On logistic regression, a higher heart rate, longer QRS duration, increased TMD, and larger TWR were all independently associated with LVEF < 40%. Among 40 patients who underwent CRT, those with a larger TMD (P = .007), larger PL (P = .025), and more negative TCRT (P = .015) had better response to CRT. A large TMD (P = .018) and large PL (P = .003) were also independent predictors of the clinical outcome endpoint.
Conclusions
Increases in repolarization heterogeneity in patients with cLBBB are associated with impaired LVEF. A large TMD and large PL may be useful as additional predictors of response to CRT, improving patient selection for CRT.</description><subject>cardiac resynchronization therapy</subject><subject>Congestive heart failure</subject><subject>Echocardiography</subject><subject>EKG</subject><subject>electrocardiography</subject><subject>Heart rate</subject><subject>Heart transplantation</subject><subject>left bundle branch block</subject><subject>Morphology</subject><subject>T‐wave loop area</subject><subject>T‐wave morphology</subject><subject>Ventricle</subject><issn>1045-3873</issn><issn>1540-8167</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp1kctu1DAUhiMEohdY8ALIEhu6SGvH1yzRqDdUiQ2sI8c-YTxk7GA7VOlr8YJ4mpYFEt7YOvrO91v6q-odweeknIudgXPCmFIvqmPCGa4VEfJleWPGa6okPapOUtphTKjA_HV1RJtGckrVcfX71psIOkFCzqMIUxh1dA86u-DRFjLE8B08uLygKYJ1JqMRhox-gc_RmbnQKC0ph9EZZJc0zN487mpviy5NwSdAOSCjo3XaHGaLN9sY_HNK3kLU03LIn8qkiBO6d3m7BvWztyOgPuqyhfoxmB9vqleDHhO8fbpPq29Xl183N_Xdl-vbzae72lBOVU0YFxKINoIb4AZb0FLhdsCi50pJYVk_aGCCtAwDYb1lFgbRWJCaWStaelp9XL1TDD9nSLnbu2RgHLWHMKeuoUop0iosC_rhH3QX5ujL77qGkbaRknFSqLOVMjGkFGHopuj2Oi4dwd2hya402T02Wdj3T8a534P9Sz5XV4CLFbh3Iyz_N3WfN5er8g8Ima2m</recordid><startdate>202007</startdate><enddate>202007</enddate><creator>Huang, Hui‐Chun</creator><creator>Chien, Kuo‐Liong</creator><creator>Chang, Yi‐Chung</creator><creator>Lin, Lian‐Yu</creator><creator>Wang, Jui</creator><creator>Liu, Yen‐Bin</creator><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-1743-7850</orcidid></search><sort><creationdate>202007</creationdate><title>Increases in repolarization heterogeneity predict left ventricular systolic dysfunction and response to cardiac resynchronization therapy in patients with left bundle branch block</title><author>Huang, Hui‐Chun ; Chien, Kuo‐Liong ; Chang, Yi‐Chung ; Lin, Lian‐Yu ; Wang, Jui ; Liu, Yen‐Bin</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3538-14567e1ac65ce5c0dea7809f06b58876d4bfae461940e14bd4def62de7a4dd693</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>cardiac resynchronization therapy</topic><topic>Congestive heart failure</topic><topic>Echocardiography</topic><topic>EKG</topic><topic>electrocardiography</topic><topic>Heart rate</topic><topic>Heart transplantation</topic><topic>left bundle branch block</topic><topic>Morphology</topic><topic>T‐wave loop area</topic><topic>T‐wave morphology</topic><topic>Ventricle</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Huang, Hui‐Chun</creatorcontrib><creatorcontrib>Chien, Kuo‐Liong</creatorcontrib><creatorcontrib>Chang, Yi‐Chung</creatorcontrib><creatorcontrib>Lin, Lian‐Yu</creatorcontrib><creatorcontrib>Wang, Jui</creatorcontrib><creatorcontrib>Liu, Yen‐Bin</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of cardiovascular electrophysiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Huang, Hui‐Chun</au><au>Chien, Kuo‐Liong</au><au>Chang, Yi‐Chung</au><au>Lin, Lian‐Yu</au><au>Wang, Jui</au><au>Liu, Yen‐Bin</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Increases in repolarization heterogeneity predict left ventricular systolic dysfunction and response to cardiac resynchronization therapy in patients with left bundle branch block</atitle><jtitle>Journal of cardiovascular electrophysiology</jtitle><addtitle>J Cardiovasc Electrophysiol</addtitle><date>2020-07</date><risdate>2020</risdate><volume>31</volume><issue>7</issue><spage>1770</spage><epage>1778</epage><pages>1770-1778</pages><issn>1045-3873</issn><eissn>1540-8167</eissn><abstract>Introduction
This study aimed to investigate the association between T‐wave morphology and impaired left ventricular ejection fraction (LVEF) in patients with complete left bundle branch block (cLBBB), and the predictive value of T‐wave morphology for response to cardiac resynchronization therapy (CRT).
Methods and Results
We enrolled 189 patients with cLBBB on electrocardiogram performed between January 2007 and December 2011 who underwent standard echocardiography. Repolarization parameters, including the QRS‐to‐T angle (TCRT), T‐wave morphology dispersion (TMD), T‐wave loop area (PL), and T‐wave residuum (TWR), were reconstructed from digital standard 12‐lead electrocardiograms by T‐wave morphology analysis. CRT response was defined as ≥15% reduction in left ventricular end‐systolic volume at 12 months after CRT implantation. The clinical outcome endpoint was a composite of heart failure hospitalization, heart transplantation, or death during follow up (mean, 5.8 years). On logistic regression, a higher heart rate, longer QRS duration, increased TMD, and larger TWR were all independently associated with LVEF < 40%. Among 40 patients who underwent CRT, those with a larger TMD (P = .007), larger PL (P = .025), and more negative TCRT (P = .015) had better response to CRT. A large TMD (P = .018) and large PL (P = .003) were also independent predictors of the clinical outcome endpoint.
Conclusions
Increases in repolarization heterogeneity in patients with cLBBB are associated with impaired LVEF. A large TMD and large PL may be useful as additional predictors of response to CRT, improving patient selection for CRT.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>32275338</pmid><doi>10.1111/jce.14488</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0003-1743-7850</orcidid></addata></record> |
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| subjects | cardiac resynchronization therapy Congestive heart failure Echocardiography EKG electrocardiography Heart rate Heart transplantation left bundle branch block Morphology T‐wave loop area T‐wave morphology Ventricle |
| title | Increases in repolarization heterogeneity predict left ventricular systolic dysfunction and response to cardiac resynchronization therapy in patients with left bundle branch block |
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