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5. CI-452767-4 NON-INVASIVE 3D ELECTRICAL ACTIVATION MAPPING TO PREDICT CRT RESPONSE: SITE OF LATEST LV ACTIVATION RELATIVE TO PACING SITE

Author

Parreira, Leonor, primary, Tsyganov, Alexey, additional, Artyukhina, Elena, additional, Vernooy, Kevin, additional, Tondo, Claudio, additional, Adragao, Pedro, additional, Ascione, Ciro, additional, Carmo, Pedro, additional, Carvalho, Maria, additional, Egger, Matthias, additional, Ferreira, António, additional, Ghossein, Mohammed A., additional, Holm, Magnus C., additional, Kalinin, Vitaly, additional, Malakhova, Maria, additional, Meine, Mathias, additional, Nunes, Sílvia, additional, Podolyak, Dmitry, additional, Revishvili, Amiran S., additional, Shapieva, Albina, additional, Stepanova, Vera, additional, van Stipdonk, Antonius, additional, Taymasova, Irina, additional, Wouters, Philippe, additional, Zubarev, Stepan, additional, Leyva, Francisco, additional, Auricchio, Angelo, additional, and Varma, Niraj, additional

Published
2023
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6. Non-invasive three-dimensional electrical activation mapping to predict cardiac resynchronization therapy response::site of latest left ventricular activation relative to pacing site

Author

Parreira, Leonor, Tsyganov, Alexey, Artyukhina, Elena, Vernooy, Kevin, Tondo, Claudio, Adragao, Pedro, Ascione, Ciro, Carmo, Pedro, Carvalho, Salomé, Egger, Matthias, Ferreira, Antonio, Ghossein, Mohammed, Holm, Magnus, Kalinin, Vitaly, Malakhova, Maria, Meine, Mathias, Nunes, Silvia, Podolyak, Dmitry, Revishvili, Amiran, Shapieva, Albina, Stepanova, Vera, van Stipdonk, Antonius, Taymasova, Irina, Wouters, Philippe, Zubarev, Stepan, Leyva, Francisco, Auricchio, Angelo, Varma, Niraj, Parreira, Leonor, Tsyganov, Alexey, Artyukhina, Elena, Vernooy, Kevin, Tondo, Claudio, Adragao, Pedro, Ascione, Ciro, Carmo, Pedro, Carvalho, Salomé, Egger, Matthias, Ferreira, Antonio, Ghossein, Mohammed, Holm, Magnus, Kalinin, Vitaly, Malakhova, Maria, Meine, Mathias, Nunes, Silvia, Podolyak, Dmitry, Revishvili, Amiran, Shapieva, Albina, Stepanova, Vera, van Stipdonk, Antonius, Taymasova, Irina, Wouters, Philippe, Zubarev, Stepan, Leyva, Francisco, Auricchio, Angelo, and Varma, Niraj

Abstract

AIMS: Pacing remote from the latest electrically activated site (LEAS) in the left ventricle (LV) may diminish response to cardiac resynchronization therapy (CRT). We tested whether proximity of LV pacing site (LVPS) to LEAS, determined by non-invasive three-dimensional electrical activation mapping [electrocardiographic Imaging (ECGI)], increased likelihood of CRT response. METHODS AND RESULTS: Consecutive CRT patients underwent ECGI and chest/heart computed tomography 6-24 months of post-implant. Latest electrically activated site and the distance to LVPS (dp) were assessed. Left ventricular end-systolic volume (LVESV) reduction of ≥15% at clinical follow-up defined response. Logistic regression probabilistically modelled non-response; variables included demographics, heart failure classification, left bundle branch block (LBBB), ischaemic heart disease (IHD), atrial fibrillation, QRS duration, baseline ejection fraction (EF) and LVESV, comorbidities, use of CRT optimization algorithm, angiotensin-converting enzyme inhibitor(ACE)/angiotensin-receptor blocker (ARB), beta-blocker, diuretics, and dp. Of 111 studied patients [64 ± 11 years, EF 28 ± 6%, implant duration 12 ± 5 months (mean ± SD), 98% had LBBB, 38% IHD], 67% responded at 10 ± 3 months post CRT-implant. Latest electrically activated sites were outside the mid-to-basal lateral segments in 35% of the patients. dp was 42 ± 23 mm [31 ± 14 mm for responders vs. 63 ± 24 mm non-responders (P < 0.001)]. Longer dp and the lack of use of CRT optimization algorithm were the only independent predictors of non-response [area under the curve (AUC) 0.906]. dp of 47 mm delineated responders and non-responders (AUC 0.931). CONCLUSION: The distance between LV pacing site and latest electrical activation is a strong independent predictor for CRT response. Non-invasive electrical evaluation to characterize intrinsic activation and guide LV lead deployment may improve CRT efficacy.

Published
2023

7. Prognostic implications of invasive hemodynamics during cardiac resynchronization therapy: Stroke work outperforms dP/dt max.

Author

Onderzoek Device, Team Medisch, Circulatory Health, Wouters, Philippe C, Zweerink, Alwin, van Everdingen, Wouter M, Ghossein, Mohammed A, de Roest, Gerben J, Cramer, Maarten J, Doevendans, Pieter A F M, Vernooy, Kevin, Prinzen, Frits W, Allaart, Cornelis P, Meine, Mathias, Onderzoek Device, Team Medisch, Circulatory Health, Wouters, Philippe C, Zweerink, Alwin, van Everdingen, Wouter M, Ghossein, Mohammed A, de Roest, Gerben J, Cramer, Maarten J, Doevendans, Pieter A F M, Vernooy, Kevin, Prinzen, Frits W, Allaart, Cornelis P, and Meine, Mathias

Published
2023

8. Association of vectorcardiographic T-wave area with clinical and echocardiographic outcomes in cardiac resynchronization therapy

Author

Onderzoek Device, Team Medisch, Circulatory Health, Dural, Muhammet, Ghossein, Mohammed A, Gerrits, Willem, Daniels, Fenna, Meine, Mathias, Maass, Alexander H, Rienstra, Michiel, Prinzen, Frits W, Vernooy, Kevin, van Stipdonk, Antonius M W, Onderzoek Device, Team Medisch, Circulatory Health, Dural, Muhammet, Ghossein, Mohammed A, Gerrits, Willem, Daniels, Fenna, Meine, Mathias, Maass, Alexander H, Rienstra, Michiel, Prinzen, Frits W, Vernooy, Kevin, and van Stipdonk, Antonius M W

Published
2023

9. Comparison of the relation of the ESC 2021 and ESC 2013 definitions of left bundle branch block with clinical and echocardiographic outcome in cardiac resynchronization therapy

Author

Cardiologie, Onderzoek Device, Team Medisch, Circulatory Health, Rijks, Jesse, Ghossein, Mohammed A., Wouters, Philippe C., Dural, Muhammet, Maass, Alexander H., Meine, Mathias, Kloosterman, Mariëlle, Luermans, Justin, Prinzen, Frits W., Vernooy, Kevin, van Stipdonk, Antonius M.W., Cardiologie, Onderzoek Device, Team Medisch, Circulatory Health, Rijks, Jesse, Ghossein, Mohammed A., Wouters, Philippe C., Dural, Muhammet, Maass, Alexander H., Meine, Mathias, Kloosterman, Mariëlle, Luermans, Justin, Prinzen, Frits W., Vernooy, Kevin, and van Stipdonk, Antonius M.W.

Published
2023

10. Non-invasive three-dimensional electrical activation mapping to predict cardiac resynchronization therapy response: site of latest left ventricular activation relative to pacing site

Author

Team Medisch, Circulatory Health, Onderzoek Device, Parreira, Leonor, Tsyganov, Alexey, Artyukhina, Elena, Vernooy, Kevin, Tondo, Claudio, Adragao, Pedro, Ascione, Ciro, Carmo, Pedro, Carvalho, Salomé, Egger, Matthias, Ferreira, Antonio, Ghossein, Mohammed, Holm, Magnus, Kalinin, Vitaly, Malakhova, Maria, Meine, Mathias, Nunes, Silvia, Podolyak, Dmitry, Revishvili, Amiran, Shapieva, Albina, Stepanova, Vera, van Stipdonk, Antonius, Taymasova, Irina, Wouters, Philippe, Zubarev, Stepan, Leyva, Francisco, Auricchio, Angelo, Varma, Niraj, Team Medisch, Circulatory Health, Onderzoek Device, Parreira, Leonor, Tsyganov, Alexey, Artyukhina, Elena, Vernooy, Kevin, Tondo, Claudio, Adragao, Pedro, Ascione, Ciro, Carmo, Pedro, Carvalho, Salomé, Egger, Matthias, Ferreira, Antonio, Ghossein, Mohammed, Holm, Magnus, Kalinin, Vitaly, Malakhova, Maria, Meine, Mathias, Nunes, Silvia, Podolyak, Dmitry, Revishvili, Amiran, Shapieva, Albina, Stepanova, Vera, van Stipdonk, Antonius, Taymasova, Irina, Wouters, Philippe, Zubarev, Stepan, Leyva, Francisco, Auricchio, Angelo, and Varma, Niraj

Published
2023

11. Electrocardiogram-based deep learning improves outcome prediction following cardiac resynchronization therapy

Author

Electrofysiologie, Onderzoek Device, Cardiovasculaire Immunologie, Team Onderzoek, Team Medisch, Circulatory Health, Regenerative Medicine and Stem Cells, Gezonde Vaten, Wouters, Philippe C., van de Leur, Rutger R., Vessies, Melle B., van Stipdonk, Antonius M.W., Ghossein, Mohammed A., Hassink, Rutger J., Doevendans, Pieter A., van der Harst, Pim, Maass, Alexander H., Prinzen, Frits W., Vernooy, Kevin, Meine, Mathias, van Es, René, Electrofysiologie, Onderzoek Device, Cardiovasculaire Immunologie, Team Onderzoek, Team Medisch, Circulatory Health, Regenerative Medicine and Stem Cells, Gezonde Vaten, Wouters, Philippe C., van de Leur, Rutger R., Vessies, Melle B., van Stipdonk, Antonius M.W., Ghossein, Mohammed A., Hassink, Rutger J., Doevendans, Pieter A., van der Harst, Pim, Maass, Alexander H., Prinzen, Frits W., Vernooy, Kevin, Meine, Mathias, and van Es, René

Published
2023

12. Association of vectorcardiographic T-wave area with clinical and echocardiographic outcomes in cardiac resynchronization therapy.

Author

Dural, Muhammet, Ghossein, Mohammed A, Gerrits, Willem, Daniels, Fenna, Meine, Mathias, Maass, Alexander H, Rienstra, Michiel, Prinzen, Frits W, Vernooy, Kevin, and Stipdonk, Antonius M W van

Abstract

Aims Data on repolarization parameters in cardiac resynchronization therapy (CRT) are scarce. We investigated the association of baseline T-wave area, with both clinical and echocardiographic outcomes of CRT in a large, multi-centre cohort of CRT recipients. Also, we evaluated the association between the baseline T-wave area and QRS area. Methods and results In this retrospective study, 1355 consecutive CRT recipients were evaluated. Pre-implantation T-wave and QRS area were calculated from vectorcardiograms. Echocardiographic response was defined as a reduction of ≥15% in left ventricular end-systolic volume between 3 and 12 months after implantation. The clinical outcome was a combination of all-cause mortality, heart transplantation, and left ventricular assist device implantation. Left ventricular end-systolic volume reduction was largest in patients with QRS area ≥ 109 μVs and T-wave area ≥ 66 μVs compared with QRS area ≥ 109 μVs and T-wave area < 66 μVs (P = 0.004), QRS area < 109 μVs and T-wave area ≥ 66 μVs (P < 0.001) and QRS area < 109 μVs and T-wave area < 66 μVs (P < 0.001). Event-free survival rate was higher in the subgroup of patients with QRS area ≥ 109 μVs and T-wave area ≥ 66 μVs (n = 616, P < 0.001) and QRS area ≥ 109 μVs and T-wave area < 66 μVs (n = 100, P < 0.001) than the other subgroups. In the multivariate analysis, T-wave area remained associated with echocardiographic response (P = 0.008), but not with the clinical outcome (P = 0.143), when QRS area was included in the model. Conclusion Baseline T-wave area has a significant association with both clinical and echocardiographic outcomes after CRT. The association of T-wave area with echocardiographic response is independent from QRS area; the association with clinical outcome, however, is not. [ABSTRACT FROM AUTHOR]

Published
2024
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13. Comparison of the relation of the ESC 2021 and ESC 2013 definitions of left bundle branch block with clinical and echocardiographic outcome in cardiac resynchronization therapy

Author

Rijks, Jesse, primary, Ghossein, Mohammed A., additional, Wouters, Philippe C., additional, Dural, Muhammet, additional, Maass, Alexander H., additional, Meine, Mathias, additional, Kloosterman, Mariëlle, additional, Luermans, Justin, additional, Prinzen, Frits W., additional, Vernooy, Kevin, additional, and van Stipdonk, Antonius M. W., additional

Published
2023
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14. Non-invasive three-dimensional electrical activation mapping to predict cardiac resynchronization therapy response: site of latest left ventricular activation relative to pacing site

Author

Parreira, Leonor, primary, Tsyganov, Alexey, additional, Artyukhina, Elena, additional, Vernooy, Kevin, additional, Tondo, Claudio, additional, Adragao, Pedro, additional, Ascione, Ciro, additional, Carmo, Pedro, additional, Carvalho, Salomé, additional, Egger, Matthias, additional, Ferreira, Antonio, additional, Ghossein, Mohammed, additional, Holm, Magnus, additional, Kalinin, Vitaly, additional, Malakhova, Maria, additional, Meine, Mathias, additional, Nunes, Silvia, additional, Podolyak, Dmitry, additional, Revishvili, Amiran, additional, Shapieva, Albina, additional, Stepanova, Vera, additional, van Stipdonk, Antonius, additional, Taymasova, Irina, additional, Wouters, Philippe, additional, Zubarev, Stepan, additional, Leyva, Francisco, additional, Auricchio, Angelo, additional, and Varma, Niraj, additional

Published
2023
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15. Electrocardiogram-based deep learning improves outcome prediction following cardiac resynchronization therapy

Author

Wouters, Philippe C, primary, van de Leur, Rutger R, additional, Vessies, Melle B, additional, van Stipdonk, Antonius M W, additional, Ghossein, Mohammed A, additional, Hassink, Rutger J, additional, Doevendans, Pieter A, additional, van der Harst, Pim, additional, Maass, Alexander H, additional, Prinzen, Frits W, additional, Vernooy, Kevin, additional, Meine, Mathias, additional, and van Es, René, additional

Published
2022
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17. Cardiovascular outcome 6 months after severe coronavirus disease 2019 infection

Author

Raafs, Anne G., Ghossein, Mohammed A., Brandt, Yentl, Henkens, Michiel T.H.M., Kooi, M.E., Vernooy, K., Spaanderman, M.E.A., Heymans, Stephane R.B., Ghossein-Doha, Chahinda, Raafs, Anne G., Ghossein, Mohammed A., Brandt, Yentl, Henkens, Michiel T.H.M., Kooi, M.E., Vernooy, K., Spaanderman, M.E.A., Heymans, Stephane R.B., and Ghossein-Doha, Chahinda

Abstract

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Published
2022

18. Vectorcardiographic QRS area as a predictor of response to cardiac resynchronization therapy

Author

Ghossein, Mohammed A, van Stipdonk, Antonius Mw, Prinzen, Frits W, Vernooy, Kevin, Ghossein, Mohammed A, van Stipdonk, Antonius Mw, Prinzen, Frits W, and Vernooy, Kevin

Abstract

Cardiac resynchronization therapy (CRT) is a good treatment for heart failure accompanied by ventricular conduction abnormalities. Current ECG criteria in international guidelines seem to be suboptimal to select heart failure patients for CRT. The criteria QRS duration and left bundle branch block (LBBB) QRS morphology insufficiently detect left ventricular activation delay, which is required for benefit from CRT. Additionally, there are various definitions for LBBB, in which each one has a different association with CRT benefit and is prone to subjective interpretation. Recent studies have shown that the objectively measured vectorcardiographic QRS area identifies left ventricular activation delay with higher accuracy than any of the current ECG criteria. Indeed, various studies have consistently shown that a high QRS area prior to CRT predicts both echocardiographic and clinical improvement after CRT. The beneficial relation of QRS area with CRT-outcome was largely independent from QRS morphology, QRS duration, and patient characteristics known to affect CRT-outcome including ischemic etiology and sex. On top of QRS area prior to CRT, the reduction in QRS area after CRT further improves benefit. QRS area is easily obtainable from a standard 12-lead ECG though it currently requires off-line analysis. Clinical applicability will be significantly improved when QRS area is automatically determined by ECG equipment.

Published
2022

19. Cardiovascular outcome 6 months after severe coronavirus disease 2019 infection

Author

Raafs, Anne G, Ghossein, Mohammed A, Brandt, Yentl, Henkens, Michiel T H M, Kooi, M Eline, Vernooy, Kevin, Spaanderman, Marc E A, Gerretsen, Suzanne, van Santen, Susanne, Driessen, Rob G H, Knackstedt, Christian, van der Horst, Iwan C C, van Bussel, Bas C T, Heymans, Stephane R B, Ghossein-Doha, Chahinda, MaastrICCht Collaborators, Raafs, Anne G, Ghossein, Mohammed A, Brandt, Yentl, Henkens, Michiel T H M, Kooi, M Eline, Vernooy, Kevin, Spaanderman, Marc E A, Gerretsen, Suzanne, van Santen, Susanne, Driessen, Rob G H, Knackstedt, Christian, van der Horst, Iwan C C, van Bussel, Bas C T, Heymans, Stephane R B, Ghossein-Doha, Chahinda, and MaastrICCht Collaborators

Abstract

Objectives:In coronavirus disease 2019 (COVID-19), cardiovascular risk factors and myocardial injury relate to increased mortality. We evaluated the extent of cardiac sequelae 6 months after hospital discharge in patients surviving ICU hospitalization for COVID-19.Methods:All survivors of Maastricht-ICU were invited for comprehensive cardiovascular evaluation 6 months after discharge from ICU. Cardiac screening included an electrocardiogram, cardiac biomarkers, echocardiography, cardiac magnetic resonance (CMR) and, wherever indicated, cardiac computed tomography or coronary angiogram.Results:Out of 52 survivors, 81% (n = 42) participated to the cardiovascular follow-up [median follow-up of 6 months, interquartile range (IQR) 6.1-6.7]. Eight patients (19%) had newly diagnosed coronary artery disease (CAD), of which two required a percutaneous intervention. Echocardiographic global longitudinal strain (GLS) was abnormal in 24% and CMR-derived GLS was abnormal in 12%, despite normal left ventricular ejection fraction in all. None of the patients showed elevated T1 relaxation times and five patients (14%) had an elevated T2 relaxation time. Late gadolinium enhancement (LGE) reflecting regional myocardial fibrosis was increased in eight patients (21%), of which three had myocarditis and three had pericarditis.Conclusion:Cardiovascular follow-up at 6 months after ICU-admission for severe COVID-19 revealed that one out of five invasively mechanically ventilated survivors had CAD, a quarter had subclinical left ventricular dysfunction defined as reduced echocardiographic GLS, and 42% of the patients had CMR abnormalities (reduced LVEF, reduced GLS, LGE presence, and elevated T2). On the basis of these findings, long-term cardiovascular follow-up is strongly recommended in all post-IC COVID-19.

Published
2022

20. Cardiovascular outcome 6 months after severe coronavirus disease 2019 infection

Author

Raafs, Anne G., primary, Ghossein, Mohammed A., additional, Brandt, Yentl, additional, Henkens, Michiel T.H.M., additional, Kooi, M. Eline, additional, Vernooy, Kevin, additional, Spaanderman, Marc E.A., additional, Gerretsen, Suzanne, additional, van Santen, Susanne, additional, Driessen, Rob G.H., additional, Knackstedt, Christian, additional, van der Horst, Iwan C.C., additional, van Bussel, Bas C.T., additional, Heymans, Stephane R.B., additional, and Ghossein-Doha, Chahinda, additional

Published
2022
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21. Electrocardiogram-based deep learning improves outcome prediction following cardiac resynchronization therapy.

Author

Wouters, Philippe C, Leur, Rutger R van de, Vessies, Melle B, Stipdonk, Antonius M W van, Ghossein, Mohammed A, Hassink, Rutger J, Doevendans, Pieter A, van der Harst, Pim, Maass, Alexander H, Prinzen, Frits W, Vernooy, Kevin, Meine, Mathias, and Es, René van

Subjects
HEART assist devices, CARDIAC pacing, DEEP learning, MACHINE learning, EDUCATIONAL outcomes, HEART transplantation
Abstract

Aims This study aims to identify and visualize electrocardiogram (ECG) features using an explainable deep learning–based algorithm to predict cardiac resynchronization therapy (CRT) outcome. Its performance is compared with current guideline ECG criteria and QRSAREA. Methods and results A deep learning algorithm, trained on 1.1 million ECGs from 251 473 patients, was used to compress the median beat ECG, thereby summarizing most ECG features into only 21 explainable factors (FactorECG). Pre-implantation ECGs of 1306 CRT patients from three academic centres were converted into their respective FactorECG. FactorECG predicted the combined clinical endpoint of death, left ventricular assist device, or heart transplantation [c-statistic 0.69, 95% confidence interval (CI) 0.66–0.72], significantly outperforming QRSAREA and guideline ECG criteria [c-statistic 0.61 (95% CI 0.58–0.64) and 0.57 (95% CI 0.54–0.60), P < 0.001 for both]. The addition of 13 clinical variables was of limited added value for the FactorECG model when compared with QRSAREA (Δ c-statistic 0.03 vs. 0.10). FactorECG identified inferolateral T-wave inversion, smaller right precordial S- and T-wave amplitude, ventricular rate, and increased PR interval and P-wave duration to be important predictors for poor outcome. An online visualization tool was created to provide interactive visualizations (https://crt.ecgx.ai). Conclusion Requiring only a standard 12-lead ECG, FactorECG held superior discriminative ability for the prediction of clinical outcome when compared with guideline criteria and QRSAREA, without requiring additional clinical variables. End-to-end automated visualization of ECG features allows for an explainable algorithm, which may facilitate rapid uptake of this personalized decision-making tool in CRT. [ABSTRACT FROM AUTHOR]

Published
2023
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22. Left Ventricular Lead Placement Guided by Reduction in QRS Area

Author

Ghossein, Mohammed Ali, primary, Zanon, Francesco, additional, Salden, Floor, additional, van Stipdonk, Antonius, additional, Marcantoni, Lina, additional, Engels, Elien, additional, Luermans, Justin, additional, Westra, Sjoerd, additional, Prinzen, Frits, additional, and Vernooy, Kevin, additional

Published
2021
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23. B-PO03-192 REDUCTION IN QRS AREA CORRELATES WITH HEMODYNAMIC RESPONSE DURING CARDIAC RESYNCHRONIZATION THERAPY - DEVICE IMPLANTATION

Author

Ghossein, Mohammed Ali, primary, van Stipdonk, Antonius M.W., additional, Salden, Floor CWM., additional, Engels, Elien B., additional, Zanon, Francesco, additional, Westra, Sjoerd, additional, Maass, Alexander H., additional, Rienstra, Michiel, additional, Prinzen, Frits W., additional, and Vernooy, Kevin, additional

Published
2021
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24. Left Ventricular Lead Placement Guided by Reduction in QRS Area

Author

Ghossein, Mohammed Ali, Zanon, Francesco, Salden, Floor C.W.M., Stipdonk, Antonius M.W. Van, Marcantoni, Lina, Engels, Elien B., Westra, S.W., Prinzen, Frits W., Vernooy, K., Ghossein, Mohammed Ali, Zanon, Francesco, Salden, Floor C.W.M., Stipdonk, Antonius M.W. Van, Marcantoni, Lina, Engels, Elien B., Westra, S.W., Prinzen, Frits W., and Vernooy, K.

Abstract

Contains fulltext : 244257.pdf (Publisher’s version ) (Open Access)

Published
2021

26. Reduction in the QRS area after cardiac resynchronization therapy is associated with survival and echocardiographic response

Author

Onderzoek Device, Arts Assistenten Cardiologie, Researchbureau DHL, Team Medisch, Circulatory Health, Ghossein, Mohammed A., van Stipdonk, Antonius M.W., Plesinger, Filip, Kloosterman, Mariëlle, Wouters, Philippe C., Salden, Odette A.E., Meine, Mathias, Maass, Alexander H., Prinzen, Frits W., Vernooy, Kevin, Onderzoek Device, Arts Assistenten Cardiologie, Researchbureau DHL, Team Medisch, Circulatory Health, Ghossein, Mohammed A., van Stipdonk, Antonius M.W., Plesinger, Filip, Kloosterman, Mariëlle, Wouters, Philippe C., Salden, Odette A.E., Meine, Mathias, Maass, Alexander H., Prinzen, Frits W., and Vernooy, Kevin

Published
2021

28. Reduction in the QRS area after cardiac resynchronization therapy is associated with survival and echocardiographic response

Author

Ghossein, Mohammed A., primary, Stipdonk, Antonius M. W., additional, Plesinger, Filip, additional, Kloosterman, Mariëlle, additional, Wouters, Philippe C., additional, Salden, Odette A. E., additional, Meine, Mathias, additional, Maass, Alexander H., additional, Prinzen, Frits W., additional, and Vernooy, Kevin, additional

Published
2021
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29. Vectorcardiographic QRS area as a predictor of response to cardiac resynchronization therapy.

Author

Ghossein, Mohammed A., van Stipdonk, Antonius M. W., Prinzen, Frits W., and Vernooy, Kevin

Subjects
HEART failure treatment, CARDIAC pacing, MEDICAL protocols, TREATMENT effectiveness, VECTORCARDIOGRAPHY, ELECTROCARDIOGRAPHY
Abstract

Cardiac resynchronization therapy (CRT) is a good treatment for heart failure accompanied by ventricular conduction abnormalities. Current ECG criteria in international guidelines seem to be suboptimal to select heart failure patients for CRT. The criteria QRS duration and left bundle branch block (LBBB) QRS morphology insufficiently detect left ventricular activation delay, which is required for benefit from CRT. Additionally, there are various definitions for LBBB, in which each one has a different association with CRT benefit and is prone to subjective interpretation. Recent studies have shown that the objectively measured vectorcardiographic QRS area identifies left ventricular activation delay with higher accuracy than any of the current ECG criteria. Indeed, various studies have consistently shown that a high QRS area prior to CRT predicts both echocardiographic and clinical improvement after CRT. The beneficial relation of QRS area with CRT-outcome was largely independent from QRS morphology, QRS duration, and patient characteristics known to affect CRT-outcome including ischemic etiology and sex. On top of QRS area prior to CRT, the reduction in QRS area after CRT further improves benefit. QRS area is easily obtainable from a standard 12-lead ECG though it currently requires off-line analysis. Clinical applicability will be significantly improved when QRS area is automatically determined by ECG equipment. [ABSTRACT FROM AUTHOR]

Published
2022
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