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The effect of QRS duration on cardiac resynchronization therapy in patients with a narrow QRS complex: a subgroup analysis of the EchoCRT trial

Steffel, Jan ; Robertson, Michele ; Singh, Jagmeet P. ; Abraham, William T. ; Bax, Jeroen J. ; Borer, Jeffrey S. ; Dickstein, Kenneth ; Ford, Ian ; Gorcsan, John ; Gras, Daniel ; Krum, Henry ; Sogaard, Peter ; Holzmeister, Johannes ; Brugada, Josep ; Ruschitzka, Frank

In: European Heart Journal, 2015, vol. 36, no. 30, p. 1983-1989

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    Titre
    • The effect of QRS duration on cardiac resynchronization therapy in patients with a narrow QRS complex: a subgroup analysis of the EchoCRT trial
    Auteur
    • Steffel, Jan. Department of Cardiology, Heart Failure Clinic and Transplantation, University Heart Center Zurich, Zurich, Switzerland
    • Robertson, Michele. Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
    • Singh, Jagmeet P.. Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
    • Abraham, William T.. Division of Cardiovascular Medicine, Ohio State University Medical Center, Davis Heart and Lung Research Institute, Columbus, OH, USA
    • Bax, Jeroen J.. Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
    • Borer, Jeffrey S.. Division of Cardiovascular Medicine and Howard Gilmanand Ron and Jean Schiavone Institutes, State University of New York Downstate College of Medicine, New York, NY, USA
    • Dickstein, Kenneth. University of Bergen, Stavanger University Hospital, Stavanger, Norway
    • Ford, Ian. Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
    • Gorcsan, John. University of Pittsburgh, Pittsburgh, PA, USA
    • Gras, Daniel. Nouvelles Cliniques Nantaises, Nantes, France
    • Krum, Henry. Monash Centre of Cardiovascular Research and Education in Therapeutics, Melbourne, VIC, Australia
    • Sogaard, Peter. Aalborg University, Aalborg, Denmark
    • Holzmeister, Johannes. Department of Cardiology, Heart Failure Clinic and Transplantation, University Heart Center Zurich, Zurich, Switzerland
    • Brugada, Josep. Cardiology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Spain
    • Ruschitzka, Frank. Department of Cardiology, Heart Failure Clinic and Transplantation, University Heart Center Zurich, Zurich, Switzerland
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • European Heart Journal, 2015, vol. 36, no. 30, p. 1983-1989. Oxford University Press
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:304308
    Summary
    Aims In EchoCRT, a randomized trial evaluating the effect of cardiac resynchronization therapy (CRT) in patients with a QRS duration of <130 ms and echocardiographic evidence of left ventricular dyssynchrony, the primary outcome occurred more frequently in the CRT when compared with the control group. According to current heart failure guidelines, CRT is recommended in patients with a QRS duration of ≥120 ms. However, there is some ambiguity from clinical trial data regarding the benefit of patients with a QRS duration of 120-130 ms. Methods and results The main EchoCRT trial was prematurely terminated due to futility. For the current subgroup analysis we compared data for CRT-ON vs. -OFF in patients with QRS < 120 (n = 661) and QRS 120-130 ms (n = 139). On uni- and multivariable analyses, no significant interaction was observed between the two groups and randomized treatment for the primary or any of the secondary endpoints. On multivariable analysis, a higher risk for the primary endpoint was observed in patients with a QRS duration of 120-130 ms randomized to CRT-ON vs. CRT-OFF (hazard ratio 2.18, 95% CI 1.02-4.65; P = 0.044). However, no statistically significant interaction, compared with patients with QRS < 120 ms randomized to CRT-ON vs. CRT-OFF, was noted (P-interaction = 0.160). Conclusions In this pre-specified subgroup analysis of EchoCRT, no benefit of CRT was evident in patients with a QRS duration of 120-130 ms. These data further question the usefulness of CRT in this patient population