Baseline QRS duration associates with cardiac recovery in patients with continuous-flow left ventricular assist device implantation
Year: 2022
Type: article
Study design: Observational Study
Abstract: BACKGROUND In chronic heart failure (HF) patients supported with continuous-flow left ventricular assist device (CF-LVAD), we aimed to assess the clinical association of baseline QRS duration (QRSd) with post-LVAD cardiac recovery, and its correlation with pre- to post-LVAD change in left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD). METHODS Chronic HF patients (n=402) undergoing CF-LVAD implantation were prospectively enrolled, at one of the centers comprising the U.T.A.H. (Utah Transplant Affiliated Hospitals) consortium. After excluding patients with acute HF etiologies, hypertrophic or infiltrative cardiomyopathy, and/or inadequate post-LVAD follow up (<3 months), 315 patients were included in the study. Cardiac recovery was defined as LVEF ≥40% and LVEDD <6 cm within 12 months post-LVAD implantation. Patients fulfilling this condition were termed as responders (R) and results were compared with non-responders (NR). RESULTS Thirty-five patients (11%) achieved ‘R’ criteria, and exhibited a 15% shorter QRSd compared to ‘NR’ (123±37 ms vs 145±36 ms; p<0.001). A univariate analysis identified association of baseline QRSd with post-LVAD cardiac recovery (OR:0.986, 95% CI:0.976-0.996, p<0.001). In a multivariate logistic regression model, after adjusting for duration of HF (OR:0.990, 95% CI:0.983-0.997, p=0.006) and gender (OR:0.388, 95% CI:0.160-0.943, p=0.037), pre-LVAD QRSd exhibited a significant association with post-LVAD cardiac structural and functional improvement (OR:0.987, 95% CI:0.977-0.998, p=0.027) and the predictive model showed a c-statistic of 0.73 with p<0.001. The correlations for baseline QRSd with pre- to post-LVAD change in LVEF and LVEDD were also investigated in ‘R’ and ‘NR’ groups. CONCLUSION Chronic advanced HF patients with a shorter baseline QRSd exhibit an increased potential for cardiac recovery after LVAD support.
Language: English
Subfield: Biomedical Engineering
Field: Engineering
Domain: Physical Sciences
Open Access status: gold
Estimated APC paid: $2,650
Awards: Novel lead for selective His bundle sensing and low-threshold pacing, Antitachycardia pacing and improved lead for ventricular conduction system stimulation, Cellular Remodeling in Heart Failure and after LVAD Unloading, Clinical and Metabolic Signature of Recovered Myocardium in Human Heart Failure, G2514635969, G2526394027, G4648056030, G5478768602, Utah Center for Clinical and Translational Science, G6201253843, Functional, metabolic, and patient-centered determinants of recovery in heart failure, G6601455508, G7115937697, Training in Cardiovascular Research, G981650210
OpenAlex ID: W4296143275