ハギワラ　ノブヒサ   HAGIWARA Nobuhisa
  萩原　誠久
   所属   医学部 医学科（東京女子医科大学病院）
   職種   客員教授
Article types Original article
Language English
Peer review Peer reviewed
Title Narrowing filtered QRS duration on signal-averaged electrocardiogram predicts outcomes in cardiac resynchronization therapy patients with nonischemic heart failure.
Journal Formal name：Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc
Abbreviation：Ann Noninvasive Electrocardiol
ISSN code：1082-720X/1542-474X
Domestic / ForeginForegin
Publisher Wiley Periodicals Inc.
Volume, Issue, Page 23(3),pp.e12523
Author and coauthor SUZUKI Atsushi†, SHIGA Tsuyoshi*, YAGISHITA Daigo, YAGISHITA Yoshimi, ARAI Kotaro, IWANAMI Yuji, EJIMA Koichiro, ASHIHARA Kyomi, SHODA Morio, HAGIWARA Nobuhisa
Authorship Last author
Publication date 2018/05
Summary BACKGROUND:
To evaluate the impact of changes in the filtered QRS duration (fQRS) on signal-averaged electrocardiograms (SAECGs) from pre- to postimplantation on the clinical outcomes in nonischemic heart failure (HF) patients under cardiac resynchronization therapy (CRT).

METHODS:
We studied 103 patients with nonischemic HF and sinus rhythm who underwent CRT implantation. SAECGs were obtained within 1 week before and 1 week after implantation and narrowing fQRS was defined as a decrease in fQRS from pre- to postimplantation. Echocardiography was performed before and 6 months after CRT implantation. The primary outcome was death from any cause. The secondary outcomes were hospitalization due to worsened HF and occurrence of ventricular tachyarrhythmias.

RESULTS:
Of the 103 CRT patients, 53 (51%) showed narrowing fQRS. Left ventricular end-diastolic volume and end-systolic volume were significantly reduced (both p < .001), and the left ventricular ejection fraction was significantly increased (p < .001) after CRT in patients with narrowing fQRS, but not in patients with nonnarrowing fQRS. During a median follow-up period of 33 months, patients with narrowing fQRS exhibited better survival than patients with nonnarrowing fQRS (p = .007). A lower incidence of hospitalization due to worsened HF (p < .001) and a lower occurrence of ventricular tachyarrhythmias (p = .071) were obtained in patients with narrowing fQRS. After adjusting for confounding variables, narrowing fQRS was associated with a low risk of mortality (HR 0.27, p = .006).

CONCLUSION:
Our results suggested that narrowing fQRS on SAECG after CRT implantation predicts LV reverse remodeling and long-term outcomes in nonischemic HF patients.
DOI 10.1111/anec.12523
PMID 29194868