Association of vectorcardiographic T-wave area with clinical and echocardiographic outcomes in cardiac resynchronization therapy
Muhammet Dural, Mohammed A Ghossein, Willem Gerrits, Fenna Daniels, Mathias Meine, Alexander H Maass, Michiel Rienstra, Frits W Prinzen, Kevin Vernooy, Antonius M W van Stipdonk- Physiology (medical)
- Cardiology and Cardiovascular Medicine
Abstract
Background and Aims
Data on repolarization parameters in CRT is scarce. We investigated the association of baseline T-wave area, with both clinical and echocardiographic outcomes of CRT in a large, multi-center cohort of CRT recipients. Also, we evaluated the association between baseline T-wave area and QRS area.
Methods
In this retrospective study, 1.355 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 (LVESV) between 3 to 12 months after implantation. The clinical outcome was a combination of all-cause mortality, heart transplantation, and left ventricular assist device implantation.
Results
LVESV reduction was largest in patients with QRS area ≥109μVs and T-wave area ≥66μVs compared to QRS area ≥109μVs and T-wave area <66μVs (p = 0.004), QRS area <109 μVs and T-wave area ≥66μVs (p < 0.001) and QRS area <109 μVs and T-wave area <66μVs (p < 0.001). Event-free survival rate was higher in the subgroup of patients with QRS area ≥109μVs and T-wave area ≥66μVs (n:616, p < 0.001) and QRS area ≥109μVs and T-wave area <66μVs (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.
Conclusions
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.