CRT Efficacy in “Mid-Range” QRS Duration Among Asians Contrasted to Non-Asians, and Influence of Height

Niraj Varma, Jian An Wang, Aparna Jaswal, Kamal K. Sethi, Yusuke Kondo, Boyoung Joung, Dale Yoo, Angelo Auricchio, Jagmeet P. Singh, Kwangdeok Lee, Michael R. Gold

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

Objectives: The purpose of this study was to test the hypotheses that cardiac resynchronization therapy (CRT) efficacy differed among Asians compared with non-Asian populations, differed between QRS duration (QRSd) ranges 120-149 and ≥150 ms, and was influenced by height in the multinational ADVANCE CRT trial. Background: CRT guidelines, derived from trials among U.S./European patients, assign weaker recommendations to those with midrange QRSd (QRSd <150 ms). Patient height may modulate CRT efficacy. Together, these may affect CRT prescription and efficacy in Asia. Methods: CRT response was assessed using the Clinical Composite Score 6 months postimplant (n = 934). Heart failure events and cardiac deaths were reported until 12 months. Asian and non-Asian patients were compared overall, by QRSd <150 ms (Asian n = 71 vs non-Asian n = 248), and QRSd ≥150 ms (Asian n = 180 vs non-Asian n = 435) and by height. Results: Asians comprised 27% (251 of 934) of the primary study population. More Asians had QRSd ≥150 ms (72% [180 of 251] vs 64% [435 of 683] in non-Asian patients; P = 0.022). Overall CRT response was better in Asians vs non-Asians (Clinical Composite Score 85% vs 65%; P < 0.001), and following QRSd dichotomization (QRSd <150 ms: 80% vs 59%; P < 0.001; QRS ≥150 ms: 86% vs 69%; P < 0.001). HF events and cardiac deaths were fewer in Asians irrespective of QRSd (P < 0.001). Stepwise multivariable analysis indicated that in group QRSd <150 ms, nonischemic cardiomyopathy, number of other comorbidities (0-1 vs ≥4), and atrial fibrillation influenced CRT response. The trend favoring Asian race (OR: 1.46; 95% CI: 0.72-2.95) was eliminated (OR: 1.00; 95% CI: 0.47-2.11) when height or QRSd/height were included (QRSd/height P = 0.006; OR: 1.64; 95% CI: 1.15-2.35). In QRSd <150 ms, probability of CRT response diminished as height increased, but increased with QRSd/height, in both Asians and non-Asians. In QRSd ≥150 ms, height or QRSd/height had minimal effect in Asians or non-Asians. Conclusions: Height modulates CRT efficacy among patients with QRSd <150 ms and contributes to high probability of benefit from CRT among Asians. CRT should be encouraged among Asian patients with midrange QRSd. (Advance Cardiac Resynchronization Therapy [CRT] Registry; NCT01805154)

Original languageEnglish
Pages (from-to)211-221
Number of pages11
JournalJACC: Clinical Electrophysiology
Volume8
Issue number2
DOIs
Publication statusPublished - 2022 Feb

Bibliographical note

Funding Information:
This registry was funded by Abbott. Dr Varma has received consulting fees/honoraria from Abbott, Boston Scientific, Biotronik, Medtronic, and Impulse Dynamics. Dr Sethi has received research support from Abbott. Dr Kondo has received consulting fees/honoraria from Abbott, Boston Scientific, Biotronik, Daiichi-Sankyo, and Bayer. Dr Joung has received research funds from Abbott and Medtronic. Dr Auricchio has served as a consultant for Boston Scientific, Backbeat, Biosense Webster, Cairdac, Corvia, EBR Systems, Microport CRM, Philips, and Radcliffe Publisher; has received speakers fees from Boston Scientific, Medtronic, and Microport CRM; has participated in clinical trials for Boston Scientific, EBR System, Medtronic, and Philips; and has intellectual properties with Boston Scientific, Biosense Webster, Microport CRM, and Daiichi-Sankyo. Dr Singh has received consulting fees/honoraria from Biotronik, Boston Scientific, Medtronic, Abbott, Microport, EBR, Respicardia, Impulse Dynamics, BackBeat Inc., and Toray Inc. Dr Lee has received a salary from Abbott. Dr Gold has received consulting fees/honoraria from Abbott, EBR, Medtronic, and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Publisher Copyright:
© 2022 American College of Cardiology Foundation

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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