T-wave area predicts response to cardiac resynchronization therapy in patients with left bundle branch block
Elien B Engels1, Eszter M Végh, Caroline J M Van Deursen
1Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands.
Insights
Analyzing T-wave area on ECGs can improve patient selection for cardiac resynchronization therapy (CRT). A larger T-wave area predicts better left ventricular ejection fraction (LVEF) increase in patients with left bundle branch block (LBBB).
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Cardiac resynchronization therapy (CRT) benefits chronic heart failure patients with left ventricular (LV) conduction delays, particularly left bundle branch block (LBBB).
- A significant percentage of patients (30-50%) do not respond adequately to CRT, necessitating improved patient selection strategies.
- Electrocardiogram (ECG) T-wave analysis is explored as a potential tool to enhance CRT patient selection.
Purpose of the Study:
- To investigate the predictive value of T-wave analysis from ECG for CRT response.
- To determine if T-wave characteristics can improve patient selection for CRT, especially in those with LBBB.
Main Methods:
- 244 CRT recipients with baseline 12-lead ECGs were analyzed.
- Vectorcardiograms (VCGs) were derived from ECGs using the Kors algorithm.
- Logistic regression models assessed the predictive value of repolarization variables, including T-wave area, for CRT response (defined as ≥5% increase in LV ejection fraction [LVEF]).
Main Results:
- VCG-derived T-wave area significantly predicted CRT response (OR 1.172 per 10 μVs increase, P < 0.001), outperforming QRS-wave area.
- T-wave area showed particularly strong predictive value in patients with LBBB (OR 2.77).
- LBBB patients with higher T-wave area exhibited a greater LVEF increase post-CRT (11.3 ± 9.1%) compared to those with lower T-wave area (6.1 ± 9.7%).
Conclusions:
- In LBBB patients, a larger baseline T-wave area is an independent predictor of improved LVEF response to CRT.
- T-wave analysis holds promise for optimizing patient selection for CRT.
- ECG-based T-wave assessment offers a non-invasive method to identify likely responders to CRT.
Introduction:
Chronic heart failure patients with a left ventricular (LV) conduction delay, mostly due to left bundle branch block (LBBB), generally derive benefit from cardiac resynchronization therapy (CRT). However, 30-50% of patients do not show a clear response to CRT. We investigated whether T-wave analysis of the ECG can improve patient selection.
Methods And Results:
The study population comprised 244 CRT recipients with baseline 12-lead electrocardiogram recordings. Echocardiographic response after 6-month CRT was defined as a ≥5% increase in LV ejection fraction (LVEF). Vectorcardiograms (VCGs) were constructed from the measured 12-lead ECGs using an adapted Kors algorithm on digitized ECGs. Logistic regression models indicated repolarization variables as good predictors of CRT response. The VCG-derived T-wave area predicted CRT response (odds ratio [OR] per 10 μVs increase 1.172 [P < 0.001]) even better than QRS-wave area (OR = 1.116 [P = 0.001]). T-wave area had especially predictive value in the LBBB patient group (OR = 2.77 in LBBB vs. 1.09 in non-LBBB). This predictive value persisted after adjustment of multiple covariates, such as gender, ischemia, age, hypertension, coronary artery bypass graft, and the usage of diuretics and β-blockers. In LBBB patients, the increase in LVEF was 6.1 ± 9.7% and 11.3 ± 9.1% in patients with T-wave area below and above the median value, respectively (P < 0.01).
Conclusion:
In patients with LBBB morphology of the QRS complex, a larger baseline T-wave area is an important independent predictor of LVEF increase following CRT.
More Related Videos
10:17Real-Time Cardiac Mapping with a Noninvasive Imageless Electrocardiographic Imaging System
Published on: April 11, 2025
06:57Ablation of Ischemic Ventricular Tachycardia Using a Multipolar Catheter and 3-dimensional Mapping System for High-density Electro-anatomical Reconstruction
Published on: January 31, 2019
