The effect of QRS duration on cardiac resynchronization therapy in patients with a narrow QRS complex: A subgroup analysis of the EchoCRT trial

Jan Steffel, Michele Robertson, Jagmeet P. Singh, William T. Abraham, Jeroen J. Bax, Jeffrey S. Borer, Kenneth Dickstein, Ian Ford, John Gorcsan, Daniel Gras, Henry Krum, Peter Sogaard, Johannes Holzmeister, Josep Brugada, Frank Ruschitzka

Research output: Contribution to journalArticlepeer-review

Abstract

Aims: In EchoCRT, a randomized trial evaluating the effect of cardiac resynchronization therapy (CRT) in patients with a QRS duration of <130 ms and echocardiographic evidence of left ventricular dyssynchrony, the primary outcome occurred more frequently in the CRT when compared with the control group. According to current heart failure guidelines, CRT is recommended in patients with a QRS duration of ≥120 ms. However, there is some ambiguity from clinical trial data regarding the benefit of patients with a QRS duration of 120-130 ms. Methods and results: The main EchoCRT trial was prematurely terminated due to futility. For the current subgroup analysis we compared data for CRT-ON vs. -OFF in patients with QRS < 120 (n = 661) and QRS 120-130 ms (n = 139). On uni- and multivariable analyses, no significant interaction was observed between the two groups and randomized treatment for the primary or any of the secondary endpoints. On multivariable analysis, a higher risk for the primary endpoint was observed in patients with a QRS duration of 120-130 ms randomized to CRT-ON vs. CRT-OFF (hazard ratio 2.18, 95% CI 1.02-4.65; P = 0.044). However, no statistically significant interaction, compared with patients with QRS < 120 ms randomized to CRT-ON vs. CRT-OFF, was noted (P-interaction = 0.160). Conclusions: In this pre-specified subgroup analysis of EchoCRT, no benefit of CRT was evident in patients with a QRS duration of 120-130 ms. These data further question the usefulness of CRT in this patient population.

Original languageEnglish (US)
Pages (from-to)1983-1989
Number of pages7
JournalEuropean Heart Journal
Volume36
Issue number30
DOIs
StatePublished - Aug 7 2015

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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