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Changes in QRS Duration Are Associated with a Therapeutic Response to Sacubitril?valsartan in Heart Failure with Reduced Ejection Fraction

Journal of Cardiovascular Imaging 2020년 28권 4호 p.244 ~ 253
김봉준, 박한수, 임성일, 김현수, 허정호, 차태준, 조경임,
소속 상세정보
김봉준 ( Kim Bong-Joon ) - Kosin University College of Medicine Kosin University Gospel Hospital Division of Cardiology
박한수 ( Park Han-Su ) - Kosin University College of Medicine Kosin University Gospel Hospital Division of Cardiology
임성일 ( Im Sung-Il ) - Kosin University College of Medicine Kosin University Gospel Hospital Division of Cardiology
김현수 ( Kim Hyun-Su ) - Kosin University College of Medicine Kosin University Gospel Hospital Division of Cardiology
허정호 ( Heo Jung-Ho ) - Kosin University College of Medicine Kosin University Gospel Hospital Division of Cardiology
차태준 ( Cha Tae-Joon ) - Kosin University College of Medicine Kosin University Gospel Hospital Division of Cardiology
조경임 ( Cho Kyoung-Im ) - Kosin University College of Medicine Kosin University Gospel Hospital Division of Cardiology

Abstract


BACKGROUND: Recent studies have demonstrated that angiotensin receptor neprilysin inhibitors (ARNIs) can reverse the cardiac remodeling effects that occur in heart failure with reduced ejection fraction (HFrEF). These studies have also suggested that ARNIs have favorable effects on ventricular dyssynchrony. We assessed the changes in QRS duration associated with ARNIs in patients with HFrEF.

METHODS: We retrospectively investigated patients with HFrEF (defined by a left ventricular ejection fraction [LVEF] ≤ 35%) who were treated with ARNIs for at least six months. We divided the patients into QRS shortening and non-QRS shortening groups according to their electrocardiogram (ECG) findings. We also compared changes in echocardiographic parameters between the groups.

RESULTS: A total of 68 patients with HFrEF were included (mean age: 62.5 years, 74.6% male). Twenty-one patients had significant ischemic heart disease (IHD). Thirty-five patients exhibited QRS-duration shortening on follow-up ECGs (mean change: ?7.8 msec), and 33 patients showed no changes or increased QRS duration (mean change: 5.1 msec). The QRS shortening group exhibited significant improvement in LVEF (12.5 ± 15.3% vs. 1.7 ± 9.5%; p < 0.001) when compared with the non-QRS shortening group. The QRS shortening group also had significantly lower LV end-diastolic dimension (LVEDD), LV end-systolic dimension (LVESD) and LV mass index (LVMI) than did the non-QRS shortening group. The change in QRS duration was significantly correlated with the change in LVEF (r = -0.329, p = 0.011) and LVESD (r = 0.298, p = 0.022).

CONCLUSIONS: Among patients with HFrEF treated with ARNIs, the QRS shortening group showed favorable LV systolic function recovery, and reversal of cardiac remodeling compared to those of the non-QRS shortening group. Change in the QRS duration, which reflects LV synchrony, may be associated with response to ARNIs in patients with HFrEF.

키워드

Heart failure reduced ejection fraction; Sacubitril?valsartan; QRS duration; Cardiac remodeling; Left ventricular synchrony

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