Changes in QRS Duration Are Associated with a Therapeutic Response to Sacubitril–valsartan in Heart Failure with Reduced Ejection Fraction
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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.
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.
참고문헌 (18)
- McMurray JJ, "Angiotensin-neprilysin inhibition versus enalapril in heart failure", N Engl J Med, 371, pp.993~1004 (2014)
- Vardeny O, "Combined neprilysin and renin-angiotensin system inhibition for the treatment of heart failure", JACC Heart Fail, 2, pp.663~670 (2014)
- Wang Y, "Effects of the angiotensin-receptor neprilysin inhibitor on cardiac reverse remodeling : meta-analysis", J Am Heart Assoc, 8, pp.e012272~ (2019)
- Kang DH, "Angiotensin receptor neprilysin inhibitor for functional mitral regurgitation", Circulation, 139, pp.1354~1365 (2019)
- Kim SA, "Layer-specific dyssynchrony and its relationship to the change of left ventricular function in hypertensive patients", Heart Vessels, 31, pp.528~534 (2016)
- Zhao L, "Changes in left ventricular synchrony and systolic function in dilated cardiomyopathy patients with fragmented QRS complexes", Europace, 17, pp.1712~1719 (2015)
- Tigen K, "The utility of fragmented QRS complexes to predict significant intraventricular dyssynchrony in nonischemic dilated cardiomyopathy patients with a narrow QRS interval", Can J Cardiol, 25, pp.517~522 (2009)
- Rautaharju PM, "AHA", ACCF, J Am Coll Cardiol, pp.2009, 53[DOI]
- Levy D, "Echocardiographic criteria for left ventricular hypertrophy : the Framingham Heart Study", Am J Cardiol, 59, pp.956~960 (1987)
- Smiseth OA, "The role of echocardiography in quantification of left ventricular dyssynchrony : state of the art and future directions", Eur Heart J Cardiovasc Imaging, 13, pp.61~68 (2012)
- Vasan RS, "Left ventricular dilatation and the risk of congestive heart failure in people without myocardial infarction", N Engl J Med, 336, pp.1350~1355 (1997)
- Wong M, "Echocardiographic variables as prognostic indicators and therapeutic monitors in chronic congestive heart failure. Veterans Affairs cooperative studies V-HeFT I and II. V-HeFT VA Cooperative Studies Group", Circulation, 87, pp.VI65~VI70 (1993)
- Januzzi JL Jr, "Association of change in N-terminal pro-B-type natriuretic peptide following initiation of sacubitril-valsartan treatment with cardiac structure and function in patients with heart failure with reduced ejection fraction", JAMA, 322, pp.1~11 (2019)
- Iborra-Egea O, "Mechanisms of action of sacubitril", valsartan on cardiac remodeling : a systems biology approach, 2017, pp.3, 12~
- Moss AJ, "Cardiac-resynchronization therapy for the prevention of heart-failure events", N Engl J Med, 361, pp.1329~1338 (2009)
- Koplan BA, "Heart failure decompensation and all-cause mortality in relation to percent biventricular pacing in patients with heart failure: is a goal of 100% biventricular pacing necessary?", J Am Coll Cardiol, 53, pp.355~360 (2009)
- Ypenburg C, "Mechanism of improvement in mitral regurgitation after cardiac resynchronization therapy", Eur Heart J, 29, pp.757~765 (2008)
- Kanzaki H, "A mechanism for immediate reduction in mitral regurgitation after cardiac resynchronization therapy : insights from mechanical activation strain mapping", J Am Coll Cardiol, 44, pp.1619~1625 (2004)