© 2008 European Society of Cardiology
Responders to cardiac resynchronization therapy with narrow or intermediate QRS complexes identified by simple echocardiographic indices of dyssynchrony: The DESIRE study
a Inparys Clinical Research Group 12 rue Pasteur, 92210 — St. Cloud, France
b University Hospital Rennes, France
c IRCCS Policlinico S Matteo Pavia, Italy
d Universitätskliniken des Saarlandes Homburg, Germany
e St Peters Hospital Chertsey, United Kingdom
* Corresponding author. Tel.: +33 1 41 12 07 13; fax: +33 1 41 12 07 15. E-mail address: SergeCaz{at}aol.com (S.J. Cazeau).
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Abstract |
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Background: Cardiac resynchronization therapy (CRT) is recommended for patients with NYHA class III–IV refractory heart failure (HF), ejection fraction <35% and a QRS >120ms. We attempted to identify responders to CRT from echocardiographic (echo) indices of mechanical dyssynchrony in patients with QRS < 150 ms.
Methods and results: The study enrolled 51 men and 9 women (mean age: 64.5years) in NYHA class III (n=54) or IV (n=6) presenting with a mean ejection fraction: 25.7%, LV end-diastolic diameter: 69.1mm, and QRS = 121 ± 19 ms. All patients were implanted with a CRT system and followed for 1year. Implantation was preceded and followed by clinical, functional and Doppler (D)-echo evaluation. The primary combined endpoint included 1) death from any cause, 2) HF-related hospitalisations, and 3) NYHA class at 6 months. Before implant, 27 patients had 
1 echo criterion of mechanical dyssynchrony (DES+ group) and 33 had no evidence of dyssynchrony (DES– group). At 12months, 8 patients (4 per group) had died, 7 from HF. As regards the primary endpoint at 6 months, 33 patients (55%) had improved, 10 (16%) were unchanged, and 17 (29%) had deteriorated. Clinical improvement was observed in 19 of 27 DES+ (70%), versus 14 of 33 DES– (42%) patients (P<0.04). Baseline QRS duration did not predict response to CRT.
Conclusions: In this population of HF patients with QRS < 150 ms, the presence of mechanical dyssynchrony at baseline D-echo examination, but not the QRS width, predicted 6-month clinical response to CRT.
Key Words: Cardiac resynchronization therapy • Cardiac mechanical dyssynchrony • QRS duration
Received November 2, 2007; Revised January 28, 2008; Accepted February 6, 2008
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