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European Journal of Heart Failure Advance Access originally published online on June 7, 2009
European Journal of Heart Failure 2009 11(7):699-705; doi:10.1093/eurjhf/hfp074
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

Surface electrocardiogram to predict outcome in candidates for cardiac resynchronization therapy: a sub-analysis of the CARE-HF trial

Renaud Gervais1, Christophe Leclercq1, Aparna Shankar2, Sandra Jacobs3, Hans Eiskjær4, Arne Johannessen5, Nick Freemantle2, John G.F. Cleland6, Luigi Tavazzi7, Claude Daubert1,* on behalf of the CARE-HF investigators

1 Département de Cardiologie, Centre Hospitalier Universitaire Pontchaillou, 2, rue Henri Le Guilloux, 35033 Rennes cedex 09, France
2 The University of Birmingham, Edgbaston, UK
3 Bakken Research Center, Maastricht, The Netherlands
4 Aarhus University Hospital, Aarhus, Denmark
5 Gentofte University Hospital, Hellerup, Denmark
6 University of Hull, Kingston-upon-Hull, UK
7 GVM Hospitals of Care and Research, Cotignola, Italy

* Corresponding author. Tel: +33 2 99 28 25 25, Fax: +33 2 99 28 25 10, Email: jean-claude.daubert{at}chu-rennes.fr


  Abstract

Aims: In CARE-HF, cardiac resynchronization therapy (CRT) lowered morbidity and mortality in patients with moderate to severe heart failure. We examined whether baseline and follow-up electrocardiographic characteristics might predict long-term outcome.

Methods and results: CARE-HF randomly assigned 409 patients to medical therapy (MT) plus CRT, and 404 patients to MT alone. Electrocardiographic measurements were made at baseline during sinus rhythm, and at 3 months during paced or spontaneous rhythm depending on treatment assignment. Favourable outcome was defined as freedom from death, urgent transplantation, or cardiovascular hospitalization. Among patients assigned to CRT, 39% had unfavourable outcomes including 55 deaths. By single variable analysis, (i) prolonged PR interval, left QRS axis (but not QRS duration), and left bundle branch block (BBB) at baseline, and (ii) heart rate, PR, and QRS duration at 3 months predicted unfavourable outcome. By multiple variable analysis, treatment assignment (P = 0.0001), PR (P = 0.0004), and right BBB (P < 0.00013) at baseline predicted outcome, whereas baseline JTc and QRS duration at 3 months predicted all-cause mortality and heart failure hospitalization (P = 0.0071).

Conclusion: In CARE-HF, QRS duration at baseline did not predict outcome, but QRS at 3 months was a predictor by single variable analysis. Patients with prolonged PR interval and the 5% of patients with right BBB had a particularly high event rate.

Key Words: Cardiac resynchronization therapy • Biventricular stimulation • Heart failure • Electrocardiogram • Bundle branch block • Clinical outcome

Received January 5, 2009; Revised April 6, 2009; Accepted April 16, 2009


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