Meta-analysis of the usefulness of change in QRS width to predict response to cardiac resynchronization therapy

• Korantzopoulos Panagiotis
• Zhang Zhiwei
• Li Guangping
• Fragakis Nikolaos
• Liu Tong

AbstractThe existing data regarding the role of QRS duration (QRSd) change on cardiac resynchronization therapy (CRT) response show some inconsistent results. We conducted a meta-analysis of data obtained from observational studies to examine the impact of QRS change after CRT device implantation on the clinical and/or echocardiographic response. We searched the PubMed and EMBASE databases for relevant studies published before January 2016. Twenty-seven studies were retrieved for detailed evaluation of which 12 studies with a total population of 1545 patients met our eligibility criteria. The analysis demonstrated that QRSd narrowing was a positive predictor of response to CRT [mean difference (MD) - L19.24 ms, 95% CI-L24.00 to L14.48 ms, p<0.00001]. This effect was consistent in the studies using clinical criteria (MD-L19.91 ms, 95% CI-L27.20 to L12.62 ms, p<0.00001) and in those that used echocardiographic criteria (MD-L19.51 ms, 95% CI-L25.78 to L13.25 ms, p<0.00001). The heterogeneity test showed moderate differences among the individual studies (I2=42%). Subgroup analysis showed that QRSd change was more pronounced in studies having a follow-up <6 months. We did not find significant differences in studies measuring postimplantation QRSd after a certain follow-up period compared with studies measuring QRSd immediately after CRT device implantation. Further studies should clarify the exact timing of QRSd assessments during follow-up. In conclusion, QRSd shortening after CRT device implantation is associated with a favorable clinical and echocardiographic response.

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