Value of the Paced QRS Duration

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• 作者：Wenzhi Pan ; Yangang Su ; Xue Gong ; Aijun Sun ; Xianhong Shu ; Junbo Ge
• 关键词：Pacing ; systolic dysfunction ; left ventricular ejection fraction ; QRS duration ; heart failure
• 刊名：Journal of Cardiac Failure
• 出版年：2009
• 出版时间：May 2009
• 年：2009
• 卷：15
• 期：4
• 页码：347-352
• 全文大小：208 K

文摘

Background

The value for paced QRS duration (pQRSd) to detect left ventricular (LV) dysfunction in right ventricular apex (RVA)–paced patients has not been evaluated.

Methods and Results

A total of 272 RVA-paced patients, including 99 with LV systolic dysfunction (LVSD) and 173 without LVSD, were enrolled in this study. The pQRSd, echocardiographic variables, and plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were measured. Relationships between pQRSd and echocardiographic variables, NT-proBNP levels, and New York Heart Association (NYHA) functional classification were analyzed. pQRSd was correlated with LV end-diastolic and end-systolic dimensions (β = 1.59 and 1.54, respectively; all P < .001), NT-proBNP levels (β = 12.98, P < .001) and LV ejection fraction (β = –109.25, P < .001). There was a stepwise increase in pQRSd with increasing NYHA Class (all P < .001). The pQRSd cutoff value of 200 ms, derived from the receiver operator characteristic curve, had sensitivity of 71.72 % and specificity of 86.71 % to detect LVSD. pQRSd ≥ 240 ms gave a positive predictive value of 100 % , whereas <180 ms excluded >97.3 % of patients with LVSD.

Conclusions

In RVA-paced patients, pQRSd is correlated with left ventricular structures and function and pQRSd of 200 ms is a satisfactory cutoff value in terms of sensitivity and specificity for detecting LVSD.