%0 Journal Article %T Prognostic importance of postoperative QRS widening in patients with heart failure receiving cardiac resynchronization therapy %+ Université catholique de Lille (UCL) %+ Mécanismes physiologiques et conséquences des calcifications cardiovasculaires: rôle des remodelages cardiovasculaires et osseux %+ Département de cardiologie et hypertension %+ Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517 (MP3CV) %+ Groupement Hospitalier de l'Institut Catholique de Lille %A Menet, Aymeric %A Bardet-Bouchery, Helene %A Guyomar, Yves %A Graux, Pierre %A Delelis, Francois %A Castel, Anne-Laure %A Heuls, Sebastien %A Cuvelier, Estelle %A Gevaert, Cecile %A Ennezat, Pierre-Vladimir %A Tribouilloy, Christophe %A Marechaux, Sylvestre %< avec comité de lecture %@ 1556-3871 %J Heart Rhythm %I Elsevier %V 13 %N 8 %P 1636-1643 %8 2016 %D 2016 %R 10.1016/j.hrthm.2016.05.018 %Z Life Sciences [q-bio]Journal articles %X BACKGROUND Landmark reports have suggested that patients with QRS widening immediately after cardiac resynchronization therapy (CRT) experienced less frequently reverse left ventricular remodeling during follow-up. OBJECTIVE We sought to investigate the relationship between postoperative QRS widening relative to baseline and mortality in a prospective cohort of heart failure patients receiving CRT. METHODS A 12-lead electrocardiogram was recorded for 237 heart failure patients (New York Heart Association class II to IV, left ventricular ejection fraction <= 35%, and QRS width >= 120 ms) before and immediately after CRT device implantation. The relationships between QRS widening, all-cause and cardiovascular mortality, and echocardiographic response to CRT were studied. RESULTS During a median follow-up of 24 months, 39 patients died. Fifty patients (21%) experienced QRS widening after CRT [QRS (+) group]. During follow-up, all-cause mortality was higher in QRS (+) patients than in QRS(-) patients (36-month survival free from death 81% +/- 7% vs 64% 16%; log rank, P = .029). After adjustment for important prognostic confounders, QRS(+) patients remained associated with an excess overall mortality (adjusted hazard ratio [HR] 2.67; 95% confidence interval 1.07-6.65; P = .035) and cardiovascular mortality (adjusted hazard ratio 3.63; 95% confidence interval 1.13-11.65; P = .03). QRS(+) patients were less frequent responders to CRT than were QRS(-) patients (20 [47%] vs 136 [83%]; P < .0001). CONCLUSION Postoperative QRS widening relative to baseline after CRT is associated with a considerable increased mortality risk during follow-up. Whether QRS narrowing should be achieved to optimize CRT placement, and thereby increase the rate of CRT responders and improve outcome, deserves further research. %G English %L hal-03580781 %U https://u-picardie.hal.science/hal-03580781 %~ UNIV-PICARDIE %~ U-PICARDIE %~ MP3CV %~ UNIV-CATHOLILLE %~ ICL %~ FMMS