{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T03:50:39Z","timestamp":1792554639698,"version":"4.5.0"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Arrhythmia and Electrophysiology"],"published-print":{"date-parts":[[2018,12]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The combination of left bundle branch block (LBBB) morphology and QRS duration is currently used to select patients for cardiac resynchronization therapy (CRT). These parameters, however, have limitations. This study evaluates the value of QRS area compared with that of QRS duration and morphology in the association with clinical and echocardiographic outcomes in a large cohort of CRT patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A retrospective multicentre study was conducted in 1492 CRT patients. LBBB morphology, QRS duration, and QRS area in the baseline 12-lead ECG were evaluated for their association with the occurrence of the combined primary end point of all-cause mortality, cardiac transplantation, and left ventricular assist device implantation. Secondary end points were heart failure hospitalization within the first year after implantation and echocardiographic reduction in left ventricular end-systolic volume.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      During a mean follow-up period of 3.4 years, 32% of patients reached the primary end point. The association of QRS area with all outcomes was stronger than that of LBBB morphology and QRS duration separately and at least as strong as their combination. QRS area identified patients who did not experience the primary end point better than QRS morphology and QRS duration (area under the curve, 0.61 versus 0.55 and 0.51, respectively;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001). Furthermore, QRS area identifies patients with echocardiographic remodeling in response to CRT better than QRS morphology and duration (area under the curve, 0.69 versus 0.58 and 0.58, respectively;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001). QRS area was the only independent electrocardiographic determinant associated with the primary end point; hazard ratio, 0.50 (0.35\u20130.71). Furthermore, QRS area showed significant association with outcomes in both patients with and without LBBB and QRS \u2265150 ms.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>QRS area has a strong association to clinical and echocardiographic response to CRT, at least as strong as current patient selection parameters. QRS area may be particularly useful to predict CRT response in patients without a wide LBBB.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circep.118.006497","type":"journal-article","created":{"date-parts":[[2018,12,13]],"date-time":"2018-12-13T05:00:50Z","timestamp":1544677250000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":98,"title":["QRS Area Is a Strong Determinant of Outcome in Cardiac Resynchronization Therapy"],"prefix":"10.1161","volume":"11","author":[{"given":"Antonius M.W.","family":"van Stipdonk","sequence":"first","affiliation":[{"name":"Department of Cardiology, Maastricht University Medical Centre, The Netherlands (A.M.W.v.S., H.J.G.M.C., K.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iris","family":"ter Horst","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Maastricht University Medical Centre, The Netherlands (A.M.W.v.S., H.J.G.M.C., K.V.)."},{"name":"Department of Cardiology, University Medical Centre Utrecht, The Netherlands (I.t.H., M.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marielle","family":"Kloosterman","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Centre Groningen, University of Groningen, The Netherlands (M.K., M.R., I.C.v.G., A.H.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elien B.","family":"Engels","sequence":"additional","affiliation":[{"name":"Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, The Netherlands (E.B.E., H.J.G.M.C., F.W.P., K.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michiel","family":"Rienstra","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Centre Groningen, University of Groningen, The Netherlands (M.K., M.R., I.C.v.G., A.H.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harry J.G.M.","family":"Crijns","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Maastricht University Medical Centre, The Netherlands (A.M.W.v.S., H.J.G.M.C., K.V.)."},{"name":"Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, The Netherlands (E.B.E., H.J.G.M.C., F.W.P., K.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc A.","family":"Vos","sequence":"additional","affiliation":[{"name":"Department of Medical Physiology, University of Utrecht, The Netherlands (M.A.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabelle C.","family":"van Gelder","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Centre Groningen, University of Groningen, The Netherlands (M.K., M.R., I.C.v.G., A.H.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frits W.","family":"Prinzen","sequence":"additional","affiliation":[{"name":"Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, The Netherlands (E.B.E., H.J.G.M.C., F.W.P., K.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathias","family":"Meine","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Centre Utrecht, The Netherlands (I.t.H., M.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander H.","family":"Maass","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Centre Groningen, University of Groningen, The Netherlands (M.K., M.R., I.C.v.G., A.H.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Vernooy","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Maastricht University Medical Centre, The Netherlands (A.M.W.v.S., H.J.G.M.C., K.V.)."},{"name":"Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, The Netherlands (E.B.E., H.J.G.M.C., F.W.P., K.V.)."},{"name":"Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands 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