{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T13:07:15Z","timestamp":1787317635425,"version":"build-2736575974"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"21","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2019,11,5]]},"abstract":"\n Background<\/jats:title>\n \n Predicting clinical outcomes after cardiac resynchronization therapy (\n CRT<\/jats:styled-content>\n ) and its optimization remain a challenge. We sought to determine whether pre\u2010 and postimplantation\n QRS<\/jats:styled-content>\n area (\n QRS<\/jats:styled-content>\n area<\/jats:sub>\n ) predict clinical outcomes after\n CRT<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n In this retrospective study,\n QRS<\/jats:styled-content>\n area<\/jats:sub>\n , derived from pre\u2010 and postimplantation vectorcardiography, were assessed in relation to the primary end point of cardiac mortality after\n CRT<\/jats:styled-content>\n with or without defibrillation. Other end points included total mortality, total mortality or heart failure (\n HF<\/jats:styled-content>\n ) hospitalization, total mortality or major adverse cardiac events, and the arrhythmic end point of sudden cardiac death or ventricular arrhythmias with or without a shock. In patients (n=380, age 72.0\u00b112.4\u00a0years, 68.7% male) undergoing\n CRT<\/jats:styled-content>\n over 7.7\u00a0years (median follow\u2010up: 3.8\u00a0years [interquartile range 2.3\u20135.3]), preimplantation\n QRS<\/jats:styled-content>\n area<\/jats:sub>\n \u2265102\u00a0\u03bcVs predicted cardiac mortality (\n HR<\/jats:styled-content>\n : 0.36;\n P<\/jats:italic>\n <0.001), independent of\n QRS<\/jats:styled-content>\n duration (\n QRS<\/jats:styled-content>\n d) and morphology (\n P<\/jats:italic>\n <0.001). A\n QRS<\/jats:styled-content>\n area<\/jats:sub>\n reduction \u226545\u00a0\u03bcVs after\n CRT<\/jats:styled-content>\n predicted cardiac mortality (\n HR<\/jats:styled-content>\n : 0.19), total mortality (\n HR<\/jats:styled-content>\n : 0.50), total mortality or heart failure hospitalization (\n HR<\/jats:styled-content>\n : 0.44), total mortality or major adverse cardiac events (\n HR<\/jats:styled-content>\n : 0.43) (all\n P<\/jats:italic>\n <0.001) and the arrhythmic end point (\n HR<\/jats:styled-content>\n : 0.26;\n P<\/jats:italic>\n <0.001). A concomitant reduction in\n QRS<\/jats:styled-content>\n area<\/jats:sub>\n and\n QRS<\/jats:styled-content>\n d was associated with the lowest risk of cardiac mortality and the arrhythmic end point (both\n HR<\/jats:styled-content>\n : 0.12,\n P<\/jats:italic>\n <0.001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Pre\u2010implantation\n QRS<\/jats:styled-content>\n area<\/jats:sub>\n , derived from vectorcardiography, was superior to\n QRS<\/jats:styled-content>\n d and\n QRS<\/jats:styled-content>\n morphology in predicting cardiac mortality after\n CRT<\/jats:styled-content>\n . A postimplant reduction in both\n QRS<\/jats:styled-content>\n area<\/jats:sub>\n and\n QRS<\/jats:styled-content>\n d was associated with the best outcomes, including the arrhythmic end point.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.119.013539","type":"journal-article","created":{"date-parts":[[2019,10,28]],"date-time":"2019-10-28T05:06:14Z","timestamp":1572239174000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":43,"title":["Changes in QRS Area and QRS Duration After Cardiac Resynchronization Therapy Predict Cardiac Mortality, Heart Failure Hospitalizations, and Ventricular Arrhythmias"],"prefix":"10.1161","volume":"8","author":[{"given":"Osita","family":"Okafor","sequence":"first","affiliation":[{"name":"Aston Medical Research Institute Aston Medical School Aston University Birmingham United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abbasin","family":"Zegard","sequence":"additional","affiliation":[{"name":"Aston Medical Research Institute Aston Medical School Aston University Birmingham United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"van Dam","sequence":"additional","affiliation":[{"name":"PEACS Arnhem The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Berthold","family":"Stegemann","sequence":"additional","affiliation":[{"name":"Aston Medical Research Institute Aston Medical School Aston University Birmingham United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tian","family":"Qiu","sequence":"additional","affiliation":[{"name":"Aston Medical Research Institute Aston Medical School Aston University Birmingham United Kingdom"},{"name":"Queen Elizabeth Hospital Birmingham United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Howard","family":"Marshall","sequence":"additional","affiliation":[{"name":"Queen Elizabeth Hospital Birmingham United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco","family":"Leyva","sequence":"additional","affiliation":[{"name":"Aston Medical Research Institute Aston Medical School Aston University Birmingham United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.06.1178"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.109.910778"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2017.08.005"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.107.743120"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euy254"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2018.10.019"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2015.07.033"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/jce.13132"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/jce.13241"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jelectrocard.2014.10.003"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.118.006497"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2018.08.028"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1093\/cvr\/14.10.607"},{"key":"e_1_3_1_15_2","unstructured":"National Institute of Health and Care Excellence . 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