PO-01-179 MOVING BEYOND QRS DURATION: QRS VOLTAGE-TIME-INTEGRAL (AREA) IS A SUPERIOR PREDICTOR OF CLINICAL RESPONSE TO CARDIAC RESYNCHRONIZATION THERAPY

Cardiac resynchronization therapy (CRT) can alleviate left ventricular (LV) electrical dyssynchrony mediated systolic heart failure (HF). Prolonged baseline QRS duration (QRSd) is the only conventional quantitative ECG criteria to assess dyssynchrony. Evaluate voltage-time-integral (VTI), along with QRSd, and their reduction effect after CRT as predictors of future HF events. We included 595 patients (68.1±11.5 yr., 32.6% women, 43.9% ischemic cardiomyopathy, LV ejection fraction 25.8±8.3%) who underwent CRT-defibrillator implant for clinical indications 2012-2019 analyzed ECGs before CRT. Orthogonal X, Y, Z leads were reconstructed from 12-lead using Kors’s matrix. VTIQRS-X, Y ,Z VTIQRS-3D obtained integration over in root-mean-squared (3D) respectively. Follow-up data including hospitalization, death, assist device (LVAD) implant, orthotopic transplantation (OHT) retrospective chart review. used proportional hazard models evaluate variables time (a) composite death/LVAD/OHT (b) first hospitalization follow-up 48.7±26.2 months. Models adjusted confounding by age, sex, cardiomyopathy fraction. QRSd reduced 153±26 137±22 ms but neither nor Δ predicted outcomes. VTIQRS-Z 104±49 75±44 respectively improved 67±34 33±24 μVs. Significant unadjusted (p=0.047) (p=0.002) at baseline, (p=0.01). On multivariable adjustment, (p=0.005) (p=0.02) remained significant. was significant predictor hospitalizations (unadjusted p=0.02 p=0.047). In undergoing CRT, a larger VTI (anteroposterior) axis death/LVAD/OHT. Further, associated hospitalizations. should replace patient selection prognostication.