T-wave area as biomarker of clinical response to cardiac resynchronization therapy

Eszter M. Vegh, Elien B. Engels, Caroline J. M. van Deursen, Bela Merkely, Kevin Vernooy, Jagmeet P. Singh, Frits W. Prinzen*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Aims There is increasing evidence that left bundle branch block (LBBB) morphology on the electrocardiogram is a positive predictor for response to cardiac resynchronization therapy (CRT). We previously demonstrated that the vectorcardiography (VCG)-derived T-wave area predicts echocardiographic CRT response in LBBB patients. In the present study, we investigate whether the T-wave area also predicts long-term clinical outcome to CRT. Methods and results This is a retrospective study consisting of 335 CRT recipients. Primary endpoint were the composite of heart failure (HF) hospitalization, heart transplantation, left ventricular assist device implantation or death during a 3-year follow-up period. HF hospitalization and death alone were secondary endpoints. The patient subgroup with a large T-wave area and LBBB 36% reached the primary endpoint, which was considerably less (P <0.01) than for patients with LBBB and a small T-wave area or non-LBBB patients with a small or large T-wave area (48, 57, and 51%, respectively). Similar differences were observed for the secondary endpoints, HF hospitalization (31 vs. 51, 51, and 38%, respectively, P <0.01) and death (19 vs. 42, 34, and 42%, respectively, P <0.01). In multivariate analysis, a large T-wave area and LBBB were the only independent predictors of the combined endpoint besides high creatinine levels and use of diuretics. Conclusion T-wave area may be useful as an additional biomarker to stratify CRT candidates and improve selection of those most likely to benefit from CRT. A large T-wave area may derive its predictive value from reflecting good intrinsic myocardial properties and a substrate for CRT.
Original languageEnglish
Pages (from-to)1077-1085
JournalEP Europace
Issue number7
Publication statusPublished - Jul 2016


  • Cardiac resynchronization therapy
  • Long-term clinical outcome
  • Vectorcardiography
  • Left bundle branch block
  • T wave area


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