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Relationship of echocardiographic dyssynchrony to long-term survival after cardiac resynchronization therapy.

Abstract：

BACKGROUND:The ability of echocardiographic dyssynchrony to predict response to cardiac resynchronization therapy (CRT) has been unclear. METHODS AND RESULTS:A prospective, longitudinal study was designed with predefined dyssynchrony indexes and outcome variables to test the hypothesis that baseline dyssynchrony is associated with long-term survival after CRT. We studied 229 consecutive class III to IV heart failure patients with ejection fraction ≤35 and QRS duration ≥120 milliseconds for CRT. Dyssynchrony before CRT was defined as tissue Doppler velocity opposing-wall delay ≥65 milliseconds, 12-site SD (Yu Index) ≥32 milliseconds, speckle tracking radial strain anteroseptal-to-posterior wall delay ≥130 milliseconds, or pulsed Doppler interventricular mechanical delay ≥40 milliseconds. Outcome was defined as freedom from death, heart transplantation, or left ventricular assist device implantation. Of 210 patients (89) with dyssynchrony data available, there were 62 events: 47 deaths, 9 transplantations, and 6 left ventricular assist device implantations over 4 years. Event-free survival was associated with Yu Index (P=0.003), speckle tracking radial strain (P=0.003), and interventricular mechanical delay (P=0.019). When adjusted for confounding baseline variables of ischemic origin and QRS duration, Yu Index and radial strain dyssynchrony remained independently associated with outcome (P<0.05). Lack of radial dyssynchrony was particularly associated with unfavorable outcome in those with QRS duration of 120 to 150 milliseconds (P=0.002). CONCLUSIONS:The absence of echocardiographic dyssynchrony was associated with significantly less favorable event-free survival after CRT. Patients with narrower QRS duration who lacked dyssynchrony had the least favorable long-term outcome. These observations support the relationship of dyssynchrony and CRT response.

journal_name

Circulation

journal_title

Circulation

authors

Gorcsan J 3rd,Oyenuga O,Habib PJ,Tanaka H,Adelstein EC,Hara H,McNamara DM,Saba S

doi

10.1161/CIRCULATIONAHA.110.954768

subject

Has Abstract

pub_date

2010-11-09 00:00:00

pages

1910-8

issue

eissn

0009-7322

issn

1524-4539

pii

CIRCULATIONAHA.110.954768

journal_volume

122

pub_type

杂志文章

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Relationship of echocardiographic dyssynchrony to long-term survival after cardiac resynchronization therapy.