Assessment of mechanical dyssynchrony can improve the prognostic value of guideline-based patient selection for cardiac resynchronization therapy.

Autor:	Beela AS; Department of Cardiovascular Diseases, University Hospitals Leuven, University of Leuven, Herestraat 49, Leuven, Belgium.; Department of Cardiovascular Diseases, Faculty of Medicine, Suez Canal University, km 4.5 Ring road, Ismailia, Egypt., Ünlü S; Department of Cardiovascular Diseases, University Hospitals Leuven, University of Leuven, Herestraat 49, Leuven, Belgium., Duchenne J; Department of Cardiovascular Diseases, University Hospitals Leuven, University of Leuven, Herestraat 49, Leuven, Belgium., Ciarka A; Department of Cardiovascular Diseases, University Hospitals Leuven, University of Leuven, Herestraat 49, Leuven, Belgium., Daraban AM; Department of Internal Medicine and Gastroenterology, Clinical Emergency Hospital, University of Medicine and Pharmacy 'Carol Davila', Bucharest, Romania., Kotrc M; Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic., Aarones M; Department of Cardiology, Oslo University Hospital, Oslo, Norway., Szulik M; Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Silesian University of Medicine, Silesia, Poland., Winter S; Klinik für Innere Medizin und Kardiologie, St. Vinzenz Hospital, Cologne, Germany., Penicka M; Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium., Neskovic AN; Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia., Kukulski T; Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Silesian University of Medicine, Silesia, Poland., Aakhus S; Department of Circulation and Imaging, Faculty of Medicine, NTNU, Norwegian University of Science and Technology and Clinic of Cardiology, St. Olavs Hospital, Trondheim, Norway., Willems R; Department of Cardiovascular Diseases, University Hospitals Leuven, University of Leuven, Herestraat 49, Leuven, Belgium., Fehske W; Klinik für Innere Medizin und Kardiologie, St. Vinzenz Hospital, Cologne, Germany., Faber L; Department of Cardiology, Heart and Diabetes Centre of North-Rhine Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany., Stankovic I; Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia., Voigt JU; Department of Cardiovascular Diseases, University Hospitals Leuven, University of Leuven, Herestraat 49, Leuven, Belgium.
Jazyk:	angličtina
Zdroj:	European heart journal. Cardiovascular Imaging [Eur Heart J Cardiovasc Imaging] 2019 Jan 01; Vol. 20 (1), pp. 66-74.
DOI:	10.1093/ehjci/jey029
Abstrakt:	Aim: To determine if incorporation of assessment of mechanical dyssynchrony could improve the prognostic value of patient selection based on current guidelines. Methods and Results: Echocardiography was performed in 1060 patients before and 12 ± 6 months after cardiac resynchronization therapy (CRT) implantation. Mechanical dyssynchrony, defined as the presence of apical rocking or septal flash was visually assessed at the baseline examination. Response was defined as ≥15% reduction in left ventricular end-systolic volume at follow-up. Patients were followed for a median of 59 months (interquartile range 37-86 months) for the occurrence of death of any cause. Applying the latest European guidelines retrospectively, 63.4% of the patients had been implanted with a Class I recommendation, 18.2% with Class IIa, 9.4% with Class IIb, and in 9% no clear therapy recommendation was present. Response rates were 65% in Class I, 50% in IIa, 38% in IIb patients, and 40% in patients without a clear guideline-based recommendation. Assessment of mechanical dyssynchrony improved response rates to 77% in Class I, 75% in IIa, 62% in IIb, and 69% in patients without a guideline-based recommendation. Non-significant difference in survival among guideline recommendation classes was found (Log-rank P = 0.2). Presence of mechanical dyssynchrony predicted long-term outcome better than guideline Classes I, IIa, IIb (Log-rank P < 0.0001, 0.006, 0.004, respectively) and in patients with no guideline recommendation (P = 0.02). Comparable results were observed using the latest American Guidelines. Conclusion: Our data suggest that current guideline criteria for CRT candidate selection could be improved by incorporating assessment of mechanical asynchrony.
Databáze:	MEDLINE
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