Clinical Significance of Electromechanical Dyssynchrony and QRS Narrowing in Patients With Heart Failure Receiving Cardiac Resynchronization Therapy

Autor: Sylvestre Maréchaux, Yves Guyomar, Hélène Bardet-Bouchery, Pierre Graux, Camille Binda, François Delelis, Pierre Vladimir Ennezat, Ludovic Appert, Caroline Le Goffic, Christophe Tribouilloy, Raphaëlle-Ashley Guerbaai, A. Altes, Aymeric Menet, Anne-Laure Castel
Přispěvatelé: Université catholique de Lille (UCL), Mécanismes physiologiques et conséquences des calcifications cardiovasculaires: rôle des remodelages cardiovasculaires et osseux, Université de Picardie Jules Verne (UPJV)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de cardiologie, Université de la Méditerranée - Aix-Marseille 2-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), Institut Droit et Santé (IDS - U1145), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Grenoble, Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517 (MP3CV), Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, CHU Amiens-Picardie
Rok vydání: 2018
Předmět:
Male
medicine.medical_specialty
genetic structures
[SDV]Life Sciences [q-bio]
medicine.medical_treatment
Heart Ventricles
Cardiac resynchronization therapy
030204 cardiovascular system & hematology
Cardiac Resynchronization Therapy
03 medical and health sciences
QRS complex
Electrocardiography
0302 clinical medicine
Internal medicine
medicine
Humans
Clinical significance
In patient
cardiovascular diseases
030212 general & internal medicine
Aged
Retrospective Studies
Heart Failure
Ejection fraction
medicine.diagnostic_test
business.industry
Retrospective cohort study
Stroke Volume
equipment and supplies
medicine.disease
Echocardiography
Doppler
Heart failure
cardiovascular system
Cardiology
Female
Cardiology and Cardiovascular Medicine
business
circulatory and respiratory physiology
Follow-Up Studies
Zdroj: Canadian Journal of Cardiology
Canadian Journal of Cardiology, 2019, 35 (1), pp.27-34. ⟨10.1016/j.cjca.2018.10.019⟩
ISSN: 1916-7075
0828-282X
Popis: International audience; Background: We hypothesized that preoperative electromechanical dyssynchrony amenable to cardiac resynchronization therapy (CRT) and QRS narrowing immediately after CRT are both correlated and have a cumulative impact on response and outcome after CRT. Methods: A total of 233 CRT candidates (heart failure New York Heart Association classes II-IV, ejection fraction < 35%, QRS >= 120 milliseconds, 44% women, 71 +/- 11 years old) were prospectively included. Preoperative electromechanical dyssynchrony amenable to CRT was assessed by septal deformation patterns using speckle tracking echocardiography. QRS narrowing was calculated from 12-lead electrocardiograms before and immediately after CRT implantation. The primary endpoint was overall mortality during long-term follow-up. The NTC clinical trial number is NCT02986633. Results: Eighty-seven percent of patients with preoperative electromechanical dyssynchrony experienced QRS narrowing after CRT (118/ 136), whereas 69% of patients without preoperative electromechanical dyssynchrony (67/97) experienced QRS narrowing after CRT (P < 0.001). By Cox multivariate analysis, both preoperative electromechanical dyssynchrony and lack of postoperative QRS narrowing were independently associated with an increased risk of mortality during follow-up (adjusted hazards ratio [HR] 2.24, 95% confidence interval [CI] 1.43-3.50 and HR 1.90, 95% CI 1.06-3.38, respectively). Compared with patients with preoperative electromechanical dyssynchrony, patients without both electromechanical dyssynchrony and postoperative QRS narrowing experienced a considerable increased risk of mortality during follow-up (adjusted HR 3.70, 95% CI 1.96-6.97). Conclusions: Lack of postoperative QRS narrowing after CRT is associated with preoperative electromechanical dyssynchrony. Both preoperative electromechanical dyssynchrony and postoperative QRS narrowing have a favourable cumulative impact on outcome after CRT.
Databáze: OpenAIRE
Externí odkaz: