Relationship of echocardiographic dyssynchrony to long-term survival after cardiac resynchronization therapy
| Autor: | Evan Adelstein, John Gorcsan, Phillip J Habib, Olusegun Oyenuga, Samir Saba, Hideyuki Hara, Hidekazu Tanaka, Dennis M. McNamara |
|---|---|
| Rok vydání: | 2010 |
| Předmět: |
Male
medicine.medical_specialty Heart disease medicine.medical_treatment Cardiac resynchronization therapy Article Disease-Free Survival Cardiac Resynchronization Therapy QRS complex Heart Rate Physiology (medical) Internal medicine medicine Humans Longitudinal Studies Prospective Studies Survivors Probability Heart transplantation Heart Failure Observer Variation Ejection fraction business.industry Cardiac Pacing Artificial Mitral Valve Insufficiency Stroke Volume Stroke volume medicine.disease Survival Rate Echocardiography Ventricular assist device Heart failure cardiovascular system Cardiology Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | Circulation. 122(19) |
| ISSN: | 1524-4539 |
| Popis: | 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 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. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|