Abstract 3525: Long-term Survival of Ischemic Heart Failure Patients After Cardiac Resynchronization Therapy: Role of Left Ventricular Dyssynchrony, Left Ventricular Lead Position and Myocardial Scar
Background: The incremental prognostic value of left ventricular (LV) dyssynchrony, LV lead position and myocardial scar on long-term prognosis after CRT remains unknown.
Objectives: To evaluate the incremental prognostic value of LV dyssynchrony, LV lead position and myocardial scar on long-term prognosis of ischemic heart failure patients receiving cardiac resynchronization therapy (CRT).
Methods: A total of 397 ischemic heart failure patients underwent echocardiographic evaluation before CRT device implantation, including the assessment of LV radial dyssynchrony, the latest activated myocardial segment and myocardial scar by using 2-dimensional speckle tracking imaging. The LV lead position assessed by chest-X-ray and was scored as “concordant” when it matched with the latest activated segment. Long-term follow-up included cardiovascular mortality and hospitalizations for heart failure.
Results: After a median follow-up of 21 months, 88 (22%) patients died. Significant LV radial dyssynchrony at baseline (hazard ratio [HR]: 0.996, p=0.015), concordant LV lead position (HR: 0.582, p=0.026) and myocardial scar of the segment targeted by the LV lead (HR: 0.954, p<0.001) were independent predictors of cardiovascular mortality. Myocardial scar of the targeted segment (Model 3) showed a significant incremental prognostic value over the combination of concordant LV lead position (Model 2), LV radial dyssynchrony and conventional clinical and echocardiographic variables (Model 1) (Figure⇓).
Conclusions: Long-term prognosis of ischemic heart failure patients treated with CRT is strongly influenced by the presence of myocardial scar at the targeted segment.