Abstract 12662: Echocardiographic Dyssynchrony by Tissue Doppler, Speckle Tracking and Routine Pulsed Doppler are Additive to Predict Survival Following Cardiac Resynchronization Therapy
Introduction: The utility of individual echocardiographic indices to predict outcomes following resynchronization therapy (CRT) has been recently criticized. We hypothesized that a combined approach using tissue Doppler imaging (TDI), speckle tracking, and routine Doppler dyssynchrony would predict long-term survival.
Methods: We prospectively studied 207 patients referred for CRT, all with NYHA class III-IV heart failure, QRS width ≥120ms, and ejection fraction (EF) ≤35%. Echo dyssynchrony was assessed by TDI 12-site longitudinal velocity time to peak standard deviation (Yu Index) (predefined ≥ 32ms), speckle tracking radial strain anteroseptal-posterior wall delay(predefined ≥130ms), and pulsed Doppler interventricular mechanical delay (IVMD) (predefined ≥ 40 ms). Long term outcome events were pre-specified as: death, transplant or left ventricular assist device (LVAD) and tracked over 3 years.
Results: Patients were: aged 66 ± 12 years, 31% were female, EF was 24±6%, QRS duration was 159±26ms and 57% had ischemic etiology. Baseline dyssynchrony results were: 142 (70%) had a positive Yu Index, 140 (70%) had a positive radial strain delay and 78 (47%) had a positive IVMD. There were 56 unfavorable events: 42 deaths, 8 transplants, and 5 LVADs. Patients with all 3 dyssynchrony indices positive and none negative had the most favorable long term event free survival, p=0.0069 vs. all others. Patients with 1 negative and 2 positive dyssynchrony indices had an intermediate outcome at 1 year, but similar outcome at 3 years. Those with ≥ 2 negative dyssynchrony indices had the worse outcome after CRT.
Conclusions: Echocardiographic dyssynchrony by TDI Yu Index, speckle tracking radial strain, and IVMD were additive in being associated with long term survival after CRT.
- © 2010 by American Heart Association, Inc.