Abstract 13016: Echocardiographic Yu Index Along With Degree of QRS Widening Predicts Survival Following Cardiac Resynchronization
Background: The association of tissue Doppler dyssynchrony among patients with differing degrees of QRS width and long-term survival after cardiac resynchronization therapy (CRT) is unclear.
Methods: Our Objectives was to test the hypothesis that QRS duration when combined with echocardiographic longitudinal dyssynchrony predicts survival after CRT. We studied 222 heart failure patients with routine CRT indications: New York Heart Association class III–IV, EF≤ 35%, and QRS duration ≥120ms. Longitudinal dyssynchrony was assessed using Yu Index: the standard deviation of 12-site tissue Doppler time-to-peak velocity from apical 4-chamber, 2-chamber and long axis views. A predefined Yu Index cut-off was ≥ 32ms. CRT patients were divided into 2 groups based on CARE-HF trial criteria: QRS 120–150 ms and QRS > 150ms. Long term outcome events were pre-specified as death, transplant or left ventricular assist device (LVAD) over 3 years after CRT.
Results: The tissue Doppler Yu Index was feasible in 205 patients (92%) overall. Their age was 66±12 yrs, QRS duration 159±26ms, 58% had ischemic disease. There were 83 patients (40%) with QRS duration 120 – 150ms and 122 (60%) patients with QRS duration >150ms. There were 55 events: 42 deaths, 7 transplants, and 6 LVADs over 3 yrs. Patients with QRS duration >150ms and a positive Yu Index had a better outcome than patients with QRS duration 120 — 150 ms. Interestingly, those patients with QRS duration > 150ms also had a better outcome than patients with a similar QRS width but with no dyssynchrony.
Conclusions: The tissue Doppler Yu Index was associated with event-free survivial in patients with both narrower and wider QRS widths. Patients who had QRS >150 ms and a positive Yu Index ≥ 32ms had a particularly favorable event-free survival following CRT, and this appears to be an important prognostic marker.
- © 2010 by American Heart Association, Inc.