Abstract 13776: Interaction of Baseline Left Ventricular Volume and Dyssynchrony on Long Term Prognosis After Cardiac Resynchronization Therapy
Background: Baseline dyssynchrony by radial strain (≥130 ms) has been associated with favorable outcome after cardiac resynchronization therapy (CRT) in heart failure (HF) patients with widened QRS. Because LV dilatation is associated with more advanced disease that is less responsive to CRT, we hypothesized that dyssynchrony has less prognistic value in patients with severely dilated LVs.
Methods: We prospectively studied consecutive 260 CRT patients with class II-IV HF, LV EF ≤35%, and QRS≥120 ms. Assessment of dyssynchrony was done at mid-LV level by radial strain. Patients were divided into two groups based on the median value of end diastolic volume (EDV). Outcome events were death, LV assist device or transplantation over 4 years after CRT.
Results: Out of 260 patients studied, 20 (8%) had poor image quality and 3 (1%) were lost to follow-up. Based on a median EDV of 180 ml: 121 (51%) had EDV≥180ml and 116 (49%) had EDV <180ml. Patients with EDV≥180ml were more often male, with lower LVEF and were younger (p<0.05). Baseline dyssynchrony by radial strain was detected with a higher percentage in EDV≥180ml group (p=0.02). There were 87 (37%) outcome events over 4 years. In the group with EDV<180 ml, absence of dyssynchrony at baseline was associated with a significantly higher risk for events with adjusted hazard ratio 2.09, 95% confidence interval 1.05 to 4.17 (p=0.03) after adjusting for QRS duration, LBBB, ischemia and baseline LV EF. Dyssynchrony was not associated with events in those with more dilated LVs EDV≥180 ml (p=0.8).
Conclusions: Significant baseline mechanical dyssynchony was of prognostic significance in CRT patients who had less LV dilatation. In contrast, baseline dyssynchony was not associated with outcomes after CRT in those with more severely dilated LVs, which may represent more advanced LV disease that is less responsive to CRT.
Author Disclosures: B. Tayal: None. A. Delgado-Montero: None. A. Goda: None. S. Saba: Research Grant; Modest; Medtronic, St. Jude, Boston Scientific. N. Risum: None. P. Sogaard: Research Grant; Modest; Biotronik, St. Jude, GE. J. Gorcsan: Research Grant; Modest; Medtronic, Biotronik, Toshiba, St. Jude, GE.
- © 2015 by American Heart Association, Inc.