Abstract 14856: Change in Left Ventricular Mechanical Dispersion Predicts Mortality After Cardiac Resynchronization Therapy
Introduction: Left ventricular (LV) mechanical dispersion (MD) is a novel, echocardiographic tool to quantify the heterogeneity of mechanical function, and has been associated with prognosis in patients with various cardiac pathologies.
Hypothesis: We investigated the association between changes in LV MD after cardiac resynchronization (CRT) implantation in patients with heart failure and prognosis.
Methods: From an ongoing registry of heart failure patients treated with CRT according to guidelines, demographic, clinical and echocardiographic characteristics were analyzed. Echocardiographic measurements were performed at baseline and at 6 months follow-up. LV MD change was calculated and the population was divided according to the quartiles (Q) of LV MD change.
Results: A total of 355 patients (65±9 years, 73% male, 54% ischemic heart disease, left ventricular ejection fraction 32±10%, mean QRS duration 160±23 ms) were included. The mean reduction in LV MD after CRT was 12.0 ms and the patient population was divided according to quartiles in change in MD (Q1:-152.9 ms to -40.3 ms; Q2:-40.2 ms to -12.7 ms, Q3:-12.6 ms to 15.1 ms and Q4: 15.2 ms to 208.3 ms). After a median follow-up of 1.9 years (interquartile range 0.7 - 2.5 years), 43.1% of patients died. Patients with smaller reductions in LV MD (Q3) or increases in LV MD (Q4) had significantly higher event rates for all-cause mortality (13.9% and 13.4%, respectively) compared with patients with larger reductions in LV MD (Q1, 8.0% and Q2, 8.0%) (Log-rank test P<0.001; Figure 1). Larger reductions in LV MD after CRT (Q1-Q2) were significantly associated with better survival compared with Q3 and Q4, after correcting for LV reverse remodeling (HR 0.584, 95% CI 0.418-0.817, P=0.002), age (HR 1.032, 95% CI 1.013-1.051, P=0.001) and ischemic etiology (HR 1.912, 95% CI 1.332-2.745, P<0.001).
Conclusions: The degree of reduction in LV MD after CRT is independently associated with better outcome at follow-up.
Author Disclosures: P. van der Bijl: None. M. Khidir: None. M. Leung: None. N. Marsan: None. V. Delgado: Other; Modest; Speaker fee Abbott. J.J. Bax: None.
- © 2016 by American Heart Association, Inc.