John Gorcsan1, Peter Sogaard2, Jeroen J Bax3, Jagmeet P Singh4, William T Abraham5, Jeffrey S Borer6, Kenneth Dickstein7, Daniel Gras8, Henry Krum9, Josep Brugada10, Michele Robertson11, Ian Ford11, Johannes Holzmeister12, Frank Ruschitzka13. 1. University of Pittsburgh, Scaife 564, 200 Lothrop Street, Pittsburgh, PA 15213-2582, USA gorcsanj@upmc.edu. 2. Aalborg University, Aalborg, Denmark. 3. Leiden University Medical Center, Leiden, The Netherlands. 4. Massachusetts General Hospital, Harvard Medical School, Boston, USA. 5. Division of Cardiovascular Medicine, Ohio State University Medical Center, Davis Heart and Lung Research Institute, Columbus, USA gorcsanj@upmc.edu. 6. Department of Cardiology, Division of Cardiovascular Medicine and Howard Gilmanand Ron and Jean Schiavone Institutes, State University of New York Downstate College of Medicine, New York, USA. 7. University of Bergen, Stavanger University Hospital, Stavanger, Norway. 8. Nouvelles Cliniques Nantaises, Nantes, France. 9. Monash Centre of Cardiovascular Research and Education in Therapeutics, Melbourne, VIC, Australia. 10. Cardiology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain. 11. Robertson Centre for Biostatistics, University of Glasgow, Glasgow, United Kingdom. 12. Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland. 13. Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland gorcsanj@upmc.edu.
Abstract
AIMS: EchoCRT was a randomized trial of cardiac resynchronization therapy (CRT) in severely symptomatic heart failure (HF) patients with narrow QRS width <130 ms, ejection fraction ≤35%, and echocardiographic dyssynchrony. All received CRT implants which were then randomized to CRT-On or CRT-Off. While the trial showed no benefit of CRT to these patients, the aim of this subgroup analysis was to test the hypothesis that persistent or worsening dyssynchrony is associated with unfavourable clinical outcomes. METHODS AND RESULTS: We studied 614 EchoCRT patients with baseline and 6-month echocardiograms. Baseline dyssynchrony required for study inclusion was either tissue Doppler imaginglongitudinal velocity delay≥80 ms or speckle-tracking radial strain delay ≥130 ms. Persistent dyssynchrony at 6 months was observed similarly in both groups (77% in CRT-On; 76% in CRT-Off). Persistent dyssynchrony was associated with a significantly higher primary end point of death or HF hospitalization (HR = 1.54, 95% CI 1.03-2.30, P = 0.03), and in particular secondary endpoint of HF hospitalization (HR = 1.66, 95% CI 1.07-2.57, P = 0.02). HF hospitalizations were also associated with worsening longitudinal dyssynchrony (HR = 1.45, 95% CI 1.02-2.05, P = 0.037), and worsening radial dyssynchrony (HR = 1.81, 95% CI 1.16-2.81, P = 0.008). Associations of persistent or worsening dyssynchrony with outcomes were similar in CRT-Off and CRT-On groups. CONCLUSIONS:Persistent or worsening echocardiographic dyssynchrony in HF patients with narrow QRS width was a marker for unfavourable clinical outcomes unaffected by CRT. In particular, echocardiographic dyssynchrony on follow-up was strongly associated with HF hospitalizations and appears to be a prognostic marker of disease severity. Published on behalf of the European Society of Cardiology. All rights reserved.
RCT Entities:
AIMS: EchoCRT was a randomized trial of cardiac resynchronization therapy (CRT) in severely symptomatic heart failure (HF) patients with narrow QRS width <130 ms, ejection fraction ≤35%, and echocardiographic dyssynchrony. All received CRT implants which were then randomized to CRT-On or CRT-Off. While the trial showed no benefit of CRT to these patients, the aim of this subgroup analysis was to test the hypothesis that persistent or worsening dyssynchrony is associated with unfavourable clinical outcomes. METHODS AND RESULTS: We studied 614 EchoCRT patients with baseline and 6-month echocardiograms. Baseline dyssynchrony required for study inclusion was either tissue Doppler imaging longitudinal velocity delay ≥80 ms or speckle-tracking radial strain delay ≥130 ms. Persistent dyssynchrony at 6 months was observed similarly in both groups (77% in CRT-On; 76% in CRT-Off). Persistent dyssynchrony was associated with a significantly higher primary end point of death or HF hospitalization (HR = 1.54, 95% CI 1.03-2.30, P = 0.03), and in particular secondary endpoint of HF hospitalization (HR = 1.66, 95% CI 1.07-2.57, P = 0.02). HF hospitalizations were also associated with worsening longitudinal dyssynchrony (HR = 1.45, 95% CI 1.02-2.05, P = 0.037), and worsening radial dyssynchrony (HR = 1.81, 95% CI 1.16-2.81, P = 0.008). Associations of persistent or worsening dyssynchrony with outcomes were similar in CRT-Off and CRT-On groups. CONCLUSIONS: Persistent or worsening echocardiographic dyssynchrony in HF patients with narrow QRS width was a marker for unfavourable clinical outcomes unaffected by CRT. In particular, echocardiographic dyssynchrony on follow-up was strongly associated with HF hospitalizations and appears to be a prognostic marker of disease severity. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Tor Biering-Sørensen; Sanjiv J Shah; Inder Anand; Nancy Sweitzer; Brian Claggett; Li Liu; Bertram Pitt; Marc A Pfeffer; Scott D Solomon; Amil M Shah Journal: Eur J Heart Fail Date: 2017-03-21 Impact factor: 15.534