Bhupendar Tayal1, John Gorcsan2, Antonia Delgado-Montero2, Josef J Marek2, Kristina H Haugaa2, Keiko Ryo2, Akiko Goda2, Niels Thue Olsen3, Samir Saba2, Niels Risum4, Peter Sogaard5. 1. Division of Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark. Electronic address: bhupendar.tayal@gmail.com. 2. Division of Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania. 3. Department of Cardiology, Rigshospitalet, Copenhagen, Denmark. 4. Department of Cardiology, Hvidovre University Hospital, Copenhagen, Denmark. 5. Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
Abstract
BACKGROUND: Tissue Doppler cross-correlation analysis has been shown to be associated with long-term survival after cardiac resynchronization defibrillator therapy (CRT-D). Its association with ventricular arrhythmia (VA) is unknown. METHODS:From two centers 151 CRT-D patients (New York Heart Association functional classes II-IV, ejection fraction ≤ 35%, and QRS duration ≥ 120 msec) were prospectively included. Tissue Doppler cross-correlation analysis of myocardial acceleration curves from the basal segments in the apical views both at baseline and 6 months after CRT-D implantation was performed. Patients were divided into four subgroups on the basis of dyssynchrony at baseline and follow-up after CRT-D. Outcome events were predefined as appropriate antitachycardia pacing, shock, or death over 2 years. RESULTS:Mechanical dyssynchrony was present in 97 patients (64%) at baseline. At follow-up, 42 of these 97 patients (43%) had persistent dyssynchrony. Furthermore, among 54 patients with no dyssynchrony at baseline, 15 (28%) had onset of new dyssynchrony after CRT-D. In comparison with the group with reduced dyssynchrony, patients with persistent dyssynchrony after CRT-D were associated with a substantially increased risk for VA (hazard ratio [HR], 4.4; 95% CI, 1.2-16.3; P = .03) and VA or death (HR, 4.0; 95% CI, 1.7-9.6; P = .002) after adjusting for other covariates. Similarly, patients with new dyssynchrony had increased risk for VA (HR, 10.6; 95% CI, 2.8-40.4; P = .001) and VA or death (HR, 5.0; 95% CI, 1.8-13.5; P = .002). CONCLUSIONS: Persistent and new mechanical dyssynchrony after CRT-D was associated with subsequent complex VA. Dyssynchrony after CRT-D is a marker of poor prognosis.
RCT Entities:
BACKGROUND: Tissue Doppler cross-correlation analysis has been shown to be associated with long-term survival after cardiac resynchronization defibrillator therapy (CRT-D). Its association with ventricular arrhythmia (VA) is unknown. METHODS: From two centers 151 CRT-D patients (New York Heart Association functional classes II-IV, ejection fraction ≤ 35%, and QRS duration ≥ 120 msec) were prospectively included. Tissue Doppler cross-correlation analysis of myocardial acceleration curves from the basal segments in the apical views both at baseline and 6 months after CRT-D implantation was performed. Patients were divided into four subgroups on the basis of dyssynchrony at baseline and follow-up after CRT-D. Outcome events were predefined as appropriate antitachycardia pacing, shock, or death over 2 years. RESULTS:Mechanical dyssynchrony was present in 97 patients (64%) at baseline. At follow-up, 42 of these 97 patients (43%) had persistent dyssynchrony. Furthermore, among 54 patients with no dyssynchrony at baseline, 15 (28%) had onset of new dyssynchrony after CRT-D. In comparison with the group with reduced dyssynchrony, patients with persistent dyssynchrony after CRT-D were associated with a substantially increased risk for VA (hazard ratio [HR], 4.4; 95% CI, 1.2-16.3; P = .03) and VA or death (HR, 4.0; 95% CI, 1.7-9.6; P = .002) after adjusting for other covariates. Similarly, patients with new dyssynchrony had increased risk for VA (HR, 10.6; 95% CI, 2.8-40.4; P = .001) and VA or death (HR, 5.0; 95% CI, 1.8-13.5; P = .002). CONCLUSIONS: Persistent and new mechanical dyssynchrony after CRT-D was associated with subsequent complex VA. Dyssynchrony after CRT-D is a marker of poor prognosis.
Authors: Christoffer Polcwiartek; Daniel J Friedman; Kasper Emerek; Claus Graff; Peter L Sørensen; Joseph Kisslo; Zak Loring; Steen M Hansen; Kristian Kragholm; Bhupendar Tayal; Svend E Jensen; Peter Søgaard; Christian Torp-Pedersen; Brett D Atwater Journal: Pacing Clin Electrophysiol Date: 2020-09-26 Impact factor: 1.976
Authors: Tomas Zaremba; Bhupendar Tayal; Sam Riahi; Anna Margrethe Thøgersen; Niels Eske Bruun; Kasper Janus Grønn Emerek; Joseph Kisslo; Thomas Fritz Hansen; Niels Risum; Peter Søgaard Journal: Cardiovasc Ultrasound Date: 2019-10-10 Impact factor: 2.062