Aymeric Menet1, Yves Guyomar2, Pierre-Vladimir Ennezat3, Pierre Graux2, Anne Laure Castel2, François Delelis2, Sébastien Heuls2, Estelle Cuvelier2, Cécile Gevaert2, Caroline Le Goffic2, Christophe Tribouilloy4, Sylvestre Maréchaux5. 1. Université Lille Nord de France/GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille/Faculté Libre de Médecine, Cardiology Department, Université Catholique de Lille, 59000 Lille, France; INSERM U 1088, Université de Picardie, Amiens, France. 2. Université Lille Nord de France/GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille/Faculté Libre de Médecine, Cardiology Department, Université Catholique de Lille, 59000 Lille, France. 3. Cardiology Department, CHU de Grenoble, Grenoble, France. 4. Pôle Cardiovasculaire et Thoracique, Centre Hospitalier Universitaire Amiens, Amiens, France; INSERM U 1088, Université de Picardie, Amiens, France. 5. Université Lille Nord de France/GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille/Faculté Libre de Médecine, Cardiology Department, Université Catholique de Lille, 59000 Lille, France; INSERM U 1088, Université de Picardie, Amiens, France. Electronic address: sylvestre.marechaux@yahoo.fr.
Abstract
BACKGROUND: The present study was designed to evaluate the respective value of left ventricular (LV) reverse remodeling (changes in LV end-systolic volume relative to baseline (ΔLVESV)) or LV performance improvement (ΔLV ejection fraction (ΔLVEF) or ΔGlobal longitudinal strain (GLS)) to predict long-term outcome in a prospective cohort of consecutive patients receiving routine cardiac resynchronization therapy (CRT). METHODS: One hundred and seventy heart failure patients (NYHA classes II-IV, LVEF ≤ 35%, QRS width ≥ 120 ms) underwent echocardiography before and 9 months after CRT. The relationships between ΔLVESV, ΔLVEF, ΔGLS and outcome (all-cause mortality and/or CHF hospitalization, overall mortality, cardiovascular mortality, CHF hospitalization) were investigated. RESULTS: During a median follow-up of 32 months, 20 patients died and 27 were hospitalized for heart failure. ΔLVESV, ΔLVEF or ΔGLS were significantly associated with all-cause mortality or CHF hospitalization (adjusted hazard's ratio (HR) per standard deviation 0.58 (0.43-0.77), 0.39 (0.27-0.57) or 0.55 (0.37-0.83) respectively, all p < 0.01) and all other endpoints (all p < 0.01). Patients with ΔLVESV≥15%, ΔLVEF ≥ 10% and ΔGLS ≥ 1% had a reduced risk of mortality or CHF hospitalization (adjusted HR=0.25 (0.12-0.51), p < 0.001, adjusted HR = 0.26 (0.13-0.54), p < 0.001 and adjusted HR 0.38 (0.19-0.75), p = 0.006 respectively). Overall performance of multivariate models was better using ΔLVESV or ΔLVEF compared with ΔGLS. Interobserver agreement was excellent for ΔLVESV (Intraclass correlation coefficient - ICC-0.91) and ΔGLS (ICC 0.90) but modest for ΔLVEF (ICC 0.76) in a sample of 20 patients from the study population. CONCLUSIONS: LV reverse remodeling assessed by ΔLVESV is a strong and reproducible predictor of outcome following CRT. Compared with ΔLVESV, ΔLVEF and ΔGLS have important shortcomings: poorer reproducibility or lower predictive value.
BACKGROUND: The present study was designed to evaluate the respective value of left ventricular (LV) reverse remodeling (changes in LV end-systolic volume relative to baseline (ΔLVESV)) or LV performance improvement (ΔLV ejection fraction (ΔLVEF) or ΔGlobal longitudinal strain (GLS)) to predict long-term outcome in a prospective cohort of consecutive patients receiving routine cardiac resynchronization therapy (CRT). METHODS: One hundred and seventy heart failurepatients (NYHA classes II-IV, LVEF ≤ 35%, QRS width ≥ 120 ms) underwent echocardiography before and 9 months after CRT. The relationships between ΔLVESV, ΔLVEF, ΔGLS and outcome (all-cause mortality and/or CHF hospitalization, overall mortality, cardiovascular mortality, CHF hospitalization) were investigated. RESULTS: During a median follow-up of 32 months, 20 patients died and 27 were hospitalized for heart failure. ΔLVESV, ΔLVEF or ΔGLS were significantly associated with all-cause mortality or CHF hospitalization (adjusted hazard's ratio (HR) per standard deviation 0.58 (0.43-0.77), 0.39 (0.27-0.57) or 0.55 (0.37-0.83) respectively, all p < 0.01) and all other endpoints (all p < 0.01). Patients with ΔLVESV≥15%, ΔLVEF ≥ 10% and ΔGLS ≥ 1% had a reduced risk of mortality or CHF hospitalization (adjusted HR=0.25 (0.12-0.51), p < 0.001, adjusted HR = 0.26 (0.13-0.54), p < 0.001 and adjusted HR 0.38 (0.19-0.75), p = 0.006 respectively). Overall performance of multivariate models was better using ΔLVESV or ΔLVEF compared with ΔGLS. Interobserver agreement was excellent for ΔLVESV (Intraclass correlation coefficient - ICC-0.91) and ΔGLS (ICC 0.90) but modest for ΔLVEF (ICC 0.76) in a sample of 20 patients from the study population. CONCLUSIONS: LV reverse remodeling assessed by ΔLVESV is a strong and reproducible predictor of outcome following CRT. Compared with ΔLVESV, ΔLVEF and ΔGLS have important shortcomings: poorer reproducibility or lower predictive value.
Authors: Michal Orszulak; Artur Filipecki; Wojciech Wrobel; Adrianna Berger-Kucza; Witold Orszulak; Dagmara Urbanczyk-Swic; Wojciech Kwasniewski; Katarzyna Mizia-Stec Journal: Heart Vessels Date: 2021-02-06 Impact factor: 2.037
Authors: Vinesh Appadurai; Nicholas D'Elia; Thomas Mew; Stephen Tomlinson; Jonathan Chan; Christian Hamilton-Craig; Gregory M Scalia Journal: Int J Cardiol Heart Vasc Date: 2021-07-31
Authors: Lingyu Xu; Joseph Pagano; Kelvin Chow; Gavin Y Oudit; Mark J Haykowsky; Yoko Mikami; Andrew G Howarth; James A White; Jonathan G Howlett; Jason R B Dyck; Todd J Anderson; Justin A Ezekowitz; Richard B Thompson; D Ian Paterson Journal: ESC Heart Fail Date: 2021-09-26