Jeroen J Bax1, Victoria Delgado1, Peter Sogaard2, Jagmeet P Singh3, William T Abraham4, Jeffrey S Borer5, Kenneth Dickstein6, Daniel Gras7, Josep Brugada8, Michele Robertson9, Ian Ford9, Henry Krum10, Johannes Holzmeister11, Frank Ruschitzka11, John Gorcsan12. 1. Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands. 2. Aalborg University, Fredrik Bajers Vej 7-D3, Aalborg 9220, Denmark. 3. Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, Corrigan Minehan Heart Center, 55 Fruit Street, Boston, MA 02114, USA. 4. The Division of Cardiovascular Medicine, Ohio State University Medical Center, Davis Heart and Lung Research Institute, 473 West 12th Avenue, Room 110P, Columbus, OH 43210-1252, USA. 5. The Division of Cardiovascular Medicine and Howard Gilman and Ron and Jean Schiavone Institutes, State University of New York Downstate College of Medicine, 450 Clarkson Avenue, Division of Cardiovascular Medicine, Sixth Floor, Brooklyn, NY, New York, USA. 6. University of Bergen, Stavanger University Hospital, Postboks 8600 Forus, 4036 Stavanger, Norway. 7. Nouvelles Cliniques Nantaises, 2 - 4 Rue Eric Tabarly, 44200 Nantes, France. 8. Cardiology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain. 9. Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK. 10. Monash Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Victoria 3800, Australia. 11. Clinic for Cardiology, University Hospital Zurich, Moussonstrasse 4, CH 8091 Zürich, Switzerland. 12. The University of Pittsburgh, 4200 Fifth Ave, Pittsburgh, PA 15260, USA.
Abstract
AIM: Left ventricular (LV) global longitudinal strain (GLS) reflects LV systolic function and correlates inversely with the extent of LV myocardial scar and fibrosis. The present subanalysis of the Echocardiography Guided CRT trial investigated the prognostic value of LV GLS in patients with narrow QRS complex. METHODS AND RESULTS: Left ventricular (LV) global longitudinal strain (GLS) was measured on the apical 2-, 4- and 3-chamber views using speckle tracking analysis. Measurement of baseline LV GLS was feasible in 755 patients (374 with cardiac resynchronization therapy (CRT)-ON and 381 with CRT-OFF). The median value of LV GLS in the overall population was 7.9%, interquartile range 6.2-10.1%. After a mean follow-up period of 19.4 months, 95 patients in the CRT-OFF group and 111 in the CRT-ON group reached the combined primary endpoint of all-cause mortality and heart failure hospitalization. Each 1% absolute unit decrease in LV GLS was independently associated with 11% increase in the risk to reach the primary endpoint (Hazard ratio 1.11; 95% confidence interval 95% 1.04-1.17, P < 0.001), after adjusting for ischaemic cardiomyopathy and randomization treatment among other clinically relevant variables. When categorizing patients according to quartiles of LV GLS, the primary endpoint occurred more frequently in patients in the lowest quartile (<6.2%) treated with CRT-ON vs. CRT-OFF (45.6% vs. 28.7%, P = 0.009) whereas, no differences were observed in patients with LV GLS ≥6.2% treated with CRT-OFF vs. CRT-ON (23.7% vs. 24.5%, respectively; P = 0.62). CONCLUSION: Low LV GLS is associated with poor outcome in heart failure patients with QRS width <130 ms, independent of randomization to CRT or not. Importantly, in the group of patients with the lowest LV GLS quartile, CRT may have a detrimental effect on clinical outcomes. Published on behalf of the European Society of Cardiology. All rights reserved.
AIM: Left ventricular (LV) global longitudinal strain (GLS) reflects LV systolic function and correlates inversely with the extent of LV myocardial scar and fibrosis. The present subanalysis of the Echocardiography Guided CRT trial investigated the prognostic value of LV GLS in patients with narrow QRS complex. METHODS AND RESULTS: Left ventricular (LV) global longitudinal strain (GLS) was measured on the apical 2-, 4- and 3-chamber views using speckle tracking analysis. Measurement of baseline LV GLS was feasible in 755 patients (374 with cardiac resynchronization therapy (CRT)-ON and 381 with CRT-OFF). The median value of LV GLS in the overall population was 7.9%, interquartile range 6.2-10.1%. After a mean follow-up period of 19.4 months, 95 patients in the CRT-OFF group and 111 in the CRT-ON group reached the combined primary endpoint of all-cause mortality and heart failure hospitalization. Each 1% absolute unit decrease in LV GLS was independently associated with 11% increase in the risk to reach the primary endpoint (Hazard ratio 1.11; 95% confidence interval 95% 1.04-1.17, P < 0.001), after adjusting for ischaemic cardiomyopathy and randomization treatment among other clinically relevant variables. When categorizing patients according to quartiles of LV GLS, the primary endpoint occurred more frequently in patients in the lowest quartile (<6.2%) treated with CRT-ON vs. CRT-OFF (45.6% vs. 28.7%, P = 0.009) whereas, no differences were observed in patients with LV GLS ≥6.2% treated with CRT-OFF vs. CRT-ON (23.7% vs. 24.5%, respectively; P = 0.62). CONCLUSION: Low LV GLS is associated with poor outcome in heart failure patients with QRS width <130 ms, independent of randomization to CRT or not. Importantly, in the group of patients with the lowest LV GLS quartile, CRT may have a detrimental effect on clinical outcomes. Published on behalf of the European Society of Cardiology. All rights reserved.
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