Ivan Stankovic1,2, Ann Belmans3, Christian Prinz4, Agnieszka Ciarka1, Ana Maria Daraban1,5, Martin Kotrc6, Marit Aarones7, Mariola Szulik8, Stefan Winter9, Aleksandar N Neskovic2, Tomasz Kukulski8, Svend Aakhus7,10, Rik Willems1, Wolfgang Fehske9, Martin Penicka6, Lothar Faber4, Jens-Uwe Voigt1. 1. Department of Cardiovascular Diseases, University Hospital Gasthuisberg, Catholic University Leuven, Herestraat 49, 3000 Leuven, Belgium. 2. Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia. 3. Leuven Biostatistics and Statistical Bioinformatics Centre, Catholic University Leuven, Leuven, Belgium. 4. Department of Cardiology, Heart and Diabetes Centre of North-Rhine Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany. 5. Department of Internal Medicine and Gastroenterology, Clinical Emergency Hospital, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania. 6. Cardiovascular Center Aalst, OLV Clinic, Belgium. 7. Department of Cardiology, Oslo University Hopsital, Oslo, Norway. 8. Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Medical University-Katowice, Silesian Center for Heart Diseases, Zabrze, Poland. 9. Klinik für Innere Medizin und Kardiologie, St. Vinzenz Hospital, Cologne, Germany. 10. Department of Circulation and Imaging, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway and Clinic of Cardiology, St. Olav Hospital, Trondheim, Norway.
Abstract
AIMS: Clinical experience indicates that limited or no reverse left ventricular (LV) remodelling may not necessarily imply non-response to cardiac resynchronization therapy (CRT). We investigated the association of the extent of LV remodelling, mechanical dyssynchrony, and survival in patients undergoing CRT. METHODS AND RESULTS: In 356 CRT candidates, three blinded readers visually assessed the presence of mechanical dyssynchrony (either apical rocking and/or septal flash) before device implantation and also its correction by CRT 12 ± 3 months post-implantation. To assess LV reverse remodelling, end-systolic volumes (ESV) were measured at the same time points. Patients were divided into four subgroups: no LV remodelling (ESV change 0 ± 5%), mild LV reverse remodelling (ESV reduction 5-15%), significant LV reverse remodelling (ESV reduction ≥15%), and LV volume expansion (ESV increase ≥5%). Patients were followed for all-cause mortality during the median follow-up of 36 months. Patients with LV remodelling as in the above defined groups showed 58, 54, and 84% reduction in all-cause mortality compared to patients with volume expansion. In multivariable analysis, LVESV change remained independently associated with survival, with an 8% reduction in mortality for every 10% decrease in LVESV (P = 0.0039), but an optimal cut-off point could not be established. In comparison, patients with corrected mechanical dyssynchrony showed 71% reduction in all-cause mortality (P < 0.001). CONCLUSION: Volumetric response assessed at 1-year after CRT is strongly associated with long-term mortality. However, an optimal cut-off cannot be established. The association of the correction of mechanical dyssynchrony with survival was stronger than that of any volumetric cut-off. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Clinical experience indicates that limited or no reverse left ventricular (LV) remodelling may not necessarily imply non-response to cardiac resynchronization therapy (CRT). We investigated the association of the extent of LV remodelling, mechanical dyssynchrony, and survival in patients undergoing CRT. METHODS AND RESULTS: In 356 CRT candidates, three blinded readers visually assessed the presence of mechanical dyssynchrony (either apical rocking and/or septal flash) before device implantation and also its correction by CRT 12 ± 3 months post-implantation. To assess LV reverse remodelling, end-systolic volumes (ESV) were measured at the same time points. Patients were divided into four subgroups: no LV remodelling (ESV change 0 ± 5%), mild LV reverse remodelling (ESV reduction 5-15%), significant LV reverse remodelling (ESV reduction ≥15%), and LV volume expansion (ESV increase ≥5%). Patients were followed for all-cause mortality during the median follow-up of 36 months. Patients with LV remodelling as in the above defined groups showed 58, 54, and 84% reduction in all-cause mortality compared to patients with volume expansion. In multivariable analysis, LVESV change remained independently associated with survival, with an 8% reduction in mortality for every 10% decrease in LVESV (P = 0.0039), but an optimal cut-off point could not be established. In comparison, patients with corrected mechanical dyssynchrony showed 71% reduction in all-cause mortality (P < 0.001). CONCLUSION: Volumetric response assessed at 1-year after CRT is strongly associated with long-term mortality. However, an optimal cut-off cannot be established. The association of the correction of mechanical dyssynchrony with survival was stronger than that of any volumetric cut-off. Published on behalf of the European Society of Cardiology. All rights reserved.