Pieter van der Bijl1, Mand J H Khidir1, Melissa Leung1, Dilek Yilmaz1, Bart Mertens2, Nina Ajmone Marsan1, Victoria Delgado1, Jeroen J Bax3. 1. Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands. 2. Bioinformatics Center of Expertise, Leiden University Medical Center, Leiden, The Netherlands. 3. Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: j.j.bax@lumc.nl.
Abstract
BACKGROUND: In heart failure (HF) patients, left ventricular mechanical dispersion (LVMD) reflects heterogeneous mechanical activation of the left ventricle. In HF patients, LVMD can be reduced after CRT. Whether lesser LVMD is associated with improved outcome is unknown. OBJECTIVE: The purpose of this study was to relate LVMD to long-term prognosis in a large cohort of HF patients after 6 months of cardiac resynchronization therapy (CRT). METHODS: Clinical, echocardiographic, and ventricular arrhythmia (VA) data were analyzed from an ongoing registry of HF recipients of CRT. Baseline (before CRT) and 6-month echocardiograms were evaluated. LVMD was calculated as the standard deviation of the time from onset of the QRS complex to the peak longitudinal strain in a 17-segment model. Patients were divided into 2 groups according to the median LVMD (84 ms) at 6 months post-CRT. RESULTS: Of 1185 patients (mean age 65 ± 10 years; 76% male), 343 (29%) died during a mean follow-up of 55 ± 36 months. Baseline LVMD was not associated with all-cause mortality and VA at follow-up. In contrast, patients with less LVMD (≤84 ms) at 6 months post-CRT had lower event rates (VA and mortality) compared to those with LVMD >84 ms. On multivariable analysis, greater LVMD at 6 months after CRT was independently associated with an increased risk of mortality (hazard ratio 1.002; P = .037) and VA (hazard ratio 1.003; P = .026). CONCLUSION: Larger LVMD at 6 months after CRT is independently associated with all-cause mortality and VA. LVMD may be valuable in identifying patients who remain at high mortality risk after CRT implantation.
BACKGROUND: In heart failure (HF) patients, left ventricular mechanical dispersion (LVMD) reflects heterogeneous mechanical activation of the left ventricle. In HF patients, LVMD can be reduced after CRT. Whether lesser LVMD is associated with improved outcome is unknown. OBJECTIVE: The purpose of this study was to relate LVMD to long-term prognosis in a large cohort of HF patients after 6 months of cardiac resynchronization therapy (CRT). METHODS: Clinical, echocardiographic, and ventricular arrhythmia (VA) data were analyzed from an ongoing registry of HF recipients of CRT. Baseline (before CRT) and 6-month echocardiograms were evaluated. LVMD was calculated as the standard deviation of the time from onset of the QRS complex to the peak longitudinal strain in a 17-segment model. Patients were divided into 2 groups according to the median LVMD (84 ms) at 6 months post-CRT. RESULTS: Of 1185 patients (mean age 65 ± 10 years; 76% male), 343 (29%) died during a mean follow-up of 55 ± 36 months. Baseline LVMD was not associated with all-cause mortality and VA at follow-up. In contrast, patients with less LVMD (≤84 ms) at 6 months post-CRT had lower event rates (VA and mortality) compared to those with LVMD >84 ms. On multivariable analysis, greater LVMD at 6 months after CRT was independently associated with an increased risk of mortality (hazard ratio 1.002; P = .037) and VA (hazard ratio 1.003; P = .026). CONCLUSION: Larger LVMD at 6 months after CRT is independently associated with all-cause mortality and VA. LVMD may be valuable in identifying patients who remain at high mortality risk after CRT implantation.
Authors: Lea Melki; Daniel Y Wang; Christopher S Grubb; Rachel Weber; Angelo Biviano; Elaine Y Wan; Hasan Garan; Elisa E Konofagou Journal: J Am Soc Echocardiogr Date: 2021-03-04 Impact factor: 7.722
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: Issa Pour-Ghaz; Mark Heckle; Ikechukwu Ifedili; Sharif Kayali; Christopher Nance; Rajesh Kabra; Sunil K Jha; John L Jefferies; Yehoshua C Levine Journal: Curr Cardiol Rev Date: 2022