Relationship of echocardiographic dyssynchrony to long-term survival after cardiac resynchronization therapy

John Gorcsan, Olusegun Oyenuga, Phillip J. Habib, Hidekazu Tanaka, Evan C. Adelstein, Hideyuki Hara, Dennis M. McNamara, Samir Saba

Research output: Contribution to journalArticle

136 Scopus citations

Abstract

Background-: The ability of echocardiographic dyssynchrony to predict response to cardiac resynchronization therapy (CRT) has been unclear. Methods and results-: A prospective, longitudinal study was designed with predefined dyssynchrony indexes and outcome variables to test the hypothesis that baseline dyssynchrony is associated with long-term survival after CRT. We studied 229 consecutive class III to IV heart failure patients with ejection fraction ≤35% and QRS duration ≥120 milliseconds for CRT. Dyssynchrony before CRT was defined as tissue Doppler velocity opposing-wall delay ≥65 milliseconds, 12-site SD (Yu Index) ≥32 milliseconds, speckle tracking radial strain anteroseptal-to-posterior wall delay ≥130 milliseconds, or pulsed Doppler interventricular mechanical delay ≥40 milliseconds. Outcome was defined as freedom from death, heart transplantation, or left ventricular assist device implantation. Of 210 patients (89%) with dyssynchrony data available, there were 62 events: 47 deaths, 9 transplantations, and 6 left ventricular assist device implantations over 4 years. Event-free survival was associated with Yu Index (P=0.003), speckle tracking radial strain (P=0.003), and interventricular mechanical delay (P=0.019). When adjusted for confounding baseline variables of ischemic origin and QRS duration, Yu Index and radial strain dyssynchrony remained independently associated with outcome (P<0.05). Lack of radial dyssynchrony was particularly associated with unfavorable outcome in those with QRS duration of 120 to 150 milliseconds (P=0.002). Conclusions-: The absence of echocardiographic dyssynchrony was associated with significantly less favorable event-free survival after CRT. Patients with narrower QRS duration who lacked dyssynchrony had the least favorable long-term outcome. These observations support the relationship of dyssynchrony and CRT response.

Original languageEnglish
Pages (from-to)1909-1918
Number of pages10
JournalCirculation
Volume122
Issue number19
DOIs
StatePublished - Nov 9 2010
Externally publishedYes

Keywords

  • echocardiography
  • heart failure
  • pacemakers
  • survival

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    Gorcsan, J., Oyenuga, O., Habib, P. J., Tanaka, H., Adelstein, E. C., Hara, H., McNamara, D. M., & Saba, S. (2010). Relationship of echocardiographic dyssynchrony to long-term survival after cardiac resynchronization therapy. Circulation, 122(19), 1909-1918. https://doi.org/10.1161/CIRCULATIONAHA.110.954768