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The association of volumetric response and long-term survival after cardiac resynchronization therapy.
- Source :
-
European heart journal. Cardiovascular Imaging [Eur Heart J Cardiovasc Imaging] 2017 Oct 01; Vol. 18 (10), pp. 1109-1117. - Publication Year :
- 2017
-
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.<br />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).<br />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.<br /> (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.)
- Subjects :
- Aged
Analysis of Variance
Cohort Studies
Echocardiography methods
Europe
Female
Hemodynamics physiology
Humans
Internationality
Kaplan-Meier Estimate
Male
Middle Aged
Multivariate Analysis
Predictive Value of Tests
Prognosis
Retrospective Studies
Risk Assessment
Severity of Illness Index
Survival Rate
Treatment Outcome
Ventricular Dysfunction, Left diagnostic imaging
Ventricular Remodeling physiology
Cardiac Resynchronization Therapy methods
Cause of Death
Stroke Volume physiology
Ventricular Dysfunction, Left mortality
Ventricular Dysfunction, Left therapy
Subjects
Details
- Language :
- English
- ISSN :
- 2047-2412
- Volume :
- 18
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- European heart journal. Cardiovascular Imaging
- Publication Type :
- Academic Journal
- Accession number :
- 28950379
- Full Text :
- https://doi.org/10.1093/ehjci/jex188