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Echocardiographic mechanical dyssynchrony predicts long-term mortality in patients with cardiac resynchronisation therapy.
- Source :
-
The international journal of cardiovascular imaging [Int J Cardiovasc Imaging] 2024 Jan; Vol. 40 (1), pp. 35-43. Date of Electronic Publication: 2023 Oct 11. - Publication Year :
- 2024
-
Abstract
- Cardiac resynchronisation therapy (CRT) is an established treatment for patients with symptomatic heart failure with reduced left ventricular ejection fraction (LVEF ≤ 35%; HFrEF) and conduction disturbances (QRS duration ≥ 130 ms). The presence of mechanical dyssynchrony (MD) on echocardiography has been hypothesised to be of predictive value in determining indication for CRT. This study investigated the impact of MD (apical rocking [AR] and septal flash [SF]) on long-term survival in CRT recipients. HFrEF patients (n = 425; mean age 63.0 ± 10.6 years, 72.3% male, 60.7% non-ischaemic aetiology) with a guideline-derived indication for CRT underwent device implantation. MD markers were determined at baseline and after a mean follow-up of 11.5 ± 8.0 months; long-term survival was also determined. AR and/or SF were present in 307 (72.2%) participants at baseline. During post-CRT follow-up, AR and/or SF disappeared in 256 (83.4%) patients. Overall mean survival was 95.9 ± 52.9 months, longer in women than in men (109.1 ± 52.4 vs. 90.9 ± 52.4 months; p < 0.001) and in younger (< 60 years) versus older patients (110.6 ± 53.7 vs. 88.6 ± 51.1 months; p < 0.001). Patients with versus without MD markers at baseline generally survived for longer (106.2 ± 52.0 vs. 68.9 ± 45.4 months; p < 0.001), and survival was best in patients with resolved versus persisting MD (111.6 ± 51.2 vs. 79.7 ± 47.6 months p < 0.001). Age and MD at baseline were strong predictors of long-term survival in HFrEF patients undergoing CRT on multivariate analysis. Novel echocardiography MD parameters in HFrEF CRT recipients predicted long-term mediated better outcome, and survival improved further when AR and/or SF disappear after CRT implantation.<br /> (© 2023. The Author(s).)
- Subjects :
- Humans
Male
Female
Middle Aged
Aged
Stroke Volume
Treatment Outcome
Ventricular Function, Left
Predictive Value of Tests
Echocardiography
Heart Failure diagnostic imaging
Heart Failure therapy
Cardiac Resynchronization Therapy adverse effects
Ventricular Dysfunction, Left diagnostic imaging
Ventricular Dysfunction, Left therapy
Ventricular Dysfunction, Left etiology
Subjects
Details
- Language :
- English
- ISSN :
- 1875-8312
- Volume :
- 40
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- The international journal of cardiovascular imaging
- Publication Type :
- Academic Journal
- Accession number :
- 37819382
- Full Text :
- https://doi.org/10.1007/s10554-023-02972-1