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Relationship of visually assessed apical rocking and septal flash to response and long-term survival following cardiac resynchronization therapy (PREDICT-CRT)
- Source :
- European Heart Journal – Cardiovascular Imaging. 17:262-269
- Publication Year :
- 2015
- Publisher :
- Oxford University Press (OUP), 2015.
-
Abstract
- Aims Apical rocking (ApRock) and septal flash (SF) are often observed phenomena in asynchronously contracting ventricles. We investigated the relationship of visually assessed ApRock and SF, reverse remodelling, and long-term survival in cardiac resynchronization therapy (CRT) candidates. Methods and results A total of 1060 patients eligible for CRT underwent echocardiographic examinations before and 12 ± 6 months after device implantation. Three blinded physicians were asked to visually assess the presence of ApRock and SF before device implantation and also their correction by CRT 12 ± 6 months post-implantation. Patients with a left ventricular (LV) end-systolic volume decrease of ≥15% during the first year of follow-up were regarded as responders. Patients were followed for a median period of 46 months (interquartile range: 27–65 months) for the occurrence of death of any cause. If corrected by CRT, visually assessed ApRock and SF were associated with reverse remodelling with a sensitivity of 84 and 79%, specificity of 79 and 74%, and accuracy of 82 and 77%, respectively. ApRock (hazard ratio [HR] 0.40, 95% confidence interval [CI] 0.30–0.53, P < 0.0001) and SF (HR 0.45 [CI 0.34–0.61], P < 0.001) were independently associated with lower all-cause mortality after CRT and had an incremental value over clinical variables and QRS width for identifying CRT responders. Both the absence of ApRock/SF and unsuccessful correction of ApRock/SF despite CRT were associated with a high risk for non-response and an unfavourable long-term survival. Conclusion A specific LV mechanical dyssynchrony pattern, characterized by ApRock and SF, is associated with a more favourable long-term survival after CRT. Both parameters are also indicators of an effective therapy. [10.1093/ehjci/jev324][1] [1]: /lookup/doi/10.1093/ehjci/jev324
- Subjects :
- Male
medicine.medical_specialty
Clinical variables
genetic structures
medicine.medical_treatment
Cardiac resynchronization therapy
030204 cardiovascular system & hematology
Sensitivity and Specificity
Cardiac Resynchronization Therapy
Ventricular Dysfunction, Left
03 medical and health sciences
0302 clinical medicine
Interquartile range
Internal medicine
Long term survival
medicine
Humans
Radiology, Nuclear Medicine and imaging
030212 general & internal medicine
Heart Failure
Ventricular Remodeling
Ventricular End-Systolic Volume
business.industry
Hazard ratio
General Medicine
Middle Aged
Confidence interval
3. Good health
Surgery
Survival Rate
Treatment Outcome
Echocardiography
Qrs width
Cardiology
Female
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- ISSN :
- 20472412 and 20472404
- Volume :
- 17
- Database :
- OpenAIRE
- Journal :
- European Heart Journal – Cardiovascular Imaging
- Accession number :
- edsair.doi.dedup.....e9bfc382ce2b946ea2c695d8f7f83984