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Ventricular asynchrony predicts a better outcome in patients with chronic heart failure receiving cardiac
Maria Vittoria Pitzalis1, Massimo Iacoviello, Roberta Romito
1Institute of Cardiology, University of Bari, Bari, Italy. mariavittoria.pitzalis@cardio.uniba.it
Insights
Left ventricular asynchrony, measured by septal-to-posterior wall motion delay (SPWMD), predicts cardiac resynchronization therapy (CRT) benefits in severe heart failure (HF) patients. A longer SPWMD indicates a reduced risk of HF progression and better outcomes.
Area of Science:
- Cardiology
- Heart Failure Management
- Cardiac Electrophysiology
Background:
- Cardiac resynchronization therapy (CRT) shows greater reverse remodeling in severe heart failure (HF) patients with left bundle branch block (LBBB) and left ventricular asynchrony.
- Predicting CRT's clinical benefit remains crucial for optimizing patient selection.
Purpose of the Study:
- To determine if baseline left ventricular asynchrony can prospectively predict the clinical benefit of CRT.
- To assess the correlation between echocardiographic measures of asynchrony and treatment response.
Main Methods:
- Sixty patients with severe HF and LBBB underwent assessment of baseline left ventricular asynchrony using QRS duration and septal-to-posterior wall motion delay (SPWMD).
- Evaluated left ventricular size, ejection fraction (LVEF), mitral regurgitation, and functional capacity.
- Monitored HF progression and changes in LVEF over a median 14-month follow-up.
Main Results:
- A longer baseline SPWMD was significantly associated with a reduced risk of HF progression (HR: 0.91; 95% CI: 0.83-0.99).
- Patients with SPWMD ≥130 ms showed a significant improvement in LVEF (79%) compared to those with SPWMD <130 ms (9%).
- Ischemic cardiomyopathy and post-implantation QRS duration changes also correlated with outcomes.
Conclusions:
- Baseline septal-to-posterior wall motion delay (SPWMD) is a robust predictor of long-term clinical improvement following CRT in severe HF and LBBB patients.
- SPWMD can guide treatment decisions and patient selection for CRT.
Objectives:
The aim of this study was to evaluate whether the clinical benefit of cardiac resynchronization therapy (CRT) can be prospectively predicted by means of the baseline evaluation of left ventricular asynchrony.
Background:
The reverse remodeling associated with CRT is more evident in patients with severe heart failure (HF) and left bundle branch block (LBBB) who have left ventricular asynchrony.
Methods:
Baseline left ventricular asynchrony was assessed in 60 patients with severe HF and LBBB by calculating the electrocardiographic duration of QRS and the echocardiographic septal-to-posterior wall motion delay (SPWMD). Left ventricular size and left ventricular ejection fraction (LVEF), mitral valve regurgitation, and functional capacity were also evaluated. The progression toward HF (defined as a worsening clinical condition leading to a sustained increase in conventional therapies, hospitalization, cardiac transplantation, and death) was assessed during follow-up, as were the changes in LVEF after six months.
Results:
During the median follow-up of 14 months, 16 patients experienced HF progression. Univariate analysis showed that ischemic cardiomyopathy, changes in the QRS duration after implantation, and SPWMD significantly correlated with events. At multivariate analysis, a long SPWMD remained significantly associated with a reduced risk of HF progression (hazard ratio: 0.91; 95% confidence interval: 0.83 to 0.99; p <0.05). An improvement in LVEF was observed in 79% of the patients with a baseline SPWMD of > or =130 ms and in 9% of those with an SPWMD of <130 ms (p <0.0001).
Conclusions:
Baseline SPWMD is a strong predictor of long-term clinical improvement after CRT in patients with severe HF and LBBB.
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