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Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
Published on: December 11, 2017
Septal to posterior wall motion delay fails to predict reverse remodeling or clinical improvement in patients
Gregory M Marcus1, Emily Rose, Esperanza M Viloria
1Department of Medicine, Division of Cardiology, University of California, San Francisco, San Francisco, California, USA.
Insights
Septal-to-posterior wall motion delay (SPWMD) did not predict reverse remodeling or clinical response in heart failure patients receiving cardiac resynchronization therapy (CRT). Previous findings were not reproducible in the CONTAK-CD trial.
Area of Science:
- Cardiology
- Heart Failure Management
- Echocardiography
Background:
- Previous studies suggested septal-to-posterior wall motion delay (SPWMD) predicts clinical benefit from cardiac resynchronization therapy (CRT).
- This study aimed to validate these findings in a new patient cohort.
Purpose of the Study:
- To test if a longer SPWMD predicts greater reverse remodeling and improved clinical response in heart failure patients undergoing CRT.
- To assess the reproducibility of SPWMD as a predictive marker.
Main Methods:
- Retrospective analysis of 79 heart failure patients from the CONTAK-CD trial randomized to CRT.
- SPWMD measured from baseline echocardiograms and compared with 6-month changes in echocardiographic and clinical parameters.
- Responders defined by a ≥15% reduction in left ventricular end-systolic volume index (LVESVI).
Main Results:
- Feasibility and reproducibility of SPWMD measurements were poor.
- Larger SPWMD values did not correlate with improvements in left ventricular volumes or ejection fraction.
- No significant difference in SPWMD between responders and non-responders.
- SPWMD inadequately predicted reverse remodeling or clinical response.
Conclusions:
- The hypothesis that SPWMD predicts reverse remodeling or clinical improvement with CRT was not supported in this trial.
- Previous findings on SPWMD's predictive value were not reproducible in the CONTAK-CD patient population.
Objectives:
The aim of this study was to test the hypothesis that a longer septal-to-posterior wall motion delay (SPWMD) would predict greater reverse remodeling and an improved clinical response in heart failure patients randomized to cardiac resynchronization therapy (CRT) in the CONTAK-CD trial.
Background:
The SPWMD predicted clinical benefit with CRT in two previous studies from the same center.
Methods:
In this retrospective analysis of the CONTAK-CD trial, SPWMD was measured from the baseline echocardiogram of 79 heart failure patients (ejection fraction 22 +/- 7%, QRS duration 159 +/- 27 ms, 72% ischemic, 84% male) randomized to CRT and compared with six-month changes in echocardiographic and clinical parameters. Patients with a left ventricular end-systolic volume index (LVESVI) reduction of at least 15% were considered responders.
Results:
The feasibility and reproducibility of performing the SPWMD measurements were poor. Larger values for SPWMD did not correlate with six-month changes in left ventricular end-diastolic volume index (p = 0.26), LVESVI (p = 0.41), or left ventricular ejection fraction (p = 0.36). Responders did not have a significantly different SPWMD than non-responders (p = 0.26). The SPWMD did not correlate with measures of clinical improvement. At a threshold of SPWMD >130 ms, the test characteristics to predict reverse remodeling or a clinical response were inadequate.
Conclusions:
The previous findings that SPWMD predicts reverse remodeling or clinical improvement with CRT were not reproducible in patients randomized in the CONTAK-CD trial.
