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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
Rethinking cardiac resynchronization therapy: the impact of ventricular dyssynchrony on outcome
Christian Prinz1, Cinthia Duarte Felice, Roman Lehmann
1Department of Cardiology, Heart and Diabetes Centre of North-Rhine Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany.
Insights
Left ventricular dyssynchrony (LVD) in heart failure patients predicts better outcomes with cardiac resynchronization therapy (CRT). Patients with LVD showed improved survival and reverse remodeling, highlighting its prognostic value.
Area of Science:
- Cardiology
- Medical Imaging
- Heart Failure Management
Background:
- Heart failure (CHF) with left ventricular (LV) dysfunction and conduction disturbances often requires cardiac resynchronization therapy (CRT).
- Assessing baseline left ventricular dyssynchrony (LVD) is crucial for predicting treatment response in these patients.
Purpose of the Study:
- To determine if baseline LVD predicts long-term outcomes in CHF patients undergoing CRT.
- To evaluate the association between LVD and clinical improvement after CRT.
Main Methods:
- Tissue Doppler imaging (TDI) assessed LVD, defined as electromechanical delay (EMD) ≥40 ms between opposed LV walls.
- A cohort of 535 CHF patients scheduled for CRT implantation was analyzed.
- Primary endpoint: all-cause mortality, heart transplantation, or assist device implantation. Secondary endpoints: reverse LV remodeling and symptomatic improvement.
Main Results:
- LVD was present in 61% of patients at baseline.
- Patients with LVD had a significantly lower rate of the primary endpoint (24%) compared to those without LVD (58%) (p < 0.001).
- LVD was an independent predictor of improved outcome (HR: 0.30 [95% CI: 0.21-0.42], p < 0.001) and was associated with better secondary endpoint parameters.
Conclusions:
- Baseline LVD, assessed by TDI, is linked to greater clinical improvement in CRT recipients.
- LVD is a significant predictor of transplant-free long-term survival in patients receiving CRT.
Objective:
To analyze whether left ventricular dyssynchrony (LVD) at baseline is predictive for long-term outcome in heart failure (CHF) patients with left ventricular (LV) dysfunction and conduction disturbances treated with cardiac resynchronization therapy (CRT).
Methods:
In 535 consecutive individuals with CHF scheduled for implantation of a CRT device, LVD was assessed by tissue Doppler imaging (TDI), defined as an electromechanical delay (EMD) difference of ≥40 ms in 2 opposed left ventricular wall regions (septal vs. lateral, anterior vs. inferior). All-cause mortality, heart transplantation, or assist device implantation was defined as combined primary end point. Secondary end points were measures of reverse LV remodeling and of symptomatic improvement.
Results:
Mean follow-up was 68 ± 36 [range: 4-150] months. LVD at baseline was present in 308 patients (61%). Of these, 24% reached the combined primary endpoint in contrast to 58% of patients without LVD (p < 0.001). Furthermore, patients with LVD showed pronounced improvement of all secondary end point parameters. In our cohort LVD was an independent predictor for outcome (hazard ratio [95% CI]: 0.30 [0.21-0.42], p < 0.001).
Conclusions:
LVD at baseline as assessed by TDI is associated with a more pronounced clinical improvement and is a predictor for transplant-free long-term survival in CRT recipients.
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