Author + information
- Received March 26, 2008
- Revision received June 2, 2008
- Accepted June 17, 2008
- Published online October 21, 2008.
- Claudia Ypenburg, MD⁎,
- Rutger J. van Bommel, MD⁎,
- Victoria Delgado, MD⁎,
- Sjoerd A. Mollema, MD⁎,
- Gabe B. Bleeker, MD, PhD⁎,
- Eric Boersma, PhD†,
- Martin J. Schalij, MD, PhD⁎ and
- Jeroen J. Bax, MD, PhD⁎,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Jeroen J. Bax, Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
Objectives The aim of the current study was to evaluate echocardiographic parameters after 6 months of cardiac resynchronization therapy (CRT) as well as long-term outcome in patients with the left ventricular (LV) lead positioned at the site of latest activation (concordant LV lead position) as compared with that seen in patients with a discordant LV lead position.
Background A nonoptimal LV pacing lead position may be a potential cause for nonresponse to CRT.
Methods The site of latest mechanical activation was determined by speckle tracking radial strain analysis and related to the LV lead position on chest X-ray in 244 CRT candidates. Echocardiographic evaluation was performed after 6 months. Long-term follow-up included all-cause mortality and hospitalizations for heart failure.
Results Significant LV reverse remodeling (reduction in LV end-systolic volume from 189 ± 83 ml to 134 ± 71 ml, p < 0.001) was noted in the group of patients with a concordant LV lead position (n = 153, 63%), whereas patients with a discordant lead position showed no significant improvements. In addition, during long-term follow-up (32 ± 16 months), less events (combined for heart failure hospitalizations and death) were reported in patients with a concordant LV lead position. Moreover, a concordant LV lead position appeared to be an independent predictor of hospitalization-free survival after long-term CRT (hazard ratio: 0.22, p = 0.004).
Conclusions Pacing at the site of latest mechanical activation, as determined by speckle tracking radial strain analysis, resulted in superior echocardiographic response after 6 months of CRT and better prognosis during long-term follow-up.
Dr. Delgado was supported by a grant from the European Society of Cardiology. Dr. Bleeker was supported by the Dutch Heart Foundation, grant no: 2002B109. Dr. Schalij received research grants from Biotronik, Medtronic, and Boston Scientific. Dr. Bax received research grants from GE Healthcare, BMS Medical Imaging, Boston Scientific, Medtronic, and St. Jude. Randall C. Starling, MD, MPH, FACC, served as Guest Editor for this article.
- Received March 26, 2008.
- Revision received June 2, 2008.
- Accepted June 17, 2008.
- American College of Cardiology Foundation