Author + information
- Valentina Kutyifa,
- William Jackson Hall,
- Scott Solomon,
- Dorit Knappe,
- Anne-Catherine Pouleur,
- Scott McNitt,
- Wojciech Zareba and
- Arthur Moss
Reduction in dyssynchrony has been shown to be an important prognostic factor of outcome in cardiac resynchronization therapy (CRT) patients. However, predictors of dyssynchrony improvement have been less investigated.
Predictors of dyssynchrony reduction were assessed in 435 CRT-D patients with dyssynchrony data available, enrolled in MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy), with crossovers censored (n=45). We evaluated the effects of dyssynchrony improvement at 1-year, dichotomized at 75th percentile on subsequent heart failure (HF) or death.
Baseline dyssynchrony (0.45, p<0.001), LVESV index (−0.44, p<0.001), previous myocardial infarction (−13.6, p=0.003), age (−0.53, p=0.006), systolic blood pressure (0.33,0.01), LBBB (11.62p=0.03) and QRS duration (0.28, p=0.03) predicted greater reduction in dyssynchrony. In LBBB patients, baseline QRS duration did not remain a significant prognostic factor. During the median total follow-up of 40 months, patients with dyssynchrony improvement (≥48% decrease) had significantly lower incidence (Figure), and risk of HF/Death (HR=0.43, 95% CI:0.19-0.94, p=0.036). In LBBB patients, effects were even more pronounced (HR=0.27, 95% CI:0.08-0.89, p=0.032).
CRT-induced improvement in dyssynchrony is predicted by baseline clinical factors, and is associated with significant clinical benefit, especially in patients with LBBB.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Imaging: CRT/New Technology
Abstract Category: 18. Imaging: Echo
Presentation Number: 1312-333
- 2013 American College of Cardiology Foundation