Mechanical Dyssynchrony by Tissue Doppler Cross-Correlation is Associated with Risk for Complex Ventricular Arrhythmias after Cardiac Resynchronization Therapy - 03/12/15
, John Gorcsan, MD a, Antonia Delgado-Montero, MD a, Josef J. Marek, MD a, Kristina H. Haugaa, MD, PhD a, Keiko Ryo, MD, PhD a, Akiko Goda, MD, PhD a, Niels Thue Olsen, MD, PhD c, Samir Saba, MD a, Niels Risum, MD, PhD d, Peter Sogaard, MD, DMSc bAbstract |
Background |
Tissue Doppler cross-correlation analysis has been shown to be associated with long-term survival after cardiac resynchronization defibrillator therapy (CRT-D). Its association with ventricular arrhythmia (VA) is unknown.
Methods |
From two centers 151 CRT-D patients (New York Heart Association functional classes II–IV, ejection fraction ≤ 35%, and QRS duration ≥ 120 msec) were prospectively included. Tissue Doppler cross-correlation analysis of myocardial acceleration curves from the basal segments in the apical views both at baseline and 6 months after CRT-D implantation was performed. Patients were divided into four subgroups on the basis of dyssynchrony at baseline and follow-up after CRT-D. Outcome events were predefined as appropriate antitachycardia pacing, shock, or death over 2 years.
Results |
Mechanical dyssynchrony was present in 97 patients (64%) at baseline. At follow-up, 42 of these 97 patients (43%) had persistent dyssynchrony. Furthermore, among 54 patients with no dyssynchrony at baseline, 15 (28%) had onset of new dyssynchrony after CRT-D. In comparison with the group with reduced dyssynchrony, patients with persistent dyssynchrony after CRT-D were associated with a substantially increased risk for VA (hazard ratio [HR], 4.4; 95% CI, 1.2–16.3; P = .03) and VA or death (HR, 4.0; 95% CI, 1.7–9.6; P = .002) after adjusting for other covariates. Similarly, patients with new dyssynchrony had increased risk for VA (HR, 10.6; 95% CI, 2.8–40.4; P = .001) and VA or death (HR, 5.0; 95% CI, 1.8–13.5; P = .002).
Conclusions |
Persistent and new mechanical dyssynchrony after CRT-D was associated with subsequent complex VA. Dyssynchrony after CRT-D is a marker of poor prognosis.
Le texte complet de cet article est disponible en PDF.Keywords : Cardiac resynchronization defibrillator therapy, Echocardiography, Dyssynchrony, Ventricular arrhythmia, Heart failure
Abbreviations : AD, AD-max, CCA, CRT-D, HF, HR, LBBB, LV, VA, VT
Plan
| Dr Gorcsan has received research grants from Medtronic, Biotronik, Toshiba, and GE Healthcare. Dr Saba has received research grants from Medtronic, St. Jude, and Boston Scientific. Dr Sogaard has received research grants from Biotronik and GE Healthcare. All other authors have nothing to declare. |
Vol 28 - N° 12
P. 1474-1481 - décembre 2015 Retour au numéro
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