Effect of cardiac resynchronization therapy in patients without left intraventricular dyssynchrony

Auger, Dominique, Bleeker, Gabe B., Bertini, Matteo, Ewe, See H., Van Bommel, Rutger J., Witkowski, Tomasz G., Ng, Arnold C. T., Van Erven, Lieselotvan, Schalij, Martin J., Bax, Jeroen J. and Delgado, Victoria (2012) Effect of cardiac resynchronization therapy in patients without left intraventricular dyssynchrony. European Heart Journal, 33 7: 913-920. doi:10.1093/eurheartj/ehr468

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Author Auger, Dominique
Bleeker, Gabe B.
Bertini, Matteo
Ewe, See H.
Van Bommel, Rutger J.
Witkowski, Tomasz G.
Ng, Arnold C. T.
Van Erven, Lieselotvan
Schalij, Martin J.
Bax, Jeroen J.
Delgado, Victoria
Title Effect of cardiac resynchronization therapy in patients without left intraventricular dyssynchrony
Journal name European Heart Journal   Check publisher's open access policy
ISSN 0195-668X
1522-9645
Publication date 2012
Sub-type Article (original research)
DOI 10.1093/eurheartj/ehr468
Volume 33
Issue 7
Start page 913
End page 920
Total pages 8
Place of publication Oxford, United Kingdom
Publisher Oxford University Press
Collection year 2013
Language eng
Formatted abstract
Aims
To evaluate the effects of cardiac resynchronization therapy (CRT) on long-term survival of patients without baseline left ventricular (LV) mechanical dyssynchrony.
Methods and results
A total of 290 heart failure patients (age 67±10 years, 77% males) without significant baseline LV dyssynchrony (,60 ms as assessed with tissue Doppler imaging) were treated with CRT. Patients were divided according to the median LV dyssynchrony measured after 48 h of CRT into two groups. All-cause mortality was compared between the subgroups. In addition, the all-cause mortality rates of these subgroups were compared with the allcause mortality of 290 heart failure patients treated with CRT who showed significant LV dyssynchrony (≥60 ms) at baseline. In the group of  patients without significant LV dyssynchrony, median LV dyssynchrony increased from 22 ms (inter-quartile range 16–34 ms) at baseline to 40 ms (24–56 ms) 48 h after CRT. The cumulative mortality rates at 1-, 2-, and 3-year follow-up of patients with LV dyssynchrony ≥40 ms 48 h after CRT implantation were significantly higher when compared with patients with LV dyssynchrony ,40 ms (10, 17, and 23 vs. 3, 8, and 10%, respectively; log-rank P , 0.001). Finally, the cumulative mortality rates at 1-, 2-, and 3-year follow-up of patients with baseline LV dyssynchrony were 3, 8, and 11%, respectively (log-rank P ¼ 0.375 vs. patients with LV dyssynchrony ,40 ms). Induction  of LV dyssynchrony after CRT was an independent predictor of mortality (hazard ratio: 1.247; P ¼ 0.009).
Conclusion
In patients without significant LV dyssynchrony, the induction of LV dyssynchrony after CRT may be related to a less favourable long-term outcome.
Q-Index Code C1
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Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2013 Collection
School of Medicine Publications
 
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Created: Tue, 30 Apr 2013, 11:06:54 EST by Dr Chin Tse Arnold Ng on behalf of Medicine - Princess Alexandra Hospital