Relative merits of left ventricular dyssynchrony, left ventricular lead position, and myocardial scar to predict long-term survival of ischemic heart failure patients undergoing cardiac resynchronization therapy

Delgado, Victoria, van Bommel, Rutger J., Bertini, Matteo, Borleffs, C. Jan Willem, Marsan, Nina Ajmone, Ng, Arnold C. T., Nucifora, Gaetano, de Veire, Nico R. L. van, Ypenburg, Claudia, Boersma, Eric, Holman, Eduard R., Schalij, Martin J. and Bax, Jeroen J. (2011) Relative merits of left ventricular dyssynchrony, left ventricular lead position, and myocardial scar to predict long-term survival of ischemic heart failure patients undergoing cardiac resynchronization therapy. Circulation, 123 1: 70-78. doi:10.1161/CIRCULATIONAHA.110.945345


Author Delgado, Victoria
van Bommel, Rutger J.
Bertini, Matteo
Borleffs, C. Jan Willem
Marsan, Nina Ajmone
Ng, Arnold C. T.
Nucifora, Gaetano
de Veire, Nico R. L. van
Ypenburg, Claudia
Boersma, Eric
Holman, Eduard R.
Schalij, Martin J.
Bax, Jeroen J.
Title Relative merits of left ventricular dyssynchrony, left ventricular lead position, and myocardial scar to predict long-term survival of ischemic heart failure patients undergoing cardiac resynchronization therapy
Journal name Circulation   Check publisher's open access policy
ISSN 0009-7322
1524-4539
Publication date 2011-01-01
Year available 2011
Sub-type Article (original research)
DOI 10.1161/CIRCULATIONAHA.110.945345
Volume 123
Issue 1
Start page 70
End page 78
Total pages 9
Place of publication Baltimore, MD United States
Publisher Lippincott Williams and Wilkins
Collection year 2011
Language eng
Formatted abstract
Background-: The relative merits of left ventricular (LV) dyssynchrony, LV lead position, and myocardial scar to predict long-term outcome after cardiac resynchronization therapy remain unknown and were evaluated in the present study.

Methods and results-:
In 397 ischemic heart failure patients, 2-dimensional speckle tracking imaging was performed, with comprehensive assessment of LV radial dyssynchrony, identification of the segment with latest mechanical activation, and detection of myocardial scar in the segment where the LV lead was positioned. For LV dyssynchrony, a cutoff value of 130 milliseconds was used. Segments with <16.5% radial strain in the region of the LV pacing lead were considered to have extensive myocardial scar (>50% transmurality, validated in a subgroup with contrast-enhanced magnetic resonance imaging). The LV lead position was derived from chest X-ray. Long-term follow-up included all-cause mortality and hospitalizations for heart failure. Mean baseline LV radial dyssynchrony was 133±98 milliseconds. In 271 patients (68%), the LV lead was placed at the latest activated segment (concordant LV lead position), and the mean value of peak radial strain at the targeted segment was 18.9±12.6%. Larger LV radial dyssynchrony at baseline was an independent predictor of superior long-term survival (hazard ratio, 0.995; P≤0.001), whereas a discordant LV lead position (hazard ratio, 2.086; P≤0.001) and myocardial scar in the segment targeted by the LV lead (hazard ratio, 2.913; P<0.001) were independent predictors of worse outcome. Addition of these 3 parameters yielded incremental prognostic value over the combination of clinical parameters.

Conclusions-: Baseline LV radial dyssynchrony, discordant LV lead position, and myocardial scar in the region of the LV pacing lead were independent determinants of long-term prognosis in ischemic heart failure patients treated with cardiac resynchronization therapy. Larger baseline LV dyssynchrony predicted superior long-term survival, whereas discordant LV lead position and myocardial scar predicted worse outcome.
Keyword Defibrillation
Heart failure
Medical Imaging
Conduction Delay
Echocardiography
Mortality
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
Versions
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 111 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 143 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Mon, 15 Apr 2013, 09:55:47 EST by Dr Chin Tse Arnold Ng on behalf of Medicine - Princess Alexandra Hospital