The association of volumetric response and long-term survival after cardiac resynchronization therapy

Aims Clinical experience indicates that limited or no reverse left ventricular (LV) remodelling may not necessarily imply non-response to cardiac resynchronization therapy (CRT). We investigated the association of the extent of LV remodelling, mechanical dyssynchrony, and survival in patients undergoing CRT. Methods and results In 356 CRT candidates, three blinded readers visually assessed the presence of mechanical dyssynchrony (either apical rocking and/or septal flash) before device implantation and also its correction by CRT 12 ± 3 months post-implantation. To assess LV reverse remodelling, end-systolic volumes (ESV) were measured at the same time points. Patients were divided into four subgroups: no LV remodelling (ESV change 0 ± 5%), mild LV reverse remodelling (ESV reduction 5-15%), significant LV reverse remodelling (ESV reduction ≥15%), and LV volume expansion (ESV increase ≥5%). Patients were followed for all-cause mortality during the median follow-up of 36 months. Patients with LV remodelling as in the above defined groups showed 58, 54, and 84% reduction in all-cause mortality compared to patients with volume expansion. In multivariable analysis, LVESV change remained independently associated with survival, with an 8% reduction in mortality for every 10% decrease in LVESV (P = 0.0039), but an optimal cut-off point could not be established. In comparison, patients with corrected mechanical dyssynchrony showed 71% reduction in all-cause mortality (P < 0.001). Conclusion Volumetric response assessed at 1-year after CRT is strongly associated with long-term mortality. However, an optimal cut-off cannot be established. The association of the correction of mechanical dyssynchrony with survival was stronger than that of any volumetric cut-off.

[1]  V. Kittipibul,et al.  Giant triple coronary artery aneurysms. , 2017, European heart journal cardiovascular Imaging.

[2]  Jens-Uwe Voigt,et al.  Relationship of visually assessed apical rocking and septal flash to response and long-term survival following cardiac resynchronization therapy (PREDICT-CRT). , 2016, European heart journal cardiovascular Imaging.

[3]  T. Edvardsen,et al.  Left ventricular markers of mortality and ventricular arrhythmias in heart failure patients with cardiac resynchronization therapy , 2015, European heart journal cardiovascular Imaging.

[4]  Jeroen J. Bax,et al.  Association of persistent or worsened echocardiographic dyssynchrony with unfavourable clinical outcomes in heart failure patients with narrow QRS width: a subgroup analysis of the EchoCRT trial. , 2016, European heart journal.

[5]  A. Bank,et al.  Long-Term Echocardiographic Response to Cardiac Resynchronization Therapy in Initial Nonresponders. , 2015, JACC. Heart failure.

[6]  M. Gold,et al.  The effect of reverse remodeling on long-term survival in mildly symptomatic patients with heart failure receiving cardiac resynchronization therapy: results of the REVERSE study. , 2015, Heart rhythm.

[7]  Lluís Mont,et al.  Mechanical abnormalities detected with conventional echocardiography are associated with response and midterm survival in CRT. , 2014, JACC. Cardiovascular imaging.

[8]  J. Nielsen,et al.  ESC Guidelines on cardiac pacing and cardiac resynchronization therapy , 2014 .

[9]  Jens-Uwe Voigt,et al.  Dynamic relationship of left-ventricular dyssynchrony and contractile reserve in patients undergoing cardiac resynchronization therapy. , 2014, European heart journal.

[10]  Lluís Mont,et al.  2013 ESC guidelines on cardiac pacing and cardiac resynchronization therapy: the task force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). , 2013, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[11]  Lluís Mont,et al.  2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). , 2013, European heart journal.

[12]  Mark A Hlatky,et al.  2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. , 2013, Circulation.

[13]  Michel G Khouri,et al.  Mechanical dyssynchrony evaluated by tissue Doppler cross-correlation analysis is associated with long-term survival in patients after cardiac resynchronization therapy. , 2013, European heart journal.

[14]  David Begley,et al.  Targeted left ventricular lead placement to guide cardiac resynchronization therapy: the TARGET study: a randomized, controlled trial. , 2012, Journal of the American College of Cardiology.

[15]  Eric Boersma,et al.  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 , 2011, Circulation.

[16]  J. Gorcsan.  Finding pieces of the puzzle of nonresponse to cardiac resynchronization therapy. , 2011, Circulation.

[17]  John Gorcsan,et al.  Echocardiography, dyssynchrony, and the response to cardiac resynchronization therapy. , 2010, European heart journal.

[18]  S. Solomon,et al.  Effect of Cardiac Resynchronization Therapy on Reverse Remodeling and Relation to Outcome: Multicenter Automatic Defibrillator Implantation Trial: Cardiac Resynchronization Therapy , 2010, Circulation.

[19]  F. Rademakers,et al.  Assessment of apical rocking: a new, integrative approach for selection of candidates for cardiac resynchronization therapy. , 2010, European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology.

[20]  Brandon K. Fornwalt,et al.  Agreement Is Poor Among Current Criteria Used to Define Response to Cardiac Resynchronization Therapy , 2010, Circulation.

[21]  M. Cheitlin.  Persistent Hemodynamic Benefits of Cardiac Resynchronization Therapy With Disease Progression in Advanced Heart Failure , 2010 .

[22]  J. McMurray,et al.  Selecting patients for cardiac resynchronization therapy: the fallacy of echocardiographic dyssynchrony. , 2009, Journal of the American College of Cardiology.

[23]  Piet Claus,et al.  Toward understanding response to cardiac resynchronization therapy: left ventricular dyssynchrony is only one of multiple mechanisms. , 2009, European heart journal.

[24]  F. Rademakers,et al.  Apical transverse motion as surrogate parameter to determine regional left ventricular function inhomogeneities: a new, integrative approach to left ventricular asynchrony assessment. , 2008, European heart journal.

[25]  Jeroen J. Bax,et al.  Results of the Predictors of Response to CRT (PROSPECT) Trial , 2008, Circulation.

[26]  Maxime Cannesson,et al.  Novel Speckle-Tracking Radial Strain From Routine Black-and-White Echocardiographic Images to Quantify Dyssynchrony and Predict Response to Cardiac Resynchronization Therapy , 2006, Circulation.

[27]  Jeroen J. Bax,et al.  Clinical versus echocardiographic parameters to assess response to cardiac resynchronization therapy. , 2006, The American journal of cardiology.

[28]  Jeroen J. Bax,et al.  Left Ventricular Reverse Remodeling but Not Clinical Improvement Predicts Long-Term Survival After Cardiac Resynchronization Therapy , 2005, Circulation.

[29]  Jeroen J. Bax,et al.  Left ventricular dyssynchrony predicts response and prognosis after cardiac resynchronization therapy. , 2004, Journal of the American College of Cardiology.

[30]  E Graf,et al.  Assessment and comparison of prognostic classification schemes for survival data. , 1999, Statistics in medicine.

[31]  K. Adams,et al.  Carvedilol produces dose-related improvements in left ventricular function and survival in subjects with chronic heart failure. MOCHA Investigators. , 1996, Circulation.

[32]  M. Kronenberg,et al.  Effects of the angiotensin converting enzyme inhibitor enalapril on the long-term progression of left ventricular dilatation in patients with asymptomatic systolic dysfunction. SOLVD (Studies of Left Ventricular Dysfunction) Investigators. , 1993, Circulation.

[33]  S. Yusuf,et al.  Effects of the Angiotensin Converting Enzyme Inhibitor Enalapril on the Long‐term Progression of Left Ventricular Dilatation in Patients With Asymptomatic Systolic Dysfunction , 1993, Circulation.

[34]  H. Akaike.  A new look at the statistical model identification , 1974 .