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Left ventricular dyssynchrony predicts response and prognosis after cardiac resynchronization therapy.
J Am Coll Cardiol. 2004 Nov 02; 44(9):1834-40.JACC

Abstract

OBJECTIVES

This study was designed to predict the response and prognosis after cardiac resynchronization therapy (CRT) in patients with end-stage heart failure (HF).

BACKGROUND

Cardiac resynchronization therapy improves HF symptoms, exercise capacity, and left ventricular (LV) function. Because not all patients respond, preimplantation identification of responders is needed. In the present study, response to CRT was predicted by the presence of LV dyssynchrony assessed by tissue Doppler imaging. Moreover, the prognostic value of LV dyssynchrony in patients undergoing CRT was assessed.

METHODS

Eighty-five patients with end-stage HF, QRS duration >120 ms, and left bundle-branch block were evaluated by tissue Doppler imaging before CRT. At baseline and six months follow-up, New York Heart Association functional class, quality of life and 6-min walking distance, LV volumes, and LV ejection fraction were determined. Events (death, hospitalization for decompensated HF) were obtained during one-year follow-up.

RESULTS

Responders (74%) and nonresponders (26%) had comparable baseline characteristics, except for a larger dyssynchrony in responders (87 +/- 49 ms vs. 35 +/- 20 ms, p < 0.01). Receiver-operator characteristic curve analysis demonstrated that an optimal cutoff value of 65 ms for LV dyssynchrony yielded a sensitivity and specificity of 80% to predict clinical improvement and of 92% to predict LV reverse remodeling. Patients with dyssynchrony >/=65 ms had an excellent prognosis (6% event rate) after CRT as compared with a 50% event rate in patients with dyssynchrony <65 ms (p < 0.001).

CONCLUSIONS

Patients with LV dyssynchrony >/=65 ms respond to CRT and have an excellent prognosis after CRT.

Authors+Show Affiliations

Leiden University Medical Center, Leiden, The Netherlands. jbax@knoware.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

15519016

Citation

Bax, Jeroen J., et al. "Left Ventricular Dyssynchrony Predicts Response and Prognosis After Cardiac Resynchronization Therapy." Journal of the American College of Cardiology, vol. 44, no. 9, 2004, pp. 1834-40.
Bax JJ, Bleeker GB, Marwick TH, et al. Left ventricular dyssynchrony predicts response and prognosis after cardiac resynchronization therapy. J Am Coll Cardiol. 2004;44(9):1834-40.
Bax, J. J., Bleeker, G. B., Marwick, T. H., Molhoek, S. G., Boersma, E., Steendijk, P., van der Wall, E. E., & Schalij, M. J. (2004). Left ventricular dyssynchrony predicts response and prognosis after cardiac resynchronization therapy. Journal of the American College of Cardiology, 44(9), 1834-40.
Bax JJ, et al. Left Ventricular Dyssynchrony Predicts Response and Prognosis After Cardiac Resynchronization Therapy. J Am Coll Cardiol. 2004 Nov 2;44(9):1834-40. PubMed PMID: 15519016.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Left ventricular dyssynchrony predicts response and prognosis after cardiac resynchronization therapy. AU - Bax,Jeroen J, AU - Bleeker,Gabe B, AU - Marwick,Thomas H, AU - Molhoek,Sander G, AU - Boersma,Eric, AU - Steendijk,Paul, AU - van der Wall,Ernst E, AU - Schalij,Martin J, PY - 2004/02/06/received PY - 2004/08/02/revised PY - 2004/08/03/accepted PY - 2004/11/3/pubmed PY - 2005/1/19/medline PY - 2004/11/3/entrez SP - 1834 EP - 40 JF - Journal of the American College of Cardiology JO - J. Am. Coll. Cardiol. VL - 44 IS - 9 N2 - OBJECTIVES: This study was designed to predict the response and prognosis after cardiac resynchronization therapy (CRT) in patients with end-stage heart failure (HF). BACKGROUND: Cardiac resynchronization therapy improves HF symptoms, exercise capacity, and left ventricular (LV) function. Because not all patients respond, preimplantation identification of responders is needed. In the present study, response to CRT was predicted by the presence of LV dyssynchrony assessed by tissue Doppler imaging. Moreover, the prognostic value of LV dyssynchrony in patients undergoing CRT was assessed. METHODS: Eighty-five patients with end-stage HF, QRS duration >120 ms, and left bundle-branch block were evaluated by tissue Doppler imaging before CRT. At baseline and six months follow-up, New York Heart Association functional class, quality of life and 6-min walking distance, LV volumes, and LV ejection fraction were determined. Events (death, hospitalization for decompensated HF) were obtained during one-year follow-up. RESULTS: Responders (74%) and nonresponders (26%) had comparable baseline characteristics, except for a larger dyssynchrony in responders (87 +/- 49 ms vs. 35 +/- 20 ms, p < 0.01). Receiver-operator characteristic curve analysis demonstrated that an optimal cutoff value of 65 ms for LV dyssynchrony yielded a sensitivity and specificity of 80% to predict clinical improvement and of 92% to predict LV reverse remodeling. Patients with dyssynchrony >/=65 ms had an excellent prognosis (6% event rate) after CRT as compared with a 50% event rate in patients with dyssynchrony <65 ms (p < 0.001). CONCLUSIONS: Patients with LV dyssynchrony >/=65 ms respond to CRT and have an excellent prognosis after CRT. SN - 0735-1097 UR - https://www.unboundmedicine.com/medline/citation/15519016/Left_ventricular_dyssynchrony_predicts_response_and_prognosis_after_cardiac_resynchronization_therapy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(04)01631-6 DB - PRIME DP - Unbound Medicine ER -