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Assessment of mechanical dyssynchrony can improve the prognostic value of guideline-based patient selection for cardiac resynchronization therapy.

Authors :
Beela, Ahmed S
Ünlü, Serkan
Duchenne, Jürgen
Ciarka, Agnieszka
Daraban, Ana Maria
Kotrc, Martin
Aarones, Marit
Szulik, Mariola
Winter, Stefan
Penicka, Martin
Neskovic, Aleksandar N
Kukulski, Tomasz
Aakhus, Svend
Willems, Rik
Fehske, Wolfgang
Faber, Lothar
Stankovic, Ivan
Voigt, Jens-Uwe
Source :
European Heart Journal - Cardiovascular Imaging; Jan2019, Vol. 20 Issue 1, p66-74, 9p
Publication Year :
2019

Abstract

Aim To determine if incorporation of assessment of mechanical dyssynchrony could improve the prognostic value of patient selection based on current guidelines. Methods and results Echocardiography was performed in 1060 patients before and 12 ± 6 months after cardiac resynchronization therapy (CRT) implantation. Mechanical dyssynchrony, defined as the presence of apical rocking or septal flash was visually assessed at the baseline examination. Response was defined as ≥15% reduction in left ventricular end-systolic volume at follow-up. Patients were followed for a median of 59 months (interquartile range 37–86 months) for the occurrence of death of any cause. Applying the latest European guidelines retrospectively, 63.4% of the patients had been implanted with a Class I recommendation, 18.2% with Class IIa, 9.4% with Class IIb, and in 9% no clear therapy recommendation was present. Response rates were 65% in Class I, 50% in IIa, 38% in IIb patients, and 40% in patients without a clear guideline-based recommendation. Assessment of mechanical dyssynchrony improved response rates to 77% in Class I, 75% in IIa, 62% in IIb, and 69% in patients without a guideline-based recommendation. Non-significant difference in survival among guideline recommendation classes was found (Log-rank P  = 0.2). Presence of mechanical dyssynchrony predicted long-term outcome better than guideline Classes I, IIa, IIb (Log-rank P  <   0.0001, 0.006, 0.004, respectively) and in patients with no guideline recommendation (P  = 0.02). Comparable results were observed using the latest American Guidelines. Conclusion Our data suggest that current guideline criteria for CRT candidate selection could be improved by incorporating assessment of mechanical asynchrony. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
20472404
Volume :
20
Issue :
1
Database :
Complementary Index
Journal :
European Heart Journal - Cardiovascular Imaging
Publication Type :
Academic Journal
Accession number :
133779653
Full Text :
https://doi.org/10.1093/ehjci/jey029