Abstract 4340: Left Ventricular Dyssynchrony Measured by Speckle-Tracking Radial Strain Analysis Predicts Survival After Resynchronization Therapy

Abstract

Since the introduction of cardiac resynchronization therapy (CRT) in heart failure patients, many echocardiographic criteria, including left ventricular (LV) dyssynchrony, have been investigated in improving selection of suitable candidates. A novel method for the assessment of LV dyssynchrony is speckle-tracking radial strain analysis. Aim of this study was to investigate the impact of pre-implantation, speckle-tracking derived LV dyssynchrony on survival in patients treated with CRT A total of 537 consecutive patients undergoing CRT at our center were included. In all patients, speckle-tracking radial strain analysis was applied to standard LV short-axis images. Significant LV dyssynchrony was defined as a delay between the anteroseptal and posterior segments ≥130 ms. The primary endpoint was all-cause mortality Mean LV dyssynchrony in all 537 patients was 138±105 ms and 251 patients (47%) had predefined significant LV dyssynchrony ≥130 ms. For survival analysis, mean follow-up in the study population was 34±20 months. Within this period 145 patients (27%) died. Main cause of death remained heart failure (61% of all deaths). Multivariate Cox regression analysis with correction for age, gender, etiology, QRS duration, NYHA class, quality of life score, distance covered in the 6-minute walking test, LV volumes and LVEF, demonstrated a significant survival benefit for patients with significant LV dyssynchrony ≥130 ms (HR 0.63, 95% C.I. 0.43–0.92, p=0.017, Figure ). Presence of significant LV mechanical dyssynchrony, measured with speckle-tracking radial strain, is associated with improved survival probability after CRT