B-PO02-189 TIME DELAY TO PEAK LEFT VENTRICULAR PRESSURE RISE IDENTIFIES THE SUBSTRATE FOR DYSSYNCHRONOUS HEART FAILURE AND DETECTS DISEASE MODIFICATION WITH RESYNCHRONIZATION - AN OBSERVATIONAL CLINICAL STUDY

Abstract

Listen

Translate article

Identification of disease modification prior to implantation of Cardiac Resynchronization Therapy may help to increase responder-rates and promote the utilization of CRT. To test the ability of time-to-peak left ventricular pressure rise (Td) with CRT to predict long-term volumetric response (ESV decrease >15%). Forty-five heart failure patients admitted for CRT implantation were included in the study. Td was measured from onset QRS at baseline and from onset of pacing with CRT. Baseline characteristics were mean age 63±10 years, 71% males, NYHA class 2.5, 87% LBBB, QRS duration 173±15ms, EF biplane 31±1%, ESV 144±12mL and end-diastolic volume 2044±14mL. At 6-months follow-up six patients increased ESV by 5±8%, while 37 responders (85%) had a mean ESV decrease of 40±2%. Responders presented with a higher Td at baseline compared to non-responders (163±4ms vs 119±9ms, p<0.01). Td decreased to 156±4ms (p=0.02) with CRT in responders, while in non-responders Td increased to 147±10ms (p<0.01) with CRT. A decrease in Td of less than +3.5ms from baseline accurately identified responders to therapy (AUC 0.98, p<0.01, sensitivity 97%, specificity 100%). AUC was 0.92 for baseline Td and a cut-off at 120ms yielded a sensitivity of 100% and specificity of 80% to identify volumetric responders. A linear relationship between the change in Td from baseline and ESV decrease on long term was found (β=-61, R=0.58, P<0.01). Td at baseline and the shortening of Td with CRT accurately identifies responders to CRT, with incremental value on top of current guidelines. Td carries the potential to become the marker for prediction of long-term volumetric with CRT.