Better diastolic function in CRT candidates is associated with improved survival after CRT implantation

Abstract

The relationship between diastolic dysfunction (DD) and outcome after CRT is debated. The purpose of this study was to evaluate the role of DD in predicting all-cause mortality in heart failure patients undergoing CRT. One-hundred ninety-three patients (age: 67 ± 11 years, QRS width: 167 ± 21 ms, LVEF 28 ± 8%) were included in this multicentre prospective study. Mitral filling pattern, mitral tissue Doppler velocity, tricuspid regurgitation velocity, and indexed left atrial volume were used to classify DD from grade I to III according to the 2016 recommendations of the American Society of Echocardiography/European Association of Cardiovascular Imaging. A reduction of LV end-systolic volume > 15% at 6-month follow-up (FU) identified CRT-responders and was observed in 132 (68%) patients. During a median 35 months FU, 29 (15%) patients died. Through multivariable analysis, coronary artery disease [HR 2.21 (1.00–4.89) P = 0.05], NYHA [HR 2.92 (1.45–5.87), P = 0.003] and grade I DD [HR 0.34 (0.13–0.89)] were shown to be independent predictors of prognosis ( Table 1 ). Grade I DD was associated with a longer survival rate in both responders and non-responders ( Fig. 1 ). Non-responders with grade II-III DD had the worse outcome [HR 12.5 (3.56–44.04), P < 0.0001] Better diastolic function at baseline is associated with improved survival after CRT implantation, independently of CRT-response.