Mechanical dyssynchrony, a novel marker to predict long-term survival in patients with cardiac resynchronization

Abstract

Abstract Background Cardiac resynchronization therapy (CRT) is an established therapy in patients with symptomatic heart failure with reduced left ventricular ejection fraction (LVEF <35%) (HFrEF) that have conduction disturbances as measured by prolonged QRS duration of >130 ms. Mechanical dyssynchrony (MD) in echocardiography has not proven benefit to determine CRT indication, but is hypothesized to be of predictive value. Both MD aspects of “apical rocking” (AR) but also “septal flash” (SF) have been shown to be a predictive value in short- and medium-term follow-up in CRT, but no trial has tested long-term effects yet. Purpose This study investigated the impact of AR and SF on long-term survival in CRT recipients. Methods and results 425 HFrEF patients (mean age: 63.0±10.6 years, 72.3% male, 60.7% non-ischemic etiology) with ESC guideline-derived CRT indication have been implanted and additionally investigated for MD markers at baseline as well as after a 11.5±8.0 months follow-up including long-term survival. Herein AR and/or SF were identified in 307 (72,2%) participants at baseline. During follow-up both AR and/or SF disappeared in 256 (83.4%) patients through CRT use. The overall mean survival was 95.9±52.9 months. Univariable analysis showed beneficial survival for women over men (109.1±52.4 vs. 90.9±52.4 months; p<0.001). Moreover, younger (<60 years) patients profit more than older patients (110.6±53.7 vs. 88.6±51.1 months; p<0.001). Interestingly, patients with MD markers at baseline generally had an improved overall survival (106.2±52.0 vs. 68.9±45.4 months; p<0.001), and in addition to that we found the best survival in patients with disappeared over persisting mechanical dyssynchrony echocardiography parameters in CRT (111.6±51.2 vs. 79.7±47.6 months p<0.001). Multivariate analysis shows age and presence of MD at baseline to be powerful predictors for long-term survival in CRT HFrEF patients (Figures 1 and 2). Conclusion Novel echocardiography MD parameters before CRT implantation predict long-term survival. Moreover, long-term survival even further improves when AR and/or SF disappear through CRT in HFrEF. Our results encourage a prospective, randomized, controlled, multicenter trial to study clinical implementation of MD in CRT patients. Funding Acknowledgement Type of funding sources: None.