Prognostic value of apical rocking and septal flash after cardiac resynchronization

Abstract

Introduction and objectivesApical rocking (ApR) and septal flash (SF) evaluated using echocardiography are mechanical consequences of left bundle branch block. Their presence is associated with effectiveness after cardiac resynchronization therapy (CRT) and better prognosis. The aim was to analyze the relationship between ApR and SF before CRT and the outcomes. MethodsRetrospective observational registry of 96 patients treated with CRT. ApR and SF were visually assessed by readers blinded to the CRT outcomes. The primary endpoint was a composite of all-cause death and heart failure hospitalization. ResultsApR or SF were present in 55% of the patients before CRT. At baseline, patients with ApR or SF were younger and had lower hemoglobin levels. The median follow-up was of 42 months. Composite endpoint incidence rate of the was 1.22 for 100 patients/year. The composite endpoint was significantly lower in the ApR or SF group as well as the heart failure hospitalization (17 vs 49%; P=.001). This group also improved the number of meters walked at the six-minute walking test (median [p25–p75] 61m (0–101) vs 6 (−11–37); P=.054) and the rate of CRT echocardiographic super-responders (26.5% vs 5.4%; P=.009). In multivariate analysis, the presence of Ap-Rock or SF (hazard ratio, 0.36; 95%CI, 0.15-0.86; P=.019), female sex, hemoglobin, and logarithm N-terminal pro B-type natriuretic peptide (logNT-proBNP) were associated with the composite endpoint. ConclusionsSF or ApR were present before the biventricular pacemaker implantation in more than half of the patients with CRT indication and were associated with lower all-cause mortality and heart failure hospitalization and improved functional status and left ventricle ejection fraction at follow-up.