Association of persistent or worsened echocardiographic dyssynchrony with unfavourable clinical outcomes in heart failure patients with narrow QRS width: a subgroup analysis of the EchoCRT trial

被引:39
作者
Gorcsan, John, III [1 ]
Sogaard, Peter [2 ]
Bax, Jeroen J. [3 ]
Singh, Jagmeet P. [4 ]
Abrahams, William T. [5 ]
Borer, Jeffrey S. [6 ,7 ,8 ]
Dickstein, Kenneth [9 ]
Gras, Daniel [10 ]
Krum, Henry [11 ]
Brugada, Josep [12 ]
Robertson, Michele [13 ]
Ford, Ian [13 ]
Holzmeister, Johannes [14 ]
Ruschitzka, Frank [14 ]
机构
[1] Univ Pittsburgh, Scaife 564,200 Lothrop St, Pittsburgh, PA 15213 USA
[2] Aalborg Univ, Aalborg, Denmark
[3] Leiden Univ, Med Ctr, Leiden, Netherlands
[4] Harvard Univ, Massachusetts Gen Hosp, Sch Med, Boston, MA USA
[5] Ohio State Univ, Davis Heart & Lung Res Inst, Div Cardiovasc Med, Columbus, OH 43210 USA
[6] SUNY Downstate Coll Med, Dept Cardiol, Div Cardiovasc Med, Brooklyn, NY USA
[7] SUNY Downstate Coll Med, Howard Gilmanand Ron Inst, Brooklyn, NY USA
[8] SUNY Downstate Coll Med, Jean Schiavone Inst, Brooklyn, NY USA
[9] Univ Bergen, Stavanger Univ Hosp, Stavanger, Norway
[10] Nouvelles Clin Nantaises, Nantes, France
[11] Monash Ctr Cardiovasc Res & Educ Therapeut, Melbourne, Vic, Australia
[12] Univ Barcelona, Dept Cardiol, Thorax Inst, Hosp Clin, Barcelona, Spain
[13] Univ Glasgow, Robertson Ctr Biostat, Glasgow, Lanark, Scotland
[14] Univ Heart Ctr Zurich, Dept Cardiol, Zurich, Switzerland
关键词
Heart failure; Echocardiography; Cardiac resynchronization therapy; CARDIAC-RESYNCHRONIZATION THERAPY; LEFT-VENTRICULAR DYSSYNCHRONY; LONG-TERM SURVIVAL; MECHANICAL DYSSYNCHRONY; STRAIN; ARRHYTHMIAS; PERFORMANCE; ASYNCHRONY; COMPLEXES; RISK;
D O I
10.1093/eurheartj/ehv418
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims EchoCRTwas a randomized trial of cardiac resynchronization therapy (CRT) in severely symptomatic heart failure (HF) patients with narrow QRS width <130 ms, ejection fraction <= 35%, and echocardiographic dyssynchrony. All received CRT implants which were then randomized to CRT-On or CRT-Off. While the trial showed no benefit of CRT to these patients, the aim of this subgroup analysis was to test the hypothesis that persistent or worsening dyssynchrony is associated with unfavourable clinical outcomes. Methods and results We studied 614 EchoCRT patients with baseline and 6-month echocardiograms. Baseline dyssynchrony required for study inclusion was either tissue Doppler imaging longitudinal velocity delay >= 80 ms or speckle-tracking radial strain delay >= 130 ms. Persistent dyssynchrony at 6 months was observed similarly in both groups (77% in CRT-On; 76% in CRT-Off). Persistent dyssynchrony was associated with a significantly higher primary end point of death or HF hospitalization (HR = 1.54, 95% CI 1.03-2.30, P = 0.03), and in particular secondary endpoint of HF hospitalization (HR = 1.66, 95% CI 1.07-2.57, P = 0.02). HF hospitalizations were also associated with worsening longitudinal dyssynchrony (HR = 1.45, 95% CI 1.02-2.05, P = 0.037), and worsening radial dyssynchrony (HR = 1.81, 95% CI 1.16-2.81, P = 0.008). Associations of persistent or worsening dyssynchrony with outcomes were similar in CRT-Off and CRTOn groups. Conclusions Persistent or worsening echocardiographic dyssynchrony in HF patients with narrow QRS width was a marker for unfavourable clinical outcomes unaffected by CRT. In particular, echocardiographic dyssynchrony on follow-up was strongly associated with HF hospitalizations and appears to be a prognostic marker of disease severity.
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收藏
页码:49 / 59
页数:11
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