Dyssynchrony and the risk of ventricular arrhythmias
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Dyssynchrony and the risk of ventricular arrhythmias. / Kutyifa, Valentina; Pouleur, Anne-Catherine; Knappe, Dorit; Al-Ahmad, Amin; Gibinski, Michal; Wang, Paul J; McNitt, Scott; Merkely, Bela; Goldenberg, Ilan; Solomon, Scott D; Moss, Arthur J; Zareba, Wojciech.
In: JACC-CARDIOVASC IMAG, Vol. 6, No. 4, 04.2013, p. 432-444.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Dyssynchrony and the risk of ventricular arrhythmias
AU - Kutyifa, Valentina
AU - Pouleur, Anne-Catherine
AU - Knappe, Dorit
AU - Al-Ahmad, Amin
AU - Gibinski, Michal
AU - Wang, Paul J
AU - McNitt, Scott
AU - Merkely, Bela
AU - Goldenberg, Ilan
AU - Solomon, Scott D
AU - Moss, Arthur J
AU - Zareba, Wojciech
N1 - Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
PY - 2013/4
Y1 - 2013/4
N2 - OBJECTIVES: The aim of our study was to evaluate the relationship between left ventricular (LV) dyssynchrony and the risk of ventricular tachycardia (VT) or ventricular fibrillation (VF) in patients enrolled in the MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy) trial.BACKGROUND: Intraventricular mechanical dyssynchrony might be an important factor in ventricular arrhythmogenesis by enhancing electrical heterogeneity in heart failure patients. The effects of dyssynchrony have not yet been evaluated in a large cohort of implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy with defibrillator (CRT-D) patients.METHODS: LV dyssynchrony was measured at baseline and at 12-months by speckle-tracking echocardiography, defined as the standard deviation of time to peak systolic strain in 12 LV myocardial segments. The endpoint was the first VT/VF/death or VT/VF. LV dyssynchrony was evaluated in 764 left bundle branch block (LBBB) patients and in 312 non-LBBB patients.RESULTS: Baseline LV dyssynchrony was not predictive of VT/VF/death or VT/VF in LBBB or non-LBBB patients in either treatment arm. In CRT-D patients with LBBB, improvement in LV dyssynchrony over a year was associated with significantly lower incidence of VT/VF/death (p < 0.001) and VT/VF (p < 0.001) compared to ICD patients and to CRT-D patients with unchanged or worsening dyssynchrony. Among LBBB patients, 15% decrease in LV dyssynchrony was associated with lower risk of VT/VF/death (hazard ratio: 0.49, 95% confidence interval: 0.24 to 0.99, p = 0.049) and VT/VF (hazard ratio: 0.30, 95% confidence interval: 0.12 to 0.77, p = 0.009) as compared to ICD patients. Patients without LBBB receiving CRT-D did not show reduction in VT/VF/death or in VT/VF in relation to improving dyssynchrony when evaluating cumulative event rates or risk of events.CONCLUSIONS: Baseline LV dyssynchrony did not predict VT/VF/death or VT/VF in mild heart failure patients with or without LBBB. CRT-induced improvement of LV dyssynchrony was associated with significant reduction of ventricular arrhythmias in patients with LBBB.
AB - OBJECTIVES: The aim of our study was to evaluate the relationship between left ventricular (LV) dyssynchrony and the risk of ventricular tachycardia (VT) or ventricular fibrillation (VF) in patients enrolled in the MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy) trial.BACKGROUND: Intraventricular mechanical dyssynchrony might be an important factor in ventricular arrhythmogenesis by enhancing electrical heterogeneity in heart failure patients. The effects of dyssynchrony have not yet been evaluated in a large cohort of implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy with defibrillator (CRT-D) patients.METHODS: LV dyssynchrony was measured at baseline and at 12-months by speckle-tracking echocardiography, defined as the standard deviation of time to peak systolic strain in 12 LV myocardial segments. The endpoint was the first VT/VF/death or VT/VF. LV dyssynchrony was evaluated in 764 left bundle branch block (LBBB) patients and in 312 non-LBBB patients.RESULTS: Baseline LV dyssynchrony was not predictive of VT/VF/death or VT/VF in LBBB or non-LBBB patients in either treatment arm. In CRT-D patients with LBBB, improvement in LV dyssynchrony over a year was associated with significantly lower incidence of VT/VF/death (p < 0.001) and VT/VF (p < 0.001) compared to ICD patients and to CRT-D patients with unchanged or worsening dyssynchrony. Among LBBB patients, 15% decrease in LV dyssynchrony was associated with lower risk of VT/VF/death (hazard ratio: 0.49, 95% confidence interval: 0.24 to 0.99, p = 0.049) and VT/VF (hazard ratio: 0.30, 95% confidence interval: 0.12 to 0.77, p = 0.009) as compared to ICD patients. Patients without LBBB receiving CRT-D did not show reduction in VT/VF/death or in VT/VF in relation to improving dyssynchrony when evaluating cumulative event rates or risk of events.CONCLUSIONS: Baseline LV dyssynchrony did not predict VT/VF/death or VT/VF in mild heart failure patients with or without LBBB. CRT-induced improvement of LV dyssynchrony was associated with significant reduction of ventricular arrhythmias in patients with LBBB.
KW - Aged
KW - Bundle-Branch Block/etiology
KW - Canada
KW - Cardiac Resynchronization Therapy
KW - Cardiac Resynchronization Therapy Devices
KW - Chi-Square Distribution
KW - Defibrillators, Implantable
KW - Electric Countershock/instrumentation
KW - Europe
KW - Female
KW - Heart Failure/etiology
KW - Humans
KW - Kaplan-Meier Estimate
KW - Male
KW - Middle Aged
KW - Multivariate Analysis
KW - Proportional Hazards Models
KW - Prospective Studies
KW - Risk Assessment
KW - Risk Factors
KW - Tachycardia, Ventricular/etiology
KW - Time Factors
KW - Treatment Outcome
KW - Ultrasonography
KW - United States
KW - Ventricular Dysfunction, Left/complications
KW - Ventricular Fibrillation/etiology
KW - Ventricular Function, Left
U2 - 10.1016/j.jcmg.2012.12.008
DO - 10.1016/j.jcmg.2012.12.008
M3 - SCORING: Journal article
C2 - 23579010
VL - 6
SP - 432
EP - 444
JO - JACC-CARDIOVASC IMAG
JF - JACC-CARDIOVASC IMAG
SN - 1936-878X
IS - 4
ER -