Dyssynchrony, contractile function, and response to cardiac resynchronization therapy

TY - JOUR

T1 - Dyssynchrony, contractile function, and response to cardiac resynchronization therapy

AU - Knappe, Dorit

AU - Pouleur, Anne-Catherine

AU - Shah, Amil M

AU - Cheng, Susan

AU - Uno, Hajime

AU - Hall, W Jackson

AU - Bourgoun, Mikhail

AU - Foster, Elyse

AU - Zareba, Wojciech

AU - Goldenberg, Ilan

AU - McNitt, Scott

AU - Pfeffer, Marc A

AU - Moss, Arthur J

AU - Solomon, Scott D

AU - Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy Investigators

PY - 2011/7

Y1 - 2011/7

N2 - BACKGROUND: Despite benefits of cardiac resynchronization therapy (CRT) in patients with severe but less symptomatic heart failure, approximately 30% of patients do not fully respond to treatment. We hypothesized that a combined assessment of left ventricular (LV) dyssynchrony and contractile function by strain-based imaging would identify patients who would most benefit from CRT.METHODS AND RESULTS: We studied 1077 patients with New York Heart Association class I/II, LV ejection fraction ≤30% and QRS width ≥130 ms enrolled in the Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy trial with sufficient echocardiographic image quality for cardiac deformation analysis (implantable cardioverter-defibrillator [ICD], n=416; CRT, n=661). Patients were assigned to CRT plus an ICD or to ICD alone in 3:2 random assignment. We assessed the degree to which baseline echocardiographic assessments of dyssynchrony, measured as the standard deviation of time-to-peak transverse strain over 12 segments, contractile function, measured as global longitudinal strain, or both predicted the effect of treatment on the primary outcome of death or heart failure. With 213 primary events occurring over a mean of 2.4 years, the benefit of CRT plus an ICD relative to ICD alone was greatest in patients with mild to moderate dyssynchrony (time-to-peak transverse strain standard deviation, 142 to 230 ms) and greater baseline contractile function (global longitudinal strain ≤-8.7%). Overall, those patients with mild to moderate dyssynchrony and those with best contractile function at baseline demonstrated the greatest benefit from CRT (adjusted hazards ratio, 0.20; 95% confidence interval, 0.09 to 0.44). Dyssynchrony and global longitudinal strain predicted response to CRT independent of each other, QRS width, LV ejection fraction, and presence versus absence of left bundle-branch block, although the observed benefit remained greatest in patients with left bundle-branch block.CONCLUSIONS: Both mechanical dyssynchrony and contractile function are important independent correlates of benefit from CRT.CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00180271.

AB - BACKGROUND: Despite benefits of cardiac resynchronization therapy (CRT) in patients with severe but less symptomatic heart failure, approximately 30% of patients do not fully respond to treatment. We hypothesized that a combined assessment of left ventricular (LV) dyssynchrony and contractile function by strain-based imaging would identify patients who would most benefit from CRT.METHODS AND RESULTS: We studied 1077 patients with New York Heart Association class I/II, LV ejection fraction ≤30% and QRS width ≥130 ms enrolled in the Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy trial with sufficient echocardiographic image quality for cardiac deformation analysis (implantable cardioverter-defibrillator [ICD], n=416; CRT, n=661). Patients were assigned to CRT plus an ICD or to ICD alone in 3:2 random assignment. We assessed the degree to which baseline echocardiographic assessments of dyssynchrony, measured as the standard deviation of time-to-peak transverse strain over 12 segments, contractile function, measured as global longitudinal strain, or both predicted the effect of treatment on the primary outcome of death or heart failure. With 213 primary events occurring over a mean of 2.4 years, the benefit of CRT plus an ICD relative to ICD alone was greatest in patients with mild to moderate dyssynchrony (time-to-peak transverse strain standard deviation, 142 to 230 ms) and greater baseline contractile function (global longitudinal strain ≤-8.7%). Overall, those patients with mild to moderate dyssynchrony and those with best contractile function at baseline demonstrated the greatest benefit from CRT (adjusted hazards ratio, 0.20; 95% confidence interval, 0.09 to 0.44). Dyssynchrony and global longitudinal strain predicted response to CRT independent of each other, QRS width, LV ejection fraction, and presence versus absence of left bundle-branch block, although the observed benefit remained greatest in patients with left bundle-branch block.CONCLUSIONS: Both mechanical dyssynchrony and contractile function are important independent correlates of benefit from CRT.CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00180271.

KW - Aged

KW - Canada

KW - Cardiac Resynchronization Therapy

KW - Defibrillators, Implantable

KW - Echocardiography

KW - Electrocardiography

KW - Europe

KW - Female

KW - Heart Failure/physiopathology

KW - Humans

KW - Male

KW - Middle Aged

KW - Myocardial Contraction/physiology

KW - Retrospective Studies

KW - Stroke Volume/physiology

KW - Treatment Outcome

KW - United States

KW - Ventricular Dysfunction, Left/physiopathology

U2 - 10.1161/CIRCHEARTFAILURE.111.962902

DO - 10.1161/CIRCHEARTFAILURE.111.962902

M3 - SCORING: Journal article

C2 - 21602574

VL - 4

SP - 433

EP - 440

JO - CIRC-HEART FAIL

JF - CIRC-HEART FAIL

SN - 1941-3289

IS - 4

ER -