Cardiac Resynchronization Therapy in Patients With Heart Failure and Narrow QRS Complexes

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:71

Article

Tayal, Bhupendar¹  Gorcsan, John, III²  Bax, Jeroen J.³  Risum, Niels⁴  Olsen, Niels Thue⁵  Singh, Jagmeet P.⁶  Abraham, William T.⁷  Borer, Jeffrey S.^8,9,10  Dickstein, Kenneth¹¹  Gras, Daniel¹²  Krum, Henry¹³  Brugada, Josep¹⁴  Robertson, Michele¹⁵  Ford, Ian¹⁵  Holzmeister, Johannes¹⁶  Ruschitzka, Frank¹⁶  Sogaard, Peter¹ 

[1] Aalborg Univ Hosp, Dept Cardiol, Aalborg, Denmark

[2] Washington Univ, St Louis, MO USA

[3] Leiden Univ, Med Ctr, Leiden, Netherlands

[4] Copenhagen Univ Hosp, Rigshosp, Copenhagen, Denmark

[5] Gentofte Univ Hosp, Copenhagen, Denmark

[6] Harvard Med Sch, Massachusetts Gen Hosp, Boston, MA USA

[7] Ohio State Univ, Med Ctr, Davis Heart & Lung Res Inst, Div Cardiovasc Med, Columbus, OH 43210 USA

[8] SUNY Downstate Coll Med, Div Cardiovasc Med, New York, NY USA

[9] SUNY Downstate Coll Med, Howard Gilman Inst, New York, NY USA

[10] SUNY Downstate Coll Med, Ronald & Jean Schiavone Inst, New York, NY USA

[11] Univ Bergen, Stavanger Univ Hosp, Stavanger, Norway

[12] Nouvelles Clin Nantaises, Nantes, France

[13] Monash Ctr Cardiovasc Res & Educ Therapeut, Melbourne, Vic, Australia

[14] Univ Barcelona, Thorax Inst, Hosp Clin, Cardiol Dept, Barcelona, Spain

[15] Univ Glasgow, Robertson Ctr Biostat, Glasgow, Lanark, Scotland

[16] Univ Heart Ctr Zurich, Dept Cardiol, Zurich, Switzerland

关键词: cardiac resynchronization therapy;    dyssynchrony;    echocardiography;    heart failure;    tissue Doppler imaging;   

DOI  :  10.1016/j.jacc.2018.01.042

来源: Elsevier

【 摘 要 】

BACKGROUND Cross correlation analysis (CCA) using tissue Doppler imaging has been shown to be associated with outcome after cardiac resynchronization therapy (CRT) in patients with heart failure (HF) with wide QRS. However, its significance in patients with narrow QRS treated with CRT is unknown. OBJECTIVES The aim of the current study was to investigate the association of mechanical activation delay by CCA with study outcome in patients with HF enrolled in the EchoCRT trial. METHODS Baseline CCA could be performed from tissue Doppler imaging in the apical views in 807 of 809 (99.7%) enrolled patients, and 6-month follow-up could be performed in 610 of 635 (96%) patients with available echocardiograms. Patients with a pre-specified maximal activation delay >= 35 ms were considered to have significant delay. The study outcome was HF hospitalization or death. RESULTS Of 807 patients, 375 (46%) did not have delayed mechanical activation at baseline by CCA. Patients without delayed mechanical activation who were randomized to CRT-On compared with CRT-Off had an increased risk of poor outcome (hazard ratio: 1.70; 95% confidence interval: 1.13 to 2.55; p = 0.01) with a significant interaction term (p = 0.04) between delayed mechanical activation and device randomization for the endpoint. Among patients with paired baseline and follow-up data with no events before 6-month follow-up (n = 541), new-onset delayed mechanical activation in the CRT-On group showed a significant increase in unfavorable events (hazard ratio: 3.73; 95% confidence interval: 1.15 to 12.14; p = 0.03). CONCLUSIONS In the EchoCRT population, absence of delayed mechanical activation by CCA was significantly associated with poor outcomes, possibly due to the onset of new delayed mechanical activation with CRT pacing. (Echocardiography Guided Cardiac Resynchronization Therapy [EchoCRT] Trial; NCT00683696) (c) 2018 by the American College of Cardiology Foundation.

【 授权许可】

Free