Dyssynchrony and the Risk of Ventricular Arrhythmias

JACC-CARDIOVASCULAR IMAGING

卷:6

Article

Kutyifa, Valentina^1,2  Pouleur, Anne-Catherine³  Knappe, Dorit³  Al-Ahmad, Amin⁴  Gibinski, Michal⁵  Wang, Paul J.⁴  McNitt, Scott¹  Merkely, Bela²  Goldenberg, Ilan¹  Solomon, Scott D.³  Moss, Arthur J.¹  Zareba, Wojciech¹ 

[1] Univ Rochester, Med Ctr, Rochester, NY 14642 USA

[2] Semmelweis Univ, Ctr Heart, Budapest, Hungary

[3] Brigham & Womens Hosp, Div Cardiovasc, Boston, MA 02115 USA

[4] Stanford Univ, Stanford, CA 94305 USA

[5] Samodzielny Publ Szpital Klin 7, Katowice, Poland

关键词: cardiac resynchronization therapy;    heart failure;    implantable cardioverter-defibrillator;    ventricular arrhythmia;    ventricular dyssynchrony;   

DOI  :  10.1016/j.jcmg.2012.12.008

来源: Elsevier

【 摘 要 】

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. (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy [MADIT-CRT]; NCT00180271) (J Am Coll Cardiol Img 2013;6:432-44) (C) 2013 by the American College of Cardiology Foundation

【 授权许可】

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