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PERSISTENCE OF MECHANICAL DYSSYNCHRONY AFTER CARDIAC RESYNCHRONIZATION THERAPY IS ASSOCIATED WITH ADVERSE LONG TERM OUTCOME IN EJECTION FRACTION RESPONDERS
E1113 JACC March 27, 2012 Volume 59, Issue 13
Imaging PERSISTENCE OF MECHANICAL DYSSYNCHRONY AFTER CARDIAC RESYNCHRONIZATION THERAPY IS ASSOCIATED WITH ADVERSE LONG TERM OUTCOME IN EJECTION FRACTION RESPONDERS ACC Moderated Poster Contributions McCormick Place South, Hall A Saturday, March 24, 2012, 9:30 a.m.-10:30 a.m.
Session Title: Imaging: Echo Dyssynchrony Abstract Category: 22. Imaging: Echo Presentation Number: 1093-101 Authors: Josef Marek, Mohamed Ahmed, Tetsuari Onishi, Toshinari Onishi, Samir Saba, Evan Adelstein, John Gorcsan, University of Pittsburgh, Pittsburgh, PA, USA Background: Baseline left ventricular (LV) dyssynchrony is associated with long term outcome after cardiac resynchronization therapy (CRT). However, the relevance of persistence of dyssynchrony after CRT remains unclear. Methods: We hypothesized that persistence of mechanical dyssynchrony after CRT was associated with unfavorable outcome. We studied 90 consecutive CRT patients (pts) with quantitative echo before and 6 months after CRT. Ejection fractions (EF) and dyssynchrony by speckle tracking radial strain septal to posterior wall (AS-P) delay were assessed. EF responders were defined as increases in > 5% EF units at 6 mos. Long-term outcome events were pre-defined as death, heart transplant or left ventricular assist device (LVAD). Results: Of 90 pts at baseline, 5 had inadequate echocardiograms and 2 died before 6 months leaving 83 pts; 65% who were EF responders and 35% who were EF non-responders. Long term events over 4 years were 16 deaths, 3 transplants and 2 LVADs. Long-term event rate was 22% in EF responders and 31% in EF non-responders. Even in EF responders, the persistence of radial dyssynchrony > 110 ms was associated with significantly less favorable long term event-free survival, in contrast to pts who were resynchronized (p = 0.0019). Conclusion: Persistence of mechanical dyssynchrony 6 months after CRT was associated with unfavorable long term outcome even though pts were initial EF responders. These observations may have mechanistic and clinical implications.
Imaging PERSISTENCE OF MECHANICAL DYSSYNCHRONY AFTER CARDIAC RESYNCHRONIZATION THERAPY IS ASSOCIATED WITH ADVERSE LONG TERM OUTCOME IN EJECTION FRACTION RESPONDERS ACC Moderated Poster Contributions McCormick Place South, Hall A Saturday, March 24, 2012, 9:30 a.m.-10:30 a.m.
Session Title: Imaging: Echo Dyssynchrony Abstract Category: 22. Imaging: Echo Presentation Number: 1093-101 Authors: Josef Marek, Mohamed Ahmed, Tetsuari Onishi, Toshinari Onishi, Samir Saba, Evan Adelstein, John Gorcsan, University of Pittsburgh, Pittsburgh, PA, USA Background: Baseline left ventricular (LV) dyssynchrony is associated with long term outcome after cardiac resynchronization therapy (CRT). However, the relevance of persistence of dyssynchrony after CRT remains unclear. Methods: We hypothesized that persistence of mechanical dyssynchrony after CRT was associated with unfavorable outcome. We studied 90 consecutive CRT patients (pts) with quantitative echo before and 6 months after CRT. Ejection fractions (EF) and dyssynchrony by speckle tracking radial strain septal to posterior wall (AS-P) delay were assessed. EF responders were defined as increases in > 5% EF units at 6 mos. Long-term outcome events were pre-defined as death, heart transplant or left ventricular assist device (LVAD). Results: Of 90 pts at baseline, 5 had inadequate echocardiograms and 2 died before 6 months leaving 83 pts; 65% who were EF responders and 35% who were EF non-responders. Long term events over 4 years were 16 deaths, 3 transplants and 2 LVADs. Long-term event rate was 22% in EF responders and 31% in EF non-responders. Even in EF responders, the persistence of radial dyssynchrony > 110 ms was associated with significantly less favorable long term event-free survival, in contrast to pts who were resynchronized (p = 0.0019). Conclusion: Persistence of mechanical dyssynchrony 6 months after CRT was associated with unfavorable long term outcome even though pts were initial EF responders. These observations may have mechanistic and clinical implications.