Cardiac resynchronization therapy in patients with heart failure and narrow QRS complexes

Tayal, B. et al. (2018) Cardiac resynchronization therapy in patients with heart failure and narrow QRS complexes. Journal of the American College of Cardiology, 71(12), pp. 1325-1333. (doi: 10.1016/j.jacc.2018.01.042) (PMID:29566816)

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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).

Item Type:Articles
Keywords:Cardiac resynchronization therapy, dyssynchrony, echocardiography, heart failure, tissue Doppler imaging.
Glasgow Author(s) Enlighten ID:Robertson, Mrs Michele and Ford, Professor Ian
Authors: Tayal, B., Gorcsan, J., Bax, J. J., Risum, N., Olsen, N. T., Singh, J. P., Abraham, W. T., Borer, J. S., Dickstein, K., Gras, D., Krum, H., Brugada, J., Robertson, M., Ford, I., Holzmeister, J., Ruschitzka, F., and Sogaard, P.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
Journal Name:Journal of the American College of Cardiology
ISSN (Online):1558-3597
Published Online:19 March 2018
Copyright Holders:Copyright © 2018 American College of Cardiology Foundation
First Published:First published in Journal of the American College of Cardiology 71(12): 1325-1333
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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