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Myocardial constructive work is a predictor of long-term outcomes in patients with heart failure undergoing cardiac resynchronization therapy.

Session Poster Session 7

Speaker Elena Galli

Event : ESC Congress 2018

  • Topic : imaging
  • Sub-topic : Tissue Doppler, Speckle Tracking and Strain Imaging
  • Session type : Poster Session

Authors : E Galli (Rennes,FR), A Hubert (Rennes,FR), V Le Rolle (Rennes,FR), A Hernandez (Rennes,FR), O Smiseth (Oslo,NO), P Mabo (Rennes,FR), C Leclercq (Rennes,FR), E Donal (Rennes,FR)

Authors:
E. Galli1 , A. Hubert1 , V. Le Rolle2 , A. Hernandez2 , O. Smiseth3 , P. Mabo1 , C. Leclercq1 , E. Donal1 , 1University Hospital of Rennes, Cardiology - Rennes - France , 2University of Rennes, Laboratoire Traitement du Signal et de l'Image, INSERM U-1099 - Rennes - France , 3University of Oslo - Oslo - Norway ,

Citation:
European Heart Journal ( 2018 ) 39 ( Supplement ), 1371-1372

Background: Myocardial constructive work (CW) assessed by pressure strain loops (PSLs) is an independent predictor of cardiac resynchronization therapy response (CRT+).

Purpose of the study: To assess the role of CW in the prediction of long-term outcome in patients undergoing CRT.

Methods: 2D- and speckle-tracking echocardiography were performed in 166 CRT candidates (mean age: 66±10 years, males: 69%) before CRT implantation and at 6-month follow-up. Left-ventricular (LV) end-systolic volume reduction >15% at 6-month follow-up defined CRT+ and occurred in 48 (29%) patients.

Results: After a median 4-year FU (range: 1.3–5 years), all-cause death occurred in 28 patients (17%), cardiac death in 14 (8%). At Cox-regression analysis, CW emerged as an independent predictor of outcome (Table 1). A CW cut-off of 888 mmHg% (AUC 0.71, p=0.007 and AUC 0.67, p=0.004 for cardiac and all-cause mortality) was associated with an increased mortality risk (Figures 1, 2).

Conclusions: The estimation of LV-CW is a relatively novel tool, which allows the prediction of long-term outcome in CRT candidates.

Univariable analysisMultivariable analysis
Cardiac deathHR95% CIp-valueHR95% CIp-value
Age, per year1.08(1.01–1.15)0.021.07(1.00–1.15)0.04
Ischaemic disease3.99(1.34–11.94)0.012.33(0.71–1.15)0.16
NYHA >21.39(0.46–4.24)0.56
LBBB0.87(0.27–2.77)0.81
LVEF, per %0.99(0.92–1.08)0.89
Septal flash0.19(0.06–0.62)0.0060.48(0.12–1.95)0.30
CW, per mmHg%0.99(0.99–1.00)0.040.99(0.99–1.00)0.04
CRT-response0.26(0.09–0.78)0.020.68(0.18–2.57)0.58
All-cause death
  Age, per year1.05(1.01–1.09)0.011.06(1.01–1.10)0.01
  Ischaemic disease2.69(1.27–5.66)0.0091.94(0.86–4.39)0.11
  NYHA>21.86(0.80–4.30)0.15
  LBBB0.85(0.34–2.12)0.72
  LVEF, per %0.98(0.93–1.04)0.50
  Septal flash0.39(0.19–0.83)0.020.87(0.34–2.22)0.77
  CW, per mmHg%0.99(0.99–1.00)0.030.99(0.99–1.00)0.03
  CRT-response0.36(0.17–0.76)0.0070.24(0.24–1.43)0.59

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