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Myocardial constructive work is additive to volumetric response to cardiac resynchronization therapy in the prediction of mortality after CRT implantation

Session Prognostic impact of deformation imaging

Speaker Elena Galli

Event : ESC Congress 2018

  • Topic : imaging
  • Sub-topic : Echocardiography: Systolic and Diastolic Function
  • Session type : Rapid Fire Abstracts

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. Hernandez3 , O. Smiseth4 , 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 , 3INSERM, Laboratoire du traitement du Signal et de l'Image - RENNES - France , 4University of Oslo - Oslo - Norway ,

Citation:
European Heart Journal ( 2018 ) 39 ( Supplement ), 1030

Background: Recent studies have shown that myocardial constructive work (CW) is an independent predictor of the volumetric response to cardiac resynchronization therapy (CRT).

Purpose of the study: To assess if CW is additive to volumetric CRT-response in the prediction of cardiac mortality in CRT-candidates.

Methods: 2D-standard 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) CW was assessed by pressure-strain loops (PSLs). A reduction in LV end-systolic volume >15% at 6-month follow-up defined CRT-volumetric response and was observed in 48 (29%) patients.

Results: After a median 4-year FU (range: 1.3–5 years), cardiac death occurred in 14 patients (8%). CW and age were the only prognostic predictors of cardiac death (Table 1), independently from septal flash and CRT-volumetric response. At ROC curve analysis, CW≤888 mmHg% was the best cut-off to predict cardiac mortality (AUC 0.71, p=0.007). Among CRT responders, the presence of CW≤888 mmHg was associated with a dismal prognosis (log-rank test p=0.04). The concomitance of CW≤888 mmHg and absence of volumetric response to CRT identified patients with the worst prognosis (log-rank test p=0.001) (Figure 1)

Conclusions: Left ventricular CW allows the prediction of cardiac death in CRT candidates. A CW≤888 mmHg is associated with a increased cardiac mortality in both CRT responders and non-responders.

Table 1
Predictors of cardiac deathUnivariable analysisMultivariable analysis
HR95% CIp-valueHR95% CIp-value
Age, per year1.08(1.01–1.15)0.021.07(1.00–1.15)0.04
Male sex1.75(0.49–6.27)0.39
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
QRS duration, per ms0.99(0.97–1.03)0.81
LBBB0.87(0.27–2.77)0.81
LVEF, per %0.99(0.92–1.08)0.89
LVEDV, per ml1.02(0.99–1.01)0.49
LVESV, per ml1.00(0.99–1.01)0.53
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

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