Abstract
A left bundle-branch block (LBBB) contraction pattern identified from longitudinal-strain analysis predicts outcomes following cardiac resynchronization therapy (CRT). We investigated the use of an LBBB-contraction pattern identified from radial- or circumferential-strain analysis in the prediction of CRT benefits. Eighty CRT candidates were prospectively enrolled. Before CRT implantation, speckle-tracking analyses in three deformation directions were performed to determine whether an LBBB-contraction pattern was present. The study endpoints were reverse remodeling at 6 months, and adverse outcomes including death or heart failure hospitalization. At 6 months, 49 (61%) patients had reverse remodeling. An LBBB-contraction pattern identified from the radial strain in the mid-ventricular short-axis view or longitudinal strain in the four-chamber view provided excellent true-positive (86%) and false-negative (8%) rates for predicting reverse remodeling. During a median follow-up of 30 months, 31 patients (39%) had adverse outcomes. Absence of an LBBB-contraction pattern in radial (hazard ratio 3.74; 95% confidence interval 1.83–7.62) or longitudinal strain (hazard ratio 3.49; 95% confidence interval 1.71–7.13) was significantly associated with an increased risk of adverse outcomes. Adding the LBBB-pattern assessment by radial-(model χ2 from 8.2 to 18.5, p = 0.005), or longitudinal-strain analysis (model χ2 from 8.2 to 16.9, p = 0.011) to a risk model significantly improved the model, including QRS duration and ischemic etiology. In conclusion, an LBBB-contraction pattern identified from radial-strain analysis in the mid-ventricular short-axis view predicted reverse remodeling and outcome following CRT, similarly to the longitudinal-strain analysis.
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This study was supported by Grants CMRPG 5E0031 from the Chang Gung Memorial Hospital, Linkou, Taiwan.
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The study protocol has been approved by the local ethics committee and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
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Wang, CL., Wu, CT., Yeh, YH. et al. Left bundle-branch block contraction patterns identified from radial-strain analysis predicts outcomes following cardiac resynchronization therapy. Int J Cardiovasc Imaging 33, 869–877 (2017). https://doi.org/10.1007/s10554-017-1083-5
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DOI: https://doi.org/10.1007/s10554-017-1083-5