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The association of mechanical dyssynchrony and resynchronization therapy with survival in heart failure with a wide QRS complex: a two-world study

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Abstract

Setting up a randomized trial to assess the association of mechanical dyssynchrony (MD) and the success of cardiac resynchronization therapy (CRT) in heart failure with a wide QRS complex is ethically challenging. We therefore investigated this association in a retrospective cohort study observing different treatment strategies which were chosen based on the availability of health care resources. The survival of 500 patients from six Western European centers treated with CRT was compared to their 137 Eastern European counterparts not treated with CRT, with regard to the presence of MD. MD was visually assessed and was defined as the presence of apical rocking and/or septal flash. Patients were followed for a mean of 26 ± 8 months for the occurrence of death of any cause. As compared with medical therapy alone, CRT was associated with a more favorable survival (hazard ratio (HR), 0.53; 95% confidence interval (CI) 0.35–0.79; P = 0.002). Patients with MD treated by CRT had better survival than patients belonging to all other groups—they showed 72%, 66% and 56% reduction in all-cause mortality, respectively, compared to patients with MD not treated by CRT (HR 0.28; 95% CI 0.17–0.44), patients without MD treated by CRT (HR 0.34; 95% CI 0.22–0.52) and patients without MD not treated by CRT (HR 0.44; 95% CI 0.25–0.76). Patients with wide QRS complex who are treated with CRT have a significantly better survival when MD is present.

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Acknowledgements

The authors would like to thank Aleksandra Janicijevic, Aleksandra Zivanic and Milica Tanasijevic for their assistance in data collection.

Funding

IS was supported by a research grant from the European Association of Cardiovascular Imaging. AMD was supported by a research grant from the European Heart Failure Association. JUV is supported by a research grant of the University Hospitals Leuven (OT/12/085) and holds a personal research mandate from the Flemish Research Foundation (1832912N). ANN is partially supported by the Grant No. 175099 of the Ministry of Science, Republic of Serbia. RW receives unconditional research funding from Boston Scientific and Medtronic Belgium, and is supported as a clinical researcher by the Fund for Scientific Research Flanders.

Author information

Author notes

  1. Christian Prinz

    Present address: Practice Steuber & Prinz, Clemens-August-Str. 15, 49751, Sögel, Germany

  2. Ana Maria Daraban

    Present address: Department of Internal Medicine and Gastroenterology, Clinical Emergency Hospital, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania

  3. Martin Kotrc

    Present address: Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic

Authors and Affiliations

  1. Department of Cardiovascular Diseases, University Hospital Gasthuisberg, Catholic University Leuven, Herestraat 49, 3000, Leuven, Belgium

    Ivan Stankovic, Agnieszka Ciarka, Ana Maria Daraban, Rik Willems & Jens-Uwe Voigt

  2. Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia

    Ivan Stankovic, Milica Stefanovic & Aleksandar N. Neskovic

  3. Department of Cardiology, Heart and Diabetes Centre of North-Rhine Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany

    Christian Prinz & Lothar Faber

  4. Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium

    Martin Kotrc & Martin Penicka

  5. Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway

    Marit Aarones

  6. Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, School of Medicine With the Division of Dentistry, Silesian Center for Heart Diseases, Zabrze, Poland

    Mariola Szulik & Tomasz Kukulski

  7. WSB Academy, Dąbrowa Górnicza, Poland

    Mariola Szulik

  8. Klinik für Innere Medizin Und Kardiologie, St. Vinzenz Hospital, Cologne, Germany

    Stefan Winter & Wolfgang Fehske

  9. Department of Circulation and Imaging, Faculty of Medicine and Health Science, NTNU, Norwegian University of Science and Technology, and Clinic of Cardiology, St. Olavs Hospital, Trondheim, Norway

    Svend Aakhus

Authors
  1. Ivan Stankovic
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  2. Milica Stefanovic
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  4. Agnieszka Ciarka
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  5. Ana Maria Daraban
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  6. Martin Kotrc
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  8. Mariola Szulik
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  9. Stefan Winter
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  10. Tomasz Kukulski
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  11. Svend Aakhus
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  12. Rik Willems
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  13. Wolfgang Fehske
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  14. Martin Penicka
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  15. Lothar Faber
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  16. Aleksandar N. Neskovic
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  17. Jens-Uwe Voigt
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Corresponding author

Correspondence to Jens-Uwe Voigt.

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Apical 4-chamber view showing a premature septal contraction (septal flash) pulling the apex to the septal side during the early systole, followed by the delayed lateral wall contraction during the ejection phase pulling the apex to the lateral side. This septal to lateral apical motion in systole is known as apical rocking. Supplementary file1 (AVI 62 kb)

Parasternal short-axis view showing an early inward-outward septal motion (septal flash) followed by a late contraction of the posterolateral wall of the left ventricle. Supplementary file 2 (AVI 84 kb)

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Stankovic, I., Stefanovic, M., Prinz, C. et al. The association of mechanical dyssynchrony and resynchronization therapy with survival in heart failure with a wide QRS complex: a two-world study. Int J Cardiovasc Imaging 36, 1507–1514 (2020). https://doi.org/10.1007/s10554-020-01865-x

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