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Not left ventricular lead position, but the extent of immediate asynchrony reduction predicts long-term response to cardiac resynchronization therapy

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Abstract

Cardiac resynchronization therapy (CRT) is an effective treatment for a large subgroup of chronic heart failure patients. Various attempts to improve the high non-responder rate of 30 % by preoperative asynchrony assessment have failed. We hypothesized that superior response to CRT is correlated with greater acute reduction of asynchrony and that a concordant left ventricular (LV) lead is beneficial compared to a discordant lead. Hundred and eight consecutive CRT patients from our center were prospectively included. Clinical status and asynchrony parameters were assessed before, 1 day and 6 months after CRT implantation. Super-response was defined as an increase of the LV ejection fraction by ≥15 % and a decrease in LV end systolic volume (LVESV) by ≥30 %. When the criteria for super-response were not met, average response was given with a decrease of baseline LVESV ≥15 %. Sixty eight patients were classified as responders (63 %). Comparing super- (n = 19) and average (n = 49) responders, we found that greater acute reduction of LV asynchrony (change of asynchronous segments under CRT: −1.3 vs. −0.4, p < 0.05; decrease of LV intraventricular delay: −34 ms vs. −16 ms, p < 0.05) is associated with superior reverse remodeling after 6 months. Importantly, asynchrony parameters of super-, average and non-responders were almost identical at baseline. A concordant LV lead (n = 63) was not associated with improved LV reverse remodeling compared to a discordant lead (n = 28): LVEF: +8.6 % vs. +7.8 %, p = 0.91; LVESV: −30.5 ml vs. −23.8 mL, p = 0.84. A greater immediate reduction of LV asynchrony predicts superior response. Preoperative asynchrony parameters do not correlate with outcome. A concordant LV lead is not superior to a discordant lead.

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Abbreviations

AVO:

Aortic valve opening

CRT:

Cardiac resynchronization therapy

IVMD:

Interventricular mechanical delay

LAO:

Left anterior oblique

LV:

Left ventricle

LVEF:

Left ventricular ejection fraction

LVESV:

Left ventricular end systolic volume

NYHA:

New York Heart Association

RAO:

Right anterior oblique

RV:

Right ventricle

SD:

Standard deviation

TDI:

Tissue Doppler imaging

TSI:

Tissue synchronization imaging

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Authors and Affiliations

  1. Medizinische Klinik mit Schwerpunkt Kardiologie und Angiologie (CCM), Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany

    Wolfram C. Poller, Henryk Dreger, Marius Schwerg, Hansjürgen Bondke & Christoph Melzer

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  1. Wolfram C. Poller
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  2. Henryk Dreger
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  3. Marius Schwerg
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Correspondence to Wolfram C. Poller.

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Poller, W.C., Dreger, H., Schwerg, M. et al. Not left ventricular lead position, but the extent of immediate asynchrony reduction predicts long-term response to cardiac resynchronization therapy. Clin Res Cardiol 103, 457–466 (2014). https://doi.org/10.1007/s00392-014-0672-8

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  • DOI: https://doi.org/10.1007/s00392-014-0672-8

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