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J Am Coll Cardiol, 2004; 44:1834-1840, doi:10.1016/j.jacc.2004.08.016
© 2004 by the American College of Cardiology Foundation
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HEART FAILURE

Left ventricular dyssynchrony predicts response and prognosis after cardiac resynchronization therapy

Jeroen J. Bax, MD, PhD*,*, Gabe B. Bleeker, MD*, Thomas H. Marwick, MD{dagger}, Sander G. Molhoek, MD, PhD*, Eric Boersma, PhD{ddagger}, Paul Steendijk, MD, PhD*, Ernst E. van der Wall, MD, PhD* and Martin J. Schalij, MD, PhD*

* Leiden University Medical Center, Leiden, The Netherlands
{dagger} University of Queensland, Brisbane, Australia
{ddagger} ThoraxCenter Rotterdam, The Netherlands

Manuscript received February 6, 2004; revised manuscript received August 2, 2004, accepted August 3, 2004.

* Reprint requests and correspondence: Dr. Jeroen J. Bax, Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands (Email: jbax{at}knoware.nl).

OBJECTIVES: This study was designed to predict the response and prognosis after cardiac resynchronization therapy (CRT) in patients with end-stage heart failure (HF).

BACKGROUND: Cardiac resynchronization therapy improves HF symptoms, exercise capacity, and left ventricular (LV) function. Because not all patients respond, preimplantation identification of responders is needed. In the present study, response to CRT was predicted by the presence of LV dyssynchrony assessed by tissue Doppler imaging. Moreover, the prognostic value of LV dyssynchrony in patients undergoing CRT was assessed.

METHODS: Eighty-five patients with end-stage HF, QRS duration >120 ms, and left bundle-branch block were evaluated by tissue Doppler imaging before CRT. At baseline and six months follow-up, New York Heart Association functional class, quality of life and 6-min walking distance, LV volumes, and LV ejection fraction were determined. Events (death, hospitalization for decompensated HF) were obtained during one-year follow-up.

RESULTS: Responders (74%) and nonresponders (26%) had comparable baseline characteristics, except for a larger dyssynchrony in responders (87 ± 49 ms vs. 35 ± 20 ms, p < 0.01). Receiver-operator characteristic curve analysis demonstrated that an optimal cutoff value of 65 ms for LV dyssynchrony yielded a sensitivity and specificity of 80% to predict clinical improvement and of 92% to predict LV reverse remodeling. Patients with dyssynchrony ≥65 ms had an excellent prognosis (6% event rate) after CRT as compared with a 50% event rate in patients with dyssynchrony <65 ms (p < 0.001).

CONCLUSIONS: Patients with LV dyssynchrony ≥65 ms respond to CRT and have an excellent prognosis after CRT.

Abbreviations and Acronyms
  CRT = cardiac resynchronization therapy
  HF = heart failure
  LV = left ventricular
  LVEF = left ventricular ejection fraction
  MR = mitral regurgitation
  NYHA = New York Heart Association
  ROC = receiver-operating characteristic
  RV = right ventricular
  TDI = tissue Doppler imaging
  2D = two-dimensional




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