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Left ventricular dyssynchrony predicts response and prognosis after cardiac resynchronization therapy

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

^* Leiden University Medical Center, Leiden, The Netherlands
University of Queensland, Brisbane, Australia
ThoraxCenter Rotterdam, The Netherlands

View larger version (18K): [in a new window]   Figure 1 Receiver-operating characteristic curve analysis demonstrated a sensitivity and specificity of 80% to predict response to cardiac resynchronization therapy defined as an improvement in New York Heart Association functional class 1 score and an improvement 25% in 6-min walking distance) at a cutoff level of 65 ms for left ventricular (LV) dyssynchrony.

View larger version (17K): [in a new window]   Figure 2 Receiver-operating characteristic curve analysis demonstrated a sensitivity and specificity of 92% to predict reverse left ventricular (LV) remodeling after cardiac resynchronization therapy defined as an improvement in LV end-systolic volume 15%) at a cutoff level of 65 ms for LV dyssynchrony.

View larger version (16K): [in a new window]   Figure 3 A linear relation existed between the extent of left ventricular (LV) dyssynchrony and the change in LV end-systolic volume (ESV) after cardiac resynchronization therapy. However, LV dyssynchrony over 100 ms did not result in further reduction in LV end-systolic volume.

View larger version (15K): [in a new window]   Figure 4 Cardiac events (cardiac death, hospitalization for decompensated heart failure) during one-year follow-up after cardiac resynchronization therapy. Patients with left ventricular (LV) dyssynchrony 65 ms had a significantly lower event rate after cardiac resynchronization therapy as compared with patients with dyssynchrony <65 ms (6% vs. 50%, p < 0.001).