Optimal Left Ventricular Lead Position Predicts Reverse Remodeling and Survival After Cardiac Resynchronization Therapy
Claudia Ypenburg, MD*,
Rutger J. van Bommel, MD*,
Victoria Delgado, MD*,
Sjoerd A. Mollema, MD*,
Gabe B. Bleeker, MD, PhD*,
Eric Boersma, PhD ,
Martin J. Schalij, MD, PhD* and
Jeroen J. Bax, MD, PhD*,*
* Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
Department of Epidemiology and Statistics, Erasmus University, Rotterdam, the Netherlands
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Figure 1 Speckle Tracking Radial Strain Analysis
(A) Short-axis of the left ventricle (LV) at the level of the papillary muscles, with reconstruction of the 6 LV segments. (B) Demonstrates the separate strain-time curves for each individual segment. In this patient example, severe baseline LV dyssynchrony was present; a maximum delay of 220 ms was calculated between the septum (red) and the posterior wall (purple). Site of latest activation was the posterior LV segment (purple) AVC = aortic valve closure.
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Figure 2 Distribution of Site of Latest Activation
ANT = anterior left ventricular segment; ANT-SEPT = anteroseptal left ventricular segment; INF = inferior left ventricular segment; LAT = lateral left ventricular segment; LV = left ventricular; POST = posterior left ventricular segment; SEPT = septal left ventricular segment.
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Figure 3 Echocardiographic Response After CRT in Patients With Concordant LV Lead Positions (n = 153) and Patients With Discordant LV Lead Positions (n = 91)
Open bars = baseline; solid bars = follow-up. *p < 0.001. CRT = cardiac resynchronization therapy; LV = left ventricular; LVEDV = left ventricular end-diastolic volume; LVEF = left ventricular ejection fraction; LVESV = left ventricular end-systolic volume.
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Figure 4 Survival and Event Curves After CRT According to LV Lead Position
(A) Hospitalizations for heart failure, (B) survival, and (C) event-free survival including death, heart transplantation, and hospitalization for heart failure. Abbreviations as in Figure 3.
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