Clinical Significance of Electromechanical Dyssynchrony and QRS Narrowing in Patients With Heart Failure Receiving Cardiac Resynchronization Therapy.

Aged Cardiac Resynchronization Therapy / methods Echocardiography, Doppler Electrocardiography Female Follow-Up Studies Heart Failure / diagnosis Heart Ventricles / diagnostic imaging Humans Male Retrospective Studies Stroke Volume / physiology

Journal

The Canadian journal of cardiology
ISSN: 1916-7075
Titre abrégé: Can J Cardiol
Pays: England
ID NLM: 8510280

Informations de publication

Date de publication:
01 2019
Historique:
received: 07 09 2018
revised: 18 10 2018
accepted: 29 10 2018
entrez: 1 1 2019
pubmed: 1 1 2019
medline: 23 10 2019
Statut: ppublish

Résumé

We hypothesized that preoperative electromechanical dyssynchrony amenable to cardiac resynchronization therapy (CRT) and QRS narrowing immediately after CRT are both correlated and have a cumulative impact on response and outcome after CRT. A total of 233 CRT candidates (heart failure New York Heart Association classes II-IV, ejection fraction < 35%, QRS ≥ 120 milliseconds, 44% women, 71 ± 11 years old) were prospectively included. Preoperative electromechanical dyssynchrony amenable to CRT was assessed by septal deformation patterns using speckle tracking echocardiography. QRS narrowing was calculated from 12-lead electrocardiograms before and immediately after CRT implantation. The primary endpoint was overall mortality during long-term follow-up. The NTC clinical trial number is NCT02986633. Eighty-seven percent of patients with preoperative electromechanical dyssynchrony experienced QRS narrowing after CRT (118/136), whereas 69% of patients without preoperative electromechanical dyssynchrony (67/97) experienced QRS narrowing after CRT (P < 0.001). By Cox multivariate analysis, both preoperative electromechanical dyssynchrony and lack of postoperative QRS narrowing were independently associated with an increased risk of mortality during follow-up (adjusted hazards ratio [HR] 2.24, 95% confidence interval [CI] 1.43-3.50 and HR 1.90, 95% CI 1.06-3.38, respectively). Compared with patients with preoperative electromechanical dyssynchrony, patients without both electromechanical dyssynchrony and postoperative QRS narrowing experienced a considerable increased risk of mortality during follow-up (adjusted HR 3.70, 95% CI 1.96-6.97). Lack of postoperative QRS narrowing after CRT is associated with preoperative electromechanical dyssynchrony. Both preoperative electromechanical dyssynchrony and postoperative QRS narrowing have a favourable cumulative impact on outcome after CRT.

Sections du résumé

BACKGROUND
We hypothesized that preoperative electromechanical dyssynchrony amenable to cardiac resynchronization therapy (CRT) and QRS narrowing immediately after CRT are both correlated and have a cumulative impact on response and outcome after CRT.
METHODS
A total of 233 CRT candidates (heart failure New York Heart Association classes II-IV, ejection fraction < 35%, QRS ≥ 120 milliseconds, 44% women, 71 ± 11 years old) were prospectively included. Preoperative electromechanical dyssynchrony amenable to CRT was assessed by septal deformation patterns using speckle tracking echocardiography. QRS narrowing was calculated from 12-lead electrocardiograms before and immediately after CRT implantation. The primary endpoint was overall mortality during long-term follow-up. The NTC clinical trial number is NCT02986633.
RESULTS
Eighty-seven percent of patients with preoperative electromechanical dyssynchrony experienced QRS narrowing after CRT (118/136), whereas 69% of patients without preoperative electromechanical dyssynchrony (67/97) experienced QRS narrowing after CRT (P < 0.001). By Cox multivariate analysis, both preoperative electromechanical dyssynchrony and lack of postoperative QRS narrowing were independently associated with an increased risk of mortality during follow-up (adjusted hazards ratio [HR] 2.24, 95% confidence interval [CI] 1.43-3.50 and HR 1.90, 95% CI 1.06-3.38, respectively). Compared with patients with preoperative electromechanical dyssynchrony, patients without both electromechanical dyssynchrony and postoperative QRS narrowing experienced a considerable increased risk of mortality during follow-up (adjusted HR 3.70, 95% CI 1.96-6.97).
CONCLUSIONS
Lack of postoperative QRS narrowing after CRT is associated with preoperative electromechanical dyssynchrony. Both preoperative electromechanical dyssynchrony and postoperative QRS narrowing have a favourable cumulative impact on outcome after CRT.

Identifiants

DOI: 10.1016/j.cjca.2018.10.019 PMID: 30595180
pubmed: 30595180
pii: S0828-282X(18)31275-3
doi: 10.1016/j.cjca.2018.10.019
pii:
doi:

Banques de données

ClinicalTrials.gov
['NCT02986633']

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

27-34

Commentaires et corrections

Type : CommentIn

Informations de copyright

Copyright © 2018 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Auteurs

Ludovic Appert (L)

GCS-Groupement des hôpitaux de l'institut Catholique de Lille, Cardiology Department, Université Catholique de Lille, Lille, France.

Aymeric Menet (A)

GCS-Groupement des hôpitaux de l'institut Catholique de Lille, Cardiology Department, Université Catholique de Lille, Lille, France.

Alexandre Altes (A)

GCS-Groupement des hôpitaux de l'institut Catholique de Lille, Cardiology Department, Université Catholique de Lille, Lille, France.

Pierre Vladimir Ennezat (PV)

Cardiology Department, Centre Hospitalier Universitaire de Grenoble, Grenoble, France.

Hélène Bardet-Bouchery (H)

GCS-Groupement des hôpitaux de l'institut Catholique de Lille, Cardiology Department, Université Catholique de Lille, Lille, France; Centre Hospitalier de la Région de Saint Omer, Saint Omer, France.

Camille Binda (C)

GCS-Groupement des hôpitaux de l'institut Catholique de Lille, Cardiology Department, Université Catholique de Lille, Lille, France.

Yves Guyomar (Y)

GCS-Groupement des hôpitaux de l'institut Catholique de Lille, Cardiology Department, Université Catholique de Lille, Lille, France.

François Delelis (F)

GCS-Groupement des hôpitaux de l'institut Catholique de Lille, Cardiology Department, Université Catholique de Lille, Lille, France.

Anne-Laure Castel (AL)

GCS-Groupement des hôpitaux de l'institut Catholique de Lille, Cardiology Department, Université Catholique de Lille, Lille, France.

Caroline Le Goffic (C)

GCS-Groupement des hôpitaux de l'institut Catholique de Lille, Cardiology Department, Université Catholique de Lille, Lille, France.

Raphaelle-Ashley Guerbaai (RA)

Cardiology Department, Centre Hospitalier Universitaire de Grenoble, Grenoble, France; Department of Public Health, University of Basel, Basel, Switzerland.

Pierre Graux (P)

GCS-Groupement des hôpitaux de l'institut Catholique de Lille, Cardiology Department, Université Catholique de Lille, Lille, France.

Christophe Tribouilloy (C)

Cardiology Department, Centre Hospitalier Universitaire d'Amiens, Amiens, France; Laboratoire UPJCV, Université de Picardie, Amiens, France.

Sylvestre Maréchaux (S)

GCS-Groupement des hôpitaux de l'institut Catholique de Lille, Cardiology Department, Université Catholique de Lille, Lille, France; Laboratoire UPJCV, Université de Picardie, Amiens, France. Electronic address: sylvestre.marechaux@gmail.com.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Clinical Significance of Electromechanical...
questionsmedicales.fr › Thérapeutique › Entraînement électrosystolique › Thérapie de resynchronisation cardiaque › Clinical Significance of Electromechanical...
questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Techniques de diagnostic cardiovasculaire › Tests de la fonction cardiaque › Échocardiographie › Échocardiographie-doppler › Clinical Significance of Electromechanical...
questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Électrodiagnostic › Électrocardiographie › Clinical Significance of Electromechanical...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études de suivi › Clinical Significance of Electromechanical...
questionsmedicales.fr › Maladies cardiovasculaires › Cardiopathies › Défaillance cardiaque › Clinical Significance of Electromechanical...
questionsmedicales.fr › Système cardiovasculaire › Coeur › Ventricules cardiaques › Clinical Significance of Electromechanical...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Clinical Significance of Electromechanical...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Clinical Significance of Electromechanical...
questionsmedicales.fr › Phénomènes physiologiques respiratoires et circulatoires › Phénomènes physiologiques cardiovasculaires › Hémodynamique › Débit cardiaque › Débit systolique › Clinical Significance of Electromechanical...