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Dyssynchrony and Response to Cardiac Resynchronization Therapy in Heart Failure Patients with Unfavorable Electrical Characteristics - JIMG July 2023
Among heart failure (HF) patients undergoing CRT, those with unfavorable electrical characteristics (UEC) are less frequently CRT responders. To evaluate the relationship between preprocedural echocardiographic parameters of electromechanical dyssynchrony (EMD) and outcome following CRT. Methods: Among 551 patients receiving CRT, 121 with UEC defined as atypical left bundle branch, presence of right bundle branch block or unspecified intra-ventricular conduction disturbance were enrolled. Indices of EMD were presence of septal flash, apical rocking, septal deformation patterns and global wasted work (GWW) obtained using speckle-tracking strain echocardiography. End points were response to CRT, defined as a relative decrease in left ventricular endsystolic volume ≥15% at 9-month postoperative follow-up, and all-cause death and/or HF hospitalization during follow-up. Among the 121 patients, 68 (56%) were CRT responders. In multivariate analysis, GWW > 200 mmHg% (adjusted odds ratio (aOR) 4.17 [1.33;14.56] p 0.0182) and longitudinal strain septal contraction pattern 1 and 2 (aOR 10.05 [2.82;43.97] p < 0.001) were associated with CRT response. During a 46-month follow-up (interquartile range, 42-55 months), survival free from death and/or HF hospitalization increased with the number of positive criteria (87% for two, 59% for one and 27% for none). After adjustment for established predictors of outcome in patients receiving CRT, absence of either of the two criteria remained associated with a considerable increased risk of death and/or HF hospitalization (adjusted hazard ratio 4.83 (1.84-12.68), p=0.001).
Y.S. Chandrashekhar, MD, DM, FACC

CME Editor
Kenneth A. Ellenbogen, MD 

Mahmoud Houmsse, MD, FACC 

Important Dates
Date of Release: July 3, 2023

Term of Approval/Date of CME/MOC Expiration: July 2, 2024
Availability: On-Demand
Expires on Jul 02, 2024
Cost: FREE
Credit Offered:
1 CME Credit
1 ABIM-MOC Point
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