Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Original Article

Volume 5, Number 6, December 2014, pages 163-170

Clinical Long-Term Response to Cardiac Resynchronization Therapy Is Independent of Persisting Echocardiographic Markers of Dyssynchrony

Figure 1. Percentage of atrioventricular dyssynchrony after optimizing the AV and VV intervals and its correlation to cardiac mortality/heart transplantation, re-hospitalization because of heart failure and NYHA class. HTPL: heart transplantation; HF: heart failure; LVFT: left ventricular filling time; FU: follow-up.

Figure 2. Percentage of interventricular dyssynchrony after optimizing the AV and VV intervals and its correlation to cardiac mortality/heart transplantation, re-hospitalization because of heart failure and NYHA class. HTPL: heart transplantation; HF: heart failure; LVPEP: left ventricular preejection period; IVMD: interventricular mechanical delay; FU: follow-up.

Figure 3. Percentage of intraventricular dyssynchrony after optimizing the AV and VV intervals and its correlation to cardiac mortality/heart transplantation, re-hospitalization because of heart failure and NYHA class. HTPL: heart transplantation; HF: heart failure; SPWMD: septal to posterior wall motion delay; DALW: delayed activation of the lateral wall; FU: follow-up.

**Table 1.** Baseline Characteristics of the Included Population (n = 128)
AVB: atrioventricular block; LBBB: left bundle branch block; LVEF: left ventricular ejection fraction; LVEDD: left ventricular end-diastolic diameter; LVESD: left ventricular end-systolic diameter; CAD: coronary artery disease; PCI: percutaneous cardiac intervention; BNP: brain natriuretic peptide.
Demographics
Age, years	68 ± 10
Women, n (%)	37 (29)
Characteristics
NYHA class	2.8 ± 0.8
Atrial fibrillation, n (%)	14 (11)
QRS duration (intrinsic), ms	162 ± 35
QRS duration (stimulated), ms	158 ± 28
AVB I, n (%)	30 (23)
LBBB, n (%)	88 (68)
LVEF, %	27 ± 9
LVEDD, cm	6.7 ± 0.9
LVESD, cm	5.6 ± 1.1
LVESV, mL	92 ± 0.7
Heart failure etiology, n (%)
Idiopathic	59 (46)
Ischemic	47 (37)
Hypertensive heart disease	6 (5)
Valvular disease	12 (9)
Other	4 (3)
Comorbidities, n (%)
Charlson score	2.7 ± 1.9
Hypertension	71 (55)
Diabetes	23 (18)
Hyperlipidemia	63 (49)
Positive family history for CAD	17 (13)
Smoker	70 (54)
Previous myocardial infarction	38 (30)
Previous PCI	31 (24)
Previous cardiac surgery	38 (30)
Medication, n (%)
ACE inhibitor	70 (55)
Angiotensin receptor blocker	51 (40)
Beta-blocker	108 (84)
Diuretics	109 (85)
Spironolactone	66 (51)
Laboratory data
Hemoglobin, g/L	135 ± 17
Creatinine, μmol/L	125 ± 77
BNP, ng/L	501 ± 649

Table 1. Baseline Characteristics of the Included Population (n = 128)

AVB: atrioventricular block; LBBB: left bundle branch block; LVEF: left ventricular ejection fraction; LVEDD: left ventricular end-diastolic diameter; LVESD: left ventricular end-systolic diameter; CAD: coronary artery disease; PCI: percutaneous cardiac intervention; BNP: brain natriuretic peptide.

Demographics

Age, years

68 ± 10

Women, n (%)

37 (29)

Characteristics

NYHA class

2.8 ± 0.8

Atrial fibrillation, n (%)

14 (11)

QRS duration (intrinsic), ms

162 ± 35

QRS duration (stimulated), ms

158 ± 28

AVB I, n (%)

30 (23)

LBBB, n (%)

88 (68)

LVEF, %

27 ± 9

LVEDD, cm

6.7 ± 0.9

LVESD, cm

5.6 ± 1.1

LVESV, mL

92 ± 0.7

Heart failure etiology, n (%)

Idiopathic

59 (46)

Ischemic

47 (37)

Hypertensive heart disease

6 (5)

Valvular disease

12 (9)

Other

4 (3)

Comorbidities, n (%)

Charlson score

2.7 ± 1.9

Hypertension

71 (55)

Diabetes

23 (18)

Hyperlipidemia

63 (49)

Positive family history for CAD

17 (13)

Smoker

70 (54)

Previous myocardial infarction

38 (30)

Previous PCI

31 (24)

Previous cardiac surgery

38 (30)

Medication, n (%)

ACE inhibitor

70 (55)

Angiotensin receptor blocker

51 (40)

Beta-blocker

108 (84)

Diuretics

109 (85)

Spironolactone

66 (51)

Laboratory data

Hemoglobin, g/L

135 ± 17

Creatinine, μmol/L

125 ± 77

BNP, ng/L

501 ± 649

**Table 2.** Clinical and Echocardiographic Response After CRT Implantation in the Entire Group, n = 128 (%)
HF: heart failure; LVEF: left ventricular ejection fraction; LVESV: left ventricular end-systolic volume.
Clinical response	97 (76)
All cause mortality	22 (17.2)
Cardiac mortality	10 (7.8)
Non-cardiac mortality	12 (9.4)
Heart transplantation	4 (3.1)
Rehospitalization for decompensated HF	19 (14.8)
Decrease of NYHA ≥ 1	74 (57.8)
Echocardiographic response	85 (66)
Decrease of LVEF ≥ 5%	81 (63.3)
Increase of LVESV > 15%	50 (39.1)

Table 2. Clinical and Echocardiographic Response After CRT Implantation in the Entire Group, n = 128 (%)

HF: heart failure; LVEF: left ventricular ejection fraction; LVESV: left ventricular end-systolic volume.

Clinical response

97 (76)

All cause mortality

22 (17.2)

Cardiac mortality

10 (7.8)

Non-cardiac mortality

12 (9.4)

Heart transplantation

4 (3.1)

Rehospitalization for decompensated HF

19 (14.8)

Decrease of NYHA ≥ 1

74 (57.8)

Echocardiographic response

85 (66)

Decrease of LVEF ≥ 5%

81 (63.3)

Increase of LVESV > 15%

50 (39.1)

**Table 3.** Clinical, Echocardiographic and Electrocardiographic Characteristics Comparing Patients With and Without Cardiac Death or HTPL
	Survival wo HTPL	Cardiac death/HTPL	P
wo HTPL: without heart transplantation; CAD: coronary artery disease; LVEF: left ventricular ejection fraction; LVESV: left ventricular end-systolic volume; IQR: interquartile range; BNP: brain natriuretic peptide; FU: follow-up; LVFT %: left ventricular filling time in %; LVPEP: left ventricular preejection period; IVMD: interventricular mechanical delay; SPWMD: septal-to-posterior wall motion delay.
Age	69 ± 9	69 ± 14	0.96
Female gender, n (%)	35 (32)	2 (13)	0.15
CAD, n (%)	40 (36)	8 (53)	0.19
Diabetes, n (%)	16 (14)	6 (40)	0.02
Intial LVEF, %	27 ± 9	22 ± 7	0.03
Initial LVESD, cm	5.5 ± 1.0	6.3 ± 1.4	0.03
Initial NYHA class, median (IQR)	3 (2 - 3)	4 (3 - 4)	< 0.001
Initial QRS duration, ms	159 ± 33	177 ± 28	0.03
Biventricular stimulated QRS duration, ms	157 ± 28	170 ± 26	0.67
Systolic blood pressure, mm Hg	119 ± 16	101 ± 18	0.001
BNP prior to implant, median (IQR)	254 (133 - 515)	1,024 (374 - 1,803)	< 0.001
Creatinine prior to implant, median (IQR)	101 (84 - 128)	163 (99 - 224)	0.005
LVEF during FU, %	39 ± 12	25 ± 10	< 0.001
LVESV during FU, mL	62 ± 0.9	108 ± 1.4	0.009
NYHA class during FU, median (IQR)	2 (1 - 2)	4 (3 - 4)	< 0.001
Duration diastole (LVFT %)	50 ± 9	49 ± 8	0.46
LVPEP, ms	145 ± 34	152 ± 41	0.59
IVMD, ms, median (IQR)	16 (7 - 28)	17 (6 - 33)	0.61
SPWMD, ms, median (IQR)	60 (31 - 97)	70 (28 - 115)	0.83

Table 3. Clinical, Echocardiographic and Electrocardiographic Characteristics Comparing Patients With and Without Cardiac Death or HTPL

Survival wo HTPL

Cardiac death/HTPL

wo HTPL: without heart transplantation; CAD: coronary artery disease; LVEF: left ventricular ejection fraction; LVESV: left ventricular end-systolic volume; IQR: interquartile range; BNP: brain natriuretic peptide; FU: follow-up; LVFT %: left ventricular filling time in %; LVPEP: left ventricular preejection period; IVMD: interventricular mechanical delay; SPWMD: septal-to-posterior wall motion delay.

Age

69 ± 9

69 ± 14

0.96

Female gender, n (%)

35 (32)

2 (13)

0.15

CAD, n (%)

40 (36)

8 (53)

0.19

Diabetes, n (%)

16 (14)

6 (40)

0.02

Intial LVEF, %

27 ± 9

22 ± 7

0.03

Initial LVESD, cm

5.5 ± 1.0

6.3 ± 1.4

0.03

Initial NYHA class, median (IQR)

3 (2 - 3)

4 (3 - 4)

< 0.001

Initial QRS duration, ms

159 ± 33

177 ± 28

0.03

Biventricular stimulated QRS duration, ms

157 ± 28

170 ± 26

0.67

Systolic blood pressure, mm Hg

119 ± 16

101 ± 18

0.001

BNP prior to implant, median (IQR)

254 (133 - 515)

1,024 (374 - 1,803)

< 0.001

Creatinine prior to implant, median (IQR)

101 (84 - 128)

163 (99 - 224)

0.005

LVEF during FU, %

39 ± 12

25 ± 10

< 0.001

LVESV during FU, mL

62 ± 0.9

108 ± 1.4

0.009

NYHA class during FU, median (IQR)

2 (1 - 2)

4 (3 - 4)

< 0.001

Duration diastole (LVFT %)

50 ± 9

49 ± 8

0.46

LVPEP, ms

145 ± 34

152 ± 41

0.59

IVMD, ms, median (IQR)

16 (7 - 28)

17 (6 - 33)

0.61

SPWMD, ms, median (IQR)

60 (31 - 97)

70 (28 - 115)

0.83