Mechanical dyssynchrony evaluated by tissue Doppler cross-correlation analysis is associated with long-term survival in patients after cardiac resynchronization therapy
Key result
Mechanical dyssynchrony assessed by maximal activation delay was independently associated with improved survival after cardiac resynchronization therapy (HR 0.35; 95% CI 0.16-0.77; P=0.01).
Why the study?
Does pre-implant mechanical dyssynchrony assessed by AD-max using cross-correlation analysis predict long-term survival better than other TDI indices in patients receiving CRT?
Population
131 patients referred for cardiac resynchronization therapy (CRT) from two international centres
Comparison
Pre-implant assessment of mechanical… vs Other TDI-derived indices and the presence of…
Design
Cohort
Follow-up
truncated at 1460 days
Authors
Discussion
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Implication
AD-max dyssynchrony supports refined CRT selection; leaves open incremental value over QRS in prospective trials.
Study Design
Type
Cohort (n=131)
Multicenter
Yes
Structured PICO
Does pre-implant mechanical dyssynchrony assessed by AD-max using cross-correlation analysis predict long-term survival better than other TDI indices in patients receiving CRT?
P
Population
131 patients referred for cardiac resynchronization therapy from two international centers, followed for up to 1460 days.
E
Exposure
Pre-implant assessment of mechanical dyssynchrony using maximal activation delay (AD-max) >35 ms calculated by cross-correlation analysis (XCA) of tissue Doppler imaging (TDI)-derived myocardial acceleration curves
C
Comparator
Other TDI-derived indices (time-to-peak opposing wall delay [OWD] ≥80 ms, Yu index ≥32 ms) and the presence of left bundle branch block
O
Outcome
Composite of all-cause mortality, cardiac transplantation, or implantation of a ventricular assist device (left ventricular assist device)composite
Main Result
Hazard Ratio: 0.35 (95% CI 0.16–0.77)
p-value: p=0.01
Pre-implant mechanical dyssynchrony assessed by AD-max using cross-correlation analysis is a strong independent predictor of long-term survival after CRT, outperforming other TDI-derived indices.
Cite This Study
Risum et al. (2012) conducted a cohort in Patients referred for cardiac resynchronization therapy (n=131). Mechanical dyssynchrony assessed by maximal activation delay (AD-max) >35 ms vs. Absence of mechanical dyssynchrony was evaluated on Composite of all-cause mortality, cardiac transplantation, or implantation of a ventricular assist device (HR 0.35, 95% CI 0.16-0.77, p=0.01). Mechanical dyssynchrony assessed by maximal activation delay was independently associated with improved survival after cardiac resynchronization therapy (HR 0.35; 95% CI 0.16-0.77; P=0.01).