Baseline dyssynchrony by speckle-tracking echocardiography was associated with fewer serious long-term events after CRT compared to lack of dyssynchrony (12% vs 53%; P<0.01).
Cohort (n=132)
Yes
Does baseline dyssynchrony assessed by speckle-tracking echocardiography predict ejection fraction response and long-term clinical outcomes in heart failure patients receiving cardiac resynchronization therapy?
Baseline dyssynchrony assessed by radial and transverse strain on speckle-tracking echocardiography strongly predicts favorable ejection fraction response and long-term clinical outcomes after cardiac resynchronization therapy.
Absolute Event Rate: 12% vs 53%
p-value: p=<0.01
AIMS: The Speckle Tracking and Resynchronization (STAR) study used a prospective multi-centre design to test the hypothesis that speckle-tracking echocardiography can predict response to cardiac resynchronization therapy (CRT). METHODS AND RESULTS: We studied 132 consecutive CRT patients with class III and IV heart failure, ejection fraction (EF) or =120 ms from three international centres. Baseline dyssynchrony was evaluated by four speckle tracking strain methods; radial, circumferential, transverse, and longitudinal (> or =130 ms opposing wall delay for each). Pre-specified outcome variables were EF response and three serious long-term events: death, transplant, or left ventricular assist device. Of 120 patients (91%) with baseline dyssynchrony data, both short-axis radial strain and transverse strain from apical views were associated with favourable EF response 7 +/- 4 months and long-term outcome over 3.5 years (P < 0.01). Radial strain had the highest sensitivity at 86% for predicting EF response with a specificity of 67%. Serious long-term unfavourable events occurred in 20 patients after CRT, and happened three times more frequently in those who lacked baseline radial or transverse dyssynchrony than in patients with dyssynchrony (P < 0.01). Patients who lacked both radial and transverse dyssynchrony had unfavourable clinical events occur in 53%, in contrast to events occurring in 12% if baseline dyssynchrony was present (P < 0.01). Circumferential and longitudinal strains predicted response when dyssynchrony was detected, but failed to identify dyssynchrony in one-third of patients who responded to CRT. CONCLUSION: Dyssynchrony by speckle-tracking echocardiography using radial and transverse strains is associated with EF response and long-term outcome following CRT.
Tanaka et al. (2010) conducted a cohort in Heart failure (n=132). Baseline dyssynchrony by speckle-tracking echocardiography vs. Lack of baseline dyssynchrony was evaluated on EF response and three serious long-term events: death, transplant, or left ventricular assist device (p=<0.01). Baseline dyssynchrony by speckle-tracking echocardiography was associated with fewer serious long-term events after CRT compared to lack of dyssynchrony (12% vs 53%; P<0.01).