Key result
CRT is linked to improved survival vs no CRT in HF with high mechanical dyssynchrony.
Why the study?
The value of mechanical dyssynchrony measured by equilibrium radionuclide angiography (ERNA) in predicting long-term outcome in cardiac resynchronization therapy (CRT) patients required evaluation.
Does mechanical dyssynchrony assessed by ERNA predict survival benefit from CRT in heart failure patients?
Cohort (n=146)
No
Does mechanical dyssynchrony assessed by ERNA predict survival benefit from CRT in heart failure patients?
Mechanical dyssynchrony assessed by ERNA can identify heart failure patients who will derive a survival benefit from cardiac resynchronization therapy.
May guide CRT selection via ERNA dyssynchrony in HF; leaves open need for randomized confirmation.
AIMS: To assess the value of mechanical dyssynchrony measured by equilibrium radionuclide angiography (ERNA) in predicting long-term outcome in cardiac resynchronization therapy (CRT) patients. METHODS AND RESULTS: We reviewed 146 ERNA studies performed in heart failure patients between 2001 and 2011 at our institution. Long-term follow-up focused on death from any cause or heart transplantation. Phase images were computed using the first harmonic Fourier transform. Intra-ventricular dyssynchrony was calculated as the delay between the earliest and most delayed 20% of the left ventricular (LV) (IntraV-20/80) and inter-ventricular dyssynchrony as the difference between LV- and right ventricular (RV)-mode phase angles (InterV). Eighty-three patients (57%) were implanted with a CRT device after ERNA. Median follow-up was 35 [21-50] months. Twenty-four events were observed during the first 41 months. Median baseline ERNA dyssynchrony values were 28 [3 to 46] degrees for intraV-20/80 and 9 [-6 to 24] degrees for interV. Comparing survival between CRT and non-CRT patients according to dyssynchrony status, log-rank tests showed no difference in survival in patients with no ERNA dyssynchrony (P = 0.34) while a significant difference was observed in ERNA patients with high level of mechanical dyssynchrony (P = 0.004). CONCLUSION: ERNA mechanical dyssynchrony could be of value in CRT patient selection.
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Tournoux et al. (2015) conducted a cohort in heart failure (n=146). Cardiac resynchronization therapy (CRT) vs. No CRT was evaluated on Death from any cause or heart transplantation (p=0.004). Cardiac resynchronization therapy was associated with significantly improved survival compared to no CRT in heart failure patients with high levels of mechanical dyssynchrony on ERNA (P=0.004).
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