A concordant left ventricular lead position at the site of latest mechanical activation independently predicted hospitalization-free survival after cardiac resynchronization therapy (HR 0.22; P=0.004).
Cohort (n=244)
Hazard Ratio: 0.22
p-value: p=0.004
OBJECTIVES: The aim of the current study was to evaluate echocardiographic parameters after 6 months of cardiac resynchronization therapy (CRT) as well as long-term outcome in patients with the left ventricular (LV) lead positioned at the site of latest activation (concordant LV lead position) as compared with that seen in patients with a discordant LV lead position. BACKGROUND: A nonoptimal LV pacing lead position may be a potential cause for nonresponse to CRT. METHODS: The site of latest mechanical activation was determined by speckle tracking radial strain analysis and related to the LV lead position on chest X-ray in 244 CRT candidates. Echocardiographic evaluation was performed after 6 months. Long-term follow-up included all-cause mortality and hospitalizations for heart failure. RESULTS: Significant LV reverse remodeling (reduction in LV end-systolic volume from 189 +/- 83 ml to 134 +/- 71 ml, p < 0.001) was noted in the group of patients with a concordant LV lead position (n = 153, 63%), whereas patients with a discordant lead position showed no significant improvements. In addition, during long-term follow-up (32 +/- 16 months), less events (combined for heart failure hospitalizations and death) were reported in patients with a concordant LV lead position. Moreover, a concordant LV lead position appeared to be an independent predictor of hospitalization-free survival after long-term CRT (hazard ratio: 0.22, p = 0.004). CONCLUSIONS: Pacing at the site of latest mechanical activation, as determined by speckle tracking radial strain analysis, resulted in superior echocardiographic response after 6 months of CRT and better prognosis during long-term follow-up.
Ypenburg et al. (2008) conducted a cohort in Heart failure (CRT candidates) (n=244). Concordant left ventricular lead position vs. Discordant left ventricular lead position was evaluated on Hospitalization-free survival (combined heart failure hospitalizations and death) (HR 0.22, p=0.004). A concordant left ventricular lead position at the site of latest mechanical activation independently predicted hospitalization-free survival after cardiac resynchronization therapy (HR 0.22; P=0.004).