In:
Circulation: Heart Failure, Ovid Technologies (Wolters Kluwer Health), Vol. 6, No. 4 ( 2013-07), p. 685-693
Abstract:
Mechanisms of mitral regurgitation (MR) reduction with cardiac resynchronization therapy (CRT) are complex, and their association with long-term outcome is unclear. We sought to elucidate mechanistic features of reduction in MR with CRT, which impact long-term patient survival. Methods and Results— A prospective longitudinal study of 277 patients with heart failure with QRS width ≥120 ms and ejection fraction ≤35% for CRT was performed. Quantitative echocardiography, including dyssynchrony analysis, was performed at baseline. MR was quantified by color Doppler before and 6 months after CRT. Predefined end points of death, transplant, or left ventricular assist device were tracked during 4 years. There were 114 (48%) patients with CRT with significant MR (≥moderate) at baseline; of whom 48 (42%) patients had MR improvement, and 24 (19%) patients had MR worsening after CRT. The 66 events (47 deaths, 10 transplantations, and 9 left ventricular assist devices) were strongly associated with significant MR after CRT (hazard ratio, 3.58; 95% confidence interval, 2.18–5.87; P 〈 0.0001). Three echocardiographic features were independently associated with amelioration of significant MR after CRT by multivariable analysis: anteroseptal to posterior wall radial strain dyssynchrony 〉 200 ms, lack of severe left ventricular dilatation (end-systolic dimension index 〈 29 mm/m 2 ), and lack of echocardiographic scar at papillary muscle insertion sites (all P 〈 0.05) and, when combined, were additively associated with long-term survival ( P =0.0001). Conclusions— Significant MR after CRT was strongly associated with less favorable long-term survival. Echocardiographic mechanistic features were identified that were associated with improvement in MR after CRT and favorable long-term survival.
Type of Medium:
Online Resource
ISSN:
1941-3289
,
1941-3297
DOI:
10.1161/CIRCHEARTFAILURE.112.000112
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2013
detail.hit.zdb_id:
2429459-7
detail.hit.zdb_id:
2428100-1
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