Incremental prognostic value of combining left ventricular lead position and systolic dyssynchrony in predicting long-term survival after cardiac resynchronization therapy

• Published in: Clinical science (1979) Vol. 117; no. 11-12; pp. 397 - 404
• Main Authors: ZHANG, Qing, YIP, Gabriel W.-K, CHAN, Yat-Sun, FUNG, Jeffrey W.-H, CHAN, Winnie, LAM, Yat-Yin, YU, Cheuk-Man
• Format: Journal Article
• Language: English
• Published: London Portland Press 01.12.2009
• Subjects: Aged; Biological and medical sciences; Cardiac Pacing, Artificial - methods; Cardiology. Vascular system; Echocardiography, Doppler; Epidemiologic Methods; Female; General aspects; Heart; Heart Failure - diagnostic imaging; Heart Failure - physiopathology; Heart Failure - therapy; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Humans; Male; Medical sciences; Middle Aged; Prognosis; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Treatment Outcome; Ventricular Function, Left - physiology; Ventricular Remodeling - physiology; Heart failure; Cardiac resynchronization; dyssynchrony; Position; cardiac resynchronization therapy; Mortality; Instrumentation therapy; Cardiovascular disease; Epidemiology; Long term; Survival; Left ventricle; Heavy metal; Medicine; Instrumental stimulation; left ventricular lead; Heart disease; Lead; Predictive value
• ISSN: 0143-5221; 1470-8736
• DOI: 10.1042/CS20080580

The efficacy of CRT (cardiac resynchronization therapy) can be affected by a number of factors; however, the prognostic significance of the LV (left ventricular) lead position has not been explored. The aim of the present study was to examine whether a PL (posterolateral) lead position has an additional value to systolic dyssynchrony in predicting a better survival after CRT. Patients (n=134) who received CRT were followed-up for 39+/-24 months. The LV lead position was determined by cine fluoroscopy, and baseline dyssynchrony was assessed by TDI (tissue Doppler imaging). The relationship between the LV lead position/dyssynchrony and mortality was compared using Kaplan-Meier curves, followed by Cox regression analysis. The all-cause and cardiovascular mortalities were 38 and 31% respectively. The presence of dyssynchrony and a PL lead position predicted a lower all-cause mortality (29 compared with 47%; log-rank chi2=5.38, P=0.02) and cardiovascular mortality (21 compared with 41%; log-rank chi2=6.75, P=0.009) than when absent. The all-cause mortality was as high as 62% when patients had neither dyssynchrony nor a PL lead position, but was reduced to 29% when both criteria were present, and was between 45 and 46% when only one criterion was present (chi2=6.79, P=0.01). The corresponding values for cardiovascular mortality were 62% when patients had neither dyssynchrony nor a PL lead position, 36-38% when patients had either dyssynchrony or a PL lead position, and 21% when patients had both criteria present (chi2=9.54, P=0.004). Combining dyssynchrony and a PL lead position independently predicted a lower all-cause morality {HR (hazard ratio), 0.496 [95% CI (confidence interval), 0.278-0.888]; P=0.018} and cardiovascular mortality [HR, 0.442 (95% CI, 0.232-0.844); P=0.013]. In conclusion, the placement of the LV lead at a PL position provides additional value to baseline dyssynchrony in predicting a lower all-cause and cardiovascular mortality during long-term follow-up after CRT.