Mechanical Dyssynchrony by Tissue Doppler Cross-Correlation is Associated with Risk for Complex Ventricular Arrhythmias after Cardiac Resynchronization Therapy

• Published in: Journal of the American Society of Echocardiography Vol. 28; no. 12; pp. 1474 - 1481
• Main Authors: Tayal, Bhupendar, MD, Gorcsan, John, MD, Delgado-Montero, Antonia, MD, Marek, Josef J., MD, Haugaa, Kristina H., MD, PhD, Ryo, Keiko, MD, PhD, Goda, Akiko, MD, PhD, Olsen, Niels Thue, MD, PhD, Saba, Samir, MD, Risum, Niels, MD, PhD, Sogaard, Peter, MD, DMSc
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2015
• Subjects: Aged; Cardiac resynchronization defibrillator therapy; Cardiac Resynchronization Therapy - methods; Cardiac Resynchronization Therapy - mortality; Cardiovascular; Denmark - epidemiology; Dyssynchrony; Echocardiography; Echocardiography, Doppler - methods; Female; Follow-Up Studies; Heart failure; Humans; Incidence; Male; Middle Aged; Pennsylvania - epidemiology; Prognosis; Prospective Studies; Risk Assessment - methods; Risk Factors; Stroke Volume - physiology; Survival Rate - trends; Tachycardia, Ventricular - diagnostic imaging; Tachycardia, Ventricular - epidemiology; Tachycardia, Ventricular - therapy; Time Factors; Treatment Outcome; Ventricular arrhythmia; Heart failure; CCA; Cardiac resynchronization defibrillator therapy; Echocardiography; AD; AD-max; Activation delay; Maximal absolute activation delay; Left ventricular; Ventricular arrhythmia; Dyssynchrony; Ventricular tachycardia; CRT-D; HR; LV; VA; Hazard ratio; LBBB; Left bundle branch block; HF; VT; Cross-correlation analysis
• ISSN: 0894-7317; 1097-6795
• DOI: 10.1016/j.echo.2015.07.021

Background Tissue Doppler cross-correlation analysis has been shown to be associated with long-term survival after cardiac resynchronization defibrillator therapy (CRT-D). Its association with ventricular arrhythmia (VA) is unknown. Methods From two centers 151 CRT-D patients (New York Heart Association functional classes II–IV, ejection fraction ≤ 35%, and QRS duration ≥ 120 msec) were prospectively included. Tissue Doppler cross-correlation analysis of myocardial acceleration curves from the basal segments in the apical views both at baseline and 6 months after CRT-D implantation was performed. Patients were divided into four subgroups on the basis of dyssynchrony at baseline and follow-up after CRT-D. Outcome events were predefined as appropriate antitachycardia pacing, shock, or death over 2 years. Results Mechanical dyssynchrony was present in 97 patients (64%) at baseline. At follow-up, 42 of these 97 patients (43%) had persistent dyssynchrony. Furthermore, among 54 patients with no dyssynchrony at baseline, 15 (28%) had onset of new dyssynchrony after CRT-D. In comparison with the group with reduced dyssynchrony, patients with persistent dyssynchrony after CRT-D were associated with a substantially increased risk for VA (hazard ratio [HR], 4.4; 95% CI, 1.2–16.3; P  = .03) and VA or death (HR, 4.0; 95% CI, 1.7–9.6; P  = .002) after adjusting for other covariates. Similarly, patients with new dyssynchrony had increased risk for VA (HR, 10.6; 95% CI, 2.8–40.4; P  = .001) and VA or death (HR, 5.0; 95% CI, 1.8–13.5; P  = .002). Conclusions Persistent and new mechanical dyssynchrony after CRT-D was associated with subsequent complex VA. Dyssynchrony after CRT-D is a marker of poor prognosis.