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Septal Rebound Stretch is a Strong Predictor of Outcome After Cardiac Resynchronization Therapy.
MedLine Citation:
PMID:  22555272     Owner:  NLM     Status:  In-Data-Review    
BACKGROUND: Septal rebound stretch (SRSsept) is a distinctive characteristic of discoordination-related mechanical inefficiency. We assessed how intermediate- and long-term outcome after cardiac resynchronization therapy (CRT) relate to baseline SRSsept.
METHODS AND RESULTS: A total of 101 patients (age 65 ± 11 years, 69 men, 18 New York Heart Association (NYHA) class IV, QRS 173 ± 23 ms) scheduled for CRT underwent clinical assessment, echocardiography, and brain-type natriuretic peptide (BNP) measurements before and 6.4 ± 2.3 months after CRT. Baseline SRSsept (all systolic stretch after initial shortening in the septum) was quantified by speckle tracking echocardiography. Primary composite end point was death, urgent cardiac transplantation, or left ventricular assist device implantation at the end of the study. Secondary end points were intermediate-term (6 months) response, quantified as decreases in left ventricular end-systolic volume (ΔLVESV) and BNP (ΔBNP). After a mean clinical follow-up of 15.6 ± 9.0 months; 23 patients had reached the primary end point. Baseline SRSsept (hazard ratio [HR] 0.742; 95% confidence intervals [CI] 0.601-0.916, P < .01]) was independently associated with a better outcome and NYHA class (HR 5.786: 95% CI 2.341-14.299, P < .001) with a worse outcome. Contrary to baseline NYHA class, baseline SRSsept was an independent predictor of both ΔLVESV (beta 0.53; P < .001) and ΔBNP (beta 0.29; P < .01). Intermediate-term ΔLVESV and ΔBNP were associated with a favorable long-term outcome.
CONCLUSIONS: SRSsept at baseline is a strong, independent predictor of long-term prognosis after CRT and of improvements in left ventricular remodeling and neurohormonal activation at intermediate term.
Geert E Leenders; Bart W L De Boeck; Arco J Teske; Mathias Meine; Margot D Bogaard; Frits W Prinzen; Pieter A Doevendans; Maarten J Cramer
Publication Detail:
Type:  Journal Article     Date:  2012-03-10
Journal Detail:
Title:  Journal of cardiac failure     Volume:  18     ISSN:  1532-8414     ISO Abbreviation:  J. Card. Fail.     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-05-04     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9442138     Medline TA:  J Card Fail     Country:  United States    
Other Details:
Languages:  eng     Pagination:  404-12     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 Elsevier Inc. All rights reserved.
Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
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