title: Ventricular asynchrony predicts a better outcome in patients with chronic heart failure receiving cardiac resynchronization therapy.
abstract: OBJECTIVE
  The aim of this study was to evaluate whether the clinical benefit of cardiac resynchronization therapy (CRT) can be prospectively predicted by means of the baseline evaluation of left ventricular asynchrony.
  
  
  BACKGROUND
  The reverse remodeling associated with CRT is more evident in patients with severe heart failure (HF) and left bundle branch block (LBBB) who have left ventricular asynchrony.
  
  
  METHODS
  Baseline left ventricular asynchrony was assessed in 60 patients with severe HF and LBBB by calculating the electrocardiographic duration of QRS and the echocardiographic septal-to-posterior wall motion delay (SPWMD). Left ventricular size and left ventricular ejection fraction (LVEF), mitral valve regurgitation, and functional capacity were also evaluated. The progression toward HF (defined as a worsening clinical condition leading to a sustained increase in conventional therapies, hospitalization, cardiac transplantation, and death) was assessed during follow-up, as were the changes in LVEF after six months.
  
  
  RESULTS
  During the median follow-up of 14 months, 16 patients experienced HF progression. Univariate analysis showed that ischemic cardiomyopathy, changes in the QRS duration after implantation, and SPWMD significantly correlated with events. At multivariate analysis, a long SPWMD remained significantly associated with a reduced risk of HF progression (hazard ratio: 0.91; 95% confidence interval: 0.83 to 0.99; p <0.05). An improvement in LVEF was observed in 79% of the patients with a baseline SPWMD of > or =130 ms and in 9% of those with an SPWMD of <130 ms (p <0.0001).
  
  
  CONCLUSIONS
  Baseline SPWMD is a strong predictor of long-term clinical improvement after CRT in patients with severe HF and LBBB.
authors.affiliation: Institute of Cardiology, University of Bari, Bari, Italy. mariavittoria.pitzalis@cardio.uniba.it
authors.forename: Maria Vittoria
authors.initials: MV
authors.lastname: Pitzalis
authors.forename: Massimo
authors.initials: M
authors.lastname: Iacoviello
authors.forename: Roberta
authors.initials: R
authors.lastname: Romito
authors.forename: Pietro
authors.initials: P
authors.lastname: Guida
authors.forename: Elisabetta
authors.initials: E
authors.lastname: De Tommasi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Luzzi
authors.forename: Matteo
authors.initials: M
authors.lastname: Anaclerio
authors.forename: Cinzia
authors.initials: C
authors.lastname: Forleo
authors.forename: Paolo
authors.initials: P
authors.lastname: Rizzon
mesh_terms: D000368:Aged; D002037:Bundle-Branch Block / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy*; D002304:Cardiac Pacing, Artificial; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D018450:Disease Progression; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011446:Prospective Studies; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging; D020257:Ventricular Remodeling / Q000502:physiology*