title: Relationship of visually assessed apical rocking and septal flash to response and long-term survival following cardiac resynchronization therapy (PREDICT-CRT).
abstract: OBJECTIVE
  Apical rocking (ApRock) and septal flash (SF) are often observed phenomena in asynchronously contracting ventricles. We investigated the relationship of visually assessed ApRock and SF, reverse remodelling, and long-term survival in cardiac resynchronization therapy (CRT) candidates.
  
  
  RESULTS
  A total of 1060 patients eligible for CRT underwent echocardiographic examinations before and 12 ± 6 months after device implantation. Three blinded physicians were asked to visually assess the presence of ApRock and SF before device implantation and also their correction by CRT 12 ± 6 months post-implantation. Patients with a left ventricular (LV) end-systolic volume decrease of ≥15% during the first year of follow-up were regarded as responders. Patients were followed for a median period of 46 months (interquartile range: 27-65 months) for the occurrence of death of any cause. If corrected by CRT, visually assessed ApRock and SF were associated with reverse remodelling with a sensitivity of 84 and 79%, specificity of 79 and 74%, and accuracy of 82 and 77%, respectively. ApRock (hazard ratio [HR] 0.40, 95% confidence interval [CI] 0.30-0.53, P < 0.0001) and SF (HR 0.45 [CI 0.34-0.61], P < 0.001) were independently associated with lower all-cause mortality after CRT and had an incremental value over clinical variables and QRS width for identifying CRT responders. Both the absence of ApRock/SF and unsuccessful correction of ApRock/SF despite CRT were associated with a high risk for non-response and an unfavourable long-term survival.
  
  
  CONCLUSIONS
  A specific LV mechanical dyssynchrony pattern, characterized by ApRock and SF, is associated with a more favourable long-term survival after CRT. Both parameters are also indicators of an effective therapy.
authors.affiliation: Department of Cardiovascular Diseases, University Hospital Gasthuisberg, Catholic University Leuven, Herestraat 49, Leuven 3000, Belgium Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Ivan
authors.initials: I
authors.lastname: Stankovic
authors.affiliation: Department of Cardiology, Heart and Diabetes Centre of North-Rhine Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Prinz
authors.affiliation: Department of Cardiovascular Diseases, University Hospital Gasthuisberg, Catholic University Leuven, Herestraat 49, Leuven 3000, Belgium.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Ciarka
authors.affiliation: Department of Cardiovascular Diseases, University Hospital Gasthuisberg, Catholic University Leuven, Herestraat 49, Leuven 3000, Belgium.
authors.forename: Ana Maria
authors.initials: AM
authors.lastname: Daraban
authors.affiliation: Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.
authors.forename: Martin
authors.initials: M
authors.lastname: Kotrc
authors.affiliation: Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
authors.forename: Marit
authors.initials: M
authors.lastname: Aarones
authors.affiliation: Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Silesian University of Medicine, Silesia, Poland.
authors.forename: Mariola
authors.initials: M
authors.lastname: Szulik
authors.affiliation: Klinik für Innere Medizin und Kardiologie, St. Vinzenz Hospital, Cologne, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Winter
authors.affiliation: Leuven Biostatistics and Statistical Bioinformatics Centre, Catholic University Leuven, Leuven, Belgium.
authors.forename: Ann
authors.initials: A
authors.lastname: Belmans
authors.affiliation: Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Aleksandar N
authors.initials: AN
authors.lastname: Neskovic
authors.affiliation: Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Silesian University of Medicine, Silesia, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Kukulski
authors.affiliation: Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
authors.forename: Svend
authors.initials: S
authors.lastname: Aakhus
authors.affiliation: Department of Cardiovascular Diseases, University Hospital Gasthuisberg, Catholic University Leuven, Herestraat 49, Leuven 3000, Belgium.
authors.forename: Rik
authors.initials: R
authors.lastname: Willems
authors.affiliation: Klinik für Innere Medizin und Kardiologie, St. Vinzenz Hospital, Cologne, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Fehske
authors.affiliation: Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.
authors.forename: Martin
authors.initials: M
authors.lastname: Penicka
authors.affiliation: Department of Cardiology, Heart and Diabetes Centre of North-Rhine Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany.
authors.forename: Lothar
authors.initials: L
authors.lastname: Faber
authors.affiliation: Department of Cardiovascular Diseases, University Hospital Gasthuisberg, Catholic University Leuven, Herestraat 49, Leuven 3000, Belgium jens.uwe.voigt@gmx.net.
authors.forename: Jens-Uwe
authors.initials: JU
authors.lastname: Voigt
mesh_terms: D058406:Cardiac Resynchronization Therapy; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D015996:Survival Rate; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy*; D020257:Ventricular Remodeling
keywords: Apical rocking; Cardiac resynchronization therapy; Mechanical dyssynchrony; Septal flash; Survival