title: Clinical significance of septal deformation patterns in heart failure patients receiving cardiac resynchronization therapy.
abstract: OBJECTIVE
  Specific septal motion related to dyssynchrony is strongly linked to reverse remodelling, in patients with systolic heart failure (HF) receiving cardiac resynchronization therapy (CRT). We aimed to investigate the relationship between septal deformation patterns studied by longitudinal speckle tracking and clinical outcome following CRT.
  
  
  RESULTS
  A total of 284 CRT candidates from two centres (HF NYHA classes II-IV, ejection fraction < 35%, QRS ≥ 120 ms) were prospectively included. Longitudinal strain of the septum in the apical four-chamber view determined three patterns of septal contraction. The endpoints were overall mortality, cardiovascular mortality, and hospitalization for HF. Compared with patterns 1 or 2, pattern 3 was associated with an increased risk for both overall and cardiovascular mortality [hazard ratio (HR) = 3.78, 95% confidence interval (CI): 1.85-7.75, P < 0.001 and HR = 3.84, 95% CI: 1.45-10.16, P = 0.007, respectively] and HF hospitalization (HR = 4.41, 95% CI: 2.18-8.90, P < 0.001). Addition of septal patterns to multivariable models, including baseline QRS width and presence of left bundle branch block, improved risk prediction, and discrimination. In patients with intermediate QRS duration (120-150 ms), pattern 3 remained associated with a worse outcome than pattern 1 or 2 (P < 0.05 for all endpoints).
  
  
  CONCLUSIONS
  The identification of septal deformation patterns provides important prognostic information in CRT candidates in addition to ordinary clinical, electrocardiographic, and echocardiographic predictors of outcome in HF patients. This parameter may be particularly useful in patients with intermediate QRS duration in whom the benefit of CRT remains uncertain.
authors.affiliation: GCS-Groupement des hôpitaux de l'institut Catholique de Lille, Cardiology Department, Université Catholique de Lille, 59000 Lille, France.|INSERM U 1088, Université de Picardie, Amiens, France.
authors.forename: Aymeric
authors.initials: A
authors.lastname: Menet
authors.affiliation: Service de Cardiologie et CIC-IT U 804, Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou - CHU Rennes, F-35033 Rennes, France LTSI, Université Rennes 1, INSERM 1099, Rennes, France.|Cardiology Department, Centre Hospitalier Universitaire de Tours, Tours, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Bernard
authors.affiliation: INSERM U 1088, Université de Picardie, Amiens, France.|Cardiology Department, Centre Hospitalier Universitaire d'Amiens, Amiens, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Tribouilloy
authors.affiliation: Service de Cardiologie et CIC-IT U 804, Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou - CHU Rennes, F-35033 Rennes, France LTSI, Université Rennes 1, INSERM 1099, Rennes, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Leclercq
authors.affiliation: GCS-Groupement des hôpitaux de l'institut Catholique de Lille, Cardiology Department, Université Catholique de Lille, 59000 Lille, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Gevaert
authors.affiliation: GCS-Groupement des hôpitaux de l'institut Catholique de Lille, Cardiology Department, Université Catholique de Lille, 59000 Lille, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Guyomar
authors.affiliation: Cardiology Department, Centre Hospitalier Universitaire de Grenoble, Grenoble, France.
authors.forename: Raphaelle-Ashley
authors.initials: RA
authors.lastname: Guerbaai
authors.affiliation: GCS-Groupement des hôpitaux de l'institut Catholique de Lille, Cardiology Department, Université Catholique de Lille, 59000 Lille, France.
authors.forename: François
authors.initials: F
authors.lastname: Delelis
authors.affiliation: GCS-Groupement des hôpitaux de l'institut Catholique de Lille, Cardiology Department, Université Catholique de Lille, 59000 Lille, France.
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Castel
authors.affiliation: GCS-Groupement des hôpitaux de l'institut Catholique de Lille, Cardiology Department, Université Catholique de Lille, 59000 Lille, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Graux
authors.affiliation: Cardiology Department, Centre Hospitalier Universitaire de Grenoble, Grenoble, France.
authors.forename: Pierre-Vladimir
authors.initials: PV
authors.lastname: Ennezat
authors.affiliation: Service de Cardiologie et CIC-IT U 804, Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou - CHU Rennes, F-35033 Rennes, France LTSI, Université Rennes 1, INSERM 1099, Rennes, France.
authors.forename: Erwan
authors.initials: E
authors.lastname: Donal
authors.affiliation: GCS-Groupement des hôpitaux de l'institut Catholique de Lille, Cardiology Department, Université Catholique de Lille, 59000 Lille, France.|INSERM U 1088, Université de Picardie, Amiens, France.
authors.forename: Sylvestre
authors.initials: S
authors.lastname: Maréchaux
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058406:Cardiac Resynchronization Therapy / Q000379:methods* / Q000401:mortality; D002423:Cause of Death; D015331:Cohort Studies; D004452:Echocardiography / Q000379:methods; D004562:Electrocardiography / Q000379:methods; D005260:Female; D054143:Heart Failure, Systolic / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy*; D006346:Heart Septum / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D016019:Survival Analysis
keywords: cardiac resynchronization therapy; echocardiography; heart failure; outcome; speckle tracking