Left bundle-branch block contraction patterns identified from radial-strain analysis predicts outcomes following cardiac resynchronization therapy.
A left bundle-branch block (LBBB) contraction pattern identified from longitudinal-strain analysis predicts outcomes following cardiac resynchronization therapy (CRT). We investigated the use of an LBBB-contraction pattern identified from radial- or circumferential-strain analysis in the prediction of CRT benefits. Eighty CRT candidates were prospectively enrolled. Before CRT implantation, speckle-tracking analyses in three deformation directions were performed to determine whether an LBBB-contraction pattern was present. The study endpoints were reverse remodeling at 6 months, and adverse outcomes including death or heart failure hospitalization. At 6 months, 49 (61%) patients had reverse remodeling. An LBBB-contraction pattern identified from the radial strain in the mid-ventricular short-axis view or longitudinal strain in the four-chamber view provided excellent true-positive (86%) and false-negative (8%) rates for predicting reverse remodeling. During a median follow-up of 30 months, 31 patients (39%) had adverse outcomes. Absence of an LBBB-contraction pattern in radial (hazard ratio 3.74; 95% confidence interval 1.83-7.62) or longitudinal strain (hazard ratio 3.49; 95% confidence interval 1.71-7.13) was significantly associated with an increased risk of adverse outcomes. Adding the LBBB-pattern assessment by radial-(model χ2from 8.2 to 18.5, p = 0.005), or longitudinal-strain analysis (model χ2from 8.2 to 16.9, p = 0.011) to a risk model significantly improved the model, including QRS duration and ischemic etiology. In conclusion, an LBBB-contraction pattern identified from radial-strain analysis in the mid-ventricular short-axis view predicted reverse remodeling and outcome following CRT, similarly to the longitudinal-strain analysis.
Cardiovascular Division, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, 5, Fushin Street, Kweishan District, Taoyuan, Taiwan, Republic of China. wang3015@cgmh.org.tw.|College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China. wang3015@cgmh.org.tw.
Chun-Li
CL
Wang
Cardiovascular Division, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, 5, Fushin Street, Kweishan District, Taoyuan, Taiwan, Republic of China.|College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China.
Chia-Tung
CT
Wu
Cardiovascular Division, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, 5, Fushin Street, Kweishan District, Taoyuan, Taiwan, Republic of China.|College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China.
Yung-Hsin
YH
Yeh
Cardiovascular Division, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, 5, Fushin Street, Kweishan District, Taoyuan, Taiwan, Republic of China.|College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China.
Lung-Sheng
LS
Wu
Cardiovascular Division, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, 5, Fushin Street, Kweishan District, Taoyuan, Taiwan, Republic of China.|College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China.
Yi-Hsin
YH
Chan
Cardiovascular Division, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, 5, Fushin Street, Kweishan District, Taoyuan, Taiwan, Republic of China.|College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China.
Chi-Tai
CT
Kuo
Cardiovascular Division, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, 5, Fushin Street, Kweishan District, Taoyuan, Taiwan, Republic of China.|College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China.|Heart Failure Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, Republic of China.
Pao-Hsien
PH
Chu
Cardiovascular Division, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, 5, Fushin Street, Kweishan District, Taoyuan, Taiwan, Republic of China.|College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China.
Lung-An
LA
Hsu
Cardiovascular Division, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, 5, Fushin Street, Kweishan District, Taoyuan, Taiwan, Republic of China.|College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China.
Wan-Jing
WJ
Ho
D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D002037:Bundle-Branch Block / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009200:Myocardial Contraction; D015588:Observer Variation; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D015203:Reproducibility of Results; D012307:Risk Factors; D013314:Stress, Mechanical; D013997:Time Factors; D016896:Treatment Outcome; D020257:Ventricular Remodeling
Cardiac resynchronization therapy; Echocardiography; Outcome; Strain