Septal to posterior wall motion delay fails to predict reverse remodeling or clinical improvement in patients undergoing cardiac resynchronization therapy

J Am Coll Cardiol. 2005 Dec 20;46(12):2208-14. doi: 10.1016/j.jacc.2005.05.095.


Objectives: The aim of this study was to test the hypothesis that a longer septal-to-posterior wall motion delay (SPWMD) would predict greater reverse remodeling and an improved clinical response in heart failure patients randomized to cardiac resynchronization therapy (CRT) in the CONTAK-CD trial.

Background: The SPWMD predicted clinical benefit with CRT in two previous studies from the same center.

Methods: In this retrospective analysis of the CONTAK-CD trial, SPWMD was measured from the baseline echocardiogram of 79 heart failure patients (ejection fraction 22 +/- 7%, QRS duration 159 +/- 27 ms, 72% ischemic, 84% male) randomized to CRT and compared with six-month changes in echocardiographic and clinical parameters. Patients with a left ventricular end-systolic volume index (LVESVI) reduction of at least 15% were considered responders.

Results: The feasibility and reproducibility of performing the SPWMD measurements were poor. Larger values for SPWMD did not correlate with six-month changes in left ventricular end-diastolic volume index (p = 0.26), LVESVI (p = 0.41), or left ventricular ejection fraction (p = 0.36). Responders did not have a significantly different SPWMD than non-responders (p = 0.26). The SPWMD did not correlate with measures of clinical improvement. At a threshold of SPWMD >130 ms, the test characteristics to predict reverse remodeling or a clinical response were inadequate.

Conclusions: The previous findings that SPWMD predicts reverse remodeling or clinical improvement with CRT were not reproducible in patients randomized in the CONTAK-CD trial.

MeSH terms

  • Aged
  • Cardiac Output, Low / complications*
  • Cardiac Output, Low / diagnostic imaging
  • Cardiac Output, Low / physiopathology
  • Cardiac Output, Low / therapy*
  • Cardiac Pacing, Artificial*
  • Echocardiography
  • Feasibility Studies
  • Female
  • Heart Septum / physiopathology
  • Humans
  • Male
  • Middle Aged
  • Multicenter Studies as Topic
  • Predictive Value of Tests
  • Randomized Controlled Trials as Topic
  • Retrospective Studies
  • Time Factors
  • Treatment Outcome
  • Ventricular Dysfunction, Left / etiology*
  • Ventricular Remodeling*