Left ventricular markers of mortality and ventricular arrhythmias in heart failure patients with cardiac resynchronization therapy

Eur Heart J Cardiovasc Imaging. 2016 Mar;17(3):343-50. doi: 10.1093/ehjci/jev173. Epub 2015 Jul 11.


Aims: Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in heart failure. However, prediction of the outcome remains difficult. We aimed to investigate for echocardiographic predictors of ventricular arrhythmias and fatal outcome and to explore how myocardial function is changed by biventricular pacing in heart failure.

Methods and results: We prospectively included 170 heart failure patients (66 ± 10 years, New York Heart Association class 2.8 ± 0.5, 48% ischaemic cardiomyopathy) and recorded ventricular arrhythmias and fatal end point defined as death, heart transplantation, or left ventricular assist device implantation during 2 years. Two-dimensional echocardiography was performed before and 6 months after CRT implantation. CRT response was defined as ≥15% reduction in end-systolic volume at 6 months. Speckle-tracking technique was performed to assess longitudinal and circumferential left ventricular function, defined as global longitudinal (GLS) and circumferential strain (GCS), and to assess mechanical dyssynchrony, defined as mechanical dispersion. GLS before CRT was a predictor of fatal end point independently of CRT response [hazard ratio, HR 1.14 (1.02-1.27), P = 0.02]. Patients with GLS better than -8.3% showed event-free survival benefit (log rank, P < 0.001). Mechanical dispersion at 6 months was an independent predictor of ventricular arrhythmias [HR 1.20 (1.06-1.35), P = 0.005]. CRT responders (59%) had improvement of both GLS and GCS.

Conclusion: In heart failure patients with CRT, worse longitudinal function before CRT was an important predictor of fatal outcome during 2 years, independently of CRT response. Mechanical dispersion at 6 months was a strong predictor of ventricular arrhythmias. CRT response by reverse remodelling was dependent on improvement of both longitudinal and circumferential function.

Keywords: cardiac resynchronization therapy; heart failure; left ventricular mechanics; speckle tracking echocardiography; ventricular arrhythmia.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Arrhythmias, Cardiac / mortality*
  • Arrhythmias, Cardiac / physiopathology
  • Cardiac Resynchronization Therapy*
  • Echocardiography
  • Female
  • Heart Failure / mortality*
  • Heart Failure / physiopathology
  • Heart Failure / therapy*
  • Heart Transplantation
  • Heart-Assist Devices
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Ventricular Dysfunction, Left / mortality*
  • Ventricular Dysfunction, Left / physiopathology