The efficacy of CRT (cardiac resynchronization therapy) can be affected by a number of factors; however, the prognostic significance of the LV (left ventricular) lead position has not been explored. The aim of the present study was to examine whether a PL (posterolateral) lead position has an additional value to systolic dyssynchrony in predicting a better survival after CRT. Patients (n=134) who received CRT were followed-up for 39±24 months. The LV lead position was determined by cine fluoroscopy, and baseline dyssynchrony was assessed by TDI (tissue Doppler imaging). The relationship between the LV lead position/dyssynchrony and mortality was compared using Kaplan–Meier curves, followed by Cox regression analysis. The all-cause and cardiovascular mortalities were 38 and 31% respectively. The presence of dyssynchrony and a PL lead position predicted a lower all-cause mortality (29 compared with 47%; log-rank χ2=5.38, P=0.02) and cardiovascular mortality (21 compared with 41%; log-rank χ2=6.75, P=0.009) than when absent. The all-cause mortality was as high as 62% when patients had neither dyssynchrony nor a PL lead position, but was reduced to 29% when both criteria were present, and was between 45 and 46% when only one criterion was present (χ2=6.79, P=0.01). The corresponding values for cardiovascular mortality were 62% when patients had neither dyssynchrony nor a PL lead position, 36–38% when patients had either dyssynchrony or a PL lead position, and 21% when patients had both criteria present (χ2=9.54, P=0.004). Combining dyssynchrony and a PL lead position independently predicted a lower all-cause morality {HR (hazard ratio), 0.496 [95% CI (confidence interval), 0.278–0.888]; P=0.018} and cardiovascular mortality [HR, 0.442 (95% CI, 0.232–0.844); P=0.013]. In conclusion, the placement of the LV lead at a PL position provides additional value to baseline dyssynchrony in predicting a lower all-cause and cardiovascular mortality during long-term follow-up after CRT.
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Research Article|
September 14 2009
Incremental prognostic value of combining left ventricular lead position and systolic dyssynchrony in predicting long-term survival after cardiac resynchronization therapy
Qing Zhang;
Qing Zhang
*Li Ka Shing Institute of Health and Sciences, Institute of Vascular Medicine, Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
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Gabriel W.-K. Yip;
Gabriel W.-K. Yip
*Li Ka Shing Institute of Health and Sciences, Institute of Vascular Medicine, Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
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Yat-Sun Chan;
Yat-Sun Chan
*Li Ka Shing Institute of Health and Sciences, Institute of Vascular Medicine, Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
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Jeffrey W.-H. Fung;
Jeffrey W.-H. Fung
*Li Ka Shing Institute of Health and Sciences, Institute of Vascular Medicine, Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
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Winnie Chan;
Winnie Chan
†Department of Medicine, North District Hospital, Hong Kong, China
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Yat-Yin Lam;
Yat-Yin Lam
*Li Ka Shing Institute of Health and Sciences, Institute of Vascular Medicine, Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
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Cheuk-Man Yu
*Li Ka Shing Institute of Health and Sciences, Institute of Vascular Medicine, Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
Correspondence: Professor Cheuk-Man Yu ([email protected]).
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Publisher: Portland Press Ltd
Received:
November 06 2008
Revision Received:
March 26 2009
Accepted:
April 01 2009
Accepted Manuscript online:
April 01 2009
Online ISSN: 1470-8736
Print ISSN: 0143-5221
© The Authors Journal compilation © 2009 Biochemical Society
2009
Clin Sci (Lond) (2009) 117 (11): 397–404.
Article history
Received:
November 06 2008
Revision Received:
March 26 2009
Accepted:
April 01 2009
Accepted Manuscript online:
April 01 2009
Citation
Qing Zhang, Gabriel W.-K. Yip, Yat-Sun Chan, Jeffrey W.-H. Fung, Winnie Chan, Yat-Yin Lam, Cheuk-Man Yu; Incremental prognostic value of combining left ventricular lead position and systolic dyssynchrony in predicting long-term survival after cardiac resynchronization therapy. Clin Sci (Lond) 1 December 2009; 117 (11): 397–404. doi: https://doi.org/10.1042/CS20080580
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