Mechanism and Impact of Left Atrial Dyssynchrony on Long-Term Clinical Outcome During Cardiac Resynchronization Therapy.

IF 12.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS JACC. Cardiovascular imaging Pub Date : 2024-11-11 DOI:10.1016/j.jcmg.2024.09.008

Lars-Egil R Hammersboen, Marie Stugaard, Alexis Puvrez, Camilla K Larsen, Espen W Remme, Erik Kongsgård, Jürgen Duchenne, Elena Galli, Faraz H Khan, Ole Jakob Sletten, Martin Penicka, Erwan Donal, Jens-Uwe Voigt, Otto A Smiseth, John M Aalen

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Abstract

Background: Left bundle branch block (LBBB) causes left atrial (LA) dyssynchrony. It is unknown if LA dyssynchrony impacts long-term prognosis.

Objectives: The purpose of this study was to determine mechanisms of LA dyssynchrony in LBBB and if LA dyssynchrony impacts long-term prognosis.

Methods: In a prospective multicenter study of 168 heart failure patients with LBBB, echocardiographic strain imaging was done before and after 6 months with cardiac resynchronization therapy (CRT). Outcome was assessed after 6 years. Dyssynchrony was measured relative to septum as delay in left ventricular (LV) lateral wall shortening and LA lateral wall stretch. Response to CRT was defined as at least 15% reduction in LV end-systolic volume.

Results: Before CRT, there was marked LA dyssynchrony of 105 ± 76 ms, which decreased to 37 ± 68 ms in CRT-responders (P < 0.001), whereas nonresponders showed only a modest reduction in LA dyssynchrony (P < 0.05). There was strong association between LA and LV dyssynchrony (r = 0.70), consistent with direct LV-LA mechanical interaction. CRT caused modest increase in LA reservoir strain (P < 0.01) and marked increase of LV filling time (P < 0.001) in responders. Mortality after 6 years was 21% (35 deaths). LA dyssynchrony did not independently predict mortality. However, the combination of preserved LA reservoir strain (≥18%) and resolved LA dyssynchrony (≤53 ms) after 6 months with CRT was associated with excellent long term-prognosis: HR: 0.11 (95% CI: 0.03-0.42) vs preserved reservoir strain and persistent LA dyssynchrony.

Conclusions: LA dyssynchrony in LBBB was attributed to direct LV-LA mechanical interactions. CRT improved diastolic function by increasing LV filling time. Patients with preserved LA reservoir strain and resolution of LA dyssynchrony by CRT had excellent long-term prognosis. (Contractile Reserve in Dyssynchrony: A Novel Principle to Identify Candidates for Cardiac Resynchronization Therapy [CRID-CRT]; NCT02525185).

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心脏再同步化疗法期间左心房不同步的机制及其对长期临床结果的影响

背景：左束支传导阻滞（LBBB）会导致左心房（LA）不同步。目前尚不清楚 LA 不同步是否会影响长期预后：本研究旨在确定 LBBB 中 LA 不同步的机制以及 LA 不同步是否会影响长期预后：在一项前瞻性多中心研究中，对168名患有LBBB的心衰患者在接受心脏再同步化治疗（CRT）6个月前后进行了超声心动图应变成像。6 年后对结果进行评估。相对于室间隔的不同步测量为左心室（LV）侧壁缩短和 LA 侧壁伸展的延迟。对CRT的反应定义为左心室收缩末期容积至少缩小15%：CRT前，LA不同步明显，为105 ± 76 ms，CRT反应者的LA不同步降至37 ± 68 ms（P < 0.001），而无反应者的LA不同步仅略有减少（P < 0.05）。LA 和 LV 不同步性之间有很强的关联性（r = 0.70），这与 LV-LA 的直接机械相互作用是一致的。CRT 可使 LA 储能应变适度增加（P < 0.01），并显著增加应答者的 LV 充盈时间（P < 0.001）。6年后的死亡率为21%（35例死亡）。LA 不同步并不能独立预测死亡率。然而，CRT治疗6个月后，LA储腔应变保留（≥18%）和LA不同步解决（≤53 ms）的组合与良好的长期预后相关：HR：0.11（95% CI：0.03-0.42）vs 储腔应变保留和LA不同步持续存在：结论：LBBB患者的LA不同步是由LV-LA的直接机械相互作用引起的。CRT通过增加LV充盈时间改善舒张功能。保留了LA储库应变并通过CRT解决了LA不同步的患者长期预后良好。(Dyssynchrony 中的收缩储备：识别心脏再同步化疗法候选者的新原则 [CRID-CRT]；NCT02525185）。

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来源期刊

JACC. Cardiovascular imaging CARDIAC & CARDIOVASCULAR SYSTEMS-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

CiteScore

24.90

自引率

5.70%

发文量

330

审稿时长

4-8 weeks

期刊介绍： JACC: Cardiovascular Imaging, part of the prestigious Journal of the American College of Cardiology (JACC) family, offers readers a comprehensive perspective on all aspects of cardiovascular imaging. This specialist journal covers original clinical research on both non-invasive and invasive imaging techniques, including echocardiography, CT, CMR, nuclear, optical imaging, and cine-angiography. JACC. Cardiovascular imaging highlights advances in basic science and molecular imaging that are expected to significantly impact clinical practice in the next decade. This influence encompasses improvements in diagnostic performance, enhanced understanding of the pathogenetic basis of diseases, and advancements in therapy. In addition to cutting-edge research,the content of JACC: Cardiovascular Imaging emphasizes practical aspects for the practicing cardiologist, including advocacy and practice management.The journal also features state-of-the-art reviews, ensuring a well-rounded and insightful resource for professionals in the field of cardiovascular imaging.