Are the Extent,Location, and Score of Segmental Wall Motion Abnormalities Related to Cardiac Resynchronization Therapy Response? |
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Authors: | Xuedong Shen M.D. Wilbert S. Aronow M.D. F.A.C.C. F.A.H.A. Chandra K. Nair M.D. Mark J. Holmberg M.D. Ph.D. Tom Hee M.D. Stephanie Maciejewski M.D. Dennis J. Esterbrooks M.D. |
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Affiliation: | 1. Cardiac Center of Creighton University School of Medicine, Omaha, Nebraska;2. Cardiology Division, New York Medical College, Valhalla, New York |
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Abstract: | Background: We hypothesized that segmental wall motion abnormalities (WMAs) are related to cardiac resynchronization therapy (CRT) response. Methods: We studied 108 patients who received CRT, 69 with ischemic and 39 with nonischemic heart disease. A wall motion score index (WMSI) was analyzed using a 17‐segment model and calculated by the total score/number of segments analyzed. A decrease of left ventricular end systolic volume ≥15% after CRT was defined as a positive response to CRT. Results: Of 108 patients, 1,054/1,836 segments (57%) had WMAs. The mean WMSI was 2.06 in patients with ischemic heart disease and 1.04 in patients with nonischemic heart disease (P < 0.0001). The area under the receiver operating characteristic curve for a WMSI predicting a positive response to CRT was 0.70 (P = 0.0001). The cutoff point was a WMSI ≤2 for prediction of a positive response to CRT. After adjustment for age, gender, and clinical features, the WMSI persistently related to CRT responders (P = 0.01). During 15‐month follow‐up, the percentage of CRT nonresponders in patients with a WMSI >2 was significantly higher (82%) compared to patients with a WMSI ≤2 (47%, P = 0.005) and nonischemic heart disease (36%, P < 0.001). In 59 patients with left ventricular mechanical dyssynchrony, the percentage of negative responders to CRT in patients with a WMSI >2, ≤2, and nonischemic heart disease were 53% (8 of 15), 16% (3 of 19) and 0% (0 of 25), respectively (P < 0.001). Conclusions: A large extent of WMAs and a WMSI >2 predicted a poorer CRT response. (ECHOCARDIOGRAPHY, Volume 26, November 2009) |
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Keywords: | Doppler tissue imaging echocardiography cardiac resynchronization therapy congestive heart failure coronary artery disease cardiomyopathy |
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