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Impact of Myocardial Viability and Left Ventricular Lead Location on Clinical Outcome in Cardiac Resynchronization Therapy Recipients with Ischemic Cardiomyopathy
Author(s) -
BOSE ABHISHEK,
KANDALA JAGDESH,
UPADHYAY GAURAV A.,
RIEDL LINDSAY,
AHMADO IMAD,
PADMANABHAN RAM,
GEWIRTZ HENRY,
MULLIGAN LAWRENCE J.,
SINGH JAGMEET P.
Publication year - 2014
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.12348
Subject(s) - medicine , cardiac resynchronization therapy , cardiology , heart failure , ischemic cardiomyopathy , hazard ratio , ejection fraction , clinical endpoint , cardiomyopathy , laminated veneer lumber , clinical trial , confidence interval , veneer , orthodontics
Role of Ischemia and Scar in CRT Patients with CAD Introduction Cardiac resynchronization therapy (CRT) recipients with ischemic cardiomyopathy (ICM) have scar segments that may limit ventricular resynchronization and clinical response. The impact of myocardial viability at the left ventricular (LV) pacing site on CRT response is poorly elucidated. Methods and Results A retrospective cohort of 160 ICM patients with single photon emission computed tomography‐myocardial perfusion imaging before device implantation were included. Coronary venous angiography and chest radiographs helped classify segmental location of LV lead (LVL). The primary outcome was a composite of heart failure (HF) hospitalization and mortality at 3 years, and secondary outcome was change in systolic function at 6 months. The patients were divided into groups based on the myocardial substrate at the site of LVL: LVL on or adjacent to (1) normal myocardium (LVL‐N, n = 64), (2) segmental scar (LVL‐S, n = 62), and (3) scar and ischemia (LVL‐SI, n = 34). Upon follow‐up, 75 (47%) patients reached primary endpoint with a higher incidence noted in LVL‐S (60%), and LVL‐SI (53%), compared to 31% in LVL‐N (P = 0.004). Kaplan Meier method demonstrated poor event free survival for primary outcome in LVL‐S (P = 0.002), and LVL‐SI (P = 0.03). In Cox proportional hazard model, LVL‐S (HR: 2.26, P = 0.004), and LVL‐SI (1.9, P = 0.047) were independent predictors of primary outcome. Conclusion In CRT recipients with ICM, scar and reversible ischemia in or adjacent to LV pacing site were independent predictors of HF hospitalization and death.