Prognostic implications of left ventricular global longitudinal strain in heart failure patients with narrow QRS complex treated with cardiac resynchronization therapy: A subanalysis of the randomized EchoCRT trial

Jeroen J. Bax, Victoria Delgado, Peter Sogaard, Jagmeet P. Singh, William T. Abraham, Jeffrey S. Borer, Kenneth Dickstein, Daniel Gras, Josep Brugada, Michele Robertson, Ian Ford, Henry Krum, Johannes Holzmeister, Frank Ruschitzka, John Gorcsan

Research output: Contribution to journalArticlepeer-review

Abstract

Aim Left ventricular (LV) global longitudinal strain (GLS) reflects LV systolic function and correlates inversely with the extent of LV myocardial scar and fibrosis. The present subanalysis of the Echocardiography Guided CRT trial investigated the prognostic value of LV GLS in patients with narrow QRS complex. Methods and results Left ventricular (LV) global longitudinal strain (GLS) was measured on the apical 2-, 4- and 3-chamber views using speckle tracking analysis. Measurement of baseline LV GLS was feasible in 755 patients (374 with cardiac resynchronization therapy (CRT)-ON and 381 with CRT-OFF). The median value of LV GLS in the overall population was 7.9%, interquartile range 6.2-10.1%. After a mean follow-up period of 19.4 months, 95 patients in the CRT-OFF group and 111 in the CRT-ON group reached the combined primary endpoint of all-cause mortality and heart failure hospitalization. Each 1% absolute unit decrease in LV GLS was independently associated with 11% increase in the risk to reach the primary endpoint (Hazard ratio 1.11; 95% confidence interval 95% 1.04-1.17, P<0.001), after adjusting for ischaemic cardiomyopathy and randomization treatment among other clinically relevant variables. When categorizing patients according to quartiles of LV GLS, the primary endpoint occurred more frequently in patients in the lowest quartile (<6.2%) treated with CRT-ON vs. CRT-OFF (45.6% vs. 28.7%, P=0.009) whereas, no differences were observed in patients with LV GLS-6.2% treated with CRT-OFF vs. CRT-ON (23.7% vs. 24.5%, respectively; P =0.62). Conclusion Low LV GLS is associated with poor outcome in heart failure patients with QRS width <130 ms, independent of randomization to CRT or not. Importantly, in the group of patients with the lowest LV GLS quartile, CRT may have a detrimental effect on clinical outcomes.

Original languageEnglish (US)
Pages (from-to)720-726
Number of pages7
JournalEuropean Heart Journal
Volume38
Issue number10
DOIs
StatePublished - Mar 1 2017

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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