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009 Uncovering the mechanism of the paradoxical association between cardiac dyssynchrony and better survival in heart failure
  1. R J Jabbour,
  2. J Shah,
  3. J Mayet,
  4. D P Francis
  1. Imperial College Healthcare Trust, UK

Abstract

Introduction Paradoxically, dyssynchrony before CRT is associated with a better prognosis. We tested whether this was dependent on device implantation or on how the cohort was defined (EF ≤35 vs All-comers).

Methods 419 patients (67.8±11.3 years, 79.2% males, 127 deaths) with heart failure had echocardiographic assessment of mechanical dyssynchrony and were followed up (median 3.1 years).

Results 135 had dyssynchrony and 62 received CRT. The mean EF was 33.1±15.0%; 157 (35.2%) had an EF >35%. Among patients with EF≤35% (n=249), shorter aortic pre-ejection time (ie, less dyssynchrony) was associated with a worse prognosis (p<0.05). All dyssynchrony markers were higher in survivors (p<0.001 by sign test, upper panel). EF was not prognostic and depressed by dyssynchrony (r=−0.4, p<0.001). By examining all patients (regardless of EF); the association between dyssynchrony and better survival disappeared (p>0.05, lower panel). EF was restored to its prognostic significance (p=0.02). Taking a different approach to define poor ventricular function—using low S-wave velocity—EF had prognostic significance (p<0.05) and dyssynchrony markers were non-prognostic (p>0.05).

Conclusion Dyssynchrony predicts better survival in low EF groups because dyssynchrony artifactually lowers EF without damaging survival. The effect is independent of CRT. Replacement of EF with dyssynchrony-neutral measures of LV function, for example, peak S-wave velocity would avoid the appearance that dyssynchrony is favourable.

  • Heart failure
  • dyssychrony
  • CRT

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