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Abstract: Poster Presentations |

ARE EXTENT AND LOCATION AND SCORE OF SEGMENTAL WALL-MOTION ABNORMALITIES RELATED TO NEGATIVE RESPONSES TO CARDIAC RESYNCHRONIZATION THERAPY? FREE TO VIEW

Xuedong Shen, MD*; Chandra K. Nair, MD; Mark J. Holmberg, MD; Aryan N. Mooss, MD; Stephanie Maciejewski, PharmD; Tom Hee, MD; Dennis Esterbrooks, MD
Author and Funding Information

The Cardiac Center of Creighton University, Omaha, NE


Chest


Chest. 2009;136(4_MeetingAbstracts):102S. doi:10.1378/chest.136.4_MeetingAbstracts.102S
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Abstract

PURPOSE:  We hypothesized that the extent, location and score of segmental wall motion abnormality (WMA) are related to response of cardiac resynchronization therapy (CRT).

METHODS:  We studied 108 patients who received CRT (male 78, age 69.9 ± 9.7 years). Patients with atrial fibrillation were excluded. There were 69 patients with ischemic heart disease. 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:  There were 1,054/1,836 segments (57%) with WMA before CRT. The segments with WMA in CRT non-responders were significantly greater than CRT responders (69% vs 43%, p < 0.001). Segments with WMA were more frequently attributed to left anterior descending coronary artery (LAD) in CRT non-responders (89%) compared to CRT responders (63%, p < 0.001). Mean WMSI was 1.80 ± 0.64. WMSI in patients with ischemic heart disease was significantly greater than non-ischemic heart disease (2.06 ± 0.59 vs 1.04 ± 0.07, p < 0.0001). The area under ROC curve (AUC) for WMSI predicting positive response to CRT was 0.70 (p = 0.0001, Fig). The cutoff point was WMSI≤; 2 for prediction of positive response to CRT. After adjustment for age, gender and clinical variables, WMSI continued to be related to CRT responders (p = 0.01) and associated with high Nagelkerke R2 (0.66, p < 0.0001). During follow-up of 15 ± 10.9 months, the percentage of CRT non-responders in patients with WMSI > 2 was significantly higher (82%) compared to patients with WMSI≤; 2 (47%, p = 0.005) and non-ischemic heart disease (36%, p < 0.001). Of 59 patients with left ventricular dyssynchrony, 11/59 (19%) patients had negative response to CRT.

CONCLUSION:  The large extent of WMA, WMA in the segments attributed to LAD and WMSI > 2 predicted a poorer CRT response even in patients with echocardiographic demonstrated LVMD.

CLINICAL IMPLICATIONS:  Wall motion score index > 2 predicted a poorer CRT response.

DISCLOSURE:  Xuedong Shen, No Financial Disclosure Information; No Product/Research Disclosure Information

Wednesday, November 4, 2009

12:45 PM - 2:00 PM


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