Journal of the American Society of Echocardiography
Clinical InvestigationApplications of Echocardiography in Heart FailureClinical Significance of Global Wasted Work in Patients with Heart Failure Receiving Cardiac Resynchronization Therapy
Graphical abstract
Section snippets
Study Population and Clinical Data
The population consisted of ambulatory patients with HFrEF referred to Groupement des Hôpitaux de l'Institut Catholique de Lille (Université Catholique de Lille), Hôpital Saint Philibert (Lomme, France), for CRT device implantation between 2010 and 2017. This study was a retrospective analysis of a prospective registry.18,19
CRT was indicated in patients with HFrEF and increased QRS duration. HFrEF was defined as the presence of HF (New York Heart Association functional class II, III, or
Baseline Patient Characteristics
The study population consisted of 249 patients with HF who underwent CRT. The mean age was 72 ± 11 years, and 159 patients (64%) were men (Table 1). Obstructive coronary artery disease was found in 96 patients (39%). Seventy patients (28%) had histories of atrial fibrillation. Among these 70 patients, 34 had paroxysmal atrial fibrillation and were in sinus rhythm at the time of index echocardiography. The remaining 36 patients had regular atrial fibrillation and controlled heart rates allowing
Discussion
The present data indicate that (1) low GWW is strongly associated with poor outcomes and absence of response to CRT in a cohort of patients with HF receiving CRT in clinical practice; (2) GWW provides additional prognostic information over established predictors of outcome; and (3) although immediate changes in GWW are strongly correlated with baseline GWW (i.e., the higher the baseline GWW, the greater the decrease in GWW following CRT), immediate changes in GWW do not provide meaningful
Conclusion
Preprocedural GWW assessed by PSLs is reproducible, and low GWW values are associated with poor long-term outcomes and a lower CRT response rate in patients with HFrEF receiving CRT. GWW < 200 mm Hg% provides independent prognostic information over established predictors of outcome in this population of patients with HFrEF. However, in the absence of randomized controlled studies, even if a majority of patients with preprocedural GWW < 200 mm Hg% seem to not derive benefit from CRT, these
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Cited by (0)
Drs. Riolet and Menet contributed equally to the preparation of this report.
This work was supported in part by a grant from the Groupement de Coopération Sanitaire G4 (FHU CARNAVAL).
Conflicts of interest: None.