Relation between left ventricular wall dimensions in cardiac resynchronization therapy candidates and echocardiographic and clinical outcome.
Thara van der Borgh 1  
Berthold Stegemann 1  
Maciej Sterliński 2  
Bart Gerritse 1  
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Medtronic Bakken Research Center, Maastricht, The Netherlands.
Klinika Zaburzeń Rytmu Serca, Instytut Kardiologii
Publish date: 2017-12-17
Heart Beat 2017;2:27–32
LV wall and cavity dimensions in CRT candidates may be of importance to determine the efficacy of CRT pacing. Several studies have indicated that in LBBB the late-activated LV free wall is thick and the interventricular septum is thin but none of them related these LV dimensions to outcome. The objective was to determine the thickness of the LV wall, both at the septum and the free wall. The relation between this thickness and the outcome of CRT was investigated.

Material and methods:
Wall thicknesses in the PROSPECT cohort were analyzed by echocardiography measurements and related to the outcome of these patients. Outcome was measured in two ways: LVESV reduction of ≥15% and a clinical composite score.

The LV posterior wall was significantly thinner than the interventricular septum (1.07 vs. 1.12 cm, p<0.0001). Although posterior wall thickness (PWT) and septal wall thickness (SWT) were not predictors of CRT outcome, the SWT:PWT ratio was a significant predictor of outcome as measured by clinical composite score (p=0.042; Odds Ratio = 0.32). In case of a high SWT:PWT, less improvement was observed.

The current consensus that in LBBB, the free wall is thick and the septum is thin should be revisited. The SWT:PWT ratio was predictive of CRT response. Clinical Trail Registration information: URL: Unique identifier: NCT00253357.

Maciej Sterliński   
Klinika Zaburzeń Rytmu Serca, Instytut Kardiologii, Alpejska 42, 04-628 Warszawa, Poland