Article Figures & Data
Figures
- FIGURE 1.
Distribution of scar sites and LV leads located in scar segment in 17-segment polar map. White number indicates number of leads in nonscarred segment in each location, and black number indicates number of LV leads located in scarred segment in each location. ANT = anterior; LAT = lateral; POST = posterior; SEPT = septal.
- FIGURE 2.
Kaplan–Meier analysis of the impact of scar burden on survival after cardiac resynchronization therapy: patients aged ≤70 y (A) and patients >70 y (B).
Tables
Variable Overall value Age (y) 70.2 ± 9.4 Male sex 179 (84) NICM 58 (27) Chronic atrial fibrillation 58 (27) NYHA class 3.0 ± 0.5 QRS duration (before implantation) (ms) 164.1 ± 34.7 Left bundle branch block 99 (49) B-type natriuretic peptide (before implantation) (pg/mL) Median 601.0 IQR 251.0–1,016.0 Angiotensin-converting enzyme/angiotensin II receptor blocker inhibitor 172 (82) β-blocker 186 (89) Aldactone 64 (30) Digoxin 118 (56) Values are number, with percentage in parentheses, or mean ± SD unless indicated otherwise.
Variable Before CRT After CRT P NYHA class 3.0 ± 0.4 2.4 ± 0.8 <0.001 QRS duration (ms) 166.9 ± 34.1 162.5 ± 24.5 0.16 B-type natriuretic peptide (pg/mL) 0.04 Median 580.0 386.0 IQR 234.0–1,013.0 164.5–863.5 LVEF (%) 23.8 ± 7.3 31.2 ± 11.6 <0.001 LVEDD (mm) 66.1 ± 8.7 63.6 ± 9.6 <0.001 LVESD (mm) 57.6 ± 8.9 53.7 ± 10.8 <0.001 Right ventricular size, grade 0–3 0.9 ± 0.9 0.8 ± 0.9 0.31 Right ventricular dysfunction, grade 0–3 1.0 ± 0.9 0.9 ± 0.9 0.38 Left atrial size (mm) 61.5 ± 9.4 62.4 ± 9.3 0.27 MR, grade 0–3 1.5 ± 0.8 1.3 ± 0.7 <0.001 Values are mean ± SD unless indicated otherwise.
Variable OR 95% CI P Female vs. male sex 0.93 0.39–2.21 0.865 Age (per 10 y) 1.01 0.73–1.40 0.943 NICM vs. ICM 1.59 0.79–3.20 0.189 Chronic atrial fibrillation 0.77 0.39–1.51 0.444 NYHA class 0.86 0.43–1.74 0.683 LVEF (per 10%) 0.78 0.51–1.19 0.251 QRS duration (per 10 ms) 1.05 0.96–1.15 0.314 Left bundle branch block 1.45 0.77–2.70 0.247 LVEDD (per 10 mm) 0.61 0.41–0.90 0.012 LVESD (per 10 mm) 0.71 0.45–1.13 0.146 Right ventricular size 0.79 0.56–1.12 0.185 Right ventricular dysfunction 0.94 0.67–1.32 0.721 MR 0.70 0.46–1.07 0.103 Pulmonary artery systolic pressure (per 10 mm Hg) 0.85 0.68–1.05 0.128 Biventricular pacing, 99%–100% vs. <99% 1.45 0.75–2.83 0.271 Lateral LV lead location 1.45 0.65–3.24 0.368 Number of viable myocardial segments 1.04 1.01–1.06 0.009 Number of scar segments 0.84 0.76–0.94 0.001 Extent of scarring (% LV mass) 0.97 0.95–0.99 0.001 Lateral scar location 0.049 No scar vs. nonlateral scar 1.62 0.72–3.65 0.240 Lateral scar vs. nonlateral scar 0.63 0.29–1.36 0.241 Posterior scar location 0.004 No scar vs. nonposterior scar 0.21 0.03–1.78 0.153 Posterior scar vs. nonposterior scar 0.08 0.01–0.67 0.020 Anterior scar location 0.060 No scar vs. nonanterior scar 1.69 0.75–3.81 0.206 Anterior scar vs. nonanterior scar 0.68 0.31–1.47 0.327 Septal scar location 0.022 No scar vs. nonseptal scar 1.54 0.71–3.31 0.274 Septal scar vs. nonseptal scar 0.50 0.23–1.09 0.081 LV lead in scar segment 0.94 0.34–2.61 0.902 Variable Scarring extent < 22% Scarring extent ≥ 22% P Age (y) 71.6 ± 9.5 67.9 ± 8.9 0.007 Male sex 116 (85) 61 (84) 0.83 NICM 48 (35) 7 (10) <0.001 Chronic atrial fibrillation 38 (28) 20 (27) 0.96 NYHA class 3.0 ± 0.5 3.0 ± 0.4 0.55 LVEF (before implantation), % 24.5 ± 7.0 22.1 ± 7.0 0.02 LVEDD (before implantation), mm 63.3 ± 8.3 68.1 ± 8.7 <0.001 LVESD (before implantation), mm 55.7 ± 8.5 60.2 ± 8.7 0.004 Right ventricular size, grade 0–3 0.8 ± 0.9 1.0 ± 0.9 0.22 MR, grade 0–3 1.4 ± 0.8 1.7 ± 0.8 0.02 Pulmonary artery systolic pressure (before implantation) (mm Hg) 43.7 ± 13.4 52.9 ± 15.9 <0.001 Change in NYHA class −0.7 ± 0.9 −0.5 ± 0.8 0.13 Change in QRS duration (ms) −9.3 ± 39.1 4.3 ± 38.0 0.04 Change in LVEF (%) 9.9 ± 11.9 2.8 ± 6.7 <0.001 Change in LVEDD (mm) −2.9 ± 7.9 −1.8 ± 3.5 0.33 Change in LVESD (mm) −4.5 ± 9.5 −2.9 ± 5.0 0.39 Change in right ventricular size, grade 0–3 −0.1 ± 0.7 −0.1 ± 0.9 0.82 Change in MR severity, grade 0–3 −0.3 ± 0.6 −0.2 ± 0.6 0.35 Change in pulmonary artery systolic pressure (mm Hg) −4.7 ± 13.2 −5.7 ± 15.3 0.69 Values are number, with percentage in parentheses, or mean ± SD unless indicated otherwise.
Univariate analysis Multivariate analysis Variable HR 95% CI P HR 95% CI P Female vs. male sex 0.62 0.28–1.35 0.224 Age (per 10 y) 1.56 1.17–2.08 0.003 1.36 1.01–1.83 0.046 NICM vs. ICM 0.41 0.19–0.85 0.017 0.40 0.18–0.89 0.025 Chronic atrial fibrillation 1.56 0.95–2.55 0.079 NYHA class 1.80 1.09–2.98 0.022 LVEF (per 10%) 1.15 0.81–1.62 0.429 QRS duration (per 10 ms) 1.01 0.94–1.08 0.881 LBBB 0.60 0.37–0.98 0.041 0.58 0.34–0.98 0.040 LVEDD (per 10 mm) 0.94 0.72–1.23 0.673 LVESD (per 10 mm) 0.93 0.65–1.35 0.714 Right ventricular size 1.31 1.02–1.69 0.036 Right ventricular dysfunction 1.29 1.01–1.66 0.044 MR 1.75 1.28–2.40 <0.001 1.72 1.25–2.37 <0.001 Pulmonary artery systolic pressure (per 10 mm Hg) 1.22 1.05–1.42 0.011 Biventricular pacing, 99%–100% vs. <99% 0.69 0.38–1.27 0.238 Lateral LV lead location 0.47 0.28–0.80 0.005 0.52 0.30–0.91 0.021 Total scar number 1.00 0.93–1.07 0.966 Extent of scarring (% LV) 1.00 0.99–1.01 0.971 Lateral scar location 0.927 No scar vs. nonlateral scar 0.89 0.49–1.62 0.700 Lateral scar vs. nonlateral scar 0.96 0.54–1.69 0.886 Posterior scar location 0.670 No scar vs. nonposterior scar 1.27 0.48–3.38 0.632 Posterior scar vs. nonposterior scar 1.46 0.58–3.70 0.420 Anterior scar location 0.476 No scar vs. nonanterior scar 0.77 0.43–1.37 0.367 Anterior scar vs. nonanterior scar 0.72 0.41–1.27 0.252 Septal scar location 0.909 No scar vs. nonseptal scar 0.84 0.53–1.66 0.825 Septal scar vs. nonseptal scar 1.07 0.61–1.90 0.808
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