Abstract 13016: Tissue Mitral Annular Displacement (TMAD) Predicts Long-term Prognosis in Heart Failure Patients Receiving Cardiac Resynchronization Therapy

Introduction: Assessment of left ventricular (LV) dyssynchrony by echocardiography has only a limited ability to predict response to cardiac resynchronizing therapy (CRT) because of high variability of the measurement.Tissue mitral annular displacement (TMAD) is a rapid and robust method for the assessment of left ventricular (LV) longitudinal deformity. We previously reported that TMAD predicts good responders to CRT among patients with severe heart failure (AHA scientific meeting 2012). In the present study, we investigated whether TMAD could predict the long-term prognosis after CRT implantation. Methods: We performed echocardiography study in 41 patients with dilated cardiomyopathy (DCM) before and at 6 month of CRT, using iE33 (Philips Medical Systems). TMAD was measured on an apical 4-chamber image using QLAB software (Philips Medical Systems) to assess the movement of septal- and lateral part of mitral annulus toward apex. We measured the interval between QRS complex to peak of displacement on both regions, and calculated the differences in time-to-peak (dTTP). We defined good response to CRT as decrease in LV end-systolic volume (LVESV) > 15% at 6 month of CRT. We followed the patients to observe cardiovascular events including death, myocardial infarction, stroke and hospital admission for heart failure. Results: The 27 good responders (65.8%) had significantly longer dTTP than the non-responders (156±64 vs. 63±61 msec, p<0.0001). Using 104 msec as a cutoff value, TMAD detected CRT responders with sensitivity of 79% and specificity of 78% (AUC=0.83). We observed 20 cardiac events during follow-up period of 1182±635 days. We found that dTTP was significantly associated with cardiovascular events (p=0.048 by Cox proportional hazard model), and that patients with dTTP≥104ms had better prognosis than others (Figure). Conclusion: TMAD is a promising method for predicting long-term prognosis in patients with DCM receiving CRT. ![][1] [1]: /embed/graphic-1.gif