Heart failure & cardiomyopathies
Strain-based staging as a unifying concept in cardiac resynchronization therapy
Authors' conclusion
LBBB strain stages independently predict CRT outcomes, with lower stages associated with attenuated benefits, possibly due to higher scar burden. This classification provides a framework for understanding LBBB pathophysiology and CRT response.
Study context
- Population
- Cardiac resynchronization therapy (CRT) patients undergoing pre-implantation speckle-tracking strain analysis, compared with CRT-eligible conservatively treated patientsCRT patients, 155 also underwent cardiac magnetic resonance imaging, compared with 116 CRT-eligible conservatively treated patients
- Participants
- 267 patients
- Comparison
- CRT-treated patients were compared with 116 CRT-eligible conservatively treated patients
- CRT-treated patientsn = 267
- CRT-eligible conservatively treated patientsn = 116
- Outcome
- Volumetric response across LBBB stages in CRT recipients
Main finding
As reported in the abstract
- Stepwise improvement across left bundle branch block (LBBB) stages
- P < 0.001
Further findings
| Outcome | Estimate | P value |
|---|---|---|
| Volumetric response, predicted by LBBB stagesAfter multivariable adjustment; scar burden did not predict · After multivariable adjustment | OR 2.30 | P < 0.001 |
| Survival, predicted by LBBB stagesAfter multivariable adjustment; scar burden did not predict · After multivariable adjustment | HR 0.64 | P = 0.038 |
| Survival benefit, CRT-treated vs conservatively treated patients, by LBBB stageCRT-treated patients vs conservatively treated patients · LBBB-0; survival benefits greater in CRT-treated patients | HR 1.42 | P = 0.436 |
| Survival benefit, CRT-treated vs conservatively treated patients, by LBBB stageCRT-treated patients vs conservatively treated patients · LBBB-4; survival benefits greater in CRT-treated patients | HR 16.49 | P < 0.001 |
Survival across LBBB stages in CRT recipients
- Stepwise improvement across LBBB stages
- log-rank P = 0.002
Myocardial scar
- Present in CRT patients
- 52%
- Inversely correlated with LBBB stages
- P = 0.003
Original publication
Strain-based staging as a unifying concept in cardiac resynchronization therapy. Eur Heart J Cardiovasc Imaging. Published 26 May 2025. doi:10.
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