The improvement of LV short-axis function but not long-axis function or torsion contributes to the improvement in LV global function and geometry at three-month follow up. A relatively preserved mean epsilon-circum of >or=6.5% might be useful to predict favourable responses after CRT.

Objective: To examine the impact of heart failure (HF) aetiology on long-term outcome after cardiac resynchronisation therapy (CRT). Design: Prospective cohort study. Setting: University hospital. Patients: 119 patients (44% with ischaemic and 56% non-ischaemic aetiology) who underwent CRT. Interventions: Clinical follow-up for 39 (24) months. Main outcome measures: Cardiovascular mortality, HF and cardiovascular hospitalisation were compared by Kaplan-Meier curves between the two groups, followed by Cox regression analysis for prognostic predictor(s). Results: 41 (34%) patients died, in whom cardiovascular causes were identified in 32 (27%) patients. The ischaemic group had a higher cardiovascular mortality (log-rank x 2 = 4.293, p = 0.038) and cardiovascular hospitalisation (log-rank x 2 = 5.123, p = 0.024) when compared with the non-ischaemic group, though no difference was found in HF hospitalisation (log-rank x 2 = 0.019, p = 0.892). At three months, left ventricular reverse remodelling occurred in 52% of the ischaemic group and 55% of the non-ischaemic group (x 2 = 0.128, p = 0.720). By Cox regression analysis, ischaemic aetiology and absence of reverse remodelling at three months were independent predictors of cardiovascular mortality (HR = 2.698, p = 0.032; HR = 3.541, p = 0.030) and cardiovascular hospitalisation (HR = 1.905, p = 0.015; HR = 2.361, p = 0.004). Furthermore, these two factors had an incremental value in predicting cardiovascular mortality when compared with either alone (left ventricular reverse remodelling, logrank x 2 = 10.275 vs 6.311, p = 0.05; Ischaemic aetiology, log-rank x 2 = 10.275 vs 4.293, p,0.05). Conclusion: Ischaemic aetiology of HF is an independent predictor of higher cardiovascular mortality and hospitalisation after CRT. This may implicate the progressive nature of coronary heart disease leading to a worse outcome despite similar short-term benefits of CRT.Cardiac resynchronisation therapy (CRT) is an established treatment for patients with advanced heart failure (HF) who have electromechanical delay. Its beneficial effects on cardiac function, exercise capacity, quality of life, left ventricular (LV) reverse remodelling and long-term prognosis, including mortality and cardiovascular hospitalisation, have been confirmed in large clinical trials. [1][2][3][4][5][6][7] In the MIRACLE study, a lesser degree of reduction of LV volumes at one-year follow-up was observed in ischaemic than non-ischaemic patients. 9However, it is not known whether there is any attributable difference in aetiology on long-term prognosis after CRT. In the CARE-HF study, when compared with ischaemic patients, non-ischaemic patients showed a greater extent of reduction in the estimated absolute risk for death or unplanned hospitalisation after receiving CRT, though aetiology of HF was not found to be an independent predictor for the outcome measure of CRT.10 On the other hand, early LV reverse remodelling occurring at 3-6 months after CRT detected by echocardiography has been shown to heral...

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