Should we use a semi-quantitative assessment of apical rocking to predict outcome in CRT patients?

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Apical rocking (AR) is a systolic septal-to-lateral motion the apex observed on echocardiography in apical 4-chamber view some patients with ventricular conduction delay. It strong predictor for outcome after cardiac resynchronization therapy (CRT) and has been suggested as selection criterion CRT. Critics argue that simple visual assessment AR may be too subjective clinical use. Speckle-tracking based myocardial analysis allow to objectify reduce potential observer dependence. Purpose To compare (VAR) semi-quantitative (QAR) prediction (i) volume response (ii) all-cause death assess interobserver agreement VAR QAR. Methods We retrospectively analyzed data from 166 first CRT implantation. All had an echo before implantation approximately 1 year QAR were performed by three experienced observers echocardiographic views was obtained performing speckle-tracking segments lateral septal wall. A negative displacement positive during systole considered (Figure). Areas under ROC-curves (AUC) determined compared using DeLong method. Volume defined ≥15% decrease left end-systolic (LVESV) within year. Patients followed mean duration 5.2 years. Hazard ratios (HR) all-time calculated univariate Cox proportional-hazards regression model. Interobserver analysed intraclass correlation coefficient (ICC) average measurement, absolute agreement, two-way mixed effects Results 77% (n = 122) responders. Seven died follow-up echocardiography. 31% 52) follow-up. AUC similar (0.73 vs 0.72, p 0.782). HR (0.39, 0.25–0.61; p<0.001) (0.37, 0.23–0.59; p<0.001). ICC good (0.78; 0.55–0.90) (0.84; 0.67–0.93). Conclusion Semi-quantification technology achieves comparable results when reader eligible similarly good. could used confirmation support clinicians less familiar assessment.