Purpose To investigate the clinical and echocardiographic predictors of echocardiographic super‐response to cardiac resynchronization therapy (CRT) in heart failure patients. Methods We retrospectively collected data from 97 patients, who underwent CRT and were followed up (median time = 20.33 months). All had left ventricular ejection fraction (LVEF) ≤35%, New‐York‐Heart‐Association class 3 or 4, and Q wave, R wave and S wave (QRS) duration >120 ms. Time‐to‐peak systolic velocity was measured for individual LV segments by tissue Doppler imaging prior to CRT. Two‐dimensional echocardiography was carried out before and at follow‐up, and ≥12.5% increase in LVEF was defined as super‐response. Results From the 97 patients, 23 (23.7%) were super‐responders. Super‐responders were more frequently female (52.2% vs. 24.3%, respectively; p value = 0.012). Among super‐responders, the mean of LV end‐diastolic and end‐systolic volumes were significantly lower. According to dyssynchrony indices, time delay between anteroseptal and posterior wall and SD of all LV segments timing showed significantly higher values in super‐responders. By multivariate analysis, LV end‐systolic volume and anteroseptal‐to‐posterior wall delay remained independently associated with echocardiographic super‐response to CRT. Conclusion About one‐fourth of our patients with CRT were super‐responder in that they had ≥12.5% increase in LVEF by echocardiography. Among all the clinical and echocardiographic measures, only lower LV end‐systolic volume and higher anteroseptal‐to‐posterior wall delay predicted super‐response.
Background: Usefulness of echocardiogram-associated markers for prediction of the response of the patients with cardiomyopathy to Cardiac Resynchronization Therapy (CRT) is under debate. Method: In a cross sectional retrospective design, we analyzed data from 69 cardiomyopathy patients (mean age = 57.59 ± 11.17 years, 69.6% male) with New-York-Heart-Association class ≥ III, left ventricular ejection fraction (LVEF) ≤ 35%, and QRS duration > 120 ms who underwent CRT. Transthoracic echocardiography and tissue Doppler imaging were performed before CRT and transthoracic echocardiography was repeated after CRT. More than 5% increase in the LVEF within 48 hours post CRT was considered as acute response. Results: After CRT, 36 (52.2%) patients were acute responders. Before CRT, responders had a remarkably higher frequency of diabetes mellitus (36.1% vs.15.2%, p = 0.048), lower left ventricular end systolic volume (125.82 ± 179.73 vs. 179.73 ± 77.51 ml, p = 0.002) and end diastolic volume (165.03 ± 67.09 vs. 236.06 ± 93.24 ml, p < 0.001) compared to none responders. Other echocardiography characteristics were not significantly different. In multivariable analysis, left ventricular end systolic volume remained the sole independent predictor of acute response. A cut-off of 135 ml for left ventricular end systolic volume had a good sensitivity (67.65%) and specificity (72.73%) to distinguish responders from non-responders. Conclusion: More than half of the cardiomyopathy patients had improvement ≥ 5% in LVEF within 48 hours after CRT. No relationship was found between formerly defined pre-CRT echocardiographic dyssynchrony markers and acute response. Left ventricular end systolic volume was the sole independent predictor of acute response and a threshold of 135 ml could discriminate acute responders to CRT.
Background Since the introduction of cardiac resynchronization therapy (CRT) to improve left ventricular function, the effect of CRT on the right ventricle in patients with heart failure has not been well described. Methods We evaluated the effect of CRT on right ventricular systolic function in 20 patients (80% men; mean [SD] age, 58.5 [9.8] y) with cardiomyopathy and right ventricular systolic dysfunction (New York Heart Association class III or IV, left ventricular ejection fraction ≤35%, and QRS interval ≥120 ms). The median follow-up time was 15 months. Right ventricular systolic function, defined as a tricuspid annular plane systolic excursion (TAPSE) index of 16 mm or less, was evaluated in patients before and after CRT. Results Twelve (60%) patients had ischemic cardiomyopathy, and 12 (60%) patients had left bundle branch block detected using surface electrocardiogram. The mean (SD) QRS duration was 160.5 (24.4) ms. From before CRT to the time of follow-up after CRT, the mean (SD) ejection fraction increased significantly from 22.5% (5.6%) to 29.4% (7.4%) (P < .001). The mean (SD) TAPSE index also increased significantly from 13.70 (1.78) mm to 16.50 (4.77) mm (P = .018). Eleven (55%) patients showed improved right ventricular systolic function (TAPSE ≥16 mm) after CRT. Patients with a favorable right ventricular response to CRT were significantly older (64.6 [8.2] y vs 53.6 [8.4] y, respectively) and more likely to have nonischemic origin of cardiomyopathy than were patients with unimproved right ventricular function (66.7% vs 18.2%, respectively). Conclusion Our findings indicate that CRT is associated with improved right ventricular systolic function in patients with heart failure and right ventricular systolic dysfunction. Patients with nonischemic heart disease more often show improved right ventricular function after CRT.
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