A meta-analysis of left ventricular dyssynchrony assessment and prediction of response to cardiac resynchronization therapy by three-dimensional echocardiography

Kleijn, Sebastiaan A.; Aly, Mohamed F.A.; Knol, Dirk L.; Terwee, Caroline B.; Jansma, Elise P.; El-Hady, Yasser A. Abd; Kandil, Hossam; Sorour, K.; Rossum, Albert C. van; Kamp, Otto

doi:10.1093/ehjci/jes041

Cited by 55 publications

(54 citation statements)

References 89 publications

(53 reference statements)

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“…In particular, the SDI cut‐off value with the highest predictive value was 6.4% in a large single‐center study . Furthermore, a recent meta‐analysis demonstrated that SDI is a feasible and reliable tool to predict response to CRT: a weighted mean SDI cut‐off value of 9.8% showed in pooled estimates a sensitivity and specificity of 93% and 75%, respectively . Also in another large study, SDI has been shown to be more reliable than QRS duration in the prediction of CRT response in terms of clinical improvement and LV reverse remodeling .…”

Section: Discussionmentioning

confidence: 92%

“…The optimal SDI cut‐off value to predict the primary endpoint was based on the principle of the highest sum of sensitivity and specificity. Furthermore, sensitivity and specificity were shown also for the SDI cut‐off values previously proposed in the literature: 6.4% and 9.8% . The prognostic value of resynchronization (reduction in SDI after CRT implantation, ΔSDI) was also assessed using the median split.…”

Section: Methodsmentioning

confidence: 90%

“…The SDI is calculated from the SD of 16 LV segments (after exclusion of the true apex) timings and expressed as percentage of the cardiac cycle as previously described (Figure ) . Higher SDI values indicate higher LV dyssynchrony, and based on previous literature, two cut‐off values of SDI have been proposed to define significant LV dyssynchrony: SDI > 6.4% and SDI > 9.8% . Previous studies have also already demonstrated that SDI values are highly reproducible with minimal inter‐ and intraobserver variability and an excellent test–retest agreement …”

Section: Methodsmentioning

confidence: 99%

“…Three‐dimensional (3D) echocardiography is currently recommended in HF patients for the quantification of LV volumes and function, which is also an important assessment before referring patients for CRT. From the same LV 3D data set, the systolic dyssynchrony index (SDI) can be automatically derived as a LV dyssynchrony measure, which showed to be significantly associated with response to CRT also in a large meta‐analysis . However, the predictive value of SDI for long‐term prognosis after CRT has not been evaluated yet.…”

Section: Introductionmentioning

confidence: 99%

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Assessment of left ventricular dyssynchrony by three‐dimensional echocardiography: Prognostic value in patients undergoing cardiac resynchronization therapy

Höke

Bax

Delgado

et al. 2018

Cardiovasc electrophysiol

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Section: Discussionmentioning

confidence: 92%

Section: Methodsmentioning

confidence: 90%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Assessment of left ventricular dyssynchrony by three‐dimensional echocardiography: Prognostic value in patients undergoing cardiac resynchronization therapy

Höke

Bax

Delgado

et al. 2018

Cardiovasc electrophysiol

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show abstract

“…Likewise, 3D echo assesses volumes rather than the myocardial walls and is limited to the assessment of intraventricular dyssynchrony. Nonetheless, a recent meta‐analysis of 73 adult studies concluded that 3D echo is a feasible and reliable method for assessment of LV dyssynchrony and may be useful to predict response to CRT …”

Section: Assessment Of Intraventricular Dyssynchronymentioning

confidence: 99%

Echocardiographic Assessment of Ventricular Synchrony in Congenital and Acquired Heart Disease in Children

Friedberg

Mertens

2013

Echocardiography

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Electromechanical dyssynchrony is an important consequence of and contributor to ventricular dysfunction. Echocardiography can be useful to assess the mechanisms underlying mechanical dyssynchrony, to evaluate the impact of mechanical dyssynchrony on ventricular function, and to try to predict the therapeutic response to cardiac resynchronization therapy (CRT). Mechanical dyssynchrony has been demonstrated in several pediatric acquired and congenital cardiac conditions, but experience is still limited. Moreover, the optimal method to identify dyssynchrony remains unclear, and data predicting the response to CRT in pediatrics are lacking. Understanding mechanisms of electromechanical dyssynchrony by echocardiography seems promising, at least in left bundle branch block (LBBB), but may be limited in children due to the uncommon occurrence of LBBB in this population. This review addresses the commonly used methods to diagnose mechanical dyssynchrony, discusses the emerging concepts on the mechanisms of the various types of mechanical dyssynchrony, and discusses the possible significance of mechanical synchrony in pediatric and acquired congenital heart disease.

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The effect of iron deficiency on cardiac resynchronization therapy: results from the RIDE‐CRT Study

et al. 2020

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Aims Cardiac resynchronization therapy (CRT) improves functional status, induces reverse left ventricular remodelling, and reduces hospitalization and mortality in patients with symptomatic heart failure, left ventricular systolic dysfunction, and QRS prolongation. However, the impact of iron deficiency on CRT response remains largely unclear. The purpose of the study was to assess the effect of functional and absolute iron deficiency on reverse cardiac remodelling, clinical response, and outcome after CRT implantation. Methods and results The relation of iron deficiency and cardiac resynchronization therapy response (RIDE-CRT) study is a prospective observational study. We enrolled 77 consecutive CRT recipients (mean age 71.3 ± 10.2 years) with short-term follow-up of 3.3 ± 1.9 months and long-term follow-up of 13.0 ± 3.2 months. Primary endpoints were reverse cardiac remodelling on echocardiography and clinical CRT response, assessed by change in New York Heart Association classification. Echocardiographic CRT response was defined as relative improvement of left ventricular ejection fraction ≥ 20% or left ventricular global longitudinal strain ≥ 20%. Secondary endpoints were hospitalization for heart failure and all-cause mortality (mean follow-up of 29.0 ± 8.4 months). At multivariate analysis, iron deficiency was identified as independent predictor of echocardiographic (hazard ratio 4.97; 95% confidence interval 1.15-21.51; P = 0.03) and clinical non-response to CRT (hazard ratio 4.79; 95% confidence interval 1.30-17.72, P = 0.02). We found a significant linear-by-linear association between CRT response and type of iron deficiency (P = 0.004 for left ventricular ejection fraction improvement, P = 0.02 for left ventricular global longitudinal strain improvement, and P = 0.003 for New York Heart Association response). Iron deficiency was also significantly associated with an increase in all-cause mortality (P = 0.045) but not with heart failure hospitalization. Conclusions Iron deficiency is a negative predictor of effective CRT therapy as assessed by reverse cardiac remodelling and clinical response. Assessment of iron substitution might be a relevant treatment target to increase CRT response and outcome in chronic heart failure patients.

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A meta-analysis of left ventricular dyssynchrony assessment and prediction of response to cardiac resynchronization therapy by three-dimensional echocardiography

Abstract: 3DE is a feasible and reliable tool for assessment of LV dyssynchrony and may have additional value to current selection criteria for accurate prediction of response to CRT.

Cited by 55 publications

References 89 publications

Assessment of left ventricular dyssynchrony by three‐dimensional echocardiography: Prognostic value in patients undergoing cardiac resynchronization therapy

Assessment of left ventricular dyssynchrony by three‐dimensional echocardiography: Prognostic value in patients undergoing cardiac resynchronization therapy

Echocardiographic Assessment of Ventricular Synchrony in Congenital and Acquired Heart Disease in Children

The effect of iron deficiency on cardiac resynchronization therapy: results from the RIDE‐CRT Study

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