Biomarkers to predict the response to cardiac resynchronization therapy

Abstract

Cardiac resynchronization therapy (CRT) is an established non-pharmacological treatment for selected heart failure patients with wide QRS duration. However, there is a persistent number of non-responders throughout. The prediction of the CRT response is paramount to adequately select the correct patients for CRT. One of the expanding fields of research is the development of biomarkers that predict the response to CRT. A review of the available literature on biomarkers in CRT patients has been performed to formulate a critical appraisal of the available data. The main conclusion of our review is that biomarker research in this patient population is very fragmented and broad. This results in the use of non-uniform endpoints to define the CRT response, which precludes an in-depth comparison of the available data. To improve research development in this field, a uniform definition of the CRT response and relevant endpoints is necessary to better predict the CRT response.

A lower systemic immune-inflammation index level is associated with response to cardiac resynchronization theraphy

“…In light of these data, it is well known that an increased inflammation is asscoiated with poor response to CRT. Patients who had a higher SII also had increased NLR, PLR and hs-CRP levels and these patients showed worse clinical outcomes in the follow-up [21,22]. In this context, it is not surprising that HF patients who have a higher SII levels also have poor response to CRT.…”

“…However, prediction of response to CRT remains problematic and an important proportion of patients do not respond to CRT, although they are selected according to current patient selection criteria by international guidelines [16,17]. Additional echocardiographic, electrocardiographic, and blood markers have been investigated in several studies to identfy patients most likely to respond to CRT [18][19][20][21].…”

Screening for Regenerative Therapy Responders in Heart Failure

“…CRT indications are based on the New York Heart Association functional classification, left ventricular (LV) ejection fraction and QRS duration with bundle branch block [ 26 ], criteria nonspecific for the dyssynchronous myocardium ( Figure 2 right). Scar size has been identified as a culprit impeding effective CRT pacing [ 27 ]. Thus, for advanced heart failure with extensive tissue damage, reparative approaches may be valuable [ 28 ].…”

Risk scores in cardiac resynchronization therapy–A review of the literature

“…Consequently, there is a great need for tools that might help in optimal patient selection and provide prognostic information for the patients and their families. Ever since the first implementation of CRT, several clinical factors and biomarkers have been tested in prediction models to identify those patients who might benefit the most from the therapy ( 4 , 5 ). Prediction models are useful to reveal which parameters are statistically significant in the outcome prediction by giving the hazard and odds ratios, but they are not interpretable at the level of the individual patient in the clinical practice.…”