Combined Score Using Clinical, Electrocardiographic, and Echocardiographic Parameters to Predict Left Ventricular Remodeling in Patients Having Had Cardiac Resynchronization Therapy Six Months Earlier

Brunet-Bernard, Anne; Maréchaux, Sylvestre; Fauchier, Laurent; Guiot, Aurélie; Fournet, Maxime; Reynaud, Amélie; Schnell, Frédéric; Leclercq, Christophe; Mabo, Philippe; Donal, Erwan

doi:10.1016/j.amjcard.2014.03.050

Cited by 42 publications

(32 citation statements)

References 28 publications

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“…In the present study, we confirmed such results but also that the septal flash is highly relevant [21]. That is emphasizing the potential value of multiparametric scores like the L2ANDS2 score [32]. However, septal flash was found in 79% of CRT responders and in only approximately 60% of all of the patients, regardless of cardiomyopathy etiology.…”

Section: Discussionsupporting

confidence: 89%

Pilot study using 3D–longitudinal strain computation in a multi-parametric approach for best selecting responders to cardiac resynchronization therapy

Fournet¹,

Bernard²,

Maréchaux³

et al. 2017

Cardiovasc Ultrasound

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BackgroundAlmost all attempts to improve patient selection for cardiac resynchronization therapy (CRT) using echo-derived indices have failed so far. We sought to assess: the performance of homemade software for the automatic quantification of integral 3D regional longitudinal strain curves exploring left ventricular (LV) mechanics and the potential value of this tool to predict CRT response.MethodsForty-eight heart failure patients in sinus rhythm, referred for CRT-implantation (mean age: 65 years; LV-ejection fraction: 26%; QRS-duration: 160 milliseconds) were prospectively explored. Thirty-four patients (71%) had positive responses, defined as an LV end-systolic volume decrease ≥15% at 6-months. 3D–longitudinal strain curves were exported for analysis using custom-made algorithms. The integrals of the longitudinal strain signals (IL,peak) were automatically measured and calculated for all 17 LV-segments.ResultsThe standard deviation of longitudinal strain peak (SDIL,peak) for all 17 LV-segments was greater in CRT responders than non-responders (1.18% s−1 [0.96; 1.35] versus 0.83% s−1 [0.55; 0.99], p = 0.007). The optimal cut-off value of SDIL,peak to predict response was 1.037%.s−1. In the 18-patients without septal flash, SDIL,peak was significantly higher in the CRT-responders.ConclusionsThis new automatic software for analyzing 3D longitudinal strain curves is avoiding previous limitations of imaging techniques for assessing dyssynchrony and then its value will have to be tested in a large group of patients.

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Section: Discussionsupporting

confidence: 89%

Pilot study using 3D–longitudinal strain computation in a multi-parametric approach for best selecting responders to cardiac resynchronization therapy

Fournet¹,

Bernard²,

Maréchaux³

et al. 2017

Cardiovasc Ultrasound

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“…Freedom from prior HF hospitalization and LVEDD < 75 mm were related to a 2.8‐ and 2.2‐fold increased probability of LVRR, respectively. Both parameters have previously been reported as predictors of LVRR after CRT . They are probably expression of a less advanced cardiomyopathy.…”

Section: Discussionmentioning

confidence: 68%

“…In our population, non‐ischaemic aetiology of MR and absence of diabetes were associated with a 2.5‐fold and a 2.1‐fold increased probability of LVRR, respectively. Non‐ischaemic cardiomyopathy has already been reported as a predictor of LVRR in patients receiving CRT . It is known that patients with a ventricular substrate without ischaemic area or ‘scar’ are more likely to develop LVRR …”

Section: Discussionmentioning

confidence: 99%

“…A meta‐analysis including approximately 150 000 patients from 11 studies showed that women obtain a greater LV improvement after CRT compared with men . In several studies, female rates were significantly higher among patients who developed LVRR after medical therapy or CRT compared with those who did not . However, gender‐based analyses from real‐world registries including MitraClip patients showed similar LVEF and LV volumes changes from baseline to 1‐year follow‐up in males and females …”

Section: Discussionmentioning

confidence: 99%

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Left ventricular reverse remodelling predicts long‐term outcomes in patients with functional mitral regurgitation undergoing MitraClip therapy: results from a multicentre registry

Adamo

Godino²,

Giannini

et al. 2018

European J of Heart Fail

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Aims To explore whether left ventricular reverse remodelling (LVRR) is a predictor of outcomes in patients with functional mitral regurgitation (FMR) undergoing MitraClip procedure. Methods and results We analysed 184 consecutive patients with FMR who underwent successful MitraClip procedure. LVRR was defined as a reduction in left ventricular end‐systolic volume ≥ 10% from baseline to 6 months. LVRR was observed in 79 (42.9%) patients. Compared with non‐LVRR, LVRR patients were more likely to be females, less likely to have an ischaemic aetiology of mitral regurgitation or a prior (<6 months) heart failure (HF) hospitalization, and had smaller left ventricular dimensions. New York Heart Association class improved from baseline up to 1‐year follow‐up in both groups. Higher rates of overall survival (87.3% vs. 75.2%, P = 0.039), freedom from HF hospitalization (77.2% vs. 60%, P = 0.020), and freedom from the composite endpoint (cardiovascular mortality or HF hospitalization) (74.7% vs. 55.2%; P = 0.012) were observed in LVRR vs. non‐LVRR patients at 2‐year follow‐up. LVRR was associated with a significant reduction of the adjusted relative risk of mortality, HF hospitalization and composite endpoint [hazard ratio (HR) 0.44; 95% confidence interval (CI) 0.20–0.96, P = 0.040; HR 0.55; 95% CI 0.32–0.97, P = 0.038; and HR 0.54; 95% CI 0.32–0.92, P = 0.023, respectively]. Female gender, absence of diabetes, freedom from prior HF hospitalization, non‐ischaemic aetiology of mitral regurgitation, and left ventricular end‐diastolic diameter < 75 mm were found to be independent predictors of LVRR. Conclusions Left ventricular reverse remodelling is associated with better long‐term outcomes in patients with FMR successfully treated with MitraClip. A careful patient selection may be useful as specific baseline features predict favourable left ventricular remodelling. [Correction added on 17 January 2019, after online publication: the preceding sentence has been changed.]

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“…Previous reports demonstrated that the presence of a septal flash is associated with reverse remodeling following CRT in HFrEF patients . Inclusion of the septal flash recorded by echocardiography in a multiparametric predictive score of LV reverse remodeling resulted in significant improvement of the predictive value of the score, over clinical and electrocardiographic data . However, it has been suggested that performing a dobutamine stress echocardiography, compared with a resting examination, may enhance the identification of the septal flash to help predict CRT response .…”

Section: Identification Of Electromechanical Dyssynchrony By Echocardmentioning

confidence: 99%

Role of echocardiography before cardiac resynchronization therapy: new advances and current developments

et al. 2016

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The role of echocardiography in improving the selection of patients who will benefit from cardiac resynchronization therapy (CRT) remains a source of debate. Although previous landmark reports have demonstrated a link between mechanical dyssynchrony, assessed by delays between left ventricle (LV) walls and response to CRT, the predictive value of these findings has not yet been confirmed in multicenter trials. Indeed, recent studies demonstrated that the classical assessment of LV mechanical dyssynchrony using delay between walls by echocardiography depends not only on LV electrical activation delay (electrical dyssynchrony), but also on abnormalities in regional contractility of the LV and/or loading conditions, which do not represent an appropriate target for CRT. Recent reports highlighted the value of new indices of electromechanical dyssynchrony obtained by echocardiography, to predict LV response and outcome after CRT including septal flash, left bundle branch block-typical pattern by longitudinal strain, apical rocking, septal strain patterns, and systolic stretch index. This was achieved using a mechanistic approach, based on the contractile consequences of electrical dyssynchrony. These indices are rarely found in patients with narrow QRS (<120 ms), whereas their frequency rises in patients with an increase in QRS duration (>120 ms). Theses indices should improve candidate selection for CRT in clinical practice, especially for patients in whom the benefit of CRT remains uncertain, for example, patients with intermediate QRS width (120-150 ms).

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Combined Score Using Clinical, Electrocardiographic, and Echocardiographic Parameters to Predict Left Ventricular Remodeling in Patients Having Had Cardiac Resynchronization Therapy Six Months Earlier

Cited by 42 publications

References 28 publications

Pilot study using 3D–longitudinal strain computation in a multi-parametric approach for best selecting responders to cardiac resynchronization therapy

Pilot study using 3D–longitudinal strain computation in a multi-parametric approach for best selecting responders to cardiac resynchronization therapy

Left ventricular reverse remodelling predicts long‐term outcomes in patients with functional mitral regurgitation undergoing MitraClip therapy: results from a multicentre registry

Role of echocardiography before cardiac resynchronization therapy: new advances and current developments

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