Predictors of response to cardiac resynchronization therapy: A prospective cohort study

Abstract

Introduction: Cardiac resynchronization therapy (CRT) has modified the prognosis of chronic heart failure (HF) with left ventricular systolic dysfunction. However, 30% of patients do not have a favorable response. The big question is how to determine predictors of response. Aims: To identify baseline characteristics that might influence echocardiographic response to CRT. Methods and Results:We performed a prospective single-center hospital-based cohort study of consecutive HF patients selected to CRT (NYHA class II-IV, left ventricular ejection fraction (LVEF) <35% and QRS complex ≥120 ms). Responders were defined as those with a ≥5% absolute increase in LVEF at six months. Clinical, electrocardiographic, laboratory, echocardiographic, autonomic, endothelial and cardiopulmonary function parameters were assessed before CRT device implantation. Logistic regression models were used. Seventy-nine patients were included, 54 male (68.4%), age 68.1 years (standard deviation 10.2), 19 with ischemic etiology (24%).At six months, 51 patients (64.6%) were considered responders. Although by univariate analysis baseline tricuspid annular plane systolic excursion (TAPSE) and serum creatinine were significantly different in responders, on multivariate analysis only TAPSE was independently associated with response, with higher values predicting a positive response to CRT (OR=1.13; 95% CI: 1.02-1.26; p=0.020). TAPSE ≥15 mm was strongly associated with response, and TAPSE <15 mm with non-response (p=0.005). Responders had no TAPSE values below 10 mm. * Corresponding author. E-mail address: ananabreu@hotmail.com (A. Abreu). 2174-2049Document downloaded from http://www.elsevier.es, day 21/07/2017. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. Document downloaded from http://www.elsevier.es, day 21/07/2017. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. 418 A. Abreu et al. Conclusion: From a range of clinical and technical baseline characteristics, Metodologia e resultados:Estudo cohort prospetivo, unicêntrico, hospitalar, de doentes consecutivos com HF selecionados para CRT (classes II-IV NYHA, fração de ejeção ventricular esquerda <35% e QRS≥120 mseg).Os respondedores foram definidos por aumento absoluto de fração de ejeção ventricular esquerda ≥5% aos 6 meses.Antes da implantação do ressincronizador, foram avaliados parâmetros clínicos, eletrocardiográficos, laboratoriais, ecocardiográficos, autonómicos, endoteliais e funcionais cardiorrespiratórios. Utilizaram-se modelos de regressão logística.Incluíram-se 79 doentes, 54 masculinos (68,4%), idade 68,1 (SD=10,2) anos, 19 isquémicos (24%). Aos 6 meses, consideraram-se respondedores 51 doentes (64,6%). Apesar de, por análise univariável, a excursão sistólica do plano do anel tricúspide (TAPSE) e a creatinina sérica serem significativamente diferentes nos respondedores, em análise multivariável, apenas TAPSE foi independentemente associada a res...

Imaging predictive factors and exercise training in CRT patients

“…However, decreasing cutpoint to 15, lower TAPSE values, meaning moderate and severe RV dysfunction, associated to CRT nonresponse. We concluded that TAPSE was the only parameter in multivariate analysis associated to being a CRT responder, pointing out the importance of right ventricular function for CRT response in CHF patients [55].…”

“…Our group analyzed several variables, clinical, functional, echocardiographic and scintigraphic, as possible predictive factors for response to CRT, in the first 79 patients studied (68% male, mean age 68.1±10.2 years, 24% ischemic) [55]. At 6 months, 62% were considered as echocardiographic responders.…”