The Influence of Left Ventricular Ejection Fraction on the Effectiveness of Cardiac Resynchronization Therapy

Kutyifa, Valentina; Kloppe, Axel; Zaręba, Wojciech; Solomon, Scott D.; McNitt, Scott; Polonsky, Slava; Barsheshet, Alon; Merkely, Béla; Lemke, Bernd; Nagy, Vivien Klaudia; Moss, Arthur J.; Goldenberg, Ilan

doi:10.1016/j.jacc.2012.11.051

Cited by 89 publications

(34 citation statements)

References 22 publications

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“…Of note, the ASE/EACVI does not endorse one analyses program over another (16, 19, 26) and our analysis program has been used in many prior studies. (12, 30, 31)…”

Section: Discussionmentioning

confidence: 99%

Noninvasive Measures of Ventricular-Arterial Coupling and Circumferential Strain Predict Cancer Therapeutics–Related Cardiac Dysfunction

Narayan

French

Khan

et al. 2016

JACC: Cardiovascular Imaging

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Structured Abstract Objective The objective of this study was to determine the relationships between echocardiography-derived measures of myocardial mechanics and cancer therapeutics-related cardiac dysfunction (CTRCD). Background Doxorubicin and trastuzumab are highly effective breast cancer therapies, but have a substantial risk of CTRCD. There is a critical need for the early detection of patients at increased risk of toxicity. Methods We performed a prospective, longitudinal cohort study of breast cancer participants undergoing doxorubicin and/or trastuzumab therapy. Echocardiography was performed prior to therapy initiation (baseline) and at standardized follow-up intervals during and after completion of therapy. Ejection fraction (EF), strain, strain rate, and ventricular-arterial coupling (Ea/Eessb) were quantitated. CTRCD was defined as a ≥10% reduction in EF from baseline to <50%. Multivariable logistic regression models were used to determine the associations between baseline levels and changes from baseline in echocardiographic measures and CTRCD. Receiver operating characteristic curves were used to evaluate the predictive ability of these measures. Results In total, 135 participants contributed 517 echocardiograms to the analysis. Over a median follow-up time of 1.9 years (Interquartile range 0.9, 2.4), 21 participants (15%) developed CTRCD. In adjusted models, baseline levels and changes in Ea/Eessb, circumferential strain, and circumferential strain rate were associated with 21 to 38% increased odds of CTRCD (p<0.001). Changes in longitudinal strain (p=0.037), radial strain (p=0.015), and radial strain rate (p=0.006) were also associated with CTRCD. Ea/Eessb [Area under the curve (AUC) 0.703 (95% confidence interval (CI) 0.583–0.807)] and circumferential strain [AUC 0.655 (95% CI 0.517–0.767)] demonstrated the greatest predictive utility. Sensitivity analyses using an alternative CTRCD definition did not impact our results. Conclusions Over an extended follow-up time, ventricular-arterial coupling and circumferential strain were strongly predictive of CTRCD. Our findings suggest a noninvasive strategy to identify high-risk patients prior to, during, and after cardiotoxic cancer therapy.

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“…Of note, the ASE/EACVI does not endorse one analyses program over another (16, 19, 26) and our analysis program has been used in many prior studies. (12, 30, 31)…”

Section: Discussionmentioning

confidence: 99%

Noninvasive Measures of Ventricular-Arterial Coupling and Circumferential Strain Predict Cancer Therapeutics–Related Cardiac Dysfunction

Narayan

French

Khan

et al. 2016

JACC: Cardiovascular Imaging

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“…Sub-studies have recently investigated the impact of LVEF on response to CRT in different LVEF groups; most of these studies examined the effect of CRT in patients with LVEFs beyond the current guidelines recommendations (>35%) [9,14,15]. In a retrospective analysis of the PROSPECT study, patients with core laboratory-measured LVEF >35% were compared with those whose LVEF was <35% [14].…”

Section: Discussionmentioning

confidence: 99%

“…Although this study compared the effect of CRT between patients with LVEF >30% and those with LVEF <30%, similar to our findings, improvements in ventricular function produced by CRT were independent of LVEF. In a recent sub-study of the MADIT-CRT trial, Kutyifa et al [15] investigated echocardiographic response with CRT, defined as percent change in LVEDV in 3 prespecified LVEF groups: >30%, 26–30%, and <25%. Although the clinical benefit of CRT-D was evident regardless of baseline LVEF, patients with mild HF with LVEF <25% at baseline had an increased risk for subsequent HF or death compared with patients with LVEF 26–30% or LVEF >30%.…”

Section: Discussionmentioning

confidence: 99%

What is the Lowest Value of Left Ventricular Baseline Ejection Fraction that Predicts Response to Cardiac Resynchronization Therapy?

et al. 2014

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BackgroundCardiac resynchronization therapy (CRT) is an effective treatment option for patients with refractory heart failure. However, many patients do not respond to therapy. Although it has been thought that there was no relation between response to CRT and baseline ejection fraction (EF), the response rate of patients with different baseline LVEF to CRT has not been evaluated in severe left ventricular systolic dysfunction. We aimed to investigate any difference in response to CRT between the severe heart failure patients with different baseline LVEF.Material/MethodsIn this study, 141 consecutive patients (mean age 59±13 years; 89 men) with severe heart failure and complete LBBB were included. Patients were divided into 3 groups according to their baseline LVEF: 5–15%, Group 1; 15–25%, Group 2, and 25–35%, Group 3. NYHA functional class, LVEF, LV volumes, and diameters were assessed at baseline and after 6 months of CRT. A response to CRT was defined as a decrease in LVSVi (left ventricular end-systolic volume index) ≥10% on echocardiography at 6 months.ResultsAfter 6 months, a significant increase of EF and a significant decrease of LVESVi and LVEDVi after 6 months of CRT were observed in all groups. Although the magnitude of improvement in EF was biggest in the first group, the percentage of decrease in LVESVi and LVEDVi was similar between the groups. The improvement in NYHA functional class was similar in all EF subgroups. At 6-month follow-up, 100 (71%) patients showed a reduction of >10% in LVESVi (mean reduction: −15.5±26.1 ml/m2) and were therefore classified as responders to CRT. Response rate to CRT was similar in all groups. It was 67%, 75%, and 70% in Group 1, 2, and 3, respectively, at 6-month follow-up (p>0.05). There was no statistically significant relation between the response rate to CRT and baseline LVEF, showing that the CRT has beneficial effects even in patients with very low LVEF.ConclusionsIt seems there is no lower limit for baseline LVEF to predict non-response to CRT in eligible patients according to current guidelines.

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“…The MADIT-CRT core echocardiography laboratory identified subjects with LVEF under-measured by the enrolling center that was in fact >30%. The resultant sub-study showed no interaction between EF and outcomes, suggesting that patients with a wide QRS but only mild HF symptoms and only mild systolic dysfunction may still benefit from CRT-D 16 .…”

Section: Sudden Cardiac Death (Scd) Is Among the Leading Causes Of Dementioning

confidence: 90%

Editorial commentary: MADIT–CRT and his many sons

Rogers

Morin

2016

Trends in Cardiovascular Medicine

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The Influence of Left Ventricular Ejection Fraction on the Effectiveness of Cardiac Resynchronization Therapy

Cited by 89 publications

References 22 publications

Noninvasive Measures of Ventricular-Arterial Coupling and Circumferential Strain Predict Cancer Therapeutics–Related Cardiac Dysfunction

Noninvasive Measures of Ventricular-Arterial Coupling and Circumferential Strain Predict Cancer Therapeutics–Related Cardiac Dysfunction

What is the Lowest Value of Left Ventricular Baseline Ejection Fraction that Predicts Response to Cardiac Resynchronization Therapy?

Editorial commentary: MADIT–CRT and his many sons

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