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

Ağır, Ayşen; Şahı̇n, Tayfun; Yılmaz, İrem; Karaüzüm, Kurtuluş; Bozyel, Serdar; Ural, Dilek; Vural, Ahmet

doi:10.12659/msm.891036

Cited by 4 publications

(1 citation statement)

References 19 publications

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“…Cardiac resynchronization therapy (CRT) improves heart failure (HF) symptoms, reverses myocardial remodeling, and decreases hospitalization and mortality in selected patients with HF [ 1 , 2 ]. However, approximately 30–40% of CRT recipients do not experience symptomatic improvement and up to 50% fail to have echocardiographic response to CRT [ 3 , 4 ]. The left ventricular pacing site (LVPS) has been increasingly recognized as an important determinant of CRT response in individual patients [ 5 – 10 ].…”

Section: Introductionmentioning

confidence: 99%

Short-Term Availability of Viable Left Ventricular Pacing Sites with Quartet™ Quadripolar Leads

Hua

Fan

et al. 2017

Med Sci Monit

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BackgroundWhether quadripolar leads can provide sufficient viable left ventricular pacing sites (LVPSs) for device optimization and multipoint pacing remains unclear. This study aimed to evaluate the acute and 3-month availability of viable LVPSs provided by a quadripolar LV pacing lead.Material/MethodsA single-center cohort study evaluated consecutive patients who underwent a CRT implant with the QuartetTM LV lead under local guidelines. The availability of viable LVPSs was assessed at the pre-discharge and 3-month follow-up visit. Bipolar lead configurations, which served as the control group, were modeled by eliminating the 2 proximal electrodes on the Quartet™ LV lead.ResultsA total of 24 patients were enrolled and finished 3-month follow-up. The mean follow-up period was 93±3 days. At pre-discharge, the Quartet™ LV lead provided more viable LVPSs compared with the bipolar equivalents (median 3 [IQR 2–4] vs. median 2 [IQR 1–2], P<0.001). The percentage of patients with at least 1, 2, 3, and 4 viable LVPSs were 100% (24/24), 91.7% (22/24), 58.3% (14/24), and 33.3% (8/24) for Quartet™ leads and 91.7% (22/24), 70.8% (17/24), 0% (0/24), and 0% (0/24) for bipolar lead configurations, respectively. The median and IQR values of viable LVPSs provided by the Quartet™ LV lead remained the same (3 [IQR 2–4]) between pre-discharge and 3-month follow-up (P=0.45).ConclusionsCompared with the bipolar equivalent, QuartetTM LV lead provides more viable LVPSs and opportunities for CRT optimization and multipoint LV pacing. The number of LVPSs provided by Quartet™ leads remained unchanged between pre-discharge and 3-month follow-up.

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Section: Introductionmentioning

confidence: 99%

Short-Term Availability of Viable Left Ventricular Pacing Sites with Quartet™ Quadripolar Leads

Hua

Fan

et al. 2017

Med Sci Monit

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Prognostic effects of longitudinal changes in left ventricular ejection fraction with cardiac resynchronization therapy

et al. 2020

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Aims Left ventricular ejection fraction (LVEF) is considered an indicator of cardiac resynchronization therapy (CRT). Longitudinal studies on the predictive value of LVEF are scarce. We aimed to comprehensively evaluate the prognostic role of LVEF in the outcomes of Chinese patients with CRT. Methods and results Three hundred ninety-two patients were divided into three tertiles of LVEF: ≤25%, 25-30%, and 30-35%, and four groups by LVEF changes: <0% (negative response); ≥0% and ≤5% (non-response); >5% and ≤15% (response); and >15% (super-response). One hundred six patients were super-responders. During a median follow-up of 3.6 years, 141 reached the composite endpoint. Odds ratios (ORs) for super-response depicted a reversed U-shaped relationship for baseline LVEF with a peak at 25-30%. Independent predictors of super-response were smaller left atrial diameter [odds ratio 0.897, 95% confidence interval (CI) 0.844-0.955, P = 0.001], smaller left ventricular end-diastolic diameter (OR 0.937, 95% CI 0.889-0.989, P = 0.018), and higher estimated glomerular filtration rate (OR 1.018, 95% CI 1.001-1.035, P = 0.042) in Tertile 1; atrial fibrillation (OR 0.278, 95% CI 0.086-0.901, P = 0.033), left bundle branch block (OR 4.096, 95% CI 1.046-16.037, P = 0.043), and left ventricular end-diastolic diameter (OR 0.929, 95% CI 0.876-0.986, P = 0.016) in Tertile 2; while female sex (OR 2.778, 95% CI 1.082-7.132, P = 0.034) and higher systolic blood pressure (OR 1.045, 95% CI 1.013-1.079, P = 0.006) in Tertile 3. An inverse association with the composite endpoint was found in Tertile 1 vs. Tertile 2 (hazard ratio 1.934, 95% CI 1.248-2.996, P = 0.003). The prognostic effects of CRT response in Tertile 3 and Tertile 1 varied significantly (P for trend = 0.017 and <0.001). Among three tertiles in super-responders, event-free survival was similar (P for trend = 0.143). Conclusions Left ventricular ejection fraction of 25-30% is associated with a better prognosis of super-response. Predictors of super-response are different for LVEF tertiles. CRT responses would have better prognostic performance than LVEF tertiles at baseline, which should be considered when clinicians screening eligible patients for CRT.

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One-point carotid wave intensity predicts cardiac mortality in patients with congestive heart failure and reduced ejection fraction

Vriz

Pellegrinet

Zito

et al. 2015

Int J Cardiovasc Imaging

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Wave intensity (WI) is a hemodynamic index used to evaluate the interaction between the heart and the arterial system, measured with an echo-Doppler system at the level of the common carotid artery. WI has two peaks: W1 during early systole that represents left ventricular (LV) contractility, and W2 in late systole that is related to the inertia force during isovolumetric relaxation. The aim of this study was to determine whether WI parameters improve the prediction of poor outcome in patients with heart failure and reduced ejection fraction (HFrEF). Sixty-two patients (mean age 69.4 ± 11.5 years) in NYHA class II-III were followed up for 43.5 months. They underwent routine clinical work-up, transthoracic echocardiography and WI measurement. A stratified survival analysis was conducted using the Kaplan-Meier method. During follow-up, 23 patients died from cardiovascular causes. Survivors and non-survivors were similar in age, blood pressure, heart rate and echocardiographic parameters, except for LV end-diastolic volume indexed to body surface area, E/A ratio (higher in non-survivors) and deceleration time (lower in non-survivors). W2 (1950 ± 1006 vs 1117 ± 708 mmHg m/s(3), p = 0.001) was significantly lower in non-survivors, whereas W1 (6951 ± 4119 vs 5748 ± 3891 mmHg m/s(3), p = NS) was similar. At the end of follow-up, cardiovascular mortality was higher in patients with W1 ≤ 3900 mmHg m/s(3) (p = 0.02) and W2 ≤ 1000 mmHg m/s(3) (p = 0.0002). Only E/A (cut-off 1.5) was predictive of mortality (p = 0.05). In patients with HFrEF, WI parameters derived from the carotid artery better identified patients with poor prognosis and were significant predictors of cardiovascular mortality.

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

Cited by 4 publications

References 19 publications

Short-Term Availability of Viable Left Ventricular Pacing Sites with Quartet™ Quadripolar Leads

Short-Term Availability of Viable Left Ventricular Pacing Sites with Quartet™ Quadripolar Leads

Prognostic effects of longitudinal changes in left ventricular ejection fraction with cardiac resynchronization therapy

One-point carotid wave intensity predicts cardiac mortality in patients with congestive heart failure and reduced ejection fraction

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