Predicting Clinical and Echocardiographic Response After Cardiac Resynchronization Therapy With a Score Combining Clinical, Electrocardiographic, and Echocardiographic Parameters

Abstract

The L2ANDS2 score was previously found to be able to assess the probability of left ventricular (LV) remodeling. We sought to evaluate this score in terms of clinical outcomes: 275 patients with heart failure, from 2 centers, implanted with a cardiac resynchronization therapy (CRT) device were followed at least 2years after implantation. Baseline clinical, electrocardiographic, and echocardiographic characteristics including left bundle branch block, age >70years, nonischemic etiology, LV end-diastolic diameter <40mm/m2, and septal flash by echocardiography were integrated in 4 scoring systems. Nonresponse to CRT was LV reverse remodeling <15% at 6months' follow-up and/or occurrence of major cardiovascular event (cardiovascular death or transplantation or assistance) during a clinical follow-up of at least 2years. Ninety-seven patients (36%) demonstrated nonresponse to CRT. The L2ANDS2 score demonstrated the best predictive value (C statistic of 0.783) for predicting absence of LV reverse remodeling and/or occurrence of major cardiovascular event during the 2years follow-up compared with other scoring systems that do not include septal flash. A L2ANDS2 score ≤4 was associated with a worse outcome (38% survival vs 81% survival, hazard ratio 4.19, 95% CI 2.70 to 6.48, p <0.0001). In conclusion, the L2ANDS2 score is able to assess the probability of nonresponse to CRT in terms of no reverse LV remodeling and/or major cardiovascular event at long-term follow-up. Integrating septal flash in a scoring system adds value over left bundle branch block only.