Abstract
BackgroundApproximately 30% of patients treated with cardiac resynchronization therapy (CRT) do not achieve favourable response. The purpose of the present study was to identify echocardiographic and clinical predictors of a positive response to CRT.MethodsThe study included 82 consecutive heart failure (HF) patients in New York Heart Association (NYHA) functional class III or IV with left bundle branch block (LBBB), QRS duration ≥ 120 ms and left ventricular ejection fraction (LVEF) ≤ 35%. Statistical analysis was performed using IBM SPSS statistical software (SPSS v.21.0 for Mac OS X). A p value < 0.05 was considered statistically significant.ResultsEchocardiographic response was established in 81.6% and clinical response was achieved in 82.9% of patients. Significant univariate predictors of favourable echocardiographic response after 12 months were smaller left ventricular end-diastolic diameter (LVEDD) (odds ratio [OR] 0.89; 95% confidence interval [CI] 0.82 - 0.97, p = 0.01), and smaller left ventricular end-systolic diameter (LVESD) (OR 0.91; 95% CI 0.85 - 0.98, p = 0.01). Lower uric acid concentration was associated with better echocardiographic response (OR 0.99; 95% CI 0.99 - 1.0, p = 0.01). Non-ischemic HF etiology (OR 4.89; 95% CI 1.39 - 17.15, p = 0.01) independently predicted positive clinical response. Multiple stepwise regression analysis demonstrated that LVEDD lower than 75 mm (OR 5.60; 95% confidence interval [CI] 1.36 - 18.61, p = 0.01) was the strongest independent predictor of favourable echocardiographic response.ConclusionsSmaller left ventricular end-diastolic and end-systolic diameters and lower serum uric acid concentration were associated with better response to CRT. Left ventricular end-diastolic diameter and non-ischemic heart failure etiology were the strongest independent predictors of positive response to CRT.
Highlights
30% of patients treated with cardiac resynchronization therapy (CRT) do not achieve favourable response
All patients were in sinus rhythm, electrocardiogram at rest was recorded and QRS duration was measured at baseline and after 12 months post CRT implantation
Significant univariate predictors of favourable echocardiographic response after 12 months included smaller left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD)
Summary
30% of patients treated with cardiac resynchronization therapy (CRT) do not achieve favourable response. The purpose of the present study was to identify echocardiographic and clinical predictors of a positive response to CRT. 1 – 2% of the adult population in developed countries have HF, and its prevalence rises to ≥ 10% in individuals 70 years of age or older [1]. Coronary artery disease (CAD) is the cause of approximately two-thirds of cases of systolic HF, in many cases hypertension and diabetes are likely contributing factors [2]. HF is associated with substantial mortality and morbidity, and remains the most common hospital was to identify initial echocardiographic and clinical parameters that predict positive response to CRT
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