Utilizing Cardia Dimensions to Determine Future Heart Failure Events: Analysis from the PASED CRT Study

Abstract

Background Cardiac resynchronization therapy (CRT) is a well established treatment for patients with systolic dysfunction and QRS >120ms with LBBB. Still about 30% of CRT patients with devices remain as non-responders. Few non-invasive techniques have been developed to predict clinical response to resynchronization before the device implantation to assist with better patient selection. Objective The aim of the study was to assess the relationship between the diameter of the cardiac silhouette and the distance between the pacing poles on chest radiographs with the efficacy of cardiac electrical resynchronization and clinical outcomes in patients receiving CRT devices. Methods Patients from the PASED-CRT randomized controlled trial who received a de novo CRT device were analyzed. Baseline demographic, echocardiographic, EKG, and heart failure hospitalization (HFH) data were obtained at baseline and after 3 months. Measurements of the cardiac width (CW) and the distance between the RV-LV pacing poles were obtained using chest x-rays in AP view by blinded observers. Results Of the 58 analyzed patients (Age 66±12 years, 85% Male, LVEF 27±8%), the rate of HFH in the 3 months post CRT implantation was reduced by 0.36±0.75 events when compared to the same duration before the procedure. Using univariate analysis, CW (P=0.003), LVEDD (P Conclusion In patients receiving CRT, CW is an independent predictor of cardiac electrical resynchronization and clinical outcomes as evidenced by shortening of QRS duration and reduction in HFH. Although patients with smaller hearts have more efficient resynchronization, those with larger hearts experience more reduction in HFH due to their higher baseline event rate.