Echocardiographic measures of acute haemodynamic response after cardiac resynchronization therapy predict long-term
Francois B Tournoux1, Chrisfouad Alabiad, Dali Fan
1Cardiac Arrhythmia Service and Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
Insights
Acute hemodynamic response to cardiac resynchronization therapy (CRT) predicts long-term outcomes. Patients showing a high response had significantly better clinical outcomes than poor responders, regardless of cardiomyopathy type.
Area of Science:
- Cardiology
- Cardiac Electrophysiology
- Heart Failure Management
Background:
- Cardiac resynchronization therapy (CRT) improves heart failure outcomes.
- Acute hemodynamic improvement post-CRT indicates favorable contractile response.
- Limited data exists on predicting long-term outcomes based on acute response, especially across different cardiomyopathy substrates.
Purpose of the Study:
- To evaluate if acute hemodynamic response to CRT predicts long-term clinical outcomes.
- To investigate if this predictive value differs between ischemic and non-ischemic cardiomyopathy.
Main Methods:
- Fifty-three heart failure patients with CRT indications were studied.
- Acute hemodynamic response was assessed via echocardiography (LV dP/dt) within 24h of implantation.
- Patients were classified as high-responders (HR, DeltadP/dt > 25%) or poor-responders (PR, DeltadP/dt ≤ 25%).
- Long-term clinical response was defined by a composite endpoint of hospitalization and all-cause mortality at 12 months.
Main Results:
- No significant differences in baseline characteristics were observed between ischemic and non-ischemic groups.
- The HR group demonstrated significantly better long-term clinical outcomes compared to the PR group (P=0.004).
- This improved outcome in HR patients was consistent irrespective of the cardiomyopathy etiology.
Conclusions:
- Echocardiographic assessment of acute hemodynamic response to CRT is a valuable predictor of long-term clinical outcomes.
- This predictive capability holds true for both ischemic and non-ischemic cardiomyopathy patients receiving CRT.
Aims:
Although acute haemodynamic improvement in response to cardiac resynchronization therapy (CRT) is reflective of a favourable cardiac contractile response, there is limited information regarding not only its ability to predict long-term clinical outcome but also cardiac-substrate-specific differences in the prognostic value of this measure.
Methods And Results:
Fifty-three heart failure patients (69 +/- 11 years) with low left ventricle ejection fraction (LVEF) (22 +/- 6%), wide QRS (169 +/- 31 ms), and indications for CRT were included. There were no significant differences in age, New York Heart Association (NYHA) class, medications, QRS width, or LVEF between ischaemic (n = 37) and non-ischaemic (n = 16) groups. Echocardiograms were performed within 24 h of implantation with device OFF and ON. Acute haemodynamic response was measured as LV dP/dt derived from the CW Doppler of mitral regurgitation. Percentage change in dP/dt was used to classify patients: high- (HR: DeltadP/dt > 25%) or poor-responders (PR: DeltadP/dt
Conclusion:
Echocardiographic assessment of the acute haemodynamic response to CRT predicts long-term clinical outcome in both ischaemic and non-ischaemic cardiomyopathy.
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