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Published on: April 11, 2025
Prediction of response to cardiac resynchronization therapy using simple electrocardiographic and echocardiographic
Hamid Reza Bonakdar1, Mohammad Vahid Jorat, Amir Farjam Fazelifar
11Department of Pacemaker and Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Mellat Park, Vali-E-Asr Avenue, PO Box 15745-1341, Tehran 1996911151, Iran.
Insights
Predicting cardiac resynchronization therapy (CRT) response in heart failure (HF) patients is possible. Simple ECG and echo data, including QRS width and VTI, effectively predict CRT responders.
Area of Science:
- Cardiology
- Heart Failure Management
- Electrophysiology
Background:
- Heart failure (HF) affects millions globally, often necessitating advanced therapies.
- Intraventricular conduction delay complicates HF management and impacts treatment efficacy.
- Cardiac resynchronization therapy (CRT) is a key intervention for selected HF patients.
Purpose of the Study:
- To identify predictors of CRT response in HF patients with intraventricular conduction delay.
- To establish simple criteria for predicting successful CRT outcomes.
Main Methods:
- Retrospective analysis of 82 HF patients undergoing CRT.
- Classification of responders based on clinical status and left ventricular end-systolic volume reduction (>15%).
- Multivariable logistic regression and ROC curve analysis of baseline and acute post-CRT parameters.
Main Results:
- 68% of patients responded to CRT.
- Responders showed wider baseline QRS, greater QRS shortening (DeltaQRS), and improved aortic velocity time integral (VTI).
- Independent predictors identified: baseline QRS width (>145 ms), DeltaQRS (>20 ms), and acute aortic VTI (>14 cm).
Conclusions:
- CRT response is predictable in HF patients using readily available data.
- Electrocardiographic (QRS width, DeltaQRS) and echocardiographic (VTI) measures are valuable predictive tools.
- These findings can aid in patient selection for CRT.
Aims:
To predict response to cardiac resynchronization therapy (CRT) in patients with heart failure (HF) and intraventricular conduction delay.
Methods And Results:
The study population consisted of 82 consecutive HF patients with standard CRT indications. Patients were classified as responders, if they were alive without cardiac decompensation and experienced >or=15% decrease in left ventricular end-systolic volume. Sixty-eight percent of the enrolled patients responded to CRT. When compared with non-responders, responders had a wider baseline QRS width (P = 0.001), more marked QRS shortening (DeltaQRS) immediately after CRT (P = 0.001), and a better improvement in aortic velocity time integral (VTI) 24 h after CRT (P = 0.02). Moreover, there was a trend towards a greater baseline intraventricular dyssynchrony in the responder group (P = 0.07). By multivariable logistic regression, the baseline QRS width (OR: 0.95, 95% CI: 0.90-0.97, P = 0.001), DeltaQRS (OR: 1.038, 95% CI: 1.012-1.064, P = 0.003), and acute aortic VTI (OR: 0.81, 95% CI: 0.68-0.96, P = 0.017) emerged as independent predictors of response to CRT. Receiver operating characteristic curve analysis identified a QRS width >145 ms, DeltaQRS >20 ms, and aortic VTI >14 cm to predict responders.
Conclusion:
A positive response to CRT was observed in 68% of the patients. Cardiac resynchronization therapy response is predictable using simple electrocardiographic and echocardiographic data.
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