Agreement is poor among current criteria used to define response to cardiac resynchronization therapy
Brandon K Fornwalt1, William W Sprague, Patrick BeDell
1Emory University School of Medicine, Department of Radiology, Atlanta, GA 30322, USA. bkf@gatech.edu
Insights
Agreement on cardiac resynchronization therapy response criteria is poor. Most studies use different definitions, hindering consistent results and patient outcome comparisons.
Area of Science:
- Cardiology
- Medical Device Technology
- Clinical Trials
Background:
- Multiple criteria exist for defining positive response to cardiac resynchronization therapy (CRT).
- No prior studies have assessed the agreement among these diverse response criteria.
- This study hypothesized poor agreement among various CRT response criteria.
Purpose of the Study:
- To evaluate the agreement among different response criteria for cardiac resynchronization therapy.
- To quantify the variability in response rates based on differing definitions.
Main Methods:
- Conducted a literature search for "cardiac resynchronization" and "response" to identify relevant articles.
- Reviewed 50 highly-cited publications, extracting 17 distinct primary response criteria from 26 articles.
- Assessed agreement among 15 criteria using Cohen's kappa-coefficient in 426 patients from the PROSPECT study.
Main Results:
- The overall response rate to CRT varied widely, from 32% to 91% across the 15 assessed criteria.
- Seventy-five percent of comparisons between criteria showed poor agreement (kappa ≤ 0.4).
- Only 4% of comparisons demonstrated strong agreement (kappa ≥ 0.75), with moderate agreement in 21%.
Conclusions:
- Cardiac resynchronization therapy response is defined by 17 different criteria in the most cited literature.
- Poor agreement (75%) and limited strong agreement (4%) among these criteria hinder the generalizability of study findings.
- The lack of consensus on response criteria complicates the interpretation and comparison of CRT outcomes across studies.
Background:
Numerous criteria believed to define a positive response to cardiac resynchronization therapy have been used in the literature. No study has investigated agreement among these response criteria. We hypothesized that the agreement among the various response criteria would be poor.
Methods And Results:
A literature search was conducted with the keywords "cardiac resynchronization" and "response." The 50 publications with the most citations were reviewed. After the exclusion of editorials and reviews, 17 different primary response criteria were identified from 26 relevant articles. The agreement among 15 of these 17 response criteria was assessed in 426 patients from the Predictors of Response to Cardiac Resynchronization Therapy (PROSPECT) study with Cohen's kappa-coefficient (2 response criteria were not calculable from PROSPECT data). The overall response rate ranged from 32% to 91% for the 15 response criteria. Ninety-nine percent of patients showed a positive response according to at least 1 of the 15 criteria, whereas 94% were classified as a nonresponder by at least 1 criterion. kappa-Values were calculated for all 105 possible comparisons among the 15 response criteria and classified into standard ranges: Poor agreement (kappa< or =0.4), moderate agreement (0.4
Conclusions:
The 26 most-cited publications on predicting response to cardiac resynchronization therapy define response using 17 different criteria. Agreement between different methods to define response to cardiac resynchronization therapy is poor 75% of the time and strong only 4% of the time, which severely limits the ability to generalize results over multiple studies.
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