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Utility of three-dimensional echocardiography in assessing and predicting response to cardiac resynchronization
Ching Lau1, Husam Mohamed Abdel-Qadir, Ilan Lashevsky
1Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario. ching.lau@sunnybrook.ca
Insights
Three-dimensional echocardiography (3DE) can predict cardiac resynchronization therapy (CRT) response. A baseline dyssynchrony index (DI) greater than 10 and a significant decrease in DI post-CRT identify patients likely to benefit from CRT.
Area of Science:
- Cardiology
- Medical Imaging
- Heart Failure Management
Background:
- Cardiac resynchronization therapy (CRT) is a key treatment for heart failure.
- Current CRT selection criteria result in high rates of nonresponse.
Purpose of the Study:
- To evaluate the utility of three-dimensional echocardiography (3DE) in predicting patient response to CRT.
- To identify echocardiographic markers for successful CRT.
Main Methods:
- Functional assessments and 3DE were performed on heart failure patients before and after CRT.
- The dyssynchrony index (DI) was calculated using 3DE to quantify left ventricular dyssynchrony.
- CRT response was defined by functional improvement and reduction in left ventricular end-systolic volume.
Main Results:
- Seventy-two percent of patients improved functionally; 43% showed both functional and echocardiographic response.
- Higher baseline DI and a greater post-CRT decrease in DI correlated with positive outcomes.
- A baseline DI > 10 had 100% negative predictive value for CRT response.
Conclusions:
- 3DE shows promise for predicting CRT response.
- A baseline DI > 10 effectively identifies patients unlikely to respond to CRT.
- A significant DI decrease within 24 hours post-CRT predicts long-term response.
Background:
Cardiac resynchronization therapy (CRT) can be a valuable treatment for heart failure. However, there are high nonresponse rates using current CRT inclusion criteria.
Objective:
To assess the value of three-dimensional echocardiography (3DE) in predicting response to CRT.
Methods:
Functional assessments and 3DE were performed in heart failure patients pre-CRT, 24 h post-CRT and six to 12 months after CRT. The dyssynchrony index (DI) was calculated as the SD of the time to minimum volume in 16 left ventricle segments corrected by heart rate. Response to CRT was defined as functional improvement (alive at late follow-up with improvement by one New York Heart Association class) and a decrease in left ventricular end-systolic volume by 15% or greater at six to 12 months follow-up.
Results:
A total of 53 patients were enrolled. Average 3DE acquisition time was less than 5 min. Seventy-two per cent of patients showed functional improvement, while 43% showed functional and echocardiographic evidence of response. Baseline DI and the decrease in DI at 24 h were both correlated with reverse remodelling. Responders had higher baseline DI values compared with nonresponders (mean 16.8 versus 7.1, P<0.001), and showed a greater decrease in DI values at 24 h (mean decrease 7.9 versus 0.7, P<0.001). All responders had baseline DI values of greater than 10 (negative predictive value of 100%). A decrease in the DI value by more than 5 at 24 h in patients with a baseline DI of greater than 10 identified responders with a positive predictive value of 83%.
Conclusions:
3DE may be valuable in predicting response to CRT. A baseline DI cut-off of greater than 10 in our patients excluded reverse remodelling to CRT. In addition, the decrease in DI at 24 h had a high positive predictive value for long-term response to CRT.
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