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Real-Time Cardiac Mapping with a Noninvasive Imageless Electrocardiographic Imaging System

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A patient selection score for cardiac resynchronization therapy.

Xuedong Shen¹, Chandra K Nair, Wilbert S Aronow

¹Cardiac Center of Creighton University School of Medicine, Valhalla, New York, USA.

Echocardiography (Mount Kisco, N.Y.)

|February 1, 2011

Summary

A new patient selection score (PSS) effectively predicts response to cardiac resynchronization therapy (CRT). A PSS greater than 4 identifies patients most likely to benefit from CRT, improving treatment outcomes in heart failure patients.

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Area of Science:

Cardiology
Medical Devices
Heart Failure Management

Background:

Cardiac resynchronization therapy (CRT) effectiveness varies among patients.
Improved patient selection is needed to optimize CRT outcomes.

Purpose of the Study:

To develop and validate a patient selection score (PSS) for predicting positive response to CRT.
To assess the PSS's ability to identify likely responders to CRT.

Main Methods:

A 7-point PSS was developed using six variables from 100 patients receiving CRT (Group A).
Response to CRT was defined as a ≥15% decrease in left ventricular end-systolic volume and survival from heart failure.
The PSS was validated in a separate group of 36 patients (Group B).

Main Results:

In Group A, 37% of patients responded to CRT. The PSS demonstrated high accuracy in predicting response (AUC=0.94).
Patients with a PSS > 4 showed significantly higher CRT response rates (83% in Group A, 88% in Group B) compared to those with PSS ≤ 4 (7% in Group A, 16% in Group B).
Multivariate analysis confirmed PSS as a significant predictor of CRT response (HR=10.3).

Conclusions:

A PSS > 4 is a strong predictor of positive response to CRT.
This score system can identify up to 88% of heart failure patients with wide QRS duration who are likely to respond to CRT.