Baseline aortic pre-ejection interval predicts reverse remodeling and clinical improvement after cardiac...

Area of Science:

• Cardiology
• Medical Devices
• Diagnostic Imaging

Background:

• Cardiac resynchronization therapy (CRT) improves outcomes in heart failure but lacks consistent patient response.
• Approximately one-third of patients do not benefit from CRT, necessitating better patient selection methods.

Purpose of the Study:

• To identify parameters predicting reverse remodeling and clinical improvement following CRT.
• To evaluate the efficacy of dyssynchrony parameters in predicting CRT response.

Main Methods:

• 54 heart failure patients (NYHA class III-IV, LVEF ≤ 35%, QRS duration ≥ 120 ms) underwent echocardiography before and 6 months after CRT.
• Echocardiographic response defined as ≥10% reduction in end-systolic volume; clinical response defined as ≥1 NYHA class improvement.

Main Results:

• 70.4% showed echocardiographic response and 75.9% showed clinical response to CRT.
• Aortic pre-ejection interval (APEI) was the only dyssynchrony parameter to significantly predict both echocardiographic (p=0.037) and clinical (p=0.048) response.
• An APEI cutoff of 180.5 ms predicted clinical response with 92.3% sensitivity and echocardiographic response with 93.0% sensitivity.

Conclusions:

• APEI is a simple, practical echocardiographic parameter for selecting patients likely to benefit from CRT.
• Pulsed-wave Doppler derived APEI, readily available on echocardiography machines, can aid in patient selection for CRT.