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Updated: May 27, 2026
Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
Published on: December 11, 2017
Baseline aortic pre-ejection interval predicts reverse remodeling and clinical improvement after cardiac
Hakan Aksoy1, Sercan Okutucu, Kudret Aytemir
1Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Insights
The aortic pre-ejection interval (APEI) can predict which heart failure patients will benefit from cardiac resynchronization therapy (CRT). This simple echocardiographic measurement helps identify responders for improved outcomes.
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.
Background:
Cardiac resynchronization therapy (CRT) has been shown to reduce heart failure-related morbidity and mortality. However, approximately one in three patients do not respond to CRT. The aim of the current study was to determine the parameter(s) which predict reverse remodeling and clinical improvement after CRT.
Methods:
A total of 54 patients (43 male, 11 female; mean age 61.9 ± 10.5 years) with heart failure and New York Heart Association (NYHA) class III-IV symptoms and in whom left ventricular ejection fraction (LVEF) was £ 35% and QRS duration was ≥ 120 ms, despite optimal medical therapy, were enrolled. An echocardiographic examination was performed before, and six months after, CRT. An echocardiographic response was defined as a reduction of end-systolic volume ≥ 10% after six months, and a clinical response was defined as a reduction ≥ 1 in the NYHA functional class score.
Results:
An echocardiographic response was observed in 38 (70.4%) of the patients and a clinical response occurred in 41 (75.9%) of the patients. Of the dyssynchrony parameters, only the aortic pre-ejection interval (APEI) was observed to significantly predict the clinical response (p = 0.048) and echocardiographic response (p = 0.037). A 180.5 ms cut-off value for the APEI predicted the clinical response with a sensitivity of 92.3% and a specificity of 39%, and the echocardiographic response with a sensitivity of 93.0% and a specificity of 42%.
Conclusions:
APEI derived from pulsed-wave Doppler, which is available in every echocardiography machine, is a simple and practical method that could be used to select patients for CRT.
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