Predictors of positive response to cardiac resynchronization therapy
Diana Rinkuniene1, Silvija Bucyte, Kristina Ceseviciute
1Lithuanian University of Health Sciences, Kaunas, Lithuania. diana.rinkuniene@gmail.com.
Insights
Smaller left ventricular end-diastolic diameter and non-ischemic heart failure etiology predict positive response to cardiac resynchronization therapy (CRT). Lower uric acid also correlates with better CRT outcomes.
Area of Science:
- Cardiology
- Medical Devices
- Heart Failure Management
Background:
- Approximately 30% of patients undergoing cardiac resynchronization therapy (CRT) do not experience favorable outcomes.
- Identifying predictors of CRT response is crucial for optimizing patient selection and treatment efficacy.
Purpose of the Study:
- To identify echocardiographic and clinical predictors of a positive response to cardiac resynchronization therapy (CRT).
Main Methods:
- Study included 82 heart failure patients with NYHA class III/IV, LBBB, QRS ≥ 120ms, and LVEF ≤ 35%.
- Statistical analysis performed using SPSS v.21.0; p < 0.05 considered significant.
Main Results:
- Echocardiographic and clinical response rates were 81.6% and 82.9%, respectively.
- Smaller left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD) predicted favorable echocardiographic response.
- Lower serum uric acid concentration and non-ischemic heart failure etiology were associated with better CRT response.
Conclusions:
- Smaller LVEDD and LVESD, and lower uric acid levels are linked to improved CRT response.
- LVEDD and non-ischemic heart failure etiology emerged as the strongest independent predictors of positive CRT response.
Background:
Approximately 30% of patients treated with cardiac resynchronization therapy (CRT) do not achieve favourable response. The purpose of the present study was to identify echocardiographic and clinical predictors of a positive response to CRT.
Methods:
The study included 82 consecutive heart failure (HF) patients in New York Heart Association (NYHA) functional class III or IV with left bundle branch block (LBBB), QRS duration ≥ 120 ms and left ventricular ejection fraction (LVEF) ≤ 35%. Statistical analysis was performed using IBM SPSS statistical software (SPSS v.21.0 for Mac OS X). A p value < 0.05 was considered statistically significant.
Results:
Echocardiographic response was established in 81.6% and clinical response was achieved in 82.9% of patients. Significant univariate predictors of favourable echocardiographic response after 12 months were smaller left ventricular end-diastolic diameter (LVEDD) (odds ratio [OR] 0.89; 95% confidence interval [CI] 0.82 - 0.97, p = 0.01), and smaller left ventricular end-systolic diameter (LVESD) (OR 0.91; 95% CI 0.85 - 0.98, p = 0.01). Lower uric acid concentration was associated with better echocardiographic response (OR 0.99; 95% CI 0.99 - 1.0, p = 0.01). Non-ischemic HF etiology (OR 4.89; 95% CI 1.39 - 17.15, p = 0.01) independently predicted positive clinical response. Multiple stepwise regression analysis demonstrated that LVEDD lower than 75 mm (OR 5.60; 95% confidence interval [CI] 1.36 - 18.61, p = 0.01) was the strongest independent predictor of favourable echocardiographic response.
Conclusions:
Smaller left ventricular end-diastolic and end-systolic diameters and lower serum uric acid concentration were associated with better response to CRT. Left ventricular end-diastolic diameter and non-ischemic heart failure etiology were the strongest independent predictors of positive response to CRT.
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