A new score system for predicting response to cardiac resynchronization therapy
Yu Kang, Leilei Cheng, Jie Cui
1Department of echocardiography, Zhongshan hospital of Fudan university, Shanghai institute of cardiovascular disease, Shanghai, China. shu.xianhong@zs-hospital.sh.cn.
Insights
A new score system using echocardiography and ECG can effectively select patients for cardiac resynchronization therapy (CRT). This tool improves prediction of positive CRT response, aiding clinical decision-making.
Area of Science:
- Cardiology
- Medical Devices
- Biomedical Engineering
Background:
- Cardiac resynchronization therapy (CRT) is a treatment for heart failure.
- Selecting appropriate patients for CRT is crucial for treatment success.
- Current patient selection methods may have limitations.
Purpose of the Study:
- To develop a novel score system for CRT patient selection.
- To integrate clinical, echocardiographic, and electrocardiographic data.
- To evaluate the clinical utility of this score system.
Main Methods:
- Ninety-three patients undergoing CRT were analyzed.
- A score system was derived using Cox regression models.
- Positive CRT response was defined by specific echocardiographic and clinical endpoints.
Main Results:
- A 4-point score system was created using TAPSE, LS, CLBBB, and QRSd.
- The score demonstrated high sensitivity (0.823) and specificity (0.850) for predicting CRT response.
- The area under the curve (AUC) was 0.923, indicating strong predictive accuracy.
Conclusions:
- The developed score system effectively predicts positive CRT response.
- Integration of TAPSE, LS, CLBBB, and QRSd offers reliable patient selection.
- This score can enhance clinical decision-making for CRT.
Background:
The aim of this study was to establish a score system derived from clinical, echocardiographic and electrocardiographic indexes and evaluate its clinical value for cardiac resynchronization therapy (CRT) patient selection.
Methods:
Ninety-three patients receiving CRT were enrolled. A patient selection score system was generated by the clinical, echocardiographic and electrocardiographic parameters achieving a significant level by univariate and multivariate Cox regression model. The positive response to CRT was a left ventricular end systolic volume decrease of ≥ 15% and not reaching primary clinical endpoint (death or re-hospitalization for heart failure) at the end of follow-up.
Results:
Thirty-nine patients were CRT non-responders (41.94%) and 54 were responders (58.06%). A 4-point score system was generated based on tricuspid annular plane systolic excursion (TAPSE), longitudinal strain (LS), and complete left bundle branch block (CLBBB) combined with a wide QRS duration (QRSd). The sensitivity and specificity for prediction of a positive response to CRT at a score > 2 were 0.823 and 0.850, respectively (AUC: 0.92295% CI 0.691-0.916, p< 0.001).
Conclusions:
A patient selection score system based on the integration of TAPSE, LS and CLBBB combined with a wide QRSd can help to predict positive response to CRT effectively and reliably.
