Echocardiographic Predictors of Worse Outcome After Cardiac Resynchronization Therapy
Eduardo Arrais Rocha1, Francisca Tatiana Moreira Pereira2, José Sebastião Abreu2
1Universidade de São Paulo, São Paulo, SP, Brazil.
Insights
Ejection fraction below 30%, severe diastolic dysfunction, and severe mitral regurgitation predict poor outcomes after cardiac resynchronization therapy (CRT). Identifying these factors can guide alternative treatment decisions for non-responders.
Area of Science:
- Cardiology
- Medical Imaging
- Heart Failure Management
Background:
- Cardiac resynchronization therapy (CRT) is a guideline-recommended treatment for heart failure.
- A significant portion (30-40%) of patients selected for CRT do not respond to the therapy.
Purpose of the Study:
- To develop an echocardiographic model for predicting cardiac death or transplantation (Tx) one year post-CRT.
- To identify echocardiographic predictors of poor outcomes in CRT patients.
Main Methods:
- Prospective observational study of 116 heart failure patients undergoing CRT.
- Echocardiographic assessments pre-implantation and 6-12 months post-implantation.
- Cox regression, ROC, and Kaplan-Meier analyses for outcome prediction, validated by bootstrapping.
Main Results:
- 16.3% of patients experienced cardiac mortality or transplantation.
- Ejection fraction (EF) < 30%, grade III/IV diastolic dysfunction, and grade III mitral regurgitation at 6-12 months were independent predictors of adverse events.
- The predictive model achieved an area under the ROC curve of 0.78.
Conclusions:
- Low EF (<30%), severe diastolic dysfunction, and severe mitral regurgitation are indicators of poor prognosis one year after CRT.
- A combination of two of these echocardiographic findings suggests the need for alternative treatment strategies.
Background:
Cardiac resynchronization therapy (CRT) is the recommended treatment by leading global guidelines. However, 30%-40% of selected patients are non-responders.
Objective:
To develop an echocardiographic model to predict cardiac death or transplantation (Tx) 1 year after CRT.
Method:
Observational, prospective study, with the inclusion of 116 patients, aged 64.89 ± 11.18 years, 69.8% male, 68,1% in NYHA FC III and 31,9% in FC IV, 71.55% with left bundle-branch block, and median ejection fraction (EF) of 29%. Evaluations were made in the pre‑implantation period and 6-12 months after that, and correlated with cardiac mortality/Tx at the end of follow-up. Cox and logistic regression analyses were performed with ROC and Kaplan-Meier curves. The model was internally validated by bootstrapping.
Results:
There were 29 (25%) deaths/Tx during follow-up of 34.09 ± 17.9 months. Cardiac mortality/Tx was 16.3%. In the multivariate Cox model, EF < 30%, grade III/IV diastolic dysfunction and grade III mitral regurgitation at 6‑12 months were independently related to increased cardiac mortality or Tx, with hazard ratios of 3.1, 4.63 and 7.11, respectively. The area under the ROC curve was 0.78.
Conclusion:
EF lower than 30%, severe diastolic dysfunction and severe mitral regurgitation indicate poor prognosis 1 year after CRT. The combination of two of those variables indicate the need for other treatment options.
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