Echo response and clinical outcome in CRT patients
J van 't Sant1, T P Mast2, M M Bos2
1Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. j.vantsant@gmail.nl.
Insights
Left ventricular end-systolic volume change (∆LVESV) effectively predicts cardiac resynchronisation therapy (CRT) response in non-ischaemic cardiomyopathy. However, ∆LVESV is less reliable for ischaemic cardiomyopathy, where other markers may be more suitable.
Area of Science:
- Cardiology
- Biomedical Engineering
- Medical Devices
Background:
- Cardiac resynchronisation therapy (CRT) response is often assessed using changes in left ventricular end-systolic volume (∆LVESV).
- The efficacy of ∆LVESV as a predictor of favourable outcomes in CRT patients requires further investigation, particularly across different aetiologies of heart failure.
Purpose of the Study:
- To evaluate ∆LVESV as the optimal surrogate marker for predicting long-term outcomes following CRT.
- To determine if the predictive value of ∆LVESV differs between patients with ischaemic and non-ischaemic cardiomyopathy.
Main Methods:
- A cohort of 205 CRT patients underwent baseline and 6-month assessments, including echocardiography, exercise testing, and laboratory measurements.
- Various parameters, including ∆LVESV, were analysed for their correlation with major adverse cardiac events (MACE) from 6 to 24 months post-CRT.
Main Results:
- Major adverse cardiac events (MACE) occurred in 19% of patients (13% non-ischaemic, 24% ischaemic).
- ∆LVESV was the sole significant surrogate marker for CRT response in the overall population (AUC 0.69) and non-ischaemic cardiomyopathy (AUC 0.850).
- For ischaemic cardiomyopathy, ∆BNP demonstrated the highest predictive value (AUC 0.66).
Conclusions:
- ∆LVESV is a robust surrogate marker for assessing CRT response and predicting long-term outcomes in patients with non-ischaemic cardiomyopathy.
- The utility of ∆LVESV is limited in ischaemic cardiomyopathy, highlighting challenges in measuring CRT response in this patient group.
Background:
Change in left ventricular end-systolic volume (∆LVESV) is the most frequently used surrogate marker in measuring response to cardiac resynchronisation therapy (CRT). We investigated whether ∆LVESV is the best measure to discriminate between a favourable and unfavourable outcome and whether this is equally applicable to non-ischaemic and ischaemic cardiomyopathy.
Methods:
205 CRT patients (age 65 ± 12 years, 69 % men) were included. At baseline and 6 months echocardiographic studies, exercise testing and laboratory measurements were performed. CRT response was assessed by: ∆LVESV, ∆LV ejection fraction (LVEF), ∆ interventricular mechanical delay, ∆VO2 peak, ∆VE/VCO2, ∆BNP, ∆creatinine, ∆NYHA, and ∆QRS. These were correlated to the occurrence of major adverse cardiac events (MACE) between 6 and 24 months.
Results:
MACE occurred in 19 % of the patients (non-ischaemic: 13 %, ischaemic: 24 %). ∆LVESV remained the only surrogate marker for CRT response for the total population and patients with non-ischaemic cardiomyopathy, showing areas under the curve (AUC) of 0.69 and 0.850, respectively. For ischaemic cardiomyopathy, ∆BNP was the best surrogate marker showing an AUC of 0.66.
Conclusion:
∆LVESV is an excellent surrogate marker measuring CRT response concerning long-term outcome for non-ischaemic cardiomyopathy. ∆LVESV is not suitable for ischaemic cardiomyopathy in which measuring CRT response remains difficult.
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