Electro-echocardiographic Indices to Predict Cardiac Resynchronization Therapy Non-response on Non-ischemic
Ziqing Yu1,2, Xueying Chen1,2, Fei Han1,2
1Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, PR China.
Insights
Predicting nonresponse to cardiac resynchronization therapy (CRT) is crucial. This study identified key electro-echocardiographic predictors, including LVEDV > 255 mL, for CRT nonresponse in heart failure patients.
Area of Science:
- Cardiology
- Electrophysiology
- Echocardiography
Background:
- Cardiac resynchronization therapy (CRT) is a key treatment for heart failure, but a significant portion of patients do not respond.
- Effective parameters to predict CRT non-response are currently lacking, hindering personalized treatment strategies.
- Identifying reliable predictors can optimize patient selection and improve CRT outcomes.
Purpose of the Study:
- To identify effective electro-echocardiographic predictors of nonresponse to CRT in patients with dyssynchronous heart failure.
- To analyze the association between specific echocardiographic and electrocardiographic parameters and CRT outcomes.
Main Methods:
- Retrospective study of 227 patients with dyssynchronous heart failure who underwent CRT implantation.
- Logistic analysis was performed to compare CRT responders and non-responders.
- Primary outcome: improved left ventricular ejection fraction 1 year post-CRT implantation.
Main Results:
- Left ventricular end-diastolic volume (LVEDV) > 255 mL significantly predicted CRT non-response (OR = 2.236).
- Parameters such as S wave > 5.7 cm/s, E/A > 1, E'/A' > 1, complete left bundle branch block (CLBBB), and QRS duration > 160 ms surprisingly predicted a low probability of CRT non-response.
- Left ventricular end-systolic volume (LVESV) > 160 mL and TpTe/QTc > 0.203 did not significantly predict CRT non-response.
Conclusions:
- LVEDV > 255 mL is a significant predictor of CRT non-response.
- Certain echocardiographic and electrocardiographic parameters (e.g., S wave, E/A, E'/A', CLBBB, QRS duration) may indicate a favorable response to CRT.
- These findings can aid in better patient selection for CRT and improve treatment efficacy.
Abstract:
Cardiac resynchronization therapy (CRT) threw lights on heart failure treatment, however, parts of patients showed nonresponse to CRT. Unfortunately, it lacks effective parameters to predict CRT non-response. In present study, we try to seek effective electro-echocardiographic predictors on CRT non-response. This is a retrospective study to review a total of 227 patients of dyssynchronous heart failure underwent CRT implantation. Logistic analysis was performed between CRT responders and CRT non-responders. The primary outcome was the occurrence of improved left ventricular ejection fraction 1 year after CRT implantation. We concluded that LVEDV > 255 mL (OR = 2.236; 95% CI, 1.016-4.923) rather than LVESV > 160 mL (OR = 1.18; 95% CI, 0.544-2.56) and TpTe/QTc > 0.203 (OR = 5.206; 95% CI, 1.89-14.34) significantly predicted CRT non-response. Oppositely, S wave > 5.7 cm/s (OR = 0.242; 95% CI, 0.089-0.657), E/A > 1 (OR = 0.211; 95% CI, 0.079-0.566), E'/A' > 1 (OR = 0.054; 95% CI, 0.017-0.172), CLBBB (OR = 0.141; 95% CI, 0.048-0.409), and QRS duration >160 ms (OR = 0.52; 95% CI, 0.305-0.922) surprisingly predicted low-probability of CRT non-response.
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