Left Ventricular End-Systolic Volume Can Predict 1-Year Hierarchical Clinical Composite End Point in Patients with
Jae Sun Uhm1, Jaewon Oh1, In Jeong Cho1
1Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Insights
Six-month changes in left ventricular end-systolic volume (ΔLVESV6) best predict cardiac resynchronization therapy (CRT) success. This echocardiographic measure accurately identifies patients likely to achieve improved heart failure outcomes within one year.
Area of Science:
- Cardiology
- Cardiac Imaging
- Heart Failure Management
Background:
- Cardiac resynchronization therapy (CRT) is a key treatment for heart failure (HF).
- Accurate prediction of CRT response is crucial for optimizing patient outcomes.
- Echocardiography plays a vital role in assessing cardiac function and CRT effectiveness.
Purpose of the Study:
- To determine which echocardiographic criteria, assessed at multiple time points, best predict the hierarchical clinical composite endpoint (HCCEP) after CRT.
- To evaluate the accuracy and agreement of various CRT response criteria with clinical outcomes.
Main Methods:
- 120 heart failure patients receiving CRT were studied.
- Echocardiography was performed pre-CRT and at 3, 6, and 12 months post-implantation.
- The 1-year HCCEP included mortality, HF hospitalization, and NYHA class.
- CRT response was defined by changes in LVESV, LVEDV, LVEF, and mitral regurgitation.
Main Results:
- The overall HCCEP improvement rate was 65.8%.
- In the total group, a decrease in left ventricular end-systolic volume at 6 months (ΔLVESV6) showed the highest accuracy (AUC=0.781) in predicting HCCEP.
- An optimal ΔLVESV6 cutoff of 13.5% demonstrated good sensitivity (71.9%) and specificity (71.9%).
Conclusions:
- ΔLVESV6 is the most reliable echocardiographic criterion for predicting 1-year HCCEP in patients undergoing CRT.
- This finding aids in early identification of non-responders and guides clinical management.
Purpose:
This study aimed to elucidate which echocardiographic criteria at three time points, for cardiac resynchronization therapy (CRT) response, are accurate in discriminating the hierarchical clinical composite end point (HCCEP).
Materials And Methods:
We included 120 patients (age, 66.1±12.6 years; men, 54.2%) who underwent CRT implantation for heart failure (HF). Echocardiography was performed before and at 3, 6, and 12 months after CRT implantation. The 1-year HCCEP included all-cause mortality, hospitalization for HF, and New York Heart Association functional class for 12 months. CRT response criteria were decrease in left ventricular (LV) end-systolic volume (LVESV) >15%, decrease in LV end-diastolic volume >15%, absolute increase in LV ejection fraction (LVEF) ≥5%, relative increase in LVEF ≥15%, and decrease in mitral regurgitation ≥1 grade. Temporal changes in CRT response rates, accuracy of CRT response criteria at each time and cutoff value for the discrimination of improvement in HCCEP, and agreements with improvement in HCCEP were analyzed.
Results:
HCCEP improvement rates were 65.8% in total group. In nonischemic group, CRT response rates according to all echocardiographic criteria significantly increased with time. In ischemic group, CRT response rate did not significantly change with time. In total group, ΔLVESV at 6 months (ΔLVESV6) had the most significant accuracy for the discrimination of HCCEP (area under the curve=0.781). The optimal cutoff value of ΔLVESV6 was 13.5% (sensitivity=0.719, specificity=0.719). ΔLVESV6 had fair agreement with HCCEP (κ=0.391, p<0.001).
Conclusion:
ΔLVESV6 is the most useful echocardiographic CRT response criterion for the prediction of 1-year HCCEP.
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