Response predictors to cardiac resynchronization therapy in chronic heart failure: a 10-year-cardiovascular center
Juan C Plata-Corona1, Fabio Solis-Jiménez1, Maximiliano Flores-Flamand1
1Department of Clinical Cardiology.
Insights
Predicting cardiac resynchronization therapy (CRT) success is crucial. Left bundle branch block, specific echocardiographic measures, and ventricular volumes independently predict positive CRT response in heart failure patients.
Area of Science:
- Cardiology
- Heart Failure Management
- Cardiac Electrophysiology
Background:
- Cardiac resynchronization therapy (CRT) is established for heart failure with reduced ejection fraction.
- Clinical trials confirm CRT's benefits on mortality, hospitalizations, and quality of life.
Purpose of the Study:
- Identify clinical, electrocardiographic, and echocardiographic predictors of CRT response.
- Improve patient selection for CRT.
Main Methods:
- Retrospective observational study of 102 heart failure patients undergoing CRT.
- Response defined by improved NYHA class and LVEF recovery (≥5%).
- Analysis of baseline and post-CRT clinical and echocardiographic data.
Main Results:
- 50% of patients were responders.
- Responders had wider QRS, lower baseline LVEF, and RV fractional area change.
- Left bundle branch block (LBBB), LVEDV, TAPSE, and pre-ejection time difference predicted CRT response.
Conclusions:
- LBBB, TAPSE, LVEDV, and pre-ejection time difference are independent predictors of CRT response.
- These variables can aid in optimizing CRT patient selection.
Background:
Cardiac resynchronization therapy (CRT) has been established as an effective therapy for heart failure with reduced ejection fraction. Randomized clinical trials have shown its impact on mortality and HF hospitalizations, as well as improvement of symptoms and quality of life.
Objectives:
Finding clinical, electrocardiographic, and echocardiographic variables that may predict the response to cardiac resynchronization therapy (CRT).
Methods:
We performed a single-center, observational, analytic, and retrospective study that included 102 patients with heart failure (HF) diagnosis who underwent CRT according to guideline-directed therapy from January 2010 to April 2020 in a third-level center. CRT response was defined as an improvement of New York Heart Association functional class in at least 1 category associated with a recovery of ≥ 5% in the left ventricular ejection fraction (LVEF).
Results:
Our study population was 102 patients of which 61 (59.8%) were men. The mean age at HF diagnosis was 54 ± 18.7 years. Ischemic heart disease was the etiology in 37 (36.3%) cases. Fifty-one (50%) patients were classified as responders. Responders had wider QRS, and lower LVEF and right ventricular fractional area change at baseline. After CRT, responders had a greater reduction of QRS duration, and improvement in LVEF, global longitudinal strain, and echocardiographic dyssynchrony parameters. Multivariate regression analysis showed that left bundle branch block (LBBB), left ventricular end-diastolic volume (LVEDV), tricuspid annular plane systolic excursion (TAPSE), and baseline difference of pre-ejection periods were predictors of a positive response to CRT in this population.
Conclusions:
LBBB, TAPSE, LVEDV, and pre-ejection time difference are independent variables that can predict adequate response to CRT.
Related Concept Videos
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:17Pathophysiology of Heart Failure
01:30Pulse rhythm
Conversely, an irregular pulse pattern is termed dysrhythmia, stemming from disruptions in cardiac...
01:22Heart Failure Drugs: β-Blockers