A predictive model of super response to cardiac resynchronization therapy in short-term period
Tariel A Atabekov1, Anna I Mishkina2, Mikhail S Khlynin2
1Department of Surgical Arrhythmology and Cardiac Pacing, Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Kievskaya Street, 111a, Tomsk, Russian Federation. kgma1011@mail.ru.
Insights
Identifying super responders for cardiac resynchronization therapy (CRT) is crucial. This study developed a predictive model using interventricular delay and phase standard deviation of the left ventricle anterior wall to identify patients who will benefit most from CRT.
Area of Science:
- Cardiology
- Medical Devices
- Heart Failure Management
Background:
- Left bundle branch block, nonischemic heart failure (HF), and female gender predict super response to cardiac resynchronization therapy (CRT).
- Identifying super responders is key for maximizing CRT benefits.
- This study aimed to develop a short-term predictive model for CRT super response.
Purpose of the Study:
- To establish a predictive model for identifying super responders to cardiac resynchronization therapy (CRT).
- To improve patient selection for CRT based on predicted super response.
- To aid clinicians in prognosing short-term outcomes of CRT.
Main Methods:
- Included patients with specific criteria: QRS ≥ 130 ms, NYHA II-III HF, LVEF ≤ 35%, and CRT indication.
- Assessed patients via electrocardiography, echocardiography, and cardiac scintigraphy before and 6 months after CRT.
- Developed a predictive model based on primary endpoints: NYHA class improvement ≥ 1 and LVEF improvement > 15% or LV end-systolic volume decrease > 30%.
Main Results:
- A super response to CRT was observed in 65.3% of patients (32/49).
- Super responders showed lower cardiac index, higher interventricular delay (IVD), and phase standard deviation of the left ventricle anterior wall (PSD LVAW).
- IVD and PSD LVAW were independently associated with super response; the predictive model achieved an AUC of 0.812.
Conclusions:
- The developed predictive model effectively distinguishes patients likely to be super responders to CRT.
- Interventricular delay and PSD LVAW are significant predictors of super response.
- This model can aid in optimizing CRT patient selection and management.
Background:
The left bundle branch block, nonischemic heart failure (HF) and female gender are the most powerful predictors of a super response to cardiac resynchronization therapy (CRT). It is important to identify super responders who can derive most benefits from CRT. We aimed to establish a predicting model that could be used for prognosis of a super response to CRT in short-term period.
Methods:
Patients with QRS ≥ 130 ms, New York Heart Association (NYHA) II-III class of HF, left ventricle ejection fraction (LVEF) ≤ 35% and indications for CRT were included in the study. Before and 6 month after CRT the electrocardiography, echocardiography and cardiac scintigraphy were performed. The study's primary endpoint was the NYHA class improvement ≥ 1 and left ventricle end systolic volume decrease > 30% or LVEF improvement > 15% after 6 month CRT. Based on collected data, we developed a predictive model regarding a super response to CRT.
Results:
Of 49 (100.0%) patients, 32 (65.3%) had a super response to CRT. Patients with a super response were likelier to have a lower cardiac index (p = 0.007), higher rates of interventricular delay (IVD) (p = 0.003), phase standard deviation of left ventricle anterior wall (PSD LVAW) (p = 0.009) and ∆QRS (p = 0.02). Only IVD and PSD LVAW were independently associated with a super response to CRT in univariate and multivariate logistic regression. We created a logistic equation and calculated a cut-off value. The resulting ROC curve revealed a discriminative ability with AUC of 0.812 (sensitivity 90.62%; specificity 70.59%).
Conclusion:
Our predictive model is able to distinguish patients with a super response to CRT.
