Key result
Baseline LVEF below ~22% linked to lack of CRT response at six months.
Why the study?
Clinical and echocardiographic characteristics associated with reverse left ventricular remodeling after cardiac resynchronization therapy in nonischemic dilated cardiomyopathy remained to be described.
Do baseline 2D/3D echocardiographic features predict reverse remodeling after 6 months of CRT in patients with nonischemic dilated cardiomyopathy?
Observational (n=24)
Do baseline 2D/3D echocardiographic features predict reverse remodeling after 6 months of CRT in patients with nonischemic dilated cardiomyopathy?
Effect estimate: OR 1.59 (95% CI 1.13-2.22)
p-value: p=0.007
In patients with nonischemic dilated cardiomyopathy, baseline LVEF <22.15% predicts lack of reverse remodeling response to CRT at 6 months, while mechanical dyssynchrony parameters do not improve candidate selection.
LVEF <22.15% was associated with CRT nonresponse; leaves open whether thresholds should refine selection in nonischemic cardiomyopathy.
PURPOSE: To describe clinical and echocardiographic characteristics associated with reverse left ventricular (LV) remodeling after 6 months of cardiac resynchronization therapy (CRT) in patients with nonischemic dilated cardiomyopathy. METHODS: Twenty-four consecutive patients underwent 2D and 3D echocardiography before and after 6 months of CRT implant. Several echocardiographic parameters including global longitudinal strain (GLS) and 3D mechanical dyssynchrony (MD) index were calculated. CRT response was defined as a decrease in LV end-systolic volume (LVESV) of at least 10% at follow-up. Patients were divided in two groups according to CRT response. RESULTS: Cardiac resynchronization therapy responder (CRTR+) rate was 50%. Nonresponder (CRTR-) patients showed a less significant improvement in NYHA class at follow-up. At baseline, CRTR- presented with higher LV end-diastolic volume (LVEDV) (P = 0.031), LVESV (P = 0.024), lower left ventricular ejection fraction (LVEF) (P = 0.002) and less negative GLS (P = 0.03), and with higher diastolic dysfunction, more impaired right ventricle (RV), and higher pulmonary artery systolic pressure (PASP) (P = 0.002). No significant differences in echocardiographic parameters of MD were found. Univariate determinants of CRTR+ were LVEF (OR = 1.59, CI 95% = 1.13-2.22, P = 0.007) and TAPSE (OR 1.21, CI 95% = 1.024-1.429, P = 0.025). A ROC curve analysis showed a cutoff value of LVEF of 22.15% significantly related to CRTR+ (SE 80%, SP 50%). CONCLUSIONS: Our findings suggest that end-stage HF patients, presenting before CRT with LVEF <22.15%, may not benefit from the procedure after 6 months. Mechanical dyssyncronicity did not provide additional information to improve candidate selection.
No takes yet. Share an insight, caveat, or question.
Cimino et al. (2019) conducted an observational in nonischemic dilated cardiomyopathy (n=24). Cardiac resynchronization therapy (CRT) was evaluated on CRT response (decrease in LV end-systolic volume of at least 10% at follow-up) (OR 1.59, 95% CI 1.13-2.22, p=0.007). Baseline LVEF was a significant predictor of CRT response (OR 1.59; 95% CI 1.13-2.22; P=0.007), with patients having LVEF <22.15% unlikely to benefit at 6 months.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: