Key result
LBBB morphology reliably predicts echocardiographic response to CRT with ~97% sensitivity.
Why the study?
Real-world studies have sought to identify predictors of response to CRT, prompting a systematic review and meta-analysis.
What are the independent baseline predictors of echocardiographic response to cardiac resynchronization therapy?
Meta-Analysis
What are the independent baseline predictors of echocardiographic response to cardiac resynchronization therapy?
Effect estimate: AUC 0.969 (95% CI 0.947-0.991)
p-value: p=<0.001
Female gender, non-ischemic cardiomyopathy, LBBB, and NYHA class II are independent predictors of echocardiographic response to CRT, with LBBB being the strongest predictor.
BACKGROUND: -analysis of real-world studies trying to identify predictors of response to CRT. METHODS: PubMed, Embase and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for observational prospective studies, referring the evaluation of response to CRT, defined as a decrease in left ventricle end-systolic volume (LVESV) ≥ 15% at 6-month follow-up, via two-dimensional echocardiography. RESULTS: -analysis showed that female gender (p = 0.018), non-ischemic cardiomyopathy (NICM) (p < 0.001), left bundle branch morphology (LBBB) (p = 0.001), longer QRS (p < 0.001) and New York Heart Association (NYHA) class II (p = 0.014) appear to favor response to CRT. After ROC analysis and logistic regression procedures, female gender (kappa = 0.450; p < 0.001), NICM (kappa = 0.636; p < 0.001), LBBB (kappa = 0.935; p < 0.001), and NYHA class II (kappa = 0.647; p < 0.001) were identified as independent predictors of response to CRT, being LBBB the most reliable one (sensitivity = 97.24%; specificity = 98.86%). CONCLUSIONS: Female gender, NICM, LBBB and NYHA class II are baseline variables with an apparent capability to independently predict response to CRT, being LBBB the most reliable one.
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Martins et al. (2022) conducted a meta-analysis in Heart failure with reduced ejection fraction (HFrEF). Cardiac resynchronization therapy (CRT) vs. Non-responders was evaluated on Predictors of echocardiographic response to CRT (decrease in LVESV ≥ 15%) (AUC 0.969, 95% CI 0.947-0.991, p=<0.001). Left bundle branch block morphology was the most reliable independent predictor of echocardiographic response to cardiac resynchronization therapy, with an AUC of 0.969, sensitivity of 97.24%, and specificity of 98.86%.
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