Key result
NOGA XP mapping of LV electrical potentials predicts positive CRT response with ~0.85 AUC.
Why the study?
Approximately 30% of patients who undergo CRT do not experience the expected benefits, prompting evaluation of left ventricular electrical potential measured by NOGA XP electromechanical mapping as a predictor of response.
Does left ventricular electrical potential measured by electromechanical mapping predict a positive echocardiographic response to cardiac resynchronization therapy in patients with ischemic cardiomyopathy?
Cohort (n=38)
No
Does left ventricular electrical potential measured by electromechanical mapping predict a positive echocardiographic response to cardiac resynchronization therapy in patients with ischemic cardiomyopathy?
Left ventricular electrical potentials measured by electromechanical mapping can independently predict favorable reverse remodeling responses to cardiac resynchronization therapy in patients with ischemic cardiomyopathy.
Objectives: The aim of the study was to determine whether left ventricular electrical potential measured by electromechanical mapping with the NOGA XP system has predictive value for response to CRT. Background: Approximately 30% of patients who undergo cardiac resynchronization therapy do not see the expected effects. Methods: The group of 38 patients qualified for CRT implantation were included in the study, of which 33 patients were analyzed. A 15% reduction in ESV after 6 months of pacing was used as a criterion for a positive response to CRT. The mean value and sum of unipolar and bipolar potentials obtained by mapping with the NOGA XP system and their predictive value in relation to the effect of CRT were analyzed using a bulls-eye projection at three levels: 1) the global value of the left ventricular (LV) potentials, 2) the potentials of the individual LV walls and 3) the mean value of the potentials of the individual segments (basal and middle) of the individual LV walls. Results: 24 patients met the criterion of a positive response to CRT vs. 9 non-responders. At the global analysis stage, the independent predictors of favorable response to CRT were the sum of the unipolar potential and bipolar mean potential. In the analysis of individual left ventricular walls, the mean bipolar potential of the anterior and posterior wall and in the unipolar system, mean septal potential was found to be an independent predictor of favorable response to CRT. In the detailed segmental analysis, the independent predictors were the bipolar potential of the mid-posterior wall segment and the basal anterior wall segment. Conclusions: Measurement of bipolar and unipolar electrical potentials with the NOGA XP system is a valuable method for predicting a favorable response to CRT.
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Wilczek et al. (2023) conducted a cohort in Heart failure with ischemic cardiomyopathy (n=38). NOGA XP electromechanical mapping vs. Non-responders was evaluated on Positive response to CRT (≥15% reduction in left ventricular end-systolic volume) (AUC 0.8465, 95% CI 0.67-0.95, p=0.001). Left ventricular electrical potentials measured by NOGA XP electromechanical mapping independently predicted a positive response to cardiac resynchronization therapy with an AUC of 0.8465 for the sum of unipolar potentials.
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