Key result
Contractile reserve during stress echocardiography was a strong predictor of clinical and echocardiographic response to cardiac resynchronization therapy (OR 6.2; 95% CI 1.4-27.6; P=0.015).
Why the study?
Does contractile reserve during stress echocardiography predict clinical and echocardiographic response to cardiac resynchronization therapy in patients with heart failure?
Cohort (n=69)
Does contractile reserve during stress echocardiography predict clinical and echocardiographic response to cardiac resynchronization therapy in patients with heart failure?
Odds Ratio: 6.2 (95% CI 1.4–27.6)
p-value: p=0.015
Contractile reserve assessed by dobutamine stress echocardiography is a strong predictor of clinical and echocardiographic response to cardiac resynchronization therapy, outperforming traditional measures of dyssynchrony.
May refine CRT selection; hypothesis-generating and requires prospective validation before practice change.
AIMS: The identification of responders to cardiac resynchronization therapy (CRT) remains a challenge. We assessed the role of dyssynchrony (DYS) and contractile reserve (CR) in identifying CRT responders. METHODS AND RESULTS: Sixty-nine patients (55% with ischaemic aetiology) referred for CRT (ejection fraction < or =35%, New York Heart Association > or =III, and QRS duration > or =120 ms) underwent baseline evaluation of DYS and dobutamine stress-echo [up to 40 microg/kg/min: CR was defined as a wall motion score index (WMSI) variation > or =0.20]. CRT responders were identified by clinical and/or echocardiographic [end-systolic volume (ESV) decrease > or =15%] follow-up criteria. During a median follow-up of 11 months, 46 patients (66%) were classified as clinical responders. Reverse remodelling was found in 34 of the 59 patients (58%) with echocardiographic follow-up. CR was present in 78% of clinical responders (P = 0.001) and in 69% with reverse remodelling (P = 0.005). DYS was equally present in the two groups. Reverse remodelling was correlated with rest-stress changes in ESV (r = 0.439, P = 0.003) and in WMSI (r = 0.450, P = 0.001), but not with DYS. CR (OR = 6.2, 95% CI = 1.4-27.6, P = 0.015) was the best predictor of response to CRT. CONCLUSION: Patients with CR show a favourable clinical and reverse LV remodelling response to CRT. This finding shifts the focus from electrical (dyssynchrony) to the myocardial substrate of functional response.
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Ciampi et al. (2009) conducted a cohort in Heart failure referred for cardiac resynchronization therapy (n=69). Contractile reserve during stress echocardiography vs. Absence of contractile reserve was evaluated on Response to CRT (clinical and/or echocardiographic) (OR 6.2, 95% CI 1.4-27.6, p=0.015). Contractile reserve during stress echocardiography was a strong predictor of clinical and echocardiographic response to cardiac resynchronization therapy (OR 6.2; 95% CI 1.4-27.6; P=0.015).
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