Key result
A novel response score > 2 predicted a positive response to cardiac resynchronization therapy in 95% of patients compared to 11% with a score ≤ 2 (OR 45.4, p < 0.0001).
Why the study?
Does a new baseline scoring system using clinical, ECG, and echocardiographic variables predict positive echocardiographic response to cardiac resynchronization therapy?
Cohort (n=100)
Does a new baseline scoring system using clinical, ECG, and echocardiographic variables predict positive echocardiographic response to cardiac resynchronization therapy?
Odds Ratio: 45.4
Absolute Event Rate: 95% vs 11%
p-value: p=< 0.0001
A novel scoring system incorporating RV pacing-induced LBBB, T(TDI-PW), and WMSI strongly predicts echocardiographic response to cardiac resynchronization therapy.
INTRODUCTION: The PROSPECT trial reported no single echocardiographic measurement of dyssynchrony is recommended to improve patient selection for cardiac resynchronization therapy (CRT). MATERIAL AND METHODS: In 100 consecutive patients who received CRT, we analyzed 27 ECG and echocardiographic variables to predict a positive response to CRT defined as a left ventricular (LV) end systolic volume decrease of ≥ 15% after CRT. RESULTS: Right ventricular (RV) pacing-induced left bundle branch block (LBBB), time difference between LV ejection measured by tissue Doppler and pulsed wave Doppler (T(TDI-PW)), and wall motion score index (WMSI) were significantly associated with positive CRT response by multivariate regression. We assigned 1 point for RV pacing-induced LBBB, 1 point for WMSI ≤ 1.59, and 2 points for T(TDI-PW) > 50 ms. Overall mean response score was 1.79 ±1.39. Cutoff point for response score to predict positive response to CRT was > 2 by receiver operating characteristic (ROC) analysis. Area under ROC curve was 0.97 (p = 0.0001). Cardiac resynchronization therapy responders in patients with response score > 2 and ≤ 2 were 36/38 (95%) and 7/62 (11%, p < 0.001), respectively. After age and gender adjustment, the response score was related to CRT response (OR = 45.4, p < 0.0001). CONCLUSIONS: A response score generated from clinical, ECG and echocardiographic variables may be a useful predictor for CRT response. However, this needs to be validated.
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Shen et al. (2011) conducted a cohort in Heart failure requiring cardiac resynchronization therapy (n=100). Response score > 2 vs. Response score ≤ 2 was evaluated on Positive response to CRT (left ventricular end systolic volume decrease of ≥ 15% after CRT) (OR 45.4, p=< 0.0001). A novel response score > 2 predicted a positive response to cardiac resynchronization therapy in 95% of patients compared to 11% with a score ≤ 2 (OR 45.4, p < 0.0001).
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