Key result
A wall motion score index >2 predicted a significantly higher rate of cardiac resynchronization therapy nonresponse compared to a score ≤2 (82% vs 47%, P=0.005).
Why the study?
Does the extent of segmental wall motion abnormalities (measured by WMSI) predict response to cardiac resynchronization therapy?
Cohort (n=108)
Does the extent of segmental wall motion abnormalities (measured by WMSI) predict response to cardiac resynchronization therapy?
A larger extent of wall motion abnormalities (WMSI >2) predicts a poorer echocardiographic response to cardiac resynchronization therapy.
BACKGROUND: We hypothesized that segmental wall motion abnormalities (WMAs) are related to cardiac resynchronization therapy (CRT) response. METHODS: We studied 108 patients who received CRT, 69 with ischemic and 39 with nonischemic heart disease. A wall motion score index (WMSI) was analyzed using a 17-segment model and calculated by the total score/number of segments analyzed. A decrease of left ventricular end systolic volume > or =15% after CRT was defined as a positive response to CRT. RESULTS: Of 108 patients, 1,054/1,836 segments (57%) had WMAs. The mean WMSI was 2.06 in patients with ischemic heart disease and 1.04 in patients with nonischemic heart disease (P < 0.0001). The area under the receiver operating characteristic curve for a WMSI predicting a positive response to CRT was 0.70 (P = 0.0001). The cutoff point was a WMSI < or =2 for prediction of a positive response to CRT. After adjustment for age, gender, and clinical features, the WMSI persistently related to CRT responders (P = 0.01). During 15-month follow-up, the percentage of CRT nonresponders in patients with a WMSI >2 was significantly higher (82%) compared to patients with a WMSI < or =2 (47%, P = 0.005) and nonischemic heart disease (36%, P < 0.001). In 59 patients with left ventricular mechanical dyssynchrony, the percentage of negative responders to CRT in patients with a WMSI >2, < or =2, and nonischemic heart disease were 53% (8 of 15), 16% (3 of 19) and 0% (0 of 25), respectively (P < 0.001). CONCLUSIONS: A large extent of WMAs and a WMSI >2 predicted a poorer CRT response.
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Shen et al. (2009) conducted a cohort in Heart failure receiving cardiac resynchronization therapy (n=108). Wall motion score index (WMSI) > 2 vs. WMSI ≤ 2 was evaluated on Cardiac resynchronization therapy nonresponse (failure to decrease left ventricular end systolic volume ≥15%) (p=0.005). A wall motion score index >2 predicted a significantly higher rate of cardiac resynchronization therapy nonresponse compared to a score ≤2 (82% vs 47%, P=0.005).
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