February 27, 2017EP Europace108 citationsOpen Access
View Full PaperRefining success of cardiac resynchronization therapy using a simple score predicting the amount of reverse ventricular remodelling: results from the Markers and Response to CRT (MARC) study
Key Result
The CAVIAR response score, combining age, QRSAREA, interventricular mechanical delay, and apical rocking, predicts the amount of reverse ventricular remodelling after cardiac resynchronization therapy.
Study Design
Type
Cohort (n=240)
Structured PICO
Does the CAVIAR score predict the amount of reverse ventricular remodelling after CRT in patients with systolic heart failure?
P
Population
240 patients with systolic heart failure and ventricular conduction delay undergoing cardiac resynchronization therapy, followed for 6 months.
E
Exposure
Cardiac resynchronization therapy (CRT) and application of the CAVIAR response score (age, QRSAREA, interventricular mechanical delay, apical rocking)
O
Outcome
Reduction of indexed left ventricular end-systolic volume (LVESVi) at 6 months follow-upsurrogate
The CAVIAR score, combining clinical, electrocardiographic, and echocardiographic markers, can predict reverse ventricular remodelling and clinical outcomes to improve patient selection for CRT.
Abstract
Aims: Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in systolic heart failure patients with ventricular conduction delay. Variability of individual response to CRT warrants improved patient selection. The Markers and Response to CRT (MARC) study was designed to investigate markers related to response to CRT. Methods and results: We prospectively studied the ability of 11 clinical, 11 electrocardiographic, 4 echocardiographic, and 16 blood biomarkers to predict CRT response in 240 patients. Response was measured by the reduction of indexed left ventricular end-systolic volume (LVESVi) at 6 months follow-up. Biomarkers were related to LVESVi change using log-linear regression on continuous scale. Covariates that were significant univariately were included in a multivariable model. The final model was utilized to compose a response score. Age was 67 ± 10 years, 63% were male, 46% had ischaemic aetiology, LV ejection fraction was 26 ± 8%, LVESVi was 75 ± 31 mL/m2, and QRS was 178 ± 23 ms. At 6 months LVESVi was reduced to 58 ± 31 mL/m2 (relative reduction of 22 ± 24%), 130 patients (61%) showed ≥ 15% LVESVi reduction. In univariate analysis 17 parameters were significantly associated with LVESVi change. In the final model age, QRSAREA (using vectorcardiography) and two echocardiographic markers (interventricular mechanical delay and apical rocking) remained significantly associated with the amount of reverse ventricular remodelling. This CAVIAR (CRT-Age-Vectorcardiographic QRSAREA -Interventricular Mechanical delay-Apical Rocking) response score also predicted clinical outcome assessed by heart failure hospitalizations and all-cause mortality. Conclusions: The CAVIAR response score predicts the amount of reverse remodelling after CRT and may be used to improve patient selection. Clinical Trials: NCT01519908.