Key result
The combination of baseline left ventricular end-diastolic diameter and QRS duration strongly predicted response to cardiac resynchronization therapy (AUC 0.836; 95% CI 0.76-0.91; P<0.001).
Why the study?
Approximately 20-40% of CRT recipients do not respond under current selection criteria, prompting evaluation of baseline parameters predicting response and long-term prognosis.
Cohort (n=101)
No
Effect estimate: AUC 0.836 (95% CI 0.76-0.91)
p-value: p=<0.001
The combination of baseline LVEDD ≤ 71 mm and QRS duration ≥ 170 ms strongly predicts favorable clinical response and prognosis in patients receiving cardiac resynchronization therapy.
May aid CRT selection via combined LVEDD-QRS; leaves open prospective randomized validation.
Background . Approximately 20–40% of recipients of cardiac resynchronization therapy (CRT) do not respond to it based on the current patient selection criteria. The purpose of this study was to identify baseline parameters that can predict CRT response and to evaluate the effect of those predictive parameters on long-term prognosis. Methods . This was a retrospective, nonrandomized, noncontrolled cohort study. Patients who received CRT in our centre were divided into responders and nonresponders by the definition of CRT response (an increase in left ventricular ejection fraction (LVEF) of ≥5% and improvement of ≥1 New York Heart Association (NYHA) class from baseline to the 6-month follow-up). Results . Of the 101 patients, 68 were responders and 33 were nonresponders. Left ventricular end-diastolic diameter (LVEDD; OR: 0.88, 95% CI: 0.81–0.95, P=0.001) and QRS duration (OR: 1.07, 95% CI: 1.04–1.10, P<0.001) were independent predictors of CRT response. The combination of LVEDD and QRS duration was more valuable for predicting CRT response (AUC 0.836; 95% CI: 0.76–0.91; P<0.001). Moreover, the combination of LVEDD ≤ 71 mm and QRS duration ≥ 170 ms had a low incidence of all-cause mortality, HF hospitalisation, and the composite endpoint. In addition, baseline LVEDD had a positive correlation with QRS duration (R=0.199, P=0.046). Responders to CRT had better LV reverse remodeling. Conclusion . The combination of LVEDD and QRS duration provided more robust prediction of CRT response. Moreover, the combination of LVEDD ≤ 71 mm and QRS duration ≥ 170 ms was associated with a low incidence of all-cause mortality, HF hospitalisation, and the composite endpoint. Our results may be useful to provide individualized patient selection for CRT.
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Guo et al. (2020) conducted a cohort in Heart failure requiring cardiac resynchronization therapy (n=101). Combination of left ventricular end-diastolic diameter (LVEDD) and QRS duration was evaluated on CRT response (increase in left ventricular ejection fraction of ≥5% and improvement of ≥1 NYHA class from baseline to 6-month follow-up) (AUC 0.836, 95% CI 0.76-0.91, p=<0.001). The combination of baseline left ventricular end-diastolic diameter and QRS duration strongly predicted response to cardiac resynchronization therapy (AUC 0.836; 95% CI 0.76-0.91; P<0.001).
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