Key result
In patients with class I indications for CRT, the presence of fragmented QRS (OR 2.86) or LVEDD ≥ 77 mm (OR 3.02) independently predicted non-response, with a 46.2% non-response probability when both were present.
Why the study?
Although CRT is highly effective in patients with a class I recommendation, a proportion of strictly selected patients still fail to respond, prompting the need to identify predictors of non-response.
Do markedly dilated left ventricular end-diastolic dimension and fragmented QRS predict non-response to cardiac resynchronization therapy in patients with class I indications?
Cohort (n=296)
No
Do markedly dilated left ventricular end-diastolic dimension and fragmented QRS predict non-response to cardiac resynchronization therapy in patients with class I indications?
Odds Ratio: 2.86 (95% CI 1.14–7.12)
p-value: p=0.025
The presence of a markedly dilated left ventricular end-diastolic dimension and fragmented QRS strongly predicts non-response to CRT in patients who otherwise meet class I indications.
Markedly dilated LVEDD plus fQRS may flag high non-response risk in class I CRT candidates; hypothesis-generating and requires prospective validation before practice change.
BACKGROUND: Cardiac resynchronization therapy (CRT) is a highly effective treatment in patients with a class I recommendation. However, a small proportion of the strictly selected patients still fail to respond. This study was designed to identify predictors of non-response in patients with class I indications for CRT and determine the non-response probability of the patients. METHODS: A total of 296 consecutive patients with a class I recommendation received CRT from January 2009 to January 2017 were retrospectively analyzed. Multivariate logistic regression analysis was performed to identify predictors for non-response (defined as cardiac death, heart transplantation, or HF hospitalization during 1-year follow-up). RESULTS: = 0.022). Patients with both of the predictors had a non-response probability of 46.2% (95% CI: 19.1%-73.3%). CONCLUSION: In patients with left bundle branch block and wider QRS duration, the proportion of non-response to CRT is not low in real world. The presence of the dilated LVEDD or fragmented QRS is a strong predictor of non-response to CRT. The probability of non-response in the patients with the two predictors was 46.2%.
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Hu et al. (2019) conducted a cohort in Heart failure with class I indications for cardiac resynchronization therapy (n=296). Fragmented QRS vs. Absence of fragmented QRS was evaluated on Non-response to CRT (cardiac death, heart transplantation, or HF hospitalization) (OR 2.86, 95% CI 1.14-7.12, p=0.025). In patients with class I indications for CRT, the presence of fragmented QRS (OR 2.86) or LVEDD ≥ 77 mm (OR 3.02) independently predicted non-response, with a 46.2% non-response probability when both were present.
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