Key result
Pre-CRT dyssynchrony measurements by tissue Doppler imaging and 3D echocardiography were unable to predict clinical or echocardiographic response to cardiac resynchronization therapy (AUC 0.4 to 0.6).
Why the study?
Does pre-CRT left ventricular dyssynchrony assessment by tissue Doppler imaging and 3D echocardiography predict long-term response to cardiac resynchronization therapy in patients with symptomatic heart failure?
Cohort (n=38)
Does pre-CRT left ventricular dyssynchrony assessment by tissue Doppler imaging and 3D echocardiography predict long-term response to cardiac resynchronization therapy in patients with symptomatic heart failure?
Effect estimate: AUC 0.4-0.6
Pre-implantation assessment of left ventricular dyssynchrony using TDI and 3D echocardiography does not reliably predict long-term clinical or echocardiographic response to CRT.
These metrics should not guide CRT selection; leaves open whether alternative imaging refines response prediction.
Background. Currently there are no reliable predictors of response to cardiac resynchronization therapy (CRT) before implantation. We compared pre-CRT left ventricular (LV) dyssynchrony by tissue Doppler imaging (TDI) and regional volumetric analysis by 3-dimensional transthoracic echocardiography (3DTTE) in predicting response to CRT. Methods. Thirty-eight patients (79% nonischemic cardiomyopathy) with symptomatic heart failure who underwent CRT were enrolled. Clinical and echocardiographic responses were defined as improvement in one NYHA class and reduction in LV end-systolic volume by ≥15% respectively. Functional status was assessed by Minnesota Living with Heart Failure questionnaire and 6-minute walk distance. Results. In 33 patients, after CRT for 7.86 ± 2.27 months, there were 24 (73%) clinical and 19 (58%) echocardiographic responders. Functional parameters, LV dimensions, volumes and synchrony by TDI and 3DTTE improved significantly in responders. There was no difference in the number of responders and nonresponders when cut-off values for dyssynchrony by different measurements validated in other trials were applied. Area under receiver-operating-characteristic curve ranged from 0.4 to 0.6. Conclusion. CRT improves clinical and echocardiographic parameters in patients with systolic heart failure. The dyssynchrony measurements by TDI and 3DTTE are not comparable and are unable to predict response to CRT.
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Kuppahally et al. (2010) conducted a cohort in Symptomatic heart failure (n=38). Pre-CRT left ventricular dyssynchrony assessment by TDI and 3DTTE was evaluated on Clinical response (improvement in ≥1 NYHA class) and echocardiographic response (reduction in LV end-systolic volume by ≥15%) (AUC 0.4-0.6). Pre-CRT dyssynchrony measurements by tissue Doppler imaging and 3D echocardiography were unable to predict clinical or echocardiographic response to cardiac resynchronization therapy (AUC 0.4 to 0.6).
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