Key result
LVESV reduction >13.5% at six months post-CRT predicts one-year clinical composite improvement.
Why the study?
It was unclear which echocardiographic criteria across three time points after CRT implantation accurately discriminate the hierarchical clinical composite end point.
Does the change in left ventricular end-systolic volume at 6 months predict the 1-year hierarchical clinical composite end point in patients with heart failure undergoing CRT?
Cohort (n=120)
No
Does the change in left ventricular end-systolic volume at 6 months predict the 1-year hierarchical clinical composite end point in patients with heart failure undergoing CRT?
A decrease in left ventricular end-systolic volume at 6 months is a useful echocardiographic criterion for predicting 1-year clinical outcomes in patients receiving cardiac resynchronization therapy.
Answers are grounded in this paper and cite their sources.
ΔLVESV reduction at 6 months best discriminates 1-year HCCEP among echo criteria; leaves open whether it should guide clinical CRT response assessment.
Purpose: This study aimed to elucidate which echocardiographic criteria at three time points, for cardiac resynchronization therapy (CRT) response, are accurate in discriminating the hierarchical clinical composite end point (HCCEP). Materials and Methods:We included 120 patients (age, 66.1±12.6 years; men, 54.2%) who underwent CRT implantation for heart failure (HF).Echocardiography was performed before and at 3, 6, and 12 months after CRT implantation.The 1-year HCCEP included all-cause mortality, hospitalization for HF, and New York Heart Association functional class for 12 months.CRT response criteria were decrease in left ventricular (LV) end-systolic volume (LVESV) >15%, decrease in LV end-diastolic volume >15%, absolute increase in LV ejection fraction (LVEF) ≥5%, relative increase in LVEF ≥15%, and decrease in mitral regurgitation ≥1 grade.Temporal changes in CRT response rates, accuracy of CRT response criteria at each time and cutoff value for the discrimination of improvement in HCCEP, and agreements with improvement in HCCEP were analyzed.Results: HCCEP improvement rates were 65.8% in total group.In nonischemic group, CRT response rates according to all echocardiographic criteria significantly increased with time.In ischemic group, CRT response rate did not significantly change with time.In total group, ΔLVESV at 6 months (ΔLVESV6) had the most significant accuracy for the discrimination of HCCEP (area under the curve=0.781).The optimal cutoff value of ΔLVESV6 was 13.5% (sensitivity=0.719,specificity=0.719).ΔLVESV6 had fair agreement with HCCEP (κ=0.391,p<0.001).Conclusion: ΔLVESV6 is the most useful echocardiographic CRT response criterion for the prediction of 1-year HCCEP.
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Uhm et al. (2018) conducted a cohort in Heart failure (n=120). Decrease in left ventricular end-systolic volume (ΔLVESV) at 6 months vs. Other echocardiographic criteria was evaluated on Discrimination of improvement in 1-year hierarchical clinical composite end point (HCCEP) (AUC 0.781, 95% CI 0.653-0.909). A decrease in left ventricular end-systolic volume greater than 13.5% at 6 months after cardiac resynchronization therapy accurately predicted improvement in the 1-year hierarchical clinical composite end point.
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