Key result
Higher baseline quality of life linked to ~9% lower odds of health status response after CRT.
Why the study?
There is uncertainty about the agreement between echocardiographic and patient-reported health status responses to CRT and the characteristics associated with discordant responses.
What is the degree of agreement between echocardiographic and patient-reported health status response to CRT at 6 months?
Observational (n=109)
No
What is the degree of agreement between echocardiographic and patient-reported health status response to CRT at 6 months?
There is a significant discrepancy between echocardiographic and patient-reported health status responses to CRT, suggesting that disease-specific health status measures provide additional value over objective measures alone.
Answers are grounded in this paper and cite their sources.
Discordance between echo and health status responses after CRT warrants caution in using either alone; leaves open optimal response definition for trials.
AIMS: The current study examined the degree of agreement between echocardiographic and patient-reported health status response to CRT 6 months after implantation, and evaluated the differences in pre-implantation characteristics of patients with concordant and discordant echocardiographic and health status responses. METHODS AND RESULTS: Consecutively implanted CRT-defibrillator patients (n = 109, mean age = 65.4 ± 10.1 years, 74 men) were recruited from the University Medical Center Utrecht, The Netherlands. Prior to implantation and 6 months post-implantation, all patients underwent echocardiography and completed the Kansas City Cardiomyopathy Questionnaire (KCCQ). Echocardiographic response was defined as a relative reduction of ≥15% in LV end-systolic volume; an improvement of ≥10 points in KCCQ score indicated a health status response. In the 54 patients with discordant responses, 25 (22.9%) had an echocardiographic response but no health status response and 29 (26.6%) had a health status response but no echocardiographic response. Patients with concordant and discordant responses differed on various pre-implantation characteristics, including sex, employment status, LV volumes, and pre-implantation KCCQ score. In multivariable analysis, pre-implantation KCCQ score [odds ratio (OR) = 0.91, 95% confidence interval (CI) = 0.88-0.95, P < 0.001] and QRS duration (OR = 1.03, 95% CI = 1.01-1.06, P = 0.009) were the only characteristics associated with health status response to CRT. CONCLUSIONS: Our results show a large discrepancy between echocardiographic and patient-reported health status response to CRT. The most important predictor of health status response was the pre-implantation health status score. These results emphasize that disease-specific health status measures may have additional value over 'objective' measures of CRT response and should be incorporated in clinical practice.
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Versteeg et al. (2013) conducted an observational in Heart failure requiring cardiac resynchronization therapy (n=109). Cardiac Resynchronization Therapy (CRT) was evaluated on Health status response to CRT (≥10 point improvement in KCCQ score) (OR 0.91, 95% CI 0.88-0.95, p=<0.001). Pre-implantation quality of life score was the strongest predictor of health status response 6 months after cardiac resynchronization therapy.
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