A Predictive Model for Super-Response to Cardiac Resynchronization Therapy: The QQ-LAE Score

Abstract

Objectives. It is important to identify super-responders who can derive most benefits from cardiac resynchronization therapy (CRT). We aimed to establish a scoring model that can be used for predicting super-response to CRT. Methods. We retrospectively reviewed 387 CRT patients. Multivariate logistic regression analysis was performed to identify predictors for super-response (defined as an absolute increase in left ventricular ejection fraction of ≥15% at 6-month follow-up) and to create a score model. Multivariate Cox proportional-hazard regression analysis was conducted to assess associations with the long-term endpoint (defined as cardiac death/heart transplant, heart failure (HF) hospitalization, or all-cause death) across the score categories at follow-up. Results. Among 387 patients, 109 (28.2%) met super-response. In multivariable analysis, 5 independent predictors (QQ-LAE) were identified: prior no fragmented QRS (odds ratio (OR) = 3.10 (1.39, 6.94)), QRS duration ≥170 ms (OR = 2.37 (1.35, 4.12)), left bundle branch block (OR = 2.57 (1.04, 6.37)), left atrial diameter <45 mm (OR = 3.27 (1.81, 5.89)), and left ventricular end-diastolic dimension <75 mm (OR = 4.11 (1.99, 8.48)). One point was attributed to each predictor, and three score categories were identified. The proportion of super-response after 6-month CRT implantation in patients with scores 0–3, 4, and 5 was 14.6%, 40.3%, and 64.1%, respectively (P<0.001). Patients with score 5 had an 88% reduction in the risk of cardiac death/heart transplant (P=0.042), a 71% reduction in the risk of HF hospitalization (P=0.048), and an 89% reduction in the risk of all-cause mortality (P=0.028) compared to patients with scores 0–3. Conclusions. The QQ-LAE score can be used for prediction of super-response to CRT and selection of most suitable patients in clinical practices.

Evaluation of the long-term effectiveness of cardiac resynchronization therapy

“…А вот пациенты с положительной динамикой делятся на 2 кластера, которые мы назвали "респондеры" и "супер-респондеры". Стратификация пациентов в кластер "супер-респондеры" согласуется с исследованиями, которые говорят о появлении супер-респондеров именно в отдаленные послеоперационные периоды [11][12][13], и по нашим данным это происходит через 2 года после СРТ. Критерии разделимости кластеров: "нереспондеры" так же, как и по данным первого года, те пациенты, у которых за 2 года изменение КСО и КДО ЛЖ не превышало 9%.…”

Risk scores in cardiac resynchronization therapy–A review of the literature

“…Strain analysis was included in many models later (11,(18)(19)(20). Similarly, to strain analysis, electrophysiologic modalities were also used in risk score development, such as sophisticated ECG analysis (21)(22)(23), vectorcardiography (24), or heart rate histogram analysis (25).…”