Characteristics of heart failure patients associated with good and poor response to cardiac resynchronization therapy: a PROSPECT (Predictors of Response to CRT) sub-analysis

Bommel, Rutger J. van; Bax, Jeroen J.; Abraham, William T.; Chung, Eugene S.; Pires, Luís A.; Tavazzi, Luigi; Zimetbaum, Peter; Gerritse, Bart; Kristiansen, Nina Sahlertz; Ghio, Stefano

doi:10.1093/eurheartj/ehp368

Cited by 192 publications

(181 citation statements)

References 34 publications

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“…This therapy has been demonstrated less efficacious in very advanced stages of heart failure. 22 Concordantly, our data show that in patients with high TAPSE values, CRT is more effective and produces beneficial effects in both the left and the right ventricles.…”

Section: Discussionsupporting

confidence: 76%

Tricuspid Annular Plane Systolic Excursion Evaluation Improves Selection of Cardiac Resynchronization Therapy Patients

Cappelli

Porciani

Ricceri

et al. 2010

Clinical Cardiology

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Background: The beneficial effects of cardiac resynchronization therapy (CRT) on left ventricular (LV) remodeling have been extensively described. Few data are available about the effects of CRT on right ventricular (RV) function and remodeling. Hypothesis: We hypothesized that CRT could also induce reverse remodeling in the right ventricle and that RV baseline functional status expressed as tricuspidal annular plane systolic excursion (TAPSE) could affect CRT response. Methods: Echocardiographic investigation was performed before and 6 months after CRT. In 192 patients, TAPSE, LV, and RV dimensions with functional parameters and LV dyssynchrony index were evaluated. Results: At 6 months' follow-up, 86 patients (45%) were responders to CRT according to at least 15% LV endsystolic volume reduction. Among baseline echocardiographic parameters, responders had significantly lower TAPSE, larger LV volumes, and higher LV dyssynchrony index. In responders, LV volume reduction, ejection fraction increase, and mitral regurgitation improvement were associated with RV dimensions reduction, increased TAPSE, and improved LV dyssynchrony. Receiver operating characteristic curve analysis showed that TAPSE, at 17 mm optimal cutoff, yielded 64% sensitivity and 60% specificity in predicting CRT response; similarly, LV dyssynchrony index, at 41.25 ms optimal cutoff, predicted CRT response with 60% sensitivity and 62% specificity. A subgroup analysis demonstrated that the coexistence of high TAPSE and high dyssynchrony index values increased probability of CRT response. Conclusions: Our results show that CRT induces RV and LV reverse remodeling and that CRT patient selection can be improved by simply measuring TAPSE value. IntroductionCongestive heart failure (CHF) is a major disorder associated with poor quality of life and high mortality. 1 At present, cardiac resynchronization therapy (CRT) is a new, well-established therapeutic strategy for patients with drugrefractory symptoms, advanced left ventricular (LV) systolic dysfunction, and wide QRS. 2 -7 However, because it was primarily developed to improve function and synchronism of the LV, the effects of CRT on right ventricular (RV) function have not been fully examined.The importance of the right ventricle has often been underestimated; it was long considered mainly as a conduit and the importance of its contractile performance was undervalued. Nowadays, few data are available about the effects of CRT on RV function and remodeling. 8 -10 Moreover, data about the relationship between baseline RV functional status and long-term LV reverse remodeling

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Section: Discussionsupporting

confidence: 76%

Tricuspid Annular Plane Systolic Excursion Evaluation Improves Selection of Cardiac Resynchronization Therapy Patients

Cappelli

Porciani

Ricceri

et al. 2010

Clinical Cardiology

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“…Although the PROSPECT trial showed modest sensitivity and specificity of echocardiographic parameters of dyssynchrony, 23 subanalysis including 286 patients from the original PROSPECT cohort that focused on three simple preprocedural measures of dyssynchrony reported a strong association of their parameters with more extensive reverse remodeling at 6-month follow-up. 24 LBBB is clearly more evident in early LVRR patients. 25,26 In our study, Groups B and C had a higher incidence of ischemic etiology.…”

Section: Discussionmentioning

confidence: 89%

Time to left ventricular reverse remodeling after cardiac resynchronization therapy: Better late than never

Monteiro

Oliveira

Cunha

et al. 2016

Revista Portuguesa de Cardiologia

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Introduction: Left ventricular reverse remodeling (LVRR), defined as reduction of end-diastolic and end-systolic dimensions and improvement of ejection fraction, is associated with the prognostic implications of cardiac resynchronization therapy (CRT). The time course of LVRR remains poorly characterized. Nevertheless, it has been suggested that it occurs ≤6 months after CRT. Objective: To characterize the long-term echocardiographic and clinical evolution of patients with LVRR occurring >6 months after CRT and to identify predictors of a delayed LVRR response. Methods: A total of 127 consecutive patients after successful CRT implantation were divided into three groups according to LVRR response: Group A, 19 patients (15%) with LVRR after >6 months (late LVRR); Group B, 58 patients (46%) with LVRR before 6 months (early LVRR); and Group C, 50 patients (39%) without LVRR during follow-up (no LVRR). Results: The late LVRR group was older, more often had ischemic etiology and fewer patients were in NYHA class ≤II. Overall, group A presented LVRR between group B and C. This was also the case with the percentage of clinical response (68.4% vs. 94.8% vs. 38.3%, respectively, p<0.001), and hospital readmissions due to decompensated heart failure (31.6% vs. 12.1% vs. 57.1%, respectively, p<0.001). Ischemic etiology (OR 0.044; p=0.013) and NYHA functional class 6 meses após TRC, e identificar preditores de uma resposta de RIVE tardia. Métodos: Cento e vinte e sete P consecutivos, após implantação bem-sucedida de TRC, foram divididos em três grupos, de acordo com a resposta de RIVE: grupo A, 19P (15%) com RIVE após seis meses (RIVE tardia); grupo B, 58P (46%) com RIVE antes dos seis meses (RIVE precoce) e grupo C, 50P (39%) sem RIVE durante o follow-up (sem RIVE). Resultados: O grupo da RIVE tardia era mais velho, tinha mais etiologia isquémica e menos P em classe NYHA≥III. Globalmente, o grupo A apresentou um gr...

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“…Although multiple factors including NYHA class at baseline and etiology of heart failure are associated with LV reverse remodeling after CRT, as is also shown in a sub-analysis of the PROSPECT study, at the least, the presence of mechanical dyssynchrony between the septum and free wall at baseline should be a key indicator of LV reverse remodeling after CRT. 15 In contrast, the presence of LBBB was the strongest predictor of CRT benefit. The finding suggests that the presence of LBBB can predict the presence of mechanical dyssynchrony between the septum and free wall more accurately than present echocardiographic parameters.…”

Section: Intraventricular Dyssynchrony and Cardiac Remodeling After Crtmentioning

confidence: 93%

The Role of Echocardiography in Predicting Responders to Cardiac Resynchronization Therapy - Results From the Japan Cardiac Resynchronization Therapy Registry Trial (J-CRT) -

Seo

Ito

Nakatani

et al. 2011

Circ J

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MD; the J-CRT investigatorsBackground: This multicenter prospective cohort study aimed to identify both ability of echocardiographic parameters to detect cardiac resynchronization therapy (CRT) volume responders and relation of these parameters with clinical outcomes. Methods and Results:CRT responder was defined as ≥15% reduction of left ventricular (LV) end-systolic volume at 6 months. Seven echocardiographic dyssynchrony parameters were evaluated. The clinical endpoint comprised time to death from any cause or unplanned hospitalization for a major cardiovascular event. Of the 217 patients enrolled, 63 percent were classified as volume responders, in whom significantly fewer events occurred than in non-responders (log rank, P<0.001). No single echocardiographic criterion had significant power to detect volume responders, but a combining measurement of dyssynchrony between septum and LV free wall with M-mode and tissue Doppler imaging was independently associated with volume responders. In addition, this combined parameter was associated with the endpoint (hazard ratio, 0.66, 95% confidence interval 0.30-0.98, P=0.04). In contrast, left bundle branch block was identified as an independent predictor of volume responders and more strongly associated with the endpoint (hazard ratio, 0.38, 95% confidence interval 0.20-0.72, P=0.003). Conclusions:Echocardiographic parameters did not show significant power to detect CRT responders independently. (Circ J 2011; 75: 1156 - 1163

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Characteristics of heart failure patients associated with good and poor response to cardiac resynchronization therapy: a PROSPECT (Predictors of Response to CRT) sub-analysis

Cited by 192 publications

References 34 publications

Tricuspid Annular Plane Systolic Excursion Evaluation Improves Selection of Cardiac Resynchronization Therapy Patients

Tricuspid Annular Plane Systolic Excursion Evaluation Improves Selection of Cardiac Resynchronization Therapy Patients

Time to left ventricular reverse remodeling after cardiac resynchronization therapy: Better late than never

The Role of Echocardiography in Predicting Responders to Cardiac Resynchronization Therapy - Results From the Japan Cardiac Resynchronization Therapy Registry Trial (J-CRT) -

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