Multimarker approach for assessing efficiency of cardiac resynchronization therapy in patients with sinus rhythm

Abstract

Purpose: to design mathematical model, that can predict positive response to cardiac resynchronization therapy (CRT) in patients with congestive heart failure (CHF) and sinus rhythm, according to complex analysis of neurohumoral and immune activation biomarkers, fibrosis, renal dysfunction, echocardiography.Material and methods: parameters of echocardiography, plasma levels of NT-proBNP, interleukins-1β, 6, 10, tumor necrosis factor α, С-reactive protein (СRP), matrix metalloproteinase-9 (ММР-9), tissue inhibitors of metalloproteinase 1 and 4, cystatin С (CYSTATIN) were studied in 40 CHF patients with sinus rhythm (65% coronary artery disease patients, 75% males, mean age 54.8±10.6 years old) during the period of maximum decrease of left ventricular end-systolic volume (LVESV) (mean duration 27.5 [11.1; 46.3] months). Responders (decrease in LVESV ≥15%) and non-responders (decrease in LVESV ˂15%) were identified.Results: the number of responders was 26 (65%). Initial set of variables included: age, left ventricular ejection fraction (EF), systolic pressure in the pulmonary artery, right ventricle size and NT-proBNP, СRP, ММР-9, CYSTATIN. According to logistic regression analysis, a model was created: F=3.231 + 0.344 х EF - 3.479 x CYSTATIN - 0.039 х ММР-9 - 0.638 х CRР. Prediction of response to CRT (P) was carried out using the equation: Р=1/(1+е(-F)); a less than 0.696 p-value was associated with membership of non-responders group; p-value greater than or equaled to 0.696 was associated with group of responders. The specificity of the model was 92.9%, sensitivity - 83.3%, AUC=0.952 (р˂0.001).Conclusions: the proposed model, based on assessment of left ventricular EF and laboratory data, that reflect key mechanisms of development and progression of CHF - immune inflammation, fibrosis, renal dysfunction, suggests a possible response to CRT.

Structural and functional characteristics of the heart before and after CRT in patients with heart failure

“…Different studies consider the heterogeneity of patients by cause of CHF, the presence of myocardial scar, suboptimal (notoptimal) position of the ventricular electrode and low degree of biventricular stimulation as a reason behind the poor response to CRT. There is also no unanimity in the timing of assessment of the response to CRT, although in most published studies, 6 or 12 months were chosen as an intermediate period for determining the reliability of CRT [17][18][19][20][21][22]. The results of our study show that even with a slight LVEF or a decrease in ESV (<15% compared with baseline), the clinical condition of most patients improves, therefore, in our opinion, they should not be classified as "nonresponders".…”