Should We Be Trying to Define Responders to Cardiac Resynchronization Therapy?

Cleland, John G.F.; Tageldien, Ahmed; Buga, Laszlo; Wong, Kenneth; Gorcsan, John

doi:10.1016/j.jcmg.2010.04.003

Cited by 21 publications

(17 citation statements)

References 53 publications

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“…[1][2][3]21 Although the concept of nonresponder is controversial, not all patients show symptomatic or functional improvement. 22 Because of the potential for placebo effect, response has typically been defined by echocardiographic measurements, 23 the most commonly used parameter being LV reverse remodeling (≥15% reduction in LV end-systolic volume index). [8][9][10] This finding (which occurred in 48% of patients in our study) has been associated with lower rates of clinical events and mortality.…”

Section: Definition Of Crt Responsementioning

confidence: 99%

Echocardiographic Predictors of Reverse Remodeling After Cardiac Resynchronization Therapy and Subsequent Events

Park

Negishi

Grimm

et al. 2013

Circ: Cardiovascular Imaging

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Background-Studies of echocardiographic predictors of response after cardiac resynchronization therapy (CRT) have largely involved single parameters. We hypothesized that combining parameters would be more robust and sought to develop a multiparametric echocardiographic score for predicting CRT response. Methods and Results-Global longitudinal strain of left ventricle was added to standard echocardiographic measurements in 334 consecutive patients (224 men; mean, 65±12 years) who underwent baseline echocardiography before CRT and underwent follow-up echocardiograms at 1 year. Regression analysis was performed to create an echocardiographic score for prediction of LV reverse remodeling (defined as ≥15% reduction in the LV end-systolic volume). Cox proportional hazards models were used to identify the association of the score with death, transplantation or LV assist device implantation, and heart failure hospitalization during 57±22 months of follow-up. LV reverse remodeling (n=161; 48%) was associated with pre-CRT LV end-diastolic dimension index <3.1 cm/m 2 , global longitudinal strain of left ventricle <-7%, left atrial area <26 cm 2 , right ventricular end-diastolic area index <10.0 cm 2 /m 2 , right atrial area <20 cm 2 , and right ventricular fractional area change ≥35%. Combination of these into an echocardiographic score allowed prediction of LV reverse remodeling with a sensitivity of 84% and a specificity of 79%. During follow-up, there were 134 deaths, 18 heart transplantations/LV assist device implantations, and 93 heart failure admissions. The score was associated with heart failure admission, heart transplantation/LV assist device, or death (hazard ratio, 0.97; 95% confidence interval, 0.95-0.98; P<0.001) and all-cause death (hazard ratio, 0.97; 95% confidence interval, 0.96-0.98; P<0.001), independent of age, sex, ischemic cause, and initial functional class. Conclusions-A multiparametric echocardiographic score is helpful in selecting patients likely to undergo reverse remodeling after CRT and predicts clinical outcomes. (Circ Cardiovasc Imaging. 2013;6:864-872.)

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Section: Definition Of Crt Responsementioning

confidence: 99%

Echocardiographic Predictors of Reverse Remodeling After Cardiac Resynchronization Therapy and Subsequent Events

Park

Negishi

Grimm

et al. 2013

Circ: Cardiovascular Imaging

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“…Importantly, patients with more severe dyssynchrony did not have a worse outcome, even if they only received an ICD. That may be because the dyssynchronous ventricle looks worse than it actually is (7,8). That may be because the dyssynchronous ventricle looks worse than it actually is (7,8).…”

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Why Does CRT Reduce the Risk of Arrhythmias?

Cleland¹,

Pellicori²,

Dicken³

2013

JACC: Cardiovascular Imaging

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“…It is not clear how CRT works;10 11 probably by different mechanisms for different patients at different times. Imaging, before or after CRT, has met with little success in predicting its long-term clinical effects.…”

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confidence: 99%

“…On average, the outcome of patients with DCM will be better than that of patients with LV systolic dysfunction due to IHD and this will be true whether or not the patients get CRT. But outcome with and response to a therapy are not the same 10 11. The reduction in morbidity and mortality conferred by CRT (response) is similar regardless of aetiology 8.…”

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confidence: 99%