The importance of myocardial contractile reserve in predicting response to cardiac resynchronization therapy

Abstract

The presence of global contractile reserve at baseline, as assessed by dobutamine stress echocardiography, is associated with a higher chance of CRT response in patients with heart failure.

July 2017 at a glance: clinical assessment, biomarkers, cardiac imaging and treatment

“…Kloosterman et al . performed a meta‐analysis and systematic review of all the studies evaluating the relation between contractile reserve, defined as a LVEF increase during dobutamine infusion, and the response to cardiac resynchronization therapy (CRT) . The analysis included 757 patients, 66% with contractile reserve during dobutamine infusion and 63% with response to CRT.…”

“…The analysis included 757 patients, 66% with contractile reserve during dobutamine infusion and 63% with response to CRT. Contractile reserve was predictive of CRT response with an odds ratio of 4.42 ( P <0.001) …”

Finding the road to recovery: therapeutic and clinical trial implications of dysfunctional viable myocardium in heart failure with reduced ejection fraction

“…In this issue, Kloosterman et al . present pooled data from such studies and provide added reassurance regarding the utility of CR in predicting response to CRT, irrespective of ischaemic or non‐ischaemic status . While the authors correctly acknowledge that, given the lack of large definitive trials, patients should not be denied CRT based solely on absence of CR, this meta‐analysis does support CR as an additional data point worth considering in the setting of an unclear risk–benefit ratio for an individual patient.…”

“…Likewise, lack of this myocardial reserve may fail to justify procedural risks and thus favour a non‐invasive medical or palliative approach. In this issue, we find two articles that expand existing perspective on the prognostic and therapeutic implications of myocardial viability and CR in HFrEF . Herein, we explore the role of dysfunctional viable (DV) myocardium in HFrEF with respect to prognostication, prediction of treatment response, and enrichment of clinical trial selection criteria.…”

April 2018 at a glance: focus on prognostic variables

“…Many variables may influence the effects of cardiac resynchronization therapy (CRT) on outcomes . Greater benefits were shown in women.…”