Article

Absence of left ventricular apical rocking and atrial-ventricular dyssynchrony predicts non-response to cardiac resynchronization therapy.

Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
European heart journal cardiovascular Imaging 09/2011; 13(1):86-94. DOI: 10.1093/ejechocard/jer167
Source: PubMed

ABSTRACT Current imaging techniques attempt to identify responders to cardiac resynchronization therapy (CRT). However, because CRT response may depend upon several factors, it may be clinically more useful to identify patients for whom CRT would not be beneficial even under optimal conditions. We aimed to determine the negative predictive value of a composite echocardiographic index evaluating atrial-ventricular dyssynchrony (AV-DYS) and intraventricular dyssynchrony.
Subjects with standard indications for CRT underwent echo before and during the month following device implantation. AV-DYS was defined as a percentage of left ventricular (LV) filling time over the cardiac cycle. AV-DYS, which produces a characteristic rocking of the LV apex, was quantified as the percentage of the cardiac cycle over which tissue Doppler-derived displacement curves of the septal and lateral walls showed discordance. CRT responder status was determined based on the early haemodynamic response to CRT (intra-individual improvement >25% in the Doppler-derived LV dP/dt). Among 40 patients, optimal cut-points predicting CRT response were 31% for LV apical rocking and 39% for AV-DYS. The presence of either apical rocking >31% or AV-DYS ≤ 39% had a sensitivity of 95%, specificity of 80%, positive predictive value of 83%, and a negative predictive value of 94% for CRT response.
After pre-selection of candidates for CRT by QRS duration, application of a simple composite echocardiographic index may exclude patients who would be non-responders to CRT and thus improve the global rate of therapy success.

0 Bookmarks
 · 
99 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to evaluate whether a scoring system integrating clinical, electrocardiographic and echocardiographic measurements can predict left ventricular reverse remodeling after cardiac resynchronization therapy (CRT). The derivation cohort consisted of 162 heart failure patients implanted with a CRT device. Baseline clinical, electrocardiographic and echocardiographic characteristics were entered into a univariable and multivariable model to predict reverse remodeling as defined by a ≥15% reduction in left ventricular end-systolic volume at 6 months (60%). Combinations of predictors were then tested under different scoring systems. A new 7-point CRT response score termed L2ANDS2: Left bundle branch block (2 points), Age >70 years, Non-ischemic etiology, left ventricular end-diastolic Diameter <40 mm/m2, and Septal Flash (2 points) was calculated for these patients. This score was then validated against a validation cohort of 45 patients from another academic center. A highly significant incremental predictive value was noted when Septal Flash was added to an initial 4-factor model including left bundle branch block (difference between area-under-curve C statistics = 0.125; p<0.001). The predictive accuracy using the L2ANDS2 score was then 0.79 for the C statistic. Application of the new score to the validation cohort (71% of responders) gave a similar C statistic (0.75). A score >5 had a high positive likelihood ratio (+LR=5.64), whereas a score <2 had a high negative likelihood ratio (-LR=0.19). In conclusion, this L2ANDS2 score provides an easy-to-use tool for the clinician to assess the pre-test probability of a patient being a CRT responder.
    The American journal of cardiology 01/2014; · 3.58 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The new multi-modality cardiovascular imaging journal, European Heart Journal - Cardiovascular Imaging, was started in 2012. During its first year, the new Journal has published an impressive collection of cardiovascular studies utilizing all cardiovascular imaging modalities. We will summarize the most important studies from its first year in two articles. The present 'Part I' of the review will focus on studies in myocardial function, myocardial ischaemia, and emerging techniques in cardiovascular imaging.
    European heart journal cardiovascular Imaging. 06/2013; 14(6):509-14.