Circulation. 2008;117:2608-2616
Published online before print May 5, 2008, doi: 10.1161/CIRCULATIONAHA.107.743120
Published online before print May 5, 2008, doi: 10.1161/CIRCULATIONAHA.107.743120
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(Circulation. 2008;117:2608-2616.)
© 2008 American Heart Association, Inc.
Heart Failure |
Results of the Predictors of Response to CRT (PROSPECT) Trial
From the Lindner Clinical Trial Center, The Ohio Heart and Vascular Center, and The Christ Hospital, Cincinnati, Ohio (E.S.C.); Emory University–Crawford Long Hospital, Atlanta, Ga (A.R.L., J.-P.S., J.M.); Ospedale Policlinico San Matteo, Pavia, Italy (L.T., S.G.); Imperial College London and Hammersmith Hospital, London, UK (P.N.); Ohio State University Heart Center, Columbus (W.T.A.); University Hospital, Rennes, France (C.L.); Leiden University Medical Center, Leiden, the Netherlands (J.J.B.); Prince of Wales Hospital, Hong Kong, China (C.-M.Y.); University of Pittsburgh, Pittsburgh, Pa (J.G.); University of Pennsylvania Medical Center, Philadelphia (M.S.J.S.); University Hospital Gent, Gent, Belgium (J.D.S.); and Sentara Norfolk General Hospital, Norfolk, Va (J.M.).
Correspondence to Eugene Chung, The Christ Hospital, Ohio Heart and Vascular Center, and the Lindner Clinical Trial Center, Cincinnati, OH 45219. E-mail chunge{at}ohioheart.org
Received October 24, 2007; accepted February 27, 2008.
Background— Data from single-center studies suggest that echocardiographic parameters of mechanical dyssynchrony may improve patient selection for cardiac resynchronization therapy (CRT). In a prospective, multicenter setting, the Predictors of Response to CRT (PROSPECT) study tested the performance of these parameters to predict CRT response.
Methods and Results— Fifty-three centers in Europe, Hong Kong, and the United States enrolled 498 patients with standard CRT indications (New York Heart Association class III or IV heart failure, left ventricular ejection fraction 
35%, QRS 
130 ms, stable medical regimen). Twelve echocardiographic parameters of dyssynchrony, based on both conventional and tissue Doppler–based methods, were evaluated after site training in acquisition methods and blinded core laboratory analysis. Indicators of positive CRT response were improved clinical composite score and 15% reduction in left ventricular end-systolic volume at 6 months. Clinical composite score was improved in 69% of 426 patients, whereas left ventricular end-systolic volume decreased 15% in 56% of 286 patients with paired data. The ability of the 12 echocardiographic parameters to predict clinical composite score response varied widely, with sensitivity ranging from 6% to 74% and specificity ranging from 35% to 91%; for predicting left ventricular end-systolic volume response, sensitivity ranged from 9% to 77% and specificity from 31% to 93%. For all the parameters, the area under the receiver-operating characteristics curve for positive clinical or volume response to CRT was 0.62. There was large variability in the analysis of the dyssynchrony parameters.
Conclusion— Given the modest sensitivity and specificity in this multicenter setting despite training and central analysis, no single echocardiographic measure of dyssynchrony may be recommended to improve patient selection for CRT beyond current guidelines. Efforts aimed at reducing variability arising from technical and interpretative factors may improve the predictive power of these echocardiographic parameters in a broad clinical setting.
CLINICAL PERSPECTIVE
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Clinical Summaries
Circulation 2008 117: 2567-2569.[Extract] [Full Text]
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W.H. W. Tang and G. S. Francis The Year in Heart Failure J. Am. Coll. Cardiol., November 11, 2008; 52(20): 1671 - 1678. [Full Text] [PDF]
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