This Article Full Text Full Text (PDF) CME: Take the course for this article: Circulation: May 20, 2008, Volume 117, Number 20 Data Supplement All Versions of this Article: 117/20/2608    most recent CIRCULATIONAHA.107.743120v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Google Scholar Articles by Chung, E. S. Articles by Murillo, J. PubMed PubMed Citation Articles by Chung, E. S. Articles by Murillo, J. Related Collections Congestive Pacemaker Echocardiography Related Article

(Circulation. 2008;117:2608-2616.)
© 2008 American Heart Association, Inc.

Heart Failure

Results of the Predictors of Response to CRT (PROSPECT) Trial

Eugene S. Chung, MD; Angel R. Leon, MD; Luigi Tavazzi, MD; Jing-Ping Sun, MD; Petros Nihoyannopoulos, MD; John Merlino, MD; William T. Abraham, MD; Stefano Ghio, MD; Christophe Leclercq, MD; Jeroen J. Bax, MD; Cheuk-Man Yu, MD, FRCP; John Gorcsan, III, MD; Martin St John Sutton, FRCP; Johan De Sutter, MD, PhD; Jaime Murillo, MD

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.

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CLINICAL PERSPECTIVE

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