Abstract 13601: Basal Left Ventricular Diastolic Functions Predicts Super-response To Cardiac Resynchronization Therapy
Introduction: Cardiac resynchronization therapy (CRT) improves left ventricular systolic function in heart failure. However, improvements in left ventricular ejection fraction and reductions in left ventricular volume are generally modest. A minority of patients experience a super-response to CRT, but the clinical and echocardiographic predictors associated with these patients have not been fully characterized.
Hypothesis: Some baseline clinical attributes might predict super-response to CRT.
Methods: A total of 103 consecutive patients (60.6 ± 10.7 years; 79 men; left ventricular ejection fraction 24.5 ± 4.2%) with heart failure and New York Heart Association Class III-IV symptoms of whom left ventricular ejection fraction was ≤35% and QRS duration was ≥120 ms, despite optimal medical therapy, were enrolled. All patients underwent a standard transthoracic two dimensional and Doppler echocardiographic study and tissue Doppler imaging before and 6 months after CRT. Left ventricular reverse remodelling was quantified according to percentage of decline in left ventricular end systolic volume (LVESV). A multivariate model was constructed to determine factors predictive of super-response.
Results: Based on different degrees of left ventricular reverse remodelling, 17.5% of patients were classified as super-responders (decrease in LVESV ≥30%), 41.7% as responders (decrease in LVESV 15% to 29%), 34.0% as nonresponders (decrease in LVESV 0% to 14%), and 6.8% negative responders (increase in LVESV). Baseline septal E/e' (13.02 ± 4.09 vs 21.23 ± 3.50, p=0.001) and average E/e' (10.85 ± 1.56 vs 20.31 ± 2.61, p=0.001) were lower in super-responders. In univariate logistic regression analysis, super-responders were more likely to be female; have a non-ischemic etiology, wider baseline QRS and lower baseline septal and average E/e'. In multivariate analysis; female gender, non-ischemic etiology, baseline QRS width and average E/e' ratio remained significantly associated with super-response.
Conclusions: In conclusion, female gender, non-ischemic etiology, baseline QRS width and average E/e' ratio were independent predictors of super-response.
- © 2010 by American Heart Association, Inc.