Abstract 17246: Echocardiographic Predictors of Response to Cardiac Resynchronization Therapy and Subsequent Events

Abstract

Background: We hypothesized that scoring with echocardiographic parameters can be used to predict good response after cardiac resynchronization therapy (CRT).

Methods: We enrolled total 334 consecutive pts (224 men, mean 65±12 y) with interpretable echo who underwent CRT from Feb 2005 to Aug 2007 and had follow-up echocardiography. Global longitudinal strain (LVGLS) was measured using the average of 3 apical images and time delay of septum to lateral LV wall was calculated with velocity vector imaging. Regression analysis was performed to evaluate factors associated with reverse remodeling (defined as >15% reduction in the LV end-systolic volume within 1 year after CRT) and to create a response score.

Results: During the follow-up period (57±22months), 134 deaths, 18 heart transplantations/VAD implantations and 93 hospital admissions occurred, and 161 pts (48%) showed reverse LV remodeling. Three independent echocardiographic factors were identified LV end-diastolic dimension index <3.1cm/m², LVGLS <-7% and right ventricular fractional area change >35%. Combination into a score showed a score >3 (range, 0-4) predicted LV reverse remodeling with a sensitivity of 85% and specificity 76%. Cox proportional hazard regression analysis showed a 27% (P<0.01) decrease per 1-point increment in the risk of first admission of heart failure, heart transplantation or death

Conclusion: A multiparametric echocardiographic score is helpful in selecting pts likely to reverse remodel with CRT, and predicts clinical outcomes.