Abstract 15578: Predictors of Mortality in Non-Responders to Cardiac Resynchronization Treatment Undergoing Echocardiography Guided Biventricular Pacemaker Optimization
Background: Cardiac resynchronization therapy (CRT) improves heart failure symptoms and reduces mortality. We assessed predictors of mortality/heart transplant and in NYHA class in non-responders to CRT undergoing echocardiography-guided pacemaker optimization (EGPO).
Methods: Baseline clinical, echocardiographic and pulsed wave (PW) Doppler variables pre and post EGPO were collected in 187 non-responder CRT patients (pts) (70± 14 yrs, NYHA 2.74±0.79). Follow-up data were obtained from medical records and death data from Social Security Death Index.
Results: Ninety-two (49%) pts reached the primary endpoint of death or heart transplant at a follow-up of 5.5 ± 2.1 yrs. Univariate Cox proportional regression analysis showed serum creatinine (HR 1.51, CI1.26-1.81), left ventricular (LV) ejection fraction (HR 0.96, CI 0.94-0.98), restrictive diastolic filling (HR 2.73, CI 1.66-4.48), pulmonary artery systolic pressure (HR 1.02, CI 1.00-1.03), PW Doppler LV ejection time (HR 0.99, CI 0.99-1.00) & change in LV diastolic filling time with EGPO (HR 0.99, CI 0.99-1.00) associated with primary end point. On multivariate analysis, serum creatinine, LV ejection fraction & restrictive diastolic filling were independent predictors with an incremental effect of LV diastolic dysfunction with systolic dysfunction (Figure 1). Adding echocardiographic variables to clinical variables improved the accuracy of predicting mortality/heart transplant (increase in x2 from 15.2 to 41.5 (p<0.001). Improvement in LV ejection time during EGPO was associated with an improvement in NYHA class at 1 month (OR 1.04, CI 1.01-1.07, P=0.021).
Conclusion: In non-responders to CRT referred for EGPO, renal function, LVEF and LV diastolic function predict mortality. Improvement in LV filling & ejection during EGPO is associated with improvement in survival and in symptoms respectively.
- © 2013 by American Heart Association, Inc.