Predictors of a positive response to biventricular pacing in patients with severe heart failure and ventricular conduction delay.
BACKGROUND
Cardiac resynchronization therapy (CRT) is recommended in patients with ejection fraction <35%, QRS width> 120 ms, and New York Heart Association (NYHA) functional class III or IV despite optimal medical therapy. We aimed to define demographic, clinical, and electrocardiographic predictors of positive clinical response to CRT.


RESULTS
Hundred consecutive patients fulfilling the recommended criteria were implanted with a CRT device. Demographic, clinical, two-dimensional echocardiographic and electrographic parameters were measured at baseline and after 6 months of simultaneous biventricular pacing. A positive response to CRT included an improvement of at least one NYHA functional class associated with an absence of hospitalization for worsening heart failure. At the end of follow-up, 12 patients were dead and 71% of the patients were classified as responders. After 6 months of CRT, the ejection fraction was significantly higher (P = 0.035) in responders versus nonresponders. Multivariate analysis identified three independent predictors of positive response to CRT: an idiopathic origin of the cardiomyopathy (P = 0.043), a wider QRS before implantation (P = 0.017), and a narrowing of the QRS after implantation (P = 0.037).


CONCLUSIONS
An idiopathic origin of the cardiomyopathy, a wider QRS before implantation, and a narrowing of the QRS width after implantation were identified as independent predictors of clinical positive response to CRT.
Yeim
Sunthareth
S
Hospital Haut Leveque, Service Pr Clementy, Pessac, France.
Bordachar
Pierre
P
Reuter
Sylvain
S
Laborderie
Julien
J
O'Neill
Mark D
MD
Lafitte
Stephane
S
Deplagne
Antoine
A
Garrigue
Stephane
S
Roudaut
Raymond
R
Jais
Pierre
P
Haissaguerre
Michel
M
Dossantos
Pierre
P
Clementy
Jacques
J
D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016896:Treatment Outcome; D018754:Ventricular Dysfunction / Q000150:complications / Q000503:physiopathology* / Q000628:therapy*