Low value of simple echocardiographic indices of ventricular dyssynchrony in predicting the response to cardiac resynchronization therapy.
OBJECTIVE
A recent study suggested that no single echocardiographic index of cardiac dyssynchrony can reliably identify candidates for cardiac resynchronization therapy (CRT). We examined the value of three simple echocardiographic indices for predicting the 6-month clinical and echocardiographic responses to CRT.


RESULTS
We analysed data from 75 CRT-D system recipients. Standard echocardiography was used to measure aortic pre-ejection delay (APED), interventricular mechanical delay (IVMD), and delayed activation of the left ventricular (LV) infero-lateral wall (OVERLAP). Clinical responders were defined as patients who had an improved status, based on rehospitalization for heart failure, NYHA class, and peak oxygen consumption. Echocardiographic responders had a > or =10% decrease in LV end-systolic volume. During the study, one patient died and five were lost to follow-up. Of the remaining 69 analysable patients, 50 (72.5%) were classed as clinical responders and 41 (59.4%) as echocardiographic responders to CRT. Before CRT implantation, APED, IVMD, and OVERLAP were similar in responders and non-responders. The value of these indices of dyssynchrony as single or combined predictors of the clinical or echocardiographic response to CRT was low, with sensitivities ranging between 4 and 63%, and specificities between 37 and 100%.


CONCLUSIONS
Simple echocardiographic indices of dyssynchrony were poor predictors of response to CRT.
Bordachar
Pierre
P
Hospital Haut Leveque, Pessac, France.
Lafitte
Stéphane
S
Réant
Patricia
P
Reuter
Sylvain
S
Clementy
Jacques
J
Mletzko
Ralph-Uwe
RU
Siegel
Robert M
RM
Goscinska-Bis
Kinga
K
Bowes
Robert
R
Morgan
John
J
Bénard
Sandrine
S
Leclercq
Christophe
C
D000368:Aged; D002304:Cardiac Pacing, Artificial; D004311:Double-Blind Method; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000628:therapy