Presence of left ventricular contractile reserve predicts midterm response to cardiac resynchronization therapy--results from the LOw dose DObutamine stress-echo test in Cardiac Resynchronization Therapy (LODO-CRT) trial.
BACKGROUND
Cardiac resynchronization therapy (CRT) is effective in selected patients with heart failure (HF). Nevertheless, the nonresponder rate remains high. The low-dose dobutamine stress-echo (DSE) test detects the presence of left ventricular (LV) contractile reserve (LVCR) in HF patients of any etiology and may be useful in predicting response to resynchronization.


OBJECTIVE
The purpose of this study was to present the results of the LODO-CRT trial, which evaluated whether LVCR presence at baseline increases the chances of response to CRT.


METHODS
LODO-CRT is a multicenter prospective study that enrolled CRT candidates according to guidelines. LVCR presence was defined as an LV ejection fraction increase >5 units during DSE test. CRT response is assessed at 6-month follow-up as an LV end-systolic volume reduction ≥10%.


RESULTS
Two hundred seventy-one patients were enrolled. The DSE test was feasible without complications in 99% of patients. Nine patients died from noncardiac disease, and 31 presented inadequate data. Two hundred thirty-one patients were included in the analysis. Mean patient age was 67 ± 10 years; 95% were in New York Heart Association class III, and 42% had HF of ischemic etiology. Mean QRS and LV ejection fraction were 147 ± 25 ms and 27% ± 6%, respectively. LVCR presence was found in 185 subjects (80%). At follow-up, 170 (74%) patients responded to CRT, 145/185 in the group with LVCR (78%) and 25/46 (54%) in the group without LVCR. Difference in responder proportion to CRT was 24% (P <.001). Reported test sensitivity is 85%.


CONCLUSIONS
The DSE test in CRT candidates is safe and feasible. LVCR presence at baseline increases the chances of response to CRT.
Muto
Carmine
C
Ospedale Santa Maria di Loreto Mare, Napoli, Italia. carminemuto@libero.it
Gasparini
Maurizio
M
Neja
Carlo Peraldo
CP
Iacopino
Saverio
S
Davinelli
Mario
M
Zanon
Francesco
F
Dicandia
Cosimo
C
Distefano
Giuseppe
G
Donati
Roberto
R
Calvi
Valeria
V
Denaro
Alessandra
A
Tuccillo
Bernardino
B
D000368:Aged; D058406:Cardiac Resynchronization Therapy; D025401:Echocardiography, Stress; D005240:Feasibility Studies; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D012680:Sensitivity and Specificity