title: Prediction of a good response to cardiac resynchronization therapy in patients with severe dilated cardyomyopathy: could conventional echocardiography be the answer after all?
abstract: OBJECTIVE
  The aim of this study was to assess the performance of echocardiographic parameters to predict response to cardiac resynchronization therapy (CRT).
  
  
  BACKGROUND
  CRT reduces morbidity and mortality due to the proper selection of candidates for CRT.
  
  
  METHODS
  The 12-month trial was performed on 70 optimally medicated patients with standard inclusion criteria: NYHA class III or IV heart failure, left ventricular ejection fraction (LVEF) ≤ 35%, and QRS ≥ 120 ms. All parameters were evaluated by conventional and tissue Doppler-based methods. Indicator of positive CRT response was more than 20% in improvement of LVEF.
  
  
  RESULTS
  LVEF increased >20% in 42 patients. Out of 43 tested baseline echocardiographic parameters, 12 showed statistical difference between responders and nonresponders. Out of these 12 parameters, six (LVSV, LVSI, LVFS, RVd, VPMR, and PISA) had modest to moderately good ability to predict LVEF response with sensitivity ranging from 62.2% to 82.4%, and specificity ranging from 56.5% to 81.2%. For those parameters, the area under the receiver-operating characteristic curve for positive response to CRT was ≤0.76. Multivariate regression analysis resulted in selection of LVSI and LVFS as possible predictive independent parameters for a good response. The cutoff value for LVSI was 38.7 mL/m(2) (P = 0.045) and for LVFS was 13% (P = 0.032).
  
  
  CONCLUSIONS
  Contribution of LVSI and LVFS is to be confirmed in larger trials. Simplicity of their assessment by conventional echocardiography could be an argument for adding them to the inclusion criteria for CRT in severe heart failure patients.
authors: Department for Echocardiography, Clinical Center of Serbia, Belgrade, Serbia. mpetrovic026@gmail.com
authors: Milan
authors: M
authors: Petrovic
authors: Marija T
authors: MT
authors: Petrovic
authors: Goran
authors: G
authors: Milasinovic
authors: Bosiljka
authors: B
authors: Vujisic-Tesic
authors: Danijela
authors: D
authors: Trifunovic
authors: Ivana
authors: I
authors: Nedeljkovic
authors: Zarko
authors: Z
authors: Calovic
authors: Branislava
authors: B
authors: Ivanovic
authors: Milorad
authors: M
authors: Tesic
authors: Marija
authors: M
authors: Boricic
authors: Olga
authors: O
authors: Petrovic
authors: Ivana M
authors: IM
authors: Petrovic
authors: Marko
authors: M
authors: Banovic
authors: Gordana
authors: G
authors: Draganic
authors: Miodrag
authors: M
authors: Ostojic
mesh_terms: D058406:Cardiac Resynchronization Therapy / Q000401:mortality*; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D004452:Echocardiography / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D055771:Serbia / Q000453:epidemiology; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome