Predictors of positive response to cardiac resynchronization therapy.
BACKGROUND
Approximately 30% of patients treated with cardiac resynchronization therapy (CRT) do not achieve favourable response. The purpose of the present study was to identify echocardiographic and clinical predictors of a positive response to CRT.


METHODS
The study included 82 consecutive heart failure (HF) patients in New York Heart Association (NYHA) functional class III or IV with left bundle branch block (LBBB), QRS duration ≥ 120 ms and left ventricular ejection fraction (LVEF) ≤ 35%. Statistical analysis was performed using IBM SPSS statistical software (SPSS v.21.0 for Mac OS X). A p value < 0.05 was considered statistically significant.


RESULTS
Echocardiographic response was established in 81.6% and clinical response was achieved in 82.9% of patients. Significant univariate predictors of favourable echocardiographic response after 12 months were smaller left ventricular end-diastolic diameter (LVEDD) (odds ratio [OR] 0.89; 95% confidence interval [CI] 0.82 - 0.97, p = 0.01), and smaller left ventricular end-systolic diameter (LVESD) (OR 0.91; 95% CI 0.85 - 0.98, p = 0.01). Lower uric acid concentration was associated with better echocardiographic response (OR 0.99; 95% CI 0.99 - 1.0, p = 0.01). Non-ischemic HF etiology (OR 4.89; 95% CI 1.39 - 17.15, p = 0.01) independently predicted positive clinical response. Multiple stepwise regression analysis demonstrated that LVEDD lower than 75 mm (OR 5.60; 95% confidence interval [CI] 1.36 - 18.61, p = 0.01) was the strongest independent predictor of favourable echocardiographic response.


CONCLUSIONS
Smaller left ventricular end-diastolic and end-systolic diameters and lower serum uric acid concentration were associated with better response to CRT. Left ventricular end-diastolic diameter and non-ischemic heart failure etiology were the strongest independent predictors of positive response to CRT.
Lithuanian University of Health Sciences, Kaunas, Lithuania. diana.rinkuniene@gmail.com.
Diana
D
Rinkuniene
Silvija
S
Bucyte
Kristina
K
Ceseviciute
Silvijus
S
Abramavicius
Kristina
K
Baronaite-Dudoniene
Jolanta
J
Laukaitiene
Tomas
T
Kazakevicius
Vytautas
V
Zabiela
Vytautas
V
Sileikis
Aras
A
Puodziukynas
Renaldas
R
Jurkevicius
D000368:Aged; D015415:Biomarkers / Q000097:blood; D058406:Cardiac Resynchronization Therapy; D016009:Chi-Square Distribution; D015150:Echocardiography, Doppler; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology; D006333:Heart Failure / Q000097:blood / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D018579:Patient Selection; D011237:Predictive Value of Tests; D012307:Risk Factors; D013318:Stroke Volume; D016896:Treatment Outcome; D014527:Uric Acid / Q000097:blood; D016277:Ventricular Function, Left
D015415:Biomarkers; D014527:Uric Acid