title: The left ventricular lead electrical delay predicts response to cardiac resynchronisation therapy.
abstract: Up to one-third of patients who undergo cardiac resynchronisation therapy (CRT) are not responders. To identify potential responders to CRT may be sometimes difficult and time-consuming. Forty-five patients who had undergone CRT implantation for standard indications were evaluated. Electrical left ventricular (LV) lead location was assessed by left ventricular activation time (LVAT), LV lead electrical delay (LVLED), and RV-LV interlead electrical delay (RVsense-LVsense). Anatomic LV pacing location was assessed as basal or mid-ventricular between 3:00 to 5:00 (traditionally optimal site), and all the other positions (traditionally non-optimal site). CRT response was defined as a decrease in LV end-systolic volume (LVESV) exceeding 15% at six months. LVLED was larger in the responder group than that in the non-responder group (67.3 ± 8.5% vs. 55.3 ± 8.1%, P< 0.001). In the multivariate analysis, LVLED and cLBBB morphology were the two independent predictors of positive echocardiographic response to CRT (OR=1.180, P=0.003; OR=7.497, P=0.04, respectively). A cutoff value of LVLED> 54.82% predicted responders with 96.3% sensitivity and 75.2% specificity and the area under the receiver operating characteristic (ROC) curve was 0.844 for LVLED (P=0.002). No relationship was found between the anatomic LV pacing sites and response to CRT (P=0.188). The larger left ventricular lead electrical delay may predict response to cardiac resynchronisation therapy.
authors.affiliation: Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210006, People's Republic of China. Electronic address: dxh_nari@sina.com.
authors.forename: Hang
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210006, People's Republic of China.
authors.forename: Zhenlin
authors.initials: Z
authors.lastname: Dai
authors.affiliation: Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210006, People's Republic of China.
authors.forename: Pinxi
authors.initials: P
authors.lastname: Xiao
authors.affiliation: Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210006, People's Republic of China.
authors.forename: Chang
authors.initials: C
authors.lastname: Pan
authors.affiliation: Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210006, People's Republic of China.
authors.forename: Juan
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210006, People's Republic of China. Electronic address: huzuoying@aliyun.com.
authors.forename: Zuoying
authors.initials: Z
authors.lastname: Hu
authors.affiliation: Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210006, People's Republic of China. Electronic address: chmengx@126.com.
authors.forename: Shaoliang
authors.initials: S
authors.lastname: Chen
mesh_terms: D000368:Aged; D019540:Area Under Curve; D002037:Bundle-Branch Block / Q000503:physiopathology; D058406:Cardiac Resynchronization Therapy; D058409:Cardiac Resynchronization Therapy Devices; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D013318:Stroke Volume; D013997:Time Factors
keywords: Cardiac resynchronisation therapy; Electrical dyssynchrony; Heart failure; Left ventricular pacing site; Response