Echocardiographic Predictors of Worse Outcome After Cardiac Resynchronization Therapy.
BACKGROUND
Cardiac resynchronization therapy (CRT) is the recommended treatment by leading global guidelines. However, 30%-40% of selected patients are non-responders.


OBJECTIVE
To develop an echocardiographic model to predict cardiac death or transplantation (Tx) 1 year after CRT.


METHODS
Observational, prospective study, with the inclusion of 116 patients, aged 64.89 ± 11.18 years, 69.8% male, 68,1% in NYHA FC III and 31,9% in FC IV, 71.55% with left bundle-branch block, and median ejection fraction (EF) of 29%. Evaluations were made in the pre‑implantation period and 6-12 months after that, and correlated with cardiac mortality/Tx at the end of follow-up. Cox and logistic regression analyses were performed with ROC and Kaplan-Meier curves. The model was internally validated by bootstrapping.


RESULTS
There were 29 (25%) deaths/Tx during follow-up of 34.09 ± 17.9 months. Cardiac mortality/Tx was 16.3%. In the multivariate Cox model, EF < 30%, grade III/IV diastolic dysfunction and grade III mitral regurgitation at 6‑12 months were independently related to increased cardiac mortality or Tx, with hazard ratios of 3.1, 4.63 and 7.11, respectively. The area under the ROC curve was 0.78.


CONCLUSIONS
EF lower than 30%, severe diastolic dysfunction and severe mitral regurgitation indicate poor prognosis 1 year after CRT. The combination of two of those variables indicate the need for other treatment options.
Universidade de São Paulo, São Paulo, SP, Brazil.
Eduardo Arrais
EA
Rocha
Universidade Federal do Ceará, Fortaleza, CE, Brazil.
Francisca Tatiana Moreira
FT
Pereira
Universidade Federal do Ceará, Fortaleza, CE, Brazil.
José Sebastião
JS
Abreu
Universidade Estadual do Ceará, Fortaleza, CE, Brazil.
José Wellington O
JW
Lima
Universidade Federal do Ceará, Fortaleza, CE, Brazil.
Marcelo de Paula M
Mde P
Monteiro
Universidade Federal do Ceará, Fortaleza, CE, Brazil.
Almino Cavalcante
AC
Rocha Neto
Universidade Federal do Ceará, Fortaleza, CE, Brazil.
Ana Rosa Pinto
AR
Quidute
Universidade de São Paulo, São Paulo, SP, Brazil.
Camilla Viana A
CV
Goés
Universidade Federal do Ceará, Fortaleza, CE, Brazil.
Carlos Roberto Martins
CR
Rodrigues Sobrinho
Universidade de São Paulo, São Paulo, SP, Brazil.
Maurício Ibrahim
MI
Scanavacca
D000368:Aged; D001938:Brazil / Q000453:epidemiology; D058406:Cardiac Resynchronization Therapy / Q000401:mortality*; D004452:Echocardiography; D004812:Epidemiologic Methods; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000628:therapy; D016027:Heart Transplantation / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012720:Severity of Illness Index; D013318:Stroke Volume; D013997:Time Factors; D017211:Treatment Failure; D018754:Ventricular Dysfunction / Q000000981:diagnostic imaging / Q000401:mortality