Refining success of cardiac resynchronization therapy using a simple score predicting the amount of reverse ventricular remodelling: results from the Markers and Response to CRT (MARC) study.
Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in systolic heart failure patients with ventricular conduction delay. Variability of individual response to CRT warrants improved patient selection. The Markers and Response to CRT (MARC) study was designed to investigate markers related to response to CRT.



We prospectively studied the ability of 11 clinical, 11 electrocardiographic, 4 echocardiographic, and 16 blood biomarkers to predict CRT response in 240 patients. Response was measured by the reduction of indexed left ventricular end-systolic volume (LVESVi) at 6 months follow-up. Biomarkers were related to LVESVi change using log-linear regression on continuous scale. Covariates that were significant univariately were included in a multivariable model. The final model was utilized to compose a response score. Age was 67 ± 10 years, 63% were male, 46% had ischaemic aetiology, LV ejection fraction was 26 ± 8%, LVESVi was 75 ± 31 mL/m2, and QRS was 178 ± 23 ms. At 6 months LVESVi was reduced to 58 ± 31 mL/m2 (relative reduction of 22 ± 24%), 130 patients (61%) showed ≥ 15% LVESVi reduction. In univariate analysis 17 parameters were significantly associated with LVESVi change. In the final model age, QRSAREA (using vectorcardiography) and two echocardiographic markers (interventricular mechanical delay and apical rocking) remained significantly associated with the amount of reverse ventricular remodelling. This CAVIAR (CRT-Age-Vectorcardiographic QRSAREA -Interventricular Mechanical delay-Apical Rocking) response score also predicted clinical outcome assessed by heart failure hospitalizations and all-cause mortality.



The CAVIAR response score predicts the amount of reverse remodelling after CRT and may be used to improve patient selection. Clinical Trials: NCT01519908.
Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700RB Groningen, The Netherlands.
Alexander H
AH
Maass
Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.
Kevin
K
Vernooy
Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Sofieke C
SC
Wijers
Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Jetske
J
van 't Sant
Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Maarten J
MJ
Cramer
Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Mathias
M
Meine
Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands.
Cornelis P
CP
Allaart
Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
Frederik J
FJ
De Lange
Department of Physiology, University of Maastricht, Maastricht, The Netherlands.
Frits W
FW
Prinzen
Medtronic Bakken Research Center, Maastricht, The Netherlands.
Bart
B
Gerritse
Center for Translational Molecular Medicine, Utrecht, The Netherlands.
Erna
E
Erdtsieck
Medtronic Bakken Research Center, Maastricht, The Netherlands.|Currently Employed by Medtronic Trading NL, Eindhoven, The Netherlands.
Coert O S
COS
Scheerder
Medtronic Inc, Minneapolis, MN, USA.
Michael R S
MRS
Hill
Thoraxcenter Twente, Medisch Spectrum Twente, Enschede, The Netherlands.
Marcoen
M
Scholten
Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700RB Groningen, The Netherlands.
Mariëlle
M
Kloosterman
Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Iris A H
IAH
Ter Horst
Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700RB Groningen, The Netherlands.
Adriaan A
AA
Voors
Department of Medical Physiology, University of Utrecht, Hanzeplein 1, 9700RB Groningen, Utrecht, The Netherlands.
Marc A
MA
Vos
Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700RB Groningen, The Netherlands.
Michiel
M
Rienstra
Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700RB Groningen, The Netherlands.
Isabelle C
IC
Van Gelder
D006801:Humans; D008297:Male; D008875:Middle Aged; D000368:Aged; D005260:Female; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome; D020257:Ventricular Remodeling / Q000502:physiology; D014672:Vectorcardiography; D006333:Heart Failure / Q000175:diagnosis / Q000628:therapy; D054143:Heart Failure, Systolic / Q000628:therapy; D015415:Biomarkers
D015415:Biomarkers
Biomarkers ; Cardiac resynchronization therapy ; Echocardiography; Electrocardiography ; Heart failure ; Vectorcardiography 