title: Predicting Clinical and Echocardiographic Response After Cardiac Resynchronization Therapy With a Score Combining Clinical, Electrocardiographic, and Echocardiographic Parameters.
abstract: The L2ANDS2score was previously found to be able to assess the probability of left ventricular (LV) remodeling. We sought to evaluate this score in terms of clinical outcomes: 275 patients with heart failure, from 2 centers, implanted with a cardiac resynchronization therapy (CRT) device were followed at least 2 years after implantation. Baseline clinical, electrocardiographic, and echocardiographic characteristics including left bundle branch block, age >70 years, nonischemic etiology, LV end-diastolic diameter <40 mm/m2, and septal flash by echocardiography were integrated in 4 scoring systems. Nonresponse to CRT was LV reverse remodeling <15% at 6 months' follow-up and/or occurrence of major cardiovascular event (cardiovascular death or transplantation or assistance) during a clinical follow-up of at least 2 years. Ninety-seven patients (36%) demonstrated nonresponse to CRT. The L2ANDS2score demonstrated the best predictive value (C statistic of 0.783) for predicting absence of LV reverse remodeling and/or occurrence of major cardiovascular event during the 2 years follow-up compared with other scoring systems that do not include septal flash. A L2ANDS2score ≤4 was associated with a worse outcome (38% survival vs 81% survival, hazard ratio 4.19, 95% CI 2.70 to 6.48, p <0.0001). In conclusion, the L2ANDS2score is able to assess the probability of nonresponse to CRT in terms of no reverse LV remodeling and/or major cardiovascular event at long-term follow-up. Integrating septal flash in a scoring system adds value over left bundle branch block only.
authors.affiliation: Clinical Investigation Centre, Institut national de la santé et de la recherche médicale U1414, Centre Hospitalier Universitaire Rennes, Université Rennes 1, Rennes, France; Institut national de la santé et de la recherche médicale, U1099, Rennes, France; Université Rennes 1, Laboratoire Traitement du Signal et de l'Image, Rennes, France; Université François Rabelais, Tours, France; Service de Cardiologie, Centre Hospitalier Universitaire, Tours, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Bernard
authors.affiliation: Université Lille Nord de France, GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Faculté Libre de Médecine, Université Catholique de Lille, Lille, France; Institut national de la santé et de la recherche médicale, U1088, Université de Picardie, Amiens, France.
authors.forename: Aymeric
authors.initials: A
authors.lastname: Menet
authors.affiliation: Université Lille Nord de France, GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Faculté Libre de Médecine, Université Catholique de Lille, Lille, France; Institut national de la santé et de la recherche médicale, U1088, Université de Picardie, Amiens, France.
authors.forename: Sylvestre
authors.initials: S
authors.lastname: Marechaux
authors.affiliation: Clinical Investigation Centre, Institut national de la santé et de la recherche médicale U1414, Centre Hospitalier Universitaire Rennes, Université Rennes 1, Rennes, France; Université Rennes 1, Laboratoire Traitement du Signal et de l'Image, Rennes, France; Service de Cardiologie, Centre Hospitalier Universitaire, Rennes, France.
authors.forename: Maxime
authors.initials: M
authors.lastname: Fournet
authors.affiliation: Clinical Investigation Centre, Institut national de la santé et de la recherche médicale U1414, Centre Hospitalier Universitaire Rennes, Université Rennes 1, Rennes, France; Institut national de la santé et de la recherche médicale, U1099, Rennes, France; Université Rennes 1, Laboratoire Traitement du Signal et de l'Image, Rennes, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Schnell
authors.affiliation: Université Lille Nord de France, GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Faculté Libre de Médecine, Université Catholique de Lille, Lille, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Guyomar
authors.affiliation: Clinical Investigation Centre, Institut national de la santé et de la recherche médicale U1414, Centre Hospitalier Universitaire Rennes, Université Rennes 1, Rennes, France; Université Rennes 1, Laboratoire Traitement du Signal et de l'Image, Rennes, France; Service de Cardiologie, Centre Hospitalier Universitaire, Rennes, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Leclercq
authors.affiliation: Clinical Investigation Centre, Institut national de la santé et de la recherche médicale U1414, Centre Hospitalier Universitaire Rennes, Université Rennes 1, Rennes, France; Université Rennes 1, Laboratoire Traitement du Signal et de l'Image, Rennes, France; Service de Cardiologie, Centre Hospitalier Universitaire, Rennes, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Mabo
authors.affiliation: Université François Rabelais, Tours, France; Service de Cardiologie, Centre Hospitalier Universitaire, Tours, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Fauchier
authors.affiliation: Clinical Investigation Centre, Institut national de la santé et de la recherche médicale U1414, Centre Hospitalier Universitaire Rennes, Université Rennes 1, Rennes, France; Université Rennes 1, Laboratoire Traitement du Signal et de l'Image, Rennes, France; Service de Cardiologie, Centre Hospitalier Universitaire, Rennes, France. Electronic address: erwan.donal@chu-rennes.fr.
authors.forename: Erwan
authors.initials: E
authors.lastname: Donal
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D017147:Defibrillators, Implantable; D004452:Echocardiography / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*; D020257:Ventricular Remodeling / Q000502:physiology*