Journal ArticleDOI
Echocardiographic myocardial scar burden predicts response to cardiac resynchronization therapy in ischemic heart failure.
Donato Mele,Eustachio Agricola,Maurizio Galderisi,Fausto Rigo,Rodolfo Citro,Alessandro Dal Monte,Patrizia Della Valentina,Alice Calabrese,Roberto Ferrari +8 more
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TLDR
Echocardiographic evaluation of transmural scar burden predicts CRT response after 6 months of treatment and should be performed in all candidates for CRT with ischemic heart failure before biventricular pacemaker implantation.Abstract:
Background Because echocardiography is routinely applied for left ventricle (LV) evaluation before cardiac resynchronization therapy (CRT), it is important to know whether echocardiographic assessment of myocardial scar burden may also help to predict CRT response in patients with drug-refractory systolic heart failure of ischemic origin. Methods Seventy-one patients with ischemic heart failure who underwent CRT were retrospectively analyzed. The number of LV scar segments was evaluated in each patient, defining transmural scar as an end-diastolic wall thickness ≤ 5 mm associated with increased acoustic reflectance. CRT response was defined by LV end-systolic volume decrease by at least 10% after 6 months of treatment. The role of pacing site with respect to scar location was also assessed. Results Thirty-nine patients (55%) were responders and 32 patients (45%) were nonresponders to CRT. At baseline, responders had a lower number of scar segments (1.7 ± 1.6 vs 3.5 ± 2.5, P = .001). The number of scar segments was significantly associated with CRT response and correlated significantly with end-systolic volume variation ( r = 0.57, P = .0001). The presence of 3 or more scar segments allowed the identification of nonresponders with a sensitivity of 62% and specificity of 71%. In responders, the pacing stimulus was more frequently delivered remote from scar segments, whereas in nonresponders it was more often delivered over the scar segments. Conclusion Echocardiographic evaluation of transmural scar burden predicts CRT response after 6 months of treatment and should be performed in all candidates for CRT with ischemic heart failure before biventricular pacemaker implantation.read more
Citations
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Journal ArticleDOI
Echocardiography-Guided Left Ventricular Lead Placement for Cardiac Resynchronization Therapy Results of the Speckle Tracking Assisted Resynchronization Therapy for Electrode Region Trial
Samir Saba,Josef Marek,David Schwartzman,Sandeep Jain,Evan Adelstein,Pamela White,Olusegun Oyenuga,Tetsuari Onishi,Prem Soman,John Gorcsan +9 more
TL;DR: A strategy of EG LV lead placement for cardiac resynchronization therapy improved patient outcomes by reducing the combined risk of death or HF hospitalizations and has implications for delivery of cardiac res synchronization therapy.
Journal ArticleDOI
Predictors of Response to Cardiac Resynchronization Therapy in the Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy (MADIT-CRT)
Ilan Goldenberg,Arthur J. Moss,W. Jackson Hall,Elyse Foster,Jeffrey J. Goldberger,Peter Santucci,Timothy Shinn,Scott D. Solomon,Jonathan S. Steinberg,David J. Wilber,Alon Barsheshet,Scott McNitt,Wojciech Zareba,Helmut U. Klein +13 more
TL;DR: Combined assessment of factors associated with reverse remodeling can be used for improved selection of patients for cardiac resynchronization therapy.
Journal ArticleDOI
Predictors of super-response to cardiac resynchronization therapy and associated improvement in clinical outcome: the MADIT-CRT (multicenter automatic defibrillator implantation trial with cardiac resynchronization therapy) study.
Jonathan C. Hsu,Scott D. Solomon,Mikhail Bourgoun,Scott McNitt,Ilan Goldenberg,Helmut U. Klein,Arthur J. Moss,Elyse Foster +7 more
TL;DR: Six baseline factors predicted LVEF super-response in CRT-D-treated patients with mild HF and hyporesponse was associated with increased risk of HF or all-cause death, compared with super- response.
Journal ArticleDOI
Cardiac resynchronization therapy: state-of-the-art of current applications, guidelines, ongoing trials, and areas of controversy.
TL;DR: The main findings were that REVERSE showed significant reverse remodeling, MADIT-CRT showed less hospitalization, and RAFT also showed significant reduction in mortality in the CRT arm.
Journal ArticleDOI
Role of myocardial constructive work in the identification of responders to CRT.
Elena Galli,Elena Galli,Christophe Leclercq,Christophe Leclercq,Arnaud Hubert,Arnaud Hubert,Anne Bernard,Otto A. Smiseth,Philippe Mabo,Philippe Mabo,Eigil Samset,Alfredo Hernandez,Erwan Donal,Erwan Donal +13 more
TL;DR: Evaluated the role myocardial work estimated by pressure-strain loops (PSLs) in the comprehension of physiological mechanisms associated with CRT and in the prediction of CRT response found patients with higher CWtot exhibit a favourable response to CRT.
References
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Journal ArticleDOI
Results of the Predictors of Response to CRT (PROSPECT) Trial
Eugene S. Chung,Angel R. Leon,Luigi Tavazzi,Jing Ping Sun,Petros Nihoyannopoulos,John D. Merlino,William T. Abraham,William T. Abraham,Stefano Ghio,Christophe Leclercq,Jeroen J. Bax,Cheuk-Man Yu,John Gorcsan,Martin St. John Sutton,Johan De Sutter,Jaime Murillo +15 more
TL;DR: No single echocardiographic measure of dyssynchrony may be recommended to improve patient selection for CRT beyond current guidelines, given the modest sensitivity and specificity of these parameters in this multicenter setting.
Journal ArticleDOI
Left ventricular dyssynchrony predicts response and prognosis after cardiac resynchronization therapy
Jeroen J. Bax,Gabe B. Bleeker,Thomas H. Marwick,Sander G. Molhoek,Eric Boersma,Paul Steendijk,Ernst E. van der Wall,Martin J. Schalij +7 more
TL;DR: Patients with LV dyssynchrony >/=65 ms respond to CRT and have an excellent prognosis after CRT, and Receiver-operator characteristic curve analysis demonstrated that an optimal cutoff value of 65 ms for LV dySSynchrony yielded a sensitivity and specificity of 80% to predict clinical improvement and of 92% to Predict LV reverse remodeling.
Journal ArticleDOI
Effect of posterolateral scar tissue on clinical and echocardiographic improvement after cardiac resynchronization therapy.
Gabe B. Bleeker,Theodorus A.M. Kaandorp,Hildo J. Lamb,Eric Boersma,Paul Steendijk,Albert de Roos,Ernst E. van der Wall,Martin J. Schalij,Jeroen J. Bax +8 more
TL;DR: CRT does not reduce LV dyssynchrony in patients with transmural scar tissue in the posterolateral LV segments, resulting in clinical and echocardiographic nonresponse to CRT.
Journal ArticleDOI
Left Ventricular Reverse Remodeling but Not Clinical Improvement Predicts Long-Term Survival After Cardiac Resynchronization Therapy
Cheuk-Man Yu,Gabe B. Bleeker,Jeffrey W.H. Fung,Martin J. Schalij,Qing Zhang,Ernst E. van der Wall,Yat Sun Chan,Shun Ling Kong,Jeroen J. Bax +8 more
TL;DR: It is suggested that assessing volumetric changes after an intervention in patients with heart failure provides information predictive of natural history outcomes, and a reduction in LVESV of 10% signifies clinically relevant reverse remodeling, which is a strong predictor of lower long-term mortality and heart failure events.
Journal ArticleDOI
Left ventricular dyssynchrony predicts benefit of cardiac resynchronization therapy in patients with end-stage heart failure before pacemaker implantation
Jeroen J. Bax,Thomas H. Marwick,Sander G. Molhoek,Gabe B. Bleeker,Lieselot van Erven,Eric Boersma,Paul Steendijk,Ernst E. van der Wall,Martin J. Schalij +8 more
TL;DR: It appears that 20% of patients do not respond to this expensive therapy despite the use of selection criteria, and the presence of left ventricular dyssynchrony is needed to result in improvement after cardiac resynchronization therapy.