Left Ventricular End-Systolic Volume Can Predict 1-Year Hierarchical Clinical Composite End Point in Patients with Cardiac Resynchronization Therapy.
- Author:
Jae Sun UHM
1
;
Jaewon OH
;
In Jeong CHO
;
Minsu PARK
;
In Soo KIM
;
Moo Nyun JIN
;
Han Joon BAE
;
Hee Tae YU
;
Tae Hoon KIM
;
Hui Nam PAK
;
Moon Hyoung LEE
;
Boyoung JOUNG
;
Seok Min KANG
Author Information
- Publication Type:Original Article
- Keywords: Cardiac resynchronization therapy; echocardiography; heart failure
- MeSH: Cardiac Resynchronization Therapy*; Discrimination (Psychology); Echocardiography; Heart; Heart Failure; Hospitalization; Humans; Male; Mitral Valve Insufficiency; Mortality; Stroke Volume*
- From:Yonsei Medical Journal 2019;60(1):48-55
- CountryRepublic of Korea
- Language:English
- Abstract: PURPOSE: This study aimed to elucidate which echocardiographic criteria at three time points, for cardiac resynchronization therapy (CRT) response, are accurate in discriminating the hierarchical clinical composite end point (HCCEP). MATERIALS AND METHODS: We included 120 patients (age, 66.1±12.6 years; men, 54.2%) who underwent CRT implantation for heart failure (HF). Echocardiography was performed before and at 3, 6, and 12 months after CRT implantation. The 1-year HCCEP included all-cause mortality, hospitalization for HF, and New York Heart Association functional class for 12 months. CRT response criteria were decrease in left ventricular (LV) end-systolic volume (LVESV) >15%, decrease in LV end-diastolic volume >15%, absolute increase in LV ejection fraction (LVEF) ≥5%, relative increase in LVEF ≥15%, and decrease in mitral regurgitation ≥1 grade. Temporal changes in CRT response rates, accuracy of CRT response criteria at each time and cutoff value for the discrimination of improvement in HCCEP, and agreements with improvement in HCCEP were analyzed. RESULTS: HCCEP improvement rates were 65.8% in total group. In nonischemic group, CRT response rates according to all echocardiographic criteria significantly increased with time. In ischemic group, CRT response rate did not significantly change with time. In total group, ΔLVESV at 6 months (ΔLVESV6) had the most significant accuracy for the discrimination of HCCEP (area under the curve=0.781). The optimal cutoff value of ΔLVESV6 was 13.5% (sensitivity=0.719, specificity=0.719). ΔLVESV6 had fair agreement with HCCEP (κ=0.391, p < 0.001). CONCLUSION: ΔLVESV6 is the most useful echocardiographic CRT response criterion for the prediction of 1-year HCCEP.
