Echocardiographic Predictors of Long‐Term Survival in Patients Undergoing Cardiac Resynchronization Therapy: What Is the Optimal Metric?
Reverse Remodeling Survival CRT Background Multiple definitions of reverse ventricular remodeling (RVR) employing various changes in left ventricular end‐systolic (LVESV) or diastolic volumes (LVEDVs) or left ventricular ejection fraction (LVEF) have been used in determining cardiac resynchronizatio...
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Published in | Journal of cardiovascular electrophysiology Vol. 28; no. 4; pp. 410 - 415 |
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Main Authors | , , , , , , , |
Format | Journal Article |
Language | English |
Published |
United States
Wiley Subscription Services, Inc
01.04.2017
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Subjects | |
Online Access | Get full text |
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Summary: | Reverse Remodeling Survival CRT
Background
Multiple definitions of reverse ventricular remodeling (RVR) employing various changes in left ventricular end‐systolic (LVESV) or diastolic volumes (LVEDVs) or left ventricular ejection fraction (LVEF) have been used in determining cardiac resynchronization therapy (CRT) response, making comparability across studies difficult. We compared different metrics to each other, and in combination, in terms of association with long‐term outcomes.
Methods
We collected clinical and echocardiographic data on 436 patients undergoing CRT. LVEF was assessed via a combined volumetric and visual assessment. Volumes were manually traced. Using a nested multivariate model of a priori determined predictors of long‐term survival free of left ventricular assist device (LVAD) or heart transplant, multiple definitions of RVR were added to the model individually to determine which provided the best model fit.
Results
Over a mean follow‐up of 5.4 ± 2.3 years, there were 198 endpoints (10 LVADs, 15 heart transplants, and 173 deaths). When added to a nested model controlling for multiple potential confounders, all definitions of RVR were significantly associated with improved survival. Changes in LVEF and LVESV were superior to changes in LVEDV. A combination metric of an LVEF improvement ≥ 5% and LVESV reduction ≥ 10% was the best overall metric for model fit.
Conclusions
Changes in LVESV and LVEF are better predictors of long‐term outcome following CRT compared to changes in LVEDV. Adding an assessment of LVEF to reduction in LVESV ≥ 10% provided the best overall definition for RVR in predicting CRT outcomes. |
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Bibliography: | J. Rickard: Medtronic consulting (minor); Boston Scientific speaker's bureau. RA Grimm: consulting, Siemens Health Care. M. Niebauer: patent for “Frequency Analysis Tool for cardiac Resynchronization.” BL Wilkoff: consultant/advisory board member for St. Jude Medical, Medtronic, Spectranetics; Boston Scientific speaker's bureau. N. Varma: research grants from Medtronic, St. Jude Medical, Sorin; advisory board member for St. Jude Medical. Other authors: No disclosures. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 1045-3873 1540-8167 |
DOI: | 10.1111/jce.13175 |