Covid-19 Research

Research Article

OCLC Number/Unique Identifier:

Predictors of Acute Response to Cardiac Resynchronization Therapy in Cardiomyopathy Patients

Medicine Group    Start Submission

Amirhassan Shafaatpour, Hakimeh Sadeghian*, Ali Kazemisaied, Masoumeh Lotfi Tokaldany and Arash Jalali

Volume3-Issue9
Dates: Received: 2022-09-27 | Accepted: 2022-09-30 | Published: 2022-09-30
Pages: 1130-1138

Abstract

Background: Usefulness of echocardiogram-associated markers for prediction of the response of the patients with cardiomyopathy to Cardiac Resynchronization Therapy (CRT) is under debate.

Method: In a cross sectional retrospective design, we analyzed data from 69 cardiomyopathy patients (mean age = 57.59 ± 11.17 years, 69.6% male) with New-York-Heart-Association class ≥ III, left ventricular ejection fraction (LVEF) ≤ 35%, and QRS duration > 120 ms who underwent CRT. Transthoracic echocardiography and tissue Doppler imaging were performed before CRT and transthoracic echocardiography was repeated after CRT. More than 5% increase in the LVEF within 48 hours post CRT was considered as acute response.

Results: After CRT, 36 (52.2%) patients were acute responders. Before CRT, responders had a remarkably higher frequency of diabetes mellitus (36.1% vs.15.2%, p = 0.048), lower left ventricular end systolic volume (125.82 ± 179.73 vs. 179.73 ± 77.51 ml, p = 0.002) and end diastolic volume (165.03 ± 67.09 vs. 236.06 ± 93.24 ml, p < 0.001) compared to none responders. Other echocardiography characteristics were not significantly different. In multivariable analysis, left ventricular end systolic volume remained the sole independent predictor of acute response. A cut-off of 135 ml for left ventricular end systolic volume had a good sensitivity (67.65%) and specificity (72.73%) to distinguish responders from non-responders.

Conclusion: More than half of the cardiomyopathy patients had improvement ≥ 5% in LVEF within 48 hours after CRT. No relationship was found between formerly defined pre-CRT echocardiographic dyssynchrony markers and acute response. Left ventricular end systolic volume was the sole independent predictor of acute response and a threshold of 135 ml could discriminate acute responders to CRT.

FullText HTML FullText PDF DOI: 10.37871/jbres1567


Certificate of Publication




Copyright

© 2022 Shafaatpour A, et al.. Distributed under Creative Commons CC-BY 4.0

How to cite this article

Shafaatpour A, Sadeghian H, Kazemisaied A, Tokaldany ML, Jalali A. Predictors of Acute Response to Cardiac Resynchronization Therapy in Cardiomyopathy Patients. 2022 Sep 30; 3(9): 1130-1138. doi: 10.37871/jbres1567, Article ID: JBRES1567, Available at: https://www.jelsciences.com/articles/jbres1567.pdf


Subject area(s)

References


  1. Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L, Tavazzi L; Cardiac Resynchronization-Heart Failure (CARE-HF) Study Investigators. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med. 2005 Apr 14;352(15):1539-49. doi: 10.1056/NEJMoa050496. Epub 2005 Mar 7. PMID: 15753115.
  2. Leclercq C, Kass DA. Retiming the failing heart: principles and current clinical status of cardiac resynchronization. J Am Coll Cardiol. 2002 Jan 16;39(2):194-201. doi: 10.1016/s0735-1097(01)01747-8. PMID: 11788207.
  3. Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T, Carson P, DiCarlo L, DeMets D, White BG, DeVries DW, Feldman AM; Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) Investigators. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med. 2004 May 20;350(21):2140-50. doi: 10.1056/NEJMoa032423. PMID: 15152059.
  4. Gervais R, Leclercq C, Shankar A, Jacobs S, Eiskjaer H, Johannessen A, Freemantle N, Cleland JG, Tavazzi L, Daubert C; CARE-HF investigators. Surface electrocardiogram to predict outcome in candidates for cardiac resynchronization therapy: a sub-analysis of the CARE-HF trial. Eur J Heart Fail. 2009 Jul;11(7):699-705. doi: 10.1093/eurjhf/hfp074. Epub 2009 Jun 7. PMID: 19505883.
  5. Nelson GS, Curry CW, Wyman BT, Kramer A, Declerck J, Talbot M, Douglas MR, Berger RD, McVeigh ER, Kass DA. Predictors of systolic augmentation from left ventricular preexcitation in patients with dilated cardiomyopathy and intraventricular conduction delay. Circulation. 2000 Jun 13;101(23):2703-9. doi: 10.1161/01.cir.101.23.2703. PMID: 10851207.
  6. Pitzalis MV, Iacoviello M, Romito R, Massari F, Rizzon B, Luzzi G, Guida P, Andriani A, Mastropasqua F, Rizzon P. Cardiac resynchronization therapy tailored by echocardiographic evaluation of ventricular asynchrony. J Am Coll Cardiol. 2002 Nov 6;40(9):1615-22. doi: 10.1016/s0735-1097(02)02337-9. PMID: 12427414.
  7. Yu CM, Chau E, Sanderson JE, Fan K, Tang MO, Fung WH, Lin H, Kong SL, Lam YM, Hill MR, Lau CP. Tissue Doppler echocardiographic evidence of reverse remodeling and improved synchronicity by simultaneously delaying regional contraction after biventricular pacing therapy in heart failure. Circulation. 2002 Jan 29;105(4):438-45. doi: 10.1161/hc0402.102623. PMID: 11815425.
  8. Melek M, Esen O, Esen AM, Barutcu I, Onrat E, Kaya D. Tissue Doppler evaluation of intraventricular asynchrony in isolated left bundle branch block. Echocardiography. 2006 Feb;23(2):120-6. doi: 10.1111/j.1540-8175.2006.00180.x. PMID: 16445729.
  9. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MS, Stewart WJ; Chamber Quantification Writing Group; American Society of Echocardiography's Guidelines and Standards Committee; European Association of Echocardiography. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005 Dec;18(12):1440-63. doi: 10.1016/j.echo.2005.10.005. PMID: 16376782.
  10. Quiñones MA, Otto CM, Stoddard M, Waggoner A, Zoghbi WA; Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. Recommendations for quantification of Doppler echocardiography: a report from the Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. J Am Soc Echocardiogr. 2002 Feb;15(2):167-84. doi: 10.1067/mje.2002.120202. PMID: 11836492.
  11. Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA, Nihoyannopoulos P, Otto CM, Quinones MA, Rakowski H, Stewart WJ, Waggoner A, Weissman NJ; American Society of Echocardiography. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr. 2003 Jul;16(7):777-802. doi: 10.1016/S0894-7317(03)00335-3. PMID: 12835667.
  12. Niu H, Hua W, Zhang S, Sun X, Wang F, Chen K, Chen X. Prevalence of dyssynchrony derived from echocardiographic criteria in heart failure patients with normal or prolonged QRS duration. Echocardiography. 2007 Apr;24(4):348-52. doi: 10.1111/j.1540-8175.2007.00396.x. PMID: 17381642.
  13. Yu CM, Zhang Q, Fung JW, Chan HC, Chan YS, Yip GW, Kong SL, Lin H, Zhang Y, Sanderson JE. A novel tool to assess systolic asynchrony and identify responders of cardiac resynchronization therapy by tissue synchronization imaging. J Am Coll Cardiol. 2005 Mar 1;45(5):677-84. doi: 10.1016/j.jacc.2004.12.003. PMID: 15734610.
  14. Bax JJ, Marwick TH, Molhoek SG, Bleeker GB, van Erven L, Boersma E, Steendijk P, van der Wall EE, Schalij MJ. Left ventricular dyssynchrony predicts benefit of cardiac resynchronization therapy in patients with end-stage heart failure before pacemaker implantation. Am J Cardiol. 2003 Nov 15;92(10):1238-40. doi: 10.1016/j.amjcard.2003.06.016. PMID: 14609610.
  15. Gorcsan J 3rd, Kanzaki H, Bazaz R, Dohi K, Schwartzman D. Usefulness of echocardiographic tissue synchronization imaging to predict acute response to cardiac resynchronization therapy. Am J Cardiol. 2004 May 1;93(9):1178-81. doi: 10.1016/j.amjcard.2004.01.054. PMID: 15110219.
  16. Sadeghian H, Ahmadi F, Lotfi-Tokaldany M, Kazemisaeid A, Fathollahi MS, Goodarzynejad H. Ventricular asynchrony of time-to-peak systolic velocity in structurally normal heart by tissue Doppler imaging. Echocardiography. 2010 Aug;27(7):823-30. doi: 10.1111/j.1540-8175.2010.01156.x. PMID: 20545999.
  17. Bleeker GB, Bax JJ, Fung JW, van der Wall EE, Zhang Q, Schalij MJ, Chan JY, Yu CM. Clinical versus echocardiographic parameters to assess response to cardiac resynchronization therapy. Am J Cardiol. 2006 Jan 15;97(2):260-3. doi: 10.1016/j.amjcard.2005.08.030. Epub 2005 Nov 28. PMID: 16442375.
  18. Rickard J, Brennan DM, Martin DO, Hsich E, Tang WH, Lindsay BD, Starling RC, Wilkoff BL, Grimm RA. The impact of left ventricular size on response to cardiac resynchronization therapy. Am Heart J. 2011 Oct;162(4):646-53. doi: 10.1016/j.ahj.2011.07.008. Epub 2011 Sep 14. PMID: 21982656.
  19. Carluccio E, Biagioli P, Alunni G, Murrone A, Pantano P, Biscottini E, Zuchi C, Zingarini G, Cavallini C, Ambrosio G. Presence of extensive LV remodeling limits the benefits of CRT in patients with intraventricular dyssynchrony. JACC Cardiovasc Imaging. 2011 Oct;4(10):1067-76. doi: 10.1016/j.jcmg.2011.07.006. PMID: 21999865.
  20. Park MY, Altman RK, Orencole M, Kumar P, Parks KA, Heist KE, Singh JP, Picard MH. Characteristics of responders to cardiac resynchronization therapy: the impact of echocardiographic left ventricular volume. Clin Cardiol. 2012 Dec;35(12):777-80. doi: 10.1002/clc.22043. Epub 2012 Aug 9. PMID: 22886700; PMCID: PMC3498521.
  21. van Bommel RJ, Bax JJ, Abraham WT, Chung ES, Pires LA, Tavazzi L, Zimetbaum PJ, Gerritse B, Kristiansen N, Ghio S. Characteristics of heart failure patients associated with good and poor response to cardiac resynchronization therapy: a PROSPECT (Predictors of Response to CRT) sub-analysis. Eur Heart J. 2009 Oct;30(20):2470-7. doi: 10.1093/eurheartj/ehp368. Epub 2009 Aug 30. PMID: 19717847.
  22. Goldenberg I, Moss AJ, Hall WJ, Foster E, Goldberger JJ, Santucci P, Shinn T, Solomon S, Steinberg JS, Wilber D, Barsheshet A, McNitt S, Zareba W, Klein H; MADIT-CRT Executive Committee. Predictors of response to cardiac resynchronization therapy in the Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy (MADIT-CRT). Circulation. 2011 Oct 4;124(14):1527-36. doi: 10.1161/CIRCULATIONAHA.110.014324. Epub 2011 Sep 6. PMID: 21900084.
  23. Cazeau S, Leclercq C, Lavergne T, Walker S, Varma C, Linde C, Garrigue S, Kappenberger L, Haywood GA, Santini M, Bailleul C, Daubert JC; Multisite Stimulation in Cardiomyopathies (MUSTIC) Study Investigators. Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. N Engl J Med. 2001 Mar 22;344(12):873-80. doi: 10.1056/NEJM200103223441202. PMID: 11259720.
  24. Abraham WT, Fisher WG, Smith AL, Delurgio DB, Leon AR, Loh E, Kocovic DZ, Packer M, Clavell AL, Hayes DL, Ellestad M, Trupp RJ, Underwood J, Pickering F, Truex C, McAtee P, Messenger J; MIRACLE Study Group. Multicenter InSync Randomized Clinical Evaluation. Cardiac resynchronization in chronic heart failure. N Engl J Med. 2002 Jun 13;346(24):1845-53. doi: 10.1056/NEJMoa013168. PMID: 12063368.
  25. Alonso C, Leclercq C, Victor F, Mansour H, de Place C, Pavin D, Carré F, Mabo P, Daubert JC. Electrocardiographic predictive factors of long-term clinical improvement with multisite biventricular pacing in advanced heart failure. Am J Cardiol. 1999 Dec 15;84(12):1417-21. doi: 10.1016/s0002-9149(99)00588-3. PMID: 10606115.
  26. Yu CM, Lin H, Zhang Q, Sanderson JE. High prevalence of left ventricular systolic and diastolic asynchrony in patients with congestive heart failure and normal QRS duration. Heart. 2003 Jan;89(1):54-60. doi: 10.1136/heart.89.1.54. PMID: 12482792; PMCID: PMC1767510.
  27. Bleeker GB, Holman ER, Steendijk P, Boersma E, van der Wall EE, Schalij MJ, Bax JJ. Cardiac resynchronization therapy in patients with a narrow QRS complex. J Am Coll Cardiol. 2006 Dec 5;48(11):2243-50. doi: 10.1016/j.jacc.2006.07.067. Epub 2006 Nov 9. PMID: 17161254.
  28. Auricchio A, Stellbrink C, Butter C, Sack S, Vogt J, Misier AR, Böcker D, Block M, Kirkels JH, Kramer A, Huvelle E; Pacing Therapies in Congestive Heart Failure II Study Group; Guidant Heart Failure Research Group. Clinical efficacy of cardiac resynchronization therapy using left ventricular pacing in heart failure patients stratified by severity of ventricular conduction delay. J Am Coll Cardiol. 2003 Dec 17;42(12):2109-16. doi: 10.1016/j.jacc.2003.04.003. PMID: 14680736.
  29. Molhoek SG, Bax JJ, van Erven L, Bootsma M, Boersma E, Steendijk P, van der Wall EE, Schalij MJ. Comparison of benefits from cardiac resynchronization therapy in patients with ischemic cardiomyopathy versus idiopathic dilated cardiomyopathy. Am J Cardiol. 2004 Apr 1;93(7):860-3. doi: 10.1016/j.amjcard.2003.12.024. PMID: 15050489.
  30. McLeod CJ, Shen WK, Rea RF, Friedman PA, Hayes DL, Wokhlu A, Webster TL, Wiste HJ, Hodge DO, Bradley DJ, Hammill SC, Packer DL, Cha YM. Differential outcome of cardiac resynchronization therapy in ischemic cardiomyopathy and idiopathic dilated cardiomyopathy. Heart Rhythm. 2011 Mar;8(3):377-82. doi: 10.1016/j.hrthm.2010.11.013. Epub 2010 Nov 9. Erratum in: Heart Rhythm. 2011 Apr;8(4):640. PMID: 21070886.
  31. Marsan NA, Bleeker GB, van Bommel RJ, Ypenburg C, Delgado V, Borleffs CJ, Holman ER, van der Wall EE, Schalij MJ, Bax JJ. Comparison of time course of response to cardiac resynchronization therapy in patients with ischemic versus nonischemic cardiomyopathy. Am J Cardiol. 2009 Mar 1;103(5):690-4. doi: 10.1016/j.amjcard.2008.11.008. Epub 2008 Dec 26. PMID: 19231335.
  32. Saeid AK, Bozorgi A, Davoodi G, Sadeghian S, Yaminisharif A, Moezi A, Alenabi T, Khoshnevis M. Comparison of Benefits from Cardiac Resynchronization Therapy between Patients with Ischemic Cardiomyopathy and Patients with Idiopathic Dilated Cardiomyopathy. J Teh Univ Heart Ctr. 2009;4:115-118.
  33. Chung ES, Leon AR, Tavazzi L, Sun JP, Nihoyannopoulos P, Merlino J, Abraham WT, Ghio S, Leclercq C, Bax JJ, Yu CM, Gorcsan J 3rd, St John Sutton M, De Sutter J, Murillo J. Results of the Predictors of Response to CRT (PROSPECT) trial. Circulation. 2008 May 20;117(20):2608-16. doi: 10.1161/CIRCULATIONAHA.107.743120. Epub 2008 May 5. PMID: 18458170.
  34. Tedrow UB, Kramer DB, Stevenson LW, Stevenson WG, Baughman KL, Epstein LM, Lewis EF. Relation of right ventricular peak systolic pressure to major adverse events in patients undergoing cardiac resynchronization therapy. Am J Cardiol. 2006 Jun 15;97(12):1737-40. doi: 10.1016/j.amjcard.2006.01.033. Epub 2006 Apr 24. PMID: 16765124.
  35. Stern J, Heist EK, Murray L, Alabiad C, Chung J, Picard MH, Semigran MJ, Ruskin JN, Singh JP. Elevated estimated pulmonary artery systolic pressure is associated with an adverse clinical outcome in patients receiving cardiac resynchronization therapy. Pacing Clin Electrophysiol. 2007 May;30(5):603-7. doi: 10.1111/j.1540-8159.2007.00719.x. PMID: 17461868.
  36. Field ME, Solomon SD, Lewis EF, Kramer DB, Baughman KL, Stevenson LW, Tedrow UB. Right ventricular dysfunction and adverse outcome in patients with advanced heart failure. J Card Fail. 2006 Oct;12(8):616-20. doi: 10.1016/j.cardfail.2006.06.472. PMID: 17045180.
  37. Scuteri L, Rordorf R, Marsan NA, Landolina M, Magrini G, Klersy C, Frattini F, Petracci B, Vicentini A, Campana C, Tavazzi L, Ghio S. Relevance of echocardiographic evaluation of right ventricular function in patients undergoing cardiac resynchronization therapy. Pacing Clin Electrophysiol. 2009 Aug;32(8):1040-9. doi: 10.1111/j.1540-8159.2009.02436.x. PMID: 19659624.
  38. Ypenburg C, Lancellotti P, Tops LF, Bleeker GB, Holman ER, Piérard LA, Schalij MJ, Bax JJ. Acute effects of initiation and withdrawal of cardiac resynchronization therapy on papillary muscle dyssynchrony and mitral regurgitation. J Am Coll Cardiol. 2007 Nov 20;50(21):2071-7. doi: 10.1016/j.jacc.2007.08.019. Epub 2007 Nov 7. PMID: 18021876.
  39. Sadeghian H, Lotfi-Tokaldany M, Montazeri M, Kazemi Saeed A, Sahebjam M, Sardari A, Ejmalian G. Early Improvement in Mitral Regurgitation after Cardiac Resynchronization Therapy in Cardiomyopathy Patients. J Heart Valve Dis. 2017 Sep;26(5):557-563. PMID: 29762924.
  40. van Everdingen WM, Schipper JC, van 't Sant J, Ramdat Misier K, Meine M, Cramer MJ. Echocardiography and cardiac resynchronisation therapy, friends or foes? Neth Heart J. 2016 Jan;24(1):25-38. doi: 10.1007/s12471-015-0769-3. Erratum in: Neth Heart J. 2016 Mar;24(3):221-4. PMID: 26645707; PMCID: PMC4692834.


Comments


Swift, Reliable, and studious. We aim to cherish the world by publishing precise knowledge.

  • asd
  • Brown University Library
  • University of Glasgow Library
  • University of Pennsylvania, Penn Library
  • University of Amsterdam Library
  • The University of British Columbia Library
  • UC Berkeley’s Library
  • MIT Libraries
  • Kings College London University
  • University of Texas Libraries
  • UNSW Sidney Library
  • The University of Hong Kong Libraries
  • UC Santa Barbara Library
  • University of Toronto Libraries
  • University of Oxford Library
  • Australian National University
  • ScienceOpen
  • UIC Library
  • KAUST University Library
  • Cardiff University Library
  • Ball State University Library
  • Duke University Library
  • Rutgers University Library
  • Air University Library
  • UNT University of North Texas
  • Washington Research Library Consortium
  • Penn State University Library
  • Georgetown Library
  • Princeton University Library
  • Science Gate
  • Internet Archive
  • WashingTon State University Library
  • Dimensions
  • Zenodo
  • OpenAire
  • Index Copernicus International
  • icmje
  •  International Scientific Indexing (ISI)
  • Sherpa Romeo
  • ResearchGate
  • Universidad De Lima
  • WorldCat
  • JCU Discovery
  • McGill
  • National University of Singepore Libraries
  • SearchIT
  • Scilit
  • SemantiScholar
  • Base Search
  • VU
  • KB
  • Publons
  • oaji
  • Harvard University
  • sjsu-library
  • UWLSearch
  • Florida Institute of Technology
  • CrossRef
  • LUBsearch
  • Universitat de Paris
  • Technical University of Denmark
  • ResearchBIB
  • Google Scholar
  • Microsoft Academic Search