Clinical and echocardiographic predictors of nonresponse to cardiac resynchronization therapy

Shanks, Miriam, Delgado, Victoria, Ng, Arnold C. T., Auger, Dominique, Mooyaart, Eline A. Q., Bertini, Matteo, Marsan, Nina Ajmone, van Bommel, Rutger J., Holman, Eduard R., Poldermans, Don, Schalij, Martin J. and Bax, Jeroen J. (2011) Clinical and echocardiographic predictors of nonresponse to cardiac resynchronization therapy. American Heart Journal, 161 3: 552-557. doi:10.1016/j.ahj.2010.11.011


Author Shanks, Miriam
Delgado, Victoria
Ng, Arnold C. T.
Auger, Dominique
Mooyaart, Eline A. Q.
Bertini, Matteo
Marsan, Nina Ajmone
van Bommel, Rutger J.
Holman, Eduard R.
Poldermans, Don
Schalij, Martin J.
Bax, Jeroen J.
Title Clinical and echocardiographic predictors of nonresponse to cardiac resynchronization therapy
Journal name American Heart Journal   Check publisher's open access policy
ISSN 0002-8703
1097-6744
Publication date 2011-03
Year available 2011
Sub-type Article (original research)
DOI 10.1016/j.ahj.2010.11.011
Volume 161
Issue 3
Start page 552
End page 557
Total pages 6
Place of publication Philadelphia, PA United States
Publisher Mosby
Collection year 2012
Language eng
Formatted abstract
Background: Lack of response to cardiac resynchronization therapy (CRT) ranges between 30% to 40% of heart failure (HF) patients. The present study aimed to evaluate the clinical and echocardiographic determinants of nonresponse to CRT.

Methods: A total of 581 patients (66.4 ± 10.0 years, 77.9% male) with advanced HF scheduled for CRT implantation were included. Clinical and echocardiographic evaluations were performed at baseline and 6 months of follow-up. Nonresponse was defined as no improvement in the New York Heart Association functional class, death from worsening HF or heart transplantation, and <15% reduction in left ventricular (LV) end-systolic volume.

Results: At 6 months of follow-up, 254 patients (44%) did not respond to CRT. The nonresponders were more frequently male (81.9% vs 74.3%, P = .030) and had ischemic cardiomyopathy (69.7% vs 53.2%, P < .001), shorter QRS duration (150.6 ± 29.9 milliseconds vs 156.0 ± 32.5 milliseconds, P = .041), worse New York Heart Association functional class (2.8 ± 0.6 vs 2.7 ± 0.6, P = .008) and shorter 6-minute walk distance (297.9 ± 110.7 m vs 331.8 ± 112.6 m, P = .001), larger left atrial volumes (44.9 ± 16.9 mL/m 2 vs 40.9 ± 17.6 mL/m 2, P = .006), less baseline LV dyssynchrony (56.2 ± 41.3 milliseconds vs 69.1 ± 39.9 milliseconds, P < .001), and, more frequently, anterior LV lead position (12.4% vs 4.0%, P = .007). At multivariate analysis, only the ischemic etiology of HF (odds ratio [OR] 2.264, P = .005), shorter 6-minute walk distance at baseline (OR 0.998, P = .030), less baseline LV dyssynchrony (OR 0.989, P < .001), and anterior LV lead position (OR 3.713, P < .010) remained independent predictors of nonresponse to CRT.

Conclusions: Ischemic etiology of HF, shorter baseline 6-minute walk distance, less baseline LV dyssynchrony, and anterior LV lead position are independent determinants of nonresponse to CRT.
Keyword Left Ventricular Dyssynchrony
Stage Heart Failure
Term Follow Up
Doppler echocardiography
Lead Position
Qrs Duration
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
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Created: Sun, 14 Apr 2013, 23:55:26 EST by Dr Chin Tse Arnold Ng on behalf of Medicine - Princess Alexandra Hospital