Results of the Predictors of Response to CRT (PROSPECT) Trial (original) (raw)
Related papers
Has Mechanical Dyssynchrony Still a Role in Predicting Cardiac Resynchronization Therapy Response?
Echocardiography, 2010
Current guidelines for cardiac resynchronization therapy (CRT) include electrical but not mechanical dyssynchrony assessment. Our study aims to investigate the effects of isolated or combined mechanical and electrical dyssynchrony, according, respectively, to a standard deviation of tissue Doppler imaging (TDI) derived time to systolic peak ≥32.6 ms and to a QRS duration ≥120 ms, in predicting CRT reverse remodeling. Method: One hundred ninety-two CRT patients were studied. All patients underwent a complete standard and TDI echocardiography examination before and 6 months after CRT. According to baseline evaluation patients were divided into Group 1, patients with isolated electrical dyssynchrony (QRS ≥ 120 ms, TS-SD < 32.6), Group 2, patients with isolated mechanical dyssynchrony (QRS < 120 ms, TS-SD ≥ 32.6) and Group 3, patients with combined electrical and mechanical dyssynchrony (QRS ≥ 120 ms, TS-SD ≥ 32.6). Patients were considered CRT responders according to ≥15 left ventricular end-systolic volume (LVESV) reduction at follow-up (FU). Result: At FU, 86 (45%) patients were responders. The highest CRT response rate was observed in Group 3 (62/119, 52%, P < 0.001 vs. Group 1). No significant differences in response rate were observed between Group 1 (13/47, 27%) and Group 2 (11/26, 42%). In Group1, CRT did not induce any significant change in LV end-diastolic volume (LVEDV), LVESV, LV ejection fraction (LVEF), myocardial performance index (MPI), while in Group 2, LVEF (P < 0.001) and MPI (P < 0.05) were improved. In Group 3, LVEDV, LVESV, LVEF, MPI were significantly improved (P < 0.0001 for all). Conclusion: Our data demonstrate that the highest CRT response rate can be achieved by combining traditional QRS criterion and a currently used echocardiographic dyssynchrony parameter. (Echocardiography, 2010;27:831-838)
Circulation: Heart Failure, 2010
Background-Whether mechanical dyssynchrony indices predict reverse remodeling (RR) or clinical response to cardiac resynchronization therapy (CRT) remains controversial. This prospective study evaluated whether echocardiographic dyssynchrony indices predict RR or clinical response after CRT. Methods and Results-Of 184 patients with heart failure with anticipated CRT who were prospectively enrolled, 131 with wide QRS and left ventricular ejection fraction Ͻ35% had 6-month follow-up after CRT implantation. Fourteen dyssynchrony indices (feasibility) by M-mode (94%), tissue velocity (96%), tissue Doppler strain (92%), 2D speckle strain (65% to 86%), 3D echocardiography (79%), and timing intervals (98%) were evaluated. RR (end-systolic volume reduction Ն15%) occurred in 55% and more frequently in patients without (71%) than in patients with (42%) ischemic cardiomyopathy (Pϭ0.002). Overall, only M-mode, tissue Doppler strain, and total isovolumic time had a receiver operating characteristic area under the curve (AUC) greater than the line of no information, but none of these were strongly predictive of RR (AUC, 0.63 to 0.71). In nonischemic cardiomyopathy, no dyssynchrony index predicted RR.
Echocardiography, 2010
A 81-year-old woman, with dilated cardiomyopathy and a left ventricular ejection fraction (LVEF) of 25%, in functional class III NYHA heart failure despite optimal medical therapy, with broad left bundle branch block (LBBB, QRS duration of 189 ms), and severe secondary mitral regurgitation (MR), underwent cardiac resynchronization therapy (CRT) (Biotronik Stratos, DDD; Biotronik GmbH, Berlin, Germany). The LV lead was optimally implanted in a large posterolateral vein. A sensed-AV delay of 140 ms and a maximal programmable VV delay of 100 ms (LV first) were programmed after careful echocardiographical optimization of the device, according to current guidelines. 1 The patient clinically responded to CRT (response defined as ≥1-point decrease in NYHA functional class), and one month later she was in class IIa NYHA heart failure.
The International Journal of Cardiovascular Imaging, 2019
Non-response cardiac resynchronization therapy (CRT) remains an issue, despite the refinement of selection criteria. The purpose of this study was to investigate the role of stress echocardiography along with dyssynchrony parameters for identification of CRT responders or late responders. 106 symptomatic heart failure patients were examined before, 6 months and 2-4 years after CRT implementation. Inotropic contractile reserve (ICR) and inferolateral (IL) wall viability were studied by stress echocardiography. Dyssynchrony was assessed by: (1) Septal to posterior wall motion delay (SPWMD) by m-mode. (2) Septal to lateral wall delay (SLD) by TDI. (3) Interventricular mechanical delay (IVMD) by pulsed wave Doppler for (4) difference in time to peak circumferential strain (TmaxCS) by speckle tracking. (5) Apical rocking (ApR) and septal flash (SF) by visual assessment. At 6 months there were 54 responders, with 12 additional late responders. TmaxCS had the greatest predictive value with an area under curve (AUC) of 0.835, followed by the presence of both ICR and viability of IL wall (AUC 0.799), m-mode (AUC = 0.775) and presence of either ApR or SF (AUC = 0.772). Predictive ability of ApR and of ICR is augmented if late responders are also included. Performance of dyssynchrony parameters is enhanced, in patients with both ICR and IL wall viability. Stress echocardiography and dyssynchrony parameters are simple and reliable predictors of 6-month and late CRT response. A stepwise approach with an initial assessment of ICR and viability and, if positive, further dyssynchrony analysis, could assist decision making.
Indian Heart Journal, 2021
– The benefits of CRT in select subsets of systolic heart failure patients with LBBB are proven. We prospectively evaluated conventional and newer echocardiographic parameters of left ventricular dyssynchrony in 35 patients who underwent CRT and were followed up after 6 months. Of the 33 surviving patients, 21 were echocardiographic responders and 24 were clinical responders. The parameters in clinical responders and non-responders were compared. The anatomic M Mode parameters of delays improved, while the radial strain and the mitral valve velocity time integral (MVVTI) did not show any significant change after CRT.
European Heart Journal, 2006
Aims Cardiac resynchronization therapy (CRT) reduces inter-and intraventricular dyssynchrony and shortens total isovolumic time (t-IVT). We compared the extent to which the values of ventricular dyssynchrony and t-IVT predict clinical benefits of CRT. Methods and results Ventricular dyssynchrony was assessed in 39 patients with heart failure before and 6 months after CRT. Segmental dyssynchrony was identified from time to onset and peak systolic velocity of wall motion. T-IVT (s/min) was derived as [60 2 (total ejection time þ total filling time)]. The difference between ventricular pre-ejection periods (D-PEP) was calculated. Outcome measures were fall in New York Heart Association (NYHA) class and increase in cardiac output (CO). Following CRT, NYHA class fell in 29/39 patients, CO increased (by 1.0 L/min, P , 0.001), and intraventricular delay (Intra-VD), interventricular delay (Inter-VD), t-IVT, and D-PEP shortened (by 25 ms, 72 ms, 6 s/min, and 38 ms, P , 0.01). NYHA class and CO were unchanged with CRT in 10/39, and Intra-VD, Inter-VD, t-IVT, and D-PEP lengthened (by 43 ms, 52 ms, 7 s/min, and 35 ms, P , 0.05). Though univariate predictors of CO increment with CRT were Intra-VD, Inter-VD, t-IVT, and D-PEP, only pre-CRT values of CO (P , 0.001), t-IVT (P , 0.001), and D-PEP (P ¼ 0.025) were independent. Conclusion Global, rather than segmental, measures of ventricular dyssynchrony are powerful, independent predictors of clinical response to CRT.