Yonsei Med J.  2019 Jan;60(1):48-55. 10.3349/ymj.2019.60.1.48.

Left Ventricular End-Systolic Volume Can Predict 1-Year Hierarchical Clinical Composite End Point in Patients with Cardiac Resynchronization Therapy

Affiliations
  • 1Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. smkang@yuhs.ac, cby6908@yuhs.ac
  • 2Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea.

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.

Keyword

Cardiac resynchronization therapy; echocardiography; heart failure

MeSH Terms

Cardiac Resynchronization Therapy*
Discrimination (Psychology)
Echocardiography
Heart
Heart Failure
Hospitalization
Humans
Male
Mitral Valve Insufficiency
Mortality
Stroke Volume*

Figure

  • Fig. 1 Temporal changes in CRT response rates according to (A) ΔLVESV, (B) ΔLVEDV, (C) absolute ΔLVEF, (D) relative ΔLVEF, and (E) ΔMR in total, nonischemic, and ischemic groups. p values indicate the statistical significance of temporal changes in CRT response rates according to each echocardiographic CRT response criterion in each group from 3 to 12 months. *The temporal change in CRT response, based on ΔLVEDV from 6 to 12 months, in nonischemic group is insignificant in post-hoc analysis. CRT, cardiac resynchronization therapy; LVEDV, left ventricular end-diastolic volume; LVEF, left ventricular ejection fraction; LVESV, left ventricular end-systolic volume; MR, mitral regurgitation.

  • Fig. 2 Receiver operating characteristic curve and area under the curve of (A) ΔLVESV, (B) ΔLVEDV, (C) absolute ΔLVEF, (D) relative ΔLVEF, and (E) ΔMR for the discrimination of improvement in 1-year hierarchical clinical composite end point in total group. When the optimal cutoff value of ΔLVESV at 6 months is set as 13.5% (circle), sensitivity and specificity are 0.719 and 0.719, respectively. abs, absolute; AUC, area under the curve; LVEDV, left ventricular end-diastolic volume; LVEF, left ventricular ejection fraction; LVESV, left ventricular end-systolic volume; MR, mitral regurgitation; rel, relative.

  • Fig. 3 Agreements of echocardiographic CRT response criteria at each time with improvement in 1-year hierarchical clinical composite end point in total group. *p<05. Abs, absolute; CRT, cardiac resynchronization therapy; LVEDV, left ventricular end-diastolic volume; LVEF, left ventricular ejection fraction; LVESV, left ventricular end-systolic volume; MR, mitral regurgitation; Rel, relative.


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Reference

1. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016; 37:2129–2200. PMID: 27206819.
2. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Colvin MM, et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA Guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. 2017; 136:e137–e161. PMID: 28455343.
Article
3. Packer M. Development and evolution of a hierarchical clinical composite end point for the evaluation of drugs and devices for acute and chronic heart failure: a 20-year perspective. Circulation. 2016; 134:1664–1678. PMID: 27881506.
4. Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA, et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr. 2003; 16:777–802. PMID: 12835667.
Article
5. Bleeker GB, Bax JJ, Fung JW, van der, Zhang Q, Schalij MJ, et al. Clinical versus echocardiographic parameters to assess response to cardiac resynchronization therapy. Am J Cardiol. 2006; 97:260–263. PMID: 16442375.
Article
6. Chung ES, Leon AR, Tavazzi L, Sun JP, Nihoyannopoulos P, Merlino J, et al. Results of the predictors of response to CRT (PROSPECT) trial. Circulation. 2008; 117:2608–2616. PMID: 18458170.
Article
7. Moss AJ, Hall WJ, Cannom DS, Klein H, Brown MW, Daubert JP, et al. Cardiac-resynchronization therapy for the prevention of heart-failure events. N Engl J Med. 2009; 361:1329–1338. PMID: 19723701.
Article
8. Bax JJ, Marwick TH, Molhoek SG, Bleeker GB, van Erven L, Boersma E, et al. Left ventricular dyssynchrony predicts benefit of cardiac resynchronization therapy in patients with end-stage heart failure before pacemaker implantation. Am J Cardiol. 2003; 92:1238–1240. PMID: 14609610.
Article
9. Gorcsan J 3rd, Tanabe M, Bleeker GB, Suffoletto MS, Thomas NC, Saba S, et al. Combined longitudinal and radial dyssynchrony predicts ventricular response after resynchronization therapy. J Am Coll Cardiol. 2007; 50:1476–1483. PMID: 17919568.
Article
10. Suffoletto MS, Dohi K, Cannesson M, Saba S, Gorcsan J 3rd. Novel speckle-tracking radial strain from routine black-and-white echocardiographic images to quantify dyssynchrony and predict response to cardiac resynchronization therapy. Circulation. 2006; 113:960–968. PMID: 16476850.
Article
11. Achilli A, Peraldo C, Sassara M, Orazi S, Bianchi S, Laurenzi F, et al. Prediction of response to cardiac resynchronization therapy: the selection of candidates for CRT (SCART) study. Pacing Clin Electrophysiol. 2006; 29(Suppl 2):S11–S19. PMID: 17169127.
Article
12. Abraham WT, Fisher WG, Smith AL, Delurgio DB, Leon AR, Loh E, et al. Cardiac resynchronization in chronic heart failure. N Engl J Med. 2002; 346:1845–1853. PMID: 12063368.
Article
13. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977; 33:159–174. PMID: 843571.
Article
14. Li K, Qian Z, Hou X, Wang Y, Qiu Y, Sheng Y, et al. The incidence and outcomes of delayed response to cardiac resynchronization therapy. Pacing Clin Electrophysiol. 2018; 41:73–80. PMID: 29222875.
Article
15. Marsan NA, Bleeker GB, van Bommel RJ, Ypenburg C, Delgado V, Borleffs CJ, et al. Comparison of time course of response to cardiac resynchronization therapy in patients with ischemic versus nonischemic cardiomyopathy. Am J Cardiol. 2009; 103:690–694. PMID: 19231335.
Article
16. Viveiros Monteiro A, Martins Oliveira M, Silva Cunha P, Nogueira da Silva M, Feliciano J, Branco L, et al. Time to left ventricular reverse remodeling after cardiac resynchronization therapy: Better late than never. Rev Port Cardiol. 2016; 35:161–167. PMID: 26923367.
Article
17. Higgins SL, Hummel JD, Niazi IK, Giudici MC, Worley SJ, Saxon LA, et al. Cardiac resynchronization therapy for the treatment of heart failure in patients with intraventricular conduction delay and malignant ventricular tachyarrhythmias. J Am Coll Cardiol. 2003; 42:1454–1459. PMID: 14563591.
Article
18. Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T, et al. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med. 2004; 350:2140–2150. PMID: 15152059.
Article
19. Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L, et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med. 2005; 352:1539–1549. PMID: 15753115.
Article
20. Young JB, Abraham WT, Smith AL, Leon AR, Lieberman R, Wilkoff B, et al. Combined cardiac resynchronization and implantable cardioversion defibrillation in advanced chronic heart failure: the MIRACLE ICD Trial. JAMA. 2003; 289:2685–2694. PMID: 12771115.
Article
21. Fornwalt BK, Sprague WW, BeDell P, Suever JD, Gerritse B, Merlino JD, et al. Agreement is poor among current criteria used to define response to cardiac resynchronization therapy. Circulation. 2010; 121:1985–1991. PMID: 20421518.
Article
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