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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