A new score system for predicting response to cardiac resynchronization therapy

• Published in: Cardiology journal 2015, Vol.22 (2), p.179-187
• Main Authors: Kang, Yu, Cheng, Leilei, Cui, Jie, Li, Lin, Qin, Shengmei, Su, Yangang, Mao, Jialiang, Gong, Xue, Chen, Haiyan, Pan, Cuizhen, Shen, Xuedong, He, Ben, Shu, Xianhong
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Area Under Curve; Bundle-Branch Block - diagnosis; Bundle-Branch Block - etiology; Bundle-Branch Block - mortality; Bundle-Branch Block - physiopathology; Bundle-Branch Block - therapy; Cardiac Resynchronization Therapy - adverse effects; Cardiac Resynchronization Therapy - mortality; Cardiomyopathy, Dilated - complications; Cardiomyopathy, Dilated - diagnosis; Cardiomyopathy, Dilated - mortality; Cardiomyopathy, Dilated - physiopathology; Cardiomyopathy, Dilated - therapy; Decision Support Techniques; Echocardiography, Three-Dimensional; Electrocardiography; Female; Heart Failure - diagnosis; Heart Failure - etiology; Heart Failure - mortality; Heart Failure - physiopathology; Heart Failure - therapy; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Multivariate Analysis; Patient Readmission; Patient Selection; Predictive Value of Tests; Proportional Hazards Models; Risk Assessment; Risk Factors; ROC Curve; Time Factors; Treatment Outcome
• ISSN: 1897-5593; 1897-5593; 1898-018X
• DOI: 10.5603/cj.a2014.0089

The aim of this study was to establish a score system derived from clinical, echocardiographic and electrocardiographic indexes and evaluate its clinical value for cardiac resynchronization therapy (CRT) patient selection. Ninety-three patients receiving CRT were enrolled. A patient selection score system was generated by the clinical, echocardiographic and electrocardiographic parameters achieving a significant level by univariate and multivariate Cox regression model. The positive response to CRT was a left ventricular end systolic volume decrease of ≥ 15% and not reaching primary clinical endpoint (death or re-hospitalization for heart failure) at the end of follow-up. Thirty-nine patients were CRT non-responders (41.94%) and 54 were responders (58.06%). A 4-point score system was generated based on tricuspid annular plane systolic excursion (TAPSE), longitudinal strain (LS), and complete left bundle branch block (CLBBB) combined with a wide QRS duration (QRSd). The sensitivity and specificity for prediction of a positive response to CRT at a score > 2 were 0.823 and 0.850, respectively (AUC: 0.92295% CI 0.691-0.916, p< 0.001). A patient selection score system based on the integration of TAPSE, LS and CLBBB combined with a wide QRSd can help to predict positive response to CRT effectively and reliably.