Mechanical dyssynchrony as a predictor of superresponse in cardiac resynchronisation therapy with a long term follow-up

• Kuznetsov V.A.
• Shirokov N.E.
• Soldatova A.M.
• Dyachkov S.M.
• Krinochkin D.V.

Abstract

To evaluate clinical and morpho-functional features in patients with congestive heart failure (CHF) and superresponse in patients with cardiac resynchronisation therapy (CRT), to find predictors of superresponse in patients with CRT.

Materials and methods. The study enrolled 68 patients: 88.2% of men, 11.8% of women (mean age – 54.3±8.7 years, 57.4% with ischemic cardiomyopathy) with II–IV NYHA functional class CHF. Patients were examined at baseline and in dynamics (the follow-up period was 53.4±23.4 months). According to dynamics of left ventricular (LV) end-systolic volume (ESV) patients were divided into 2 groups: 1st group (n=41) with a decrease of LV ESV ≥30% (superresponders) and 2nd group (n=27) – a decrease of LV ESV <30% (non-superresponders).

Results. Аt baseline the groups did not differ in the main clinical characteristics. In dynamics patients with superresponse had significantly lower LV ESV (103.5±48.3 vs 164.0±61.8 ml, p<0.001), left ventricular end-diastolic volume (180.9±52.4 vs 242.7±70.9 ml, p<0.001) and higher LV ejection fraction (45.6±10.2 and 34.4±7.7%, p<0.001). According to the logistic regression duration of left ventricular pre-ejection period (OR 1.018, 95% CI 1.002–1.034, p=0.024) and duration of right ventricular pre-ejection period (OR 1.034, 95% CI 1.005–1.063, p=0.023) had an independent relationship with CRT superresponse. According to the ROC analysis the sensitivity and specificity of this model in the prediction of superresponse in patients with CRT were 66.7 and 70.0% (AUC=0.749, p=0.001).

Conclusion. Duration of left ventricular pre-ejection period and duration of right ventricular pre-ejection period can be used as independent predictors of superresponse in patients with CRT.

Keywords:cardiac resynchronisation therapy, superresponse, cardiac heart failure, mechanical dyssynchrony

All articles in our journal are distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0 license)