A new baseline scoring system may help to predict response to cardiac resynchronization therapy

Xuedong Shen, Chandra K. Nair, Wilbert S. Aronow, Mak J. Holmberg, Madhu Reddy, Kishley Anand, Tom Hee, Aimin Chen, Xiang Fang, Stephanie Maciejewski, Dennis J. Esterbrooks

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Abstract

Introduction: The PROSPECT trial reported no single echocardiographic measurement of dyssynchrony is recommended to improve patient selection for cardiac resynchronization therapy (CRT). Material and methods: In 100 consecutive patients who received CRT, we analyzed 27 ECG and echocardiographic variables to predict a positive response to CRT defined as a left ventricular (LV) end systolic volume decrease of ≥ 15% after CRT. Results: Right ventricular (RV) pacing-induced left bundle branch block (LBBB), time difference between LV ejection measured by tissue Doppler and pulsed wave Doppler (T TDI-PW), and wall motion score index (WMSI) were significantly associated with positive CRT response by multivariate regression. We assigned 1 point for RV pacing-induced LBBB, 1 point for WMSI ≤ 1.59, and 2 points for TTDI-PW > 50 ms. Overall mean response score was 1.79 ±1.39. Cutoff point for response score to predict positive response to CRT was > 2 by receiver operating characteristic (ROC) analysis. Area under ROC curve was 0.97 (p = 0.0001). Cardiac resynchronization therapy responders in patients with response score > 2 and ≤ 2 were 36/38 (95%) and 7/62 (11%, p <0.001), respectively. After age and gender adjustment, the response score was related to CRT response (OR = 45.4, p <0.0001). Conclusions: A response score generated from clinical, ECG and echocardiographic variables may be a useful predictor for CRT response. However, this needs to be validated.

Original languageEnglish (US)
Pages (from-to)627-633
Number of pages7
JournalArchives of Medical Science
Volume7
Issue number4
DOIs
StatePublished - Aug 1 2011

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All Science Journal Classification (ASJC) codes

  • Medicine(all)

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