Are the extent, location, and score of segmental wall motion abnormalities related to cardiac resynchronization therapy response?

Xuedong Shen, Wilbert S. Aronow, Chandra K. Nair, Mark Jeffrey Holmberg, Tom Hee, Stephanie MacIejewski, Dennis J. Esterbrooks

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Abstract

Background: We hypothesized that segmental wall motion abnormalities (WMAs) are related to cardiac resynchronization therapy (CRT) response. Methods: We studied 108 patients who received CRT, 69 with ischemic and 39 with nonischemic heart disease. A wall motion score index (WMSI) was analyzed using a 17-segment model and calculated by the total score/number of segments analyzed. A decrease of left ventricular end systolic volume ≥15% after CRT was defined as a positive response to CRT. Results: Of 108 patients, 1,054/1,836 segments (57%) had WMAs. The mean WMSI was 2.06 in patients with ischemic heart disease and 1.04 in patients with nonischemic heart disease (P <0.0001). The area under the receiver operating characteristic curve for a WMSI predicting a positive response to CRT was 0.70 (P = 0.0001). The cutoff point was a WMSI ≤2 for prediction of a positive response to CRT. After adjustment for age, gender, and clinical features, the WMSI persistently related to CRT responders (P = 0.01). During 15-month follow-up, the percentage of CRT nonresponders in patients with a WMSI >2 was significantly higher (82%) compared to patients with a WMSI ≤2 (47%, P = 0.005) and nonischemic heart disease (36%, P <0.001). In 59 patients with left ventricular mechanical dyssynchrony, the percentage of negative responders to CRT in patients with a WMSI >2, ≤2, and nonischemic heart disease were 53% (8 of 15), 16% (3 of 19) and 0% (0 of 25), respectively (P <0.001). Conclusions: A large extent of WMAs and a WMSI >2 predicted a poorer CRT response.

Original languageEnglish
Pages (from-to)1136-1145
Number of pages10
JournalEchocardiography
Volume26
Issue number10
DOIs
StatePublished - Nov 2009

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Cardiac Resynchronization Therapy
Heart Diseases
Stroke Volume
Myocardial Ischemia

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

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Are the extent, location, and score of segmental wall motion abnormalities related to cardiac resynchronization therapy response? / Shen, Xuedong; Aronow, Wilbert S.; Nair, Chandra K.; Holmberg, Mark Jeffrey; Hee, Tom; MacIejewski, Stephanie; Esterbrooks, Dennis J.

In: Echocardiography, Vol. 26, No. 10, 11.2009, p. 1136-1145.

Research output: Contribution to journalArticle

Shen, Xuedong ; Aronow, Wilbert S. ; Nair, Chandra K. ; Holmberg, Mark Jeffrey ; Hee, Tom ; MacIejewski, Stephanie ; Esterbrooks, Dennis J. / Are the extent, location, and score of segmental wall motion abnormalities related to cardiac resynchronization therapy response?. In: Echocardiography. 2009 ; Vol. 26, No. 10. pp. 1136-1145.
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abstract = "Background: We hypothesized that segmental wall motion abnormalities (WMAs) are related to cardiac resynchronization therapy (CRT) response. Methods: We studied 108 patients who received CRT, 69 with ischemic and 39 with nonischemic heart disease. A wall motion score index (WMSI) was analyzed using a 17-segment model and calculated by the total score/number of segments analyzed. A decrease of left ventricular end systolic volume ≥15{\%} after CRT was defined as a positive response to CRT. Results: Of 108 patients, 1,054/1,836 segments (57{\%}) had WMAs. The mean WMSI was 2.06 in patients with ischemic heart disease and 1.04 in patients with nonischemic heart disease (P <0.0001). The area under the receiver operating characteristic curve for a WMSI predicting a positive response to CRT was 0.70 (P = 0.0001). The cutoff point was a WMSI ≤2 for prediction of a positive response to CRT. After adjustment for age, gender, and clinical features, the WMSI persistently related to CRT responders (P = 0.01). During 15-month follow-up, the percentage of CRT nonresponders in patients with a WMSI >2 was significantly higher (82{\%}) compared to patients with a WMSI ≤2 (47{\%}, P = 0.005) and nonischemic heart disease (36{\%}, P <0.001). In 59 patients with left ventricular mechanical dyssynchrony, the percentage of negative responders to CRT in patients with a WMSI >2, ≤2, and nonischemic heart disease were 53{\%} (8 of 15), 16{\%} (3 of 19) and 0{\%} (0 of 25), respectively (P <0.001). Conclusions: A large extent of WMAs and a WMSI >2 predicted a poorer CRT response.",
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T1 - Are the extent, location, and score of segmental wall motion abnormalities related to cardiac resynchronization therapy response?

AU - Shen, Xuedong

AU - Aronow, Wilbert S.

AU - Nair, Chandra K.

AU - Holmberg, Mark Jeffrey

AU - Hee, Tom

AU - MacIejewski, Stephanie

AU - Esterbrooks, Dennis J.

PY - 2009/11

Y1 - 2009/11

N2 - Background: We hypothesized that segmental wall motion abnormalities (WMAs) are related to cardiac resynchronization therapy (CRT) response. Methods: We studied 108 patients who received CRT, 69 with ischemic and 39 with nonischemic heart disease. A wall motion score index (WMSI) was analyzed using a 17-segment model and calculated by the total score/number of segments analyzed. A decrease of left ventricular end systolic volume ≥15% after CRT was defined as a positive response to CRT. Results: Of 108 patients, 1,054/1,836 segments (57%) had WMAs. The mean WMSI was 2.06 in patients with ischemic heart disease and 1.04 in patients with nonischemic heart disease (P <0.0001). The area under the receiver operating characteristic curve for a WMSI predicting a positive response to CRT was 0.70 (P = 0.0001). The cutoff point was a WMSI ≤2 for prediction of a positive response to CRT. After adjustment for age, gender, and clinical features, the WMSI persistently related to CRT responders (P = 0.01). During 15-month follow-up, the percentage of CRT nonresponders in patients with a WMSI >2 was significantly higher (82%) compared to patients with a WMSI ≤2 (47%, P = 0.005) and nonischemic heart disease (36%, P <0.001). In 59 patients with left ventricular mechanical dyssynchrony, the percentage of negative responders to CRT in patients with a WMSI >2, ≤2, and nonischemic heart disease were 53% (8 of 15), 16% (3 of 19) and 0% (0 of 25), respectively (P <0.001). Conclusions: A large extent of WMAs and a WMSI >2 predicted a poorer CRT response.

AB - Background: We hypothesized that segmental wall motion abnormalities (WMAs) are related to cardiac resynchronization therapy (CRT) response. Methods: We studied 108 patients who received CRT, 69 with ischemic and 39 with nonischemic heart disease. A wall motion score index (WMSI) was analyzed using a 17-segment model and calculated by the total score/number of segments analyzed. A decrease of left ventricular end systolic volume ≥15% after CRT was defined as a positive response to CRT. Results: Of 108 patients, 1,054/1,836 segments (57%) had WMAs. The mean WMSI was 2.06 in patients with ischemic heart disease and 1.04 in patients with nonischemic heart disease (P <0.0001). The area under the receiver operating characteristic curve for a WMSI predicting a positive response to CRT was 0.70 (P = 0.0001). The cutoff point was a WMSI ≤2 for prediction of a positive response to CRT. After adjustment for age, gender, and clinical features, the WMSI persistently related to CRT responders (P = 0.01). During 15-month follow-up, the percentage of CRT nonresponders in patients with a WMSI >2 was significantly higher (82%) compared to patients with a WMSI ≤2 (47%, P = 0.005) and nonischemic heart disease (36%, P <0.001). In 59 patients with left ventricular mechanical dyssynchrony, the percentage of negative responders to CRT in patients with a WMSI >2, ≤2, and nonischemic heart disease were 53% (8 of 15), 16% (3 of 19) and 0% (0 of 25), respectively (P <0.001). Conclusions: A large extent of WMAs and a WMSI >2 predicted a poorer CRT response.

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