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Echocardiographic predictors of reverse remodeling after cardiac resynchronization therapy and subsequent events

Citation

Park, JH and Negishi, K and Grimm, RA and Popovic, Z and Stanton, T and Wilkoff, BL and Marwick, TH, Echocardiographic predictors of reverse remodeling after cardiac resynchronization therapy and subsequent events, Circulation: Cardiovascular Imaging, 6, (6) pp. 864-872. ISSN 1941-9651 (2013) [Refereed Article]

Copyright Statement

Copyright 2013 American Heart Association

DOI: doi:10.1161/CIRCIMAGING.112.000026

Abstract

Background: Studies of echocardiographic predictors of response after cardiac resynchronization therapy (CRT) have largely involved single parameters. We hypothesized that combining parameters would be more robust and sought to develop a multiparametric echocardiographic score for predicting CRT response.

Methods and Results: Global longitudinal strain of left ventricle was added to standard echocardiographic measurements in 334 consecutive patients (224 men; mean, 6512 years) who underwent baseline echocardiography before CRT and underwent follow-up echocardiograms at 1 year. Regression analysis was performed to create an echocardiographic score for prediction of LV reverse remodeling (defined as ≥15% reduction in the LV end-systolic volume). Cox proportional hazards models were used to identify the association of the score with death, transplantation or LV assist device implantation, and heart failure hospitalization during 5722 months of follow-up. LV reverse remodeling (n=161; 48%) was associated with pre-CRT LV end-diastolic dimension index <3.1 cm/m2, global longitudinal strain of left ventricle <7%, left atrial area <26 cm2, right ventricular end-diastolic area index <10.0 cm2/m2, right atrial area <20 cm2, and right ventricular fractional area change ≥35%. Combination of these into an echocardiographic score allowed prediction of LV reverse remodeling with a sensitivity of 84% and a specificity of 79%. During follow-up, there were 134 deaths, 18 heart transplantations/LV assist device implantations, and 93 heart failure admissions. The score was associated with heart failure admission, heart transplantation/LV assist device, or death (hazard ratio, 0.97; 95% confidence interval, 0.950.98; P<0.001) and all-cause death (hazard ratio, 0.97; 95% confidence interval, 0.960.98; P<0.001), independent of age, sex, ischemic cause, and initial functional class.

Conclusions: A multiparametric echocardiographic score is helpful in selecting patients likely to undergo reverse remodeling after CRT and predicts clinical outcomes.

Item Details

Item Type:Refereed Article
Keywords:cardiac resynchronization therapy, echocardiography, heart failure, ventricular remodeling
Research Division:Medical and Health Sciences
Research Group:Cardiorespiratory Medicine and Haematology
Research Field:Cardiology (incl. Cardiovascular Diseases)
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Cardiovascular System and Diseases
Author:Negishi, K (Dr Kazuaki Negishi)
Author:Marwick, TH (Professor Tom Marwick)
ID Code:87632
Year Published:2013
Web of Science® Times Cited:20
Deposited By:Menzies Institute for Medical Research
Deposited On:2013-11-28
Last Modified:2015-07-29
Downloads:0

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