Predictors of short-term clinical response to cardiac resynchronization therapy

Linde, C., Abraham, W. T., Gold, M. R., Daubert, C., Tang, A. S.L., Young, J. B., Sherfesee, L., Hudnall, H., Fagan, D. H. and Cleland, J. G. (2017) Predictors of short-term clinical response to cardiac resynchronization therapy. European Journal of Heart Failure, 19(8), pp. 1056-1063. (doi: 10.1002/ejhf.795) (PMID:28295869)

Abstract

Aims: Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in patients with symptomatic heart failure and QRS prolongation but there is uncertainty about which patient characteristics predict short-term clinical response. Methods and results: In an individual patient meta-analysis of three double-blind, randomized trials, clinical composite score (CCS) at 6 months was compared in patients assigned to CRT programmed on or off. Treatment–covariate interactions were assessed to measure likelihood of improved CCS at 6 months. MIRACLE, MIRACLE ICD, and REVERSE trials contributed data for this analysis (n = 1591). Multivariable modelling identified QRS duration and left ventricular ejection fraction (LVEF) as predictors of CRT clinical response (P < 0.05). The odds ratio for a better CCS at 6 months increased by 3.7% for every 1% decrease in LVEF for patients assigned to CRT-on compared to CRT-off, and was greatest when QRS duration was between 160 and 180 ms. Conclusions: In symptomatic chronic heart failure patients (NYHA class II–IV), longer QRS duration and lower LVEF independently predict early clinical response to CRT.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Cleland, Professor John
• Authors: Linde, C., Abraham, W. T., Gold, M. R., Daubert, C., Tang, A. S.L., Young, J. B., Sherfesee, L., Hudnall, H., Fagan, D. H., and Cleland, J. G.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
• Journal Name: European Journal of Heart Failure
• Publisher: Wiley
• ISSN: 1388-9842
• ISSN (Online): 1879-0844
• Published Online: 14 March 2017
• Copyright Holders: Copyright © 2017 The Authors and European Society of Cardiology
• First Published: First published in European Journal of Heart Failure 19(8): 1056-1063
• Publisher Policy: Reproduced in accordance with the publisher copyright policy