Left Ventricular End-Systolic Volume Can Predict 1-Year Hierarchical Clinical Composite End Point in Patients with Cardiac Resynchronization Therapy
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Purpose: This study aimed to elucidate which echocardiographic criteria at three time points, for cardiac resynchronization therapy(CRT) response, are accurate in discriminating the hierarchical clinical composite end point (HCCEP). Materials and Methods: We included 120 patients (age, 66.1±12.6 years; men, 54.2%) who underwent CRT implantation for heartfailure (HF). Echocardiography was performed before and at 3, 6, and 12 months after CRT implantation. The 1-year HCCEP includedall-cause mortality, hospitalization for HF, and New York Heart Association functional class for 12 months. CRT responsecriteria were decrease in left ventricular (LV) end-systolic volume (LVESV) >15%, decrease in LV end-diastolic volume >15%, absoluteincrease in LV ejection fraction (LVEF) ≥5%, relative increase in LVEF ≥15%, and decrease in mitral regurgitation ≥1 grade. Temporal changes in CRT response rates, accuracy of CRT response criteria at each time and cutoff value for the discriminationof improvement in HCCEP, and agreements with improvement in HCCEP were analyzed. Results: HCCEP improvement rates were 65.8% in total group. In nonischemic group, CRT response rates according to all echocardiographiccriteria significantly increased with time. In ischemic group, CRT response rate did not significantly change withtime. In total group, ΔLVESV at 6 months (ΔLVESV6) had the most significant accuracy for the discrimination of HCCEP (areaunder the curve=0.781). The optimal cutoff value of ΔLVESV6 was 13.5% (sensitivity=0.719, specificity=0.719). ΔLVESV6 had fairagreement with HCCEP (κ=0.391, p<0.001). Conclusion: ΔLVESV6 is the most useful echocardiographic CRT response criterion for the prediction of 1-year HCCEP.
Abstract
Purpose: This study aimed to elucidate which echocardiographic criteria at three time points, for cardiac resynchronization therapy(CRT) response, are accurate in discriminating the hierarchical clinical composite end point (HCCEP). Materials and Methods: We included 120 patients (age, 66.1±12.6 years; men, 54.2%) who underwent CRT implantation for heartfailure (HF). Echocardiography was performed before and at 3, 6, and 12 months after CRT implantation. The 1-year HCCEP includedall-cause mortality, hospitalization for HF, and New York Heart Association functional class for 12 months. CRT responsecriteria were decrease in left ventricular (LV) end-systolic volume (LVESV) >15%, decrease in LV end-diastolic volume >15%, absoluteincrease in LV ejection fraction (LVEF) ≥5%, relative increase in LVEF ≥15%, and decrease in mitral regurgitation ≥1 grade. Temporal changes in CRT response rates, accuracy of CRT response criteria at each time and cutoff value for the discriminationof improvement in HCCEP, and agreements with improvement in HCCEP were analyzed. Results: HCCEP improvement rates were 65.8% in total group. In nonischemic group, CRT response rates according to all echocardiographiccriteria significantly increased with time. In ischemic group, CRT response rate did not significantly change withtime. In total group, ΔLVESV at 6 months (ΔLVESV6) had the most significant accuracy for the discrimination of HCCEP (areaunder the curve=0.781). The optimal cutoff value of ΔLVESV6 was 13.5% (sensitivity=0.719, specificity=0.719). ΔLVESV6 had fairagreement with HCCEP (κ=0.391, p<0.001). Conclusion: ΔLVESV6 is the most useful echocardiographic CRT response criterion for the prediction of 1-year HCCEP.
참고문헌 (21)
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