Factors Associated with a Positive Hemodynamic Response to Cardiac Resynchronization Therapy

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Abstract

AIM: This study aimed to conduct a comparative analysis of clinical, electrocardiographic, and echocardiographic factors in patients with chronic heart failure (CHF) with different hemodynamic responses to cardiac resynchronization (CRT) to assess the possibility of their use in predicting the positive effect of CRT.

MATERIALS AND METHODS: The study included 136 patients with New York Heart Association grade 3–4 CHF with a left ventricular ejection fraction of ≤ 35%, QRS duration of ≥ 150 ms, QRS duration of 130–149 ms, and QRS morphology of left bundle branch block (LBBB). For CHF treatment and primary prevention of sudden cardiac death, a cardioverter-defibrillator with CRT (CRT-D) function was implanted. The enrolled patients were followed up prospectively for 1 year to record the endpoint, namely, hemodynamic response to CRT, assessed by a decrease in the end-systolic volume of the left ventricle by ≥ 15%.

RESULTS: During the 1-year follow-up, the primary endpoint was registered in 62 (46%) patients. With a one-way logistic regression, four indicators with the highest predictive potential (p < 0.05) and associated with the occurrence of the studied endpoint were identified. Based on the results of the multivariate regression analysis, a prognostic model was developed, which included three factors with the highest levels of statistical significance, namely, a history of indications of a previous correction of valvular insufficiency, QRS duration, and LBBB criteria according to Strauss. The diagnostic efficiency of the model was 73% (sensitivity, 80%; specificity, 68%). The electrocardiographic parameters of the Strauss LBBB criteria and QRS duration were independent predictors of the studied endpoint.

CONCLUSIONS: The developed multivariate prognostic model may be useful in the selection of patients with CHF reduced ejection fraction for implantation of devices with CRT function; the lack of external validation limits its application in practice.

About the authors

Anatoly A. Nechepurenko

Federal Center for Cardiovascular Surgery

Author for correspondence.
Email: vestik@mail.ru
ORCID iD: 0000-0001-5722-9883
SPIN-code: 5582-8428

кандидат медицинских наук, заведующий отделением хирургического лечения сложных нарушений ритма сердца и электрокардиостимуляции

Russian Federation, Astrahan

Nikolay N. Ilov

Federal Center for Cardiovascular Surgery; Astrakhan State Medical University

Email: nikolay.ilov@gmail.com
ORCID iD: 0000-0003-1294-9646
SPIN-code: 7426-3796

candidate of medical sciences

Russian Federation, Astrakhan; Astrakhan

Dmitry A. Zorin

Federal Center for Cardiovascular Surgery

Email: dimusechek1997@gmail.com
ORCID iD: 0000-0001-7167-4713

surgeon

Russian Federation, Astrakhan

Eugeny I. Romantcov

Federal Center for Cardiovascular Surgery

Email: romantsov88@yandex.ru
ORCID iD: 0000-0002-8153-6637
SPIN-code: 7018-7559

cardiologist

Russian Federation, Astrakhan

Olesya V. Palnikova

Federal Center for Cardiovascular Surgery; Astrakhan State Medical University

Email: palnicovaolesya@mail.ru
ORCID iD: 0000-0002-4476-5174
SPIN-code: 3215-7250

cardiologist

Russian Federation, Astrakhan; Astrakhan

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2. Fig. 1. Flow chart of the study design.

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3. Fig. 2. ROC curve indicating the relationship between the probability of a hemodynamic response to CRT and the value of the regression equation obtained.

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