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Predictors of Response to Cardiac Resynchronization Therapy: A Prospective Cohort Study

2017-06Journal article Open access
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dc.contributor.authorAbreu, A
dc.contributor.authorOliveira, MM
dc.contributor.authorCunha, PS
dc.contributor.authorSanta Clara, H
dc.contributor.authorSantos, V
dc.contributor.authorPortugal, G
dc.contributor.authorRio, P
dc.contributor.authorSoares, R
dc.contributor.authorBranco, LM
dc.contributor.authorAlves, M
dc.contributor.authorPapoila, AL
dc.contributor.authorCruz Ferreira, R
dc.contributor.authorMota Carmo, M
dc.date.accessioned2018-01-31T15:20:33Z
dc.date.available2018-01-31T15:20:33Z
dc.date.issued2017-06
dc.description.abstractINTRODUCTION: Cardiac resynchronization therapy (CRT) has modified the prognosis of chronic heart failure (HF) with left ventricular systolic dysfunction. However, 30% of patients do not have a favorable response. The big question is how to determine predictors of response. AIMS: To identify baseline characteristics that might influence echocardiographic response to CRT. METHODS AND RESULTS: We performed a prospective single-center hospital-based cohort study of consecutive HF patients selected to CRT (NYHA class II-IV, left ventricular ejection fraction (LVEF) <35% and QRS complex ≥120 ms). Responders were defined as those with a ≥5% absolute increase in LVEF at six months. Clinical, electrocardiographic, laboratory, echocardiographic, autonomic, endothelial and cardiopulmonary function parameters were assessed before CRT device implantation. Logistic regression models were used. Seventy-nine patients were included, 54 male (68.4%), age 68.1 years (standard deviation 10.2), 19 with ischemic etiology (24%). At six months, 51 patients (64.6%) were considered responders. Although by univariate analysis baseline tricuspid annular plane systolic excursion (TAPSE) and serum creatinine were significantly different in responders, on multivariate analysis only TAPSE was independently associated with response, with higher values predicting a positive response to CRT (OR=1.13; 95% CI: 1.02-1.26; p=0.020). TAPSE ≥15 mm was strongly associated with response, and TAPSE <15 mm with non-response (p=0.005). Responders had no TAPSE values below 10 mm. CONCLUSION: From a range of clinical and technical baseline characteristics, multivariate analysis only identified TAPSE as an independent predictor of CRT response, with TAPSE <15 mm associated with non-response. This study highlights the importance of right ventricular dysfunction in CRT response.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationRev Port Cardiol. 2017 Jun;36(6):417-425pt_PT
dc.identifier.doi10.1016/j.repc.2016.10.010pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.17/2871
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherSociedade Portuguesa de Cardiologiapt_PT
dc.subjectHSM CARpt_PT
dc.subjectCHLC CINVpt_PT
dc.subjectCardiac Resynchronization Therapypt_PT
dc.subjectCohort Studiespt_PT
dc.subjectHeart Failure/therapypt_PT
dc.subjectPrognosispt_PT
dc.subjectProspective Studies
dc.subjectTreatment Outcome
dc.subjectAged
dc.titlePredictors of Response to Cardiac Resynchronization Therapy: A Prospective Cohort Studypt_PT
dc.title.alternativePreditores de Resposta à Terapêutica de Ressincronização Cardíaca: Estudo Cohort Prospetivopt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage425pt_PT
oaire.citation.issue6pt_PT
oaire.citation.startPage417pt_PT
oaire.citation.titleRevista Portuguesa de Cardiologiapt_PT
oaire.citation.volume36pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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