Usefulness of a Novel "Response Score" to Predict Hemodynamic and Clinical Outcome from Cardiac Resynchronization Therapy

E. Kevin Heist, Cynthia Taub, Dali Fan, Daniel Arzola-Castaner, Chrisfouad Raif Alabiad, Vivek Y. Reddy, Moussa Mansour, Theofanie Mela, Michael H. Picard, Jeremy N. Ruskin, Jagmeet P. Singh

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Cardiac resynchronization therapy (CRT) is an important treatment for patients with congestive heart failure and ventricular dyssynchrony, but response to CRT is highly variable. We assessed whether a scoring system that encompasses a combination of patient selection and procedural variables would improve prediction of CRT response. Thirty-nine patients who underwent CRT with echocardiographic assessment of baseline contractility and left ventricular (LV) dyssynchrony, intraprocedural assessment of LV lead electrical delay, and postprocedural chest radiography were included. Baseline LV dyssynchrony was measured by Doppler tissue velocity imaging as the maximum time difference between peak systolic velocity of anterior, lateral, posterior, and septal walls. The hemodynamic effect of CRT was measured by Doppler analysis of mitral regurgitation as percent change in maximal +dP/dt (ΔdP/dt) with CRT on versus off. Acute responders to CRT were defined as Δdp/dt ≥25%. Clinical response was measured as a combined end point of hospitalization for heart failure and all-cause mortality. A 4-point response score was generated using variables associated with ΔdP/dt and assigning 1 point for a dorsoventral LV/right ventricular interlead distance >10 cm, 1 point for a LV lead electrical delay ≥50%, 1 point for a baseline maximum +dP/dt <600 mm Hg/s, and 1 point for a maximum time difference >100 ms. In conclusion, there was a significant association between response score (0 to 4 points) and acute hemodynamic response to CRT (p <0.0001). Kaplan-Meier analysis associated a higher response score with improved 12-month event-free survival after CRT implantation (p = 0.0019).

Original languageEnglish
Pages (from-to)1732-1736
Number of pages5
JournalAmerican Journal of Cardiology
Volume97
Issue number12
DOIs
StatePublished - Jun 15 2006
Externally publishedYes

Fingerprint

Cardiac Resynchronization Therapy
Hemodynamics
Heart Failure
Kaplan-Meier Estimate
Mitral Valve Insufficiency
Radiography
Patient Selection
Disease-Free Survival
Hospitalization
Thorax
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Usefulness of a Novel "Response Score" to Predict Hemodynamic and Clinical Outcome from Cardiac Resynchronization Therapy. / Heist, E. Kevin; Taub, Cynthia; Fan, Dali; Arzola-Castaner, Daniel; Alabiad, Chrisfouad Raif; Reddy, Vivek Y.; Mansour, Moussa; Mela, Theofanie; Picard, Michael H.; Ruskin, Jeremy N.; Singh, Jagmeet P.

In: American Journal of Cardiology, Vol. 97, No. 12, 15.06.2006, p. 1732-1736.

Research output: Contribution to journalArticle

Heist, EK, Taub, C, Fan, D, Arzola-Castaner, D, Alabiad, CR, Reddy, VY, Mansour, M, Mela, T, Picard, MH, Ruskin, JN & Singh, JP 2006, 'Usefulness of a Novel "Response Score" to Predict Hemodynamic and Clinical Outcome from Cardiac Resynchronization Therapy', American Journal of Cardiology, vol. 97, no. 12, pp. 1732-1736. https://doi.org/10.1016/j.amjcard.2006.01.035
Heist, E. Kevin ; Taub, Cynthia ; Fan, Dali ; Arzola-Castaner, Daniel ; Alabiad, Chrisfouad Raif ; Reddy, Vivek Y. ; Mansour, Moussa ; Mela, Theofanie ; Picard, Michael H. ; Ruskin, Jeremy N. ; Singh, Jagmeet P. / Usefulness of a Novel "Response Score" to Predict Hemodynamic and Clinical Outcome from Cardiac Resynchronization Therapy. In: American Journal of Cardiology. 2006 ; Vol. 97, No. 12. pp. 1732-1736.
@article{ec31f6d2588e4ae6904c00abd43980fa,
title = "Usefulness of a Novel {"}Response Score{"} to Predict Hemodynamic and Clinical Outcome from Cardiac Resynchronization Therapy",
abstract = "Cardiac resynchronization therapy (CRT) is an important treatment for patients with congestive heart failure and ventricular dyssynchrony, but response to CRT is highly variable. We assessed whether a scoring system that encompasses a combination of patient selection and procedural variables would improve prediction of CRT response. Thirty-nine patients who underwent CRT with echocardiographic assessment of baseline contractility and left ventricular (LV) dyssynchrony, intraprocedural assessment of LV lead electrical delay, and postprocedural chest radiography were included. Baseline LV dyssynchrony was measured by Doppler tissue velocity imaging as the maximum time difference between peak systolic velocity of anterior, lateral, posterior, and septal walls. The hemodynamic effect of CRT was measured by Doppler analysis of mitral regurgitation as percent change in maximal +dP/dt (ΔdP/dt) with CRT on versus off. Acute responders to CRT were defined as Δdp/dt ≥25{\%}. Clinical response was measured as a combined end point of hospitalization for heart failure and all-cause mortality. A 4-point response score was generated using variables associated with ΔdP/dt and assigning 1 point for a dorsoventral LV/right ventricular interlead distance >10 cm, 1 point for a LV lead electrical delay ≥50{\%}, 1 point for a baseline maximum +dP/dt <600 mm Hg/s, and 1 point for a maximum time difference >100 ms. In conclusion, there was a significant association between response score (0 to 4 points) and acute hemodynamic response to CRT (p <0.0001). Kaplan-Meier analysis associated a higher response score with improved 12-month event-free survival after CRT implantation (p = 0.0019).",
author = "Heist, {E. Kevin} and Cynthia Taub and Dali Fan and Daniel Arzola-Castaner and Alabiad, {Chrisfouad Raif} and Reddy, {Vivek Y.} and Moussa Mansour and Theofanie Mela and Picard, {Michael H.} and Ruskin, {Jeremy N.} and Singh, {Jagmeet P.}",
year = "2006",
month = "6",
day = "15",
doi = "10.1016/j.amjcard.2006.01.035",
language = "English",
volume = "97",
pages = "1732--1736",
journal = "American Journal of Cardiology",
issn = "0002-9149",
publisher = "Elsevier Inc.",
number = "12",

}

TY - JOUR

T1 - Usefulness of a Novel "Response Score" to Predict Hemodynamic and Clinical Outcome from Cardiac Resynchronization Therapy

AU - Heist, E. Kevin

AU - Taub, Cynthia

AU - Fan, Dali

AU - Arzola-Castaner, Daniel

AU - Alabiad, Chrisfouad Raif

AU - Reddy, Vivek Y.

AU - Mansour, Moussa

AU - Mela, Theofanie

AU - Picard, Michael H.

AU - Ruskin, Jeremy N.

AU - Singh, Jagmeet P.

PY - 2006/6/15

Y1 - 2006/6/15

N2 - Cardiac resynchronization therapy (CRT) is an important treatment for patients with congestive heart failure and ventricular dyssynchrony, but response to CRT is highly variable. We assessed whether a scoring system that encompasses a combination of patient selection and procedural variables would improve prediction of CRT response. Thirty-nine patients who underwent CRT with echocardiographic assessment of baseline contractility and left ventricular (LV) dyssynchrony, intraprocedural assessment of LV lead electrical delay, and postprocedural chest radiography were included. Baseline LV dyssynchrony was measured by Doppler tissue velocity imaging as the maximum time difference between peak systolic velocity of anterior, lateral, posterior, and septal walls. The hemodynamic effect of CRT was measured by Doppler analysis of mitral regurgitation as percent change in maximal +dP/dt (ΔdP/dt) with CRT on versus off. Acute responders to CRT were defined as Δdp/dt ≥25%. Clinical response was measured as a combined end point of hospitalization for heart failure and all-cause mortality. A 4-point response score was generated using variables associated with ΔdP/dt and assigning 1 point for a dorsoventral LV/right ventricular interlead distance >10 cm, 1 point for a LV lead electrical delay ≥50%, 1 point for a baseline maximum +dP/dt <600 mm Hg/s, and 1 point for a maximum time difference >100 ms. In conclusion, there was a significant association between response score (0 to 4 points) and acute hemodynamic response to CRT (p <0.0001). Kaplan-Meier analysis associated a higher response score with improved 12-month event-free survival after CRT implantation (p = 0.0019).

AB - Cardiac resynchronization therapy (CRT) is an important treatment for patients with congestive heart failure and ventricular dyssynchrony, but response to CRT is highly variable. We assessed whether a scoring system that encompasses a combination of patient selection and procedural variables would improve prediction of CRT response. Thirty-nine patients who underwent CRT with echocardiographic assessment of baseline contractility and left ventricular (LV) dyssynchrony, intraprocedural assessment of LV lead electrical delay, and postprocedural chest radiography were included. Baseline LV dyssynchrony was measured by Doppler tissue velocity imaging as the maximum time difference between peak systolic velocity of anterior, lateral, posterior, and septal walls. The hemodynamic effect of CRT was measured by Doppler analysis of mitral regurgitation as percent change in maximal +dP/dt (ΔdP/dt) with CRT on versus off. Acute responders to CRT were defined as Δdp/dt ≥25%. Clinical response was measured as a combined end point of hospitalization for heart failure and all-cause mortality. A 4-point response score was generated using variables associated with ΔdP/dt and assigning 1 point for a dorsoventral LV/right ventricular interlead distance >10 cm, 1 point for a LV lead electrical delay ≥50%, 1 point for a baseline maximum +dP/dt <600 mm Hg/s, and 1 point for a maximum time difference >100 ms. In conclusion, there was a significant association between response score (0 to 4 points) and acute hemodynamic response to CRT (p <0.0001). Kaplan-Meier analysis associated a higher response score with improved 12-month event-free survival after CRT implantation (p = 0.0019).

UR - http://www.scopus.com/inward/record.url?scp=33744510062&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33744510062&partnerID=8YFLogxK

U2 - 10.1016/j.amjcard.2006.01.035

DO - 10.1016/j.amjcard.2006.01.035

M3 - Article

C2 - 16765123

AN - SCOPUS:33744510062

VL - 97

SP - 1732

EP - 1736

JO - American Journal of Cardiology

JF - American Journal of Cardiology

SN - 0002-9149

IS - 12

ER -