Echocardiographic Predictors of Worse Outcome After Cardiac Resynchronization Therapy

Eduardo Arrais Rocha Francisca Tatiana Moreira Pereira José Sebastião Abreu José Wellington O. Lima Marcelo de Paula M. Monteiro Almino Cavalcante Rocha Neto Ana Rosa Pinto Quidute Camilla Viana A. Goés Carlos Roberto Martins Rodrigues Sobrinho Maurício Ibrahim Scanavacca About the authors

Abstract

Background:

Cardiac resynchronization therapy (CRT) is the recommended treatment by leading global guidelines. However, 30%-40% of selected patients are non-responders.

Objective:

To develop an echocardiographic model to predict cardiac death or transplantation (Tx) 1 year after CRT.

Method:

Observational, prospective study, with the inclusion of 116 patients, aged 64.89 ± 11.18 years, 69.8% male, 68,1% in NYHA FC III and 31,9% in FC IV, 71.55% with left bundle-branch block, and median ejection fraction (EF) of 29%. Evaluations were made in the pre‑implantation period and 6-12 months after that, and correlated with cardiac mortality/Tx at the end of follow-up. Cox and logistic regression analyses were performed with ROC and Kaplan-Meier curves. The model was internally validated by bootstrapping.

Results:

There were 29 (25%) deaths/Tx during follow-up of 34.09 ± 17.9 months. Cardiac mortality/Tx was 16.3%. In the multivariate Cox model, EF < 30%, grade III/IV diastolic dysfunction and grade III mitral regurgitation at 6‑12 months were independently related to increased cardiac mortality or Tx, with hazard ratios of 3.1, 4.63 and 7.11, respectively. The area under the ROC curve was 0.78.

Conclusion:

EF lower than 30%, severe diastolic dysfunction and severe mitral regurgitation indicate poor prognosis 1 year after CRT. The combination of two of those variables indicate the need for other treatment options.

Keywords:
Heart Failure/ mortality; Echocardiography; Pacemaker, Artificial; Cardiac Resynchronization Therapy; Risk Factors

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