Clinical research
A new baseline scoring system may help to predict response to cardiac resynchronization therapy
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Submission date: 2010-09-16
Final revision date: 2010-11-23
Acceptance date: 2010-12-19
Online publication date: 2011-09-02
Publication date: 2011-08-30
Arch Med Sci 2011;7(4):627-633
Introduction : The PROSPECT trial reported no single echocardiographic measurement of dyssynchrony is recommended to improve patient selection for cardiac resynchronization therapy (CRT).
Material and methods : In 100 consecutive patients who received CRT, we analyzed 27 ECG and echocardiographic variables to predict a positive response to CRT defined as a left ventricular (LV) end systolic volume decrease of  15% after CRT.
Results : Right ventricular (RV) pacing-induced left bundle branch block (LBBB), time difference between LV ejection measured by tissue Doppler and pulsed wave Doppler (TTDI-PW), and wall motion score index (WMSI) were significantly associated with positive CRT response by multivariate regression. We assigned 1 point for RV pacing-induced LBBB, 1 point for WMSI  1.59, and 2 points for TTDI-PW > 50 ms. Overall mean response score was 1.79 ±1.39. Cutoff point for response score to predict positive response to CRT was > 2 by receiver operating characteristic (ROC) analysis. Area under ROC curve was 0.97 (p = 0.0001). Cardiac resynchronization therapy responders in patients with response score > 2 and  2 were 36/38 (95%) and 7/62 (11%, p < 0.001), respectively. After age and gender adjustment, the response score was related to CRT response (OR = 45.4, p < 0.0001).
Conclusions : A response score generated from clinical, ECG and echo­cardio­graphic variables may be a useful predictor for CRT response. However, this needs to be validated.
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