Author + information
- John Suffredinia,b,
- Gregory Sinnera,b,
- Samy-Claude Elayia,b,
- Steve Leunga,b,
- Vincent Sorrella,b and
- Paul Anayaa,b
Background: Cardiac Resynchronization Therapy (CRT) improves outcomes in low EF patients with left bundle branch block (LBBB) ≥ 150 ms, yet predicting CRT response among patients with shorter QRS durations or non-LBBB patterns remains a clinical challenge. Ventricular-arterial coupling (VAC) is a non-invasive echocardiographic measure of arterial and left ventricular (LV) elastance. This study investigates VAC as a predictor of response for patients meeting Class IIa indications for CRT.
Methods: This is a retrospective review of 51 patients who underwent CRT for an AHA/ACC Class IIa indication. The VAC ratio was calculated for patients with available echocardiograms (N=38). CRT response was defined as an absolute increase in EF of ≥ 5% or a reduction in LV end-systolic volume (LVESV) of ≥ 15%. Receiver operating characteristic (ROC) analysis was used to compare different VAC criterion.
Results: A VAC ratio ≥ 1.55 was 80.0% sensitive and 95.7% specific in predicting EF response to CRT (AUC 0.90, 95% CI 0.76 to 0.98; p<0.0001), whereas a ratio ≥ 1.38 was 78.9% sensitive and 84.2% specific in predicting LVESV response to CRT (AUC 0.89, 95% CI 0.74 to 0.97; p<0.0001).
Conclusions: A pre-implant VAC ratio of >1.5 was strongly predictive of subsequent hemodynamic response following CRT in patients meeting Class IIa indications. This study supports the use of VAC as a non-invasive tool to identify patients who may achieve the greatest benefit from CRT.
Moderated Poster Contributions
Arrhythmias and Clinical EP Moderated Poster Theater, Poster Hall, Hall C
Sunday, March 19, 2017, 10:00 a.m.-10:10 a.m.
Session Title: Arrhythmias and Heart Failure
Abstract Category: 5. Arrhythmias and Clinical EP: Devices
Presentation Number: 1305M-05
- 2017 American College of Cardiology Foundation