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Open Access Research article

Predictors of positive response to cardiac resynchronization therapy

Diana Rinkuniene123*, Silvija Bucyte12, Kristina Ceseviciute1, Silvijus Abramavicius1, Kristina Baronaite-Dudoniene12, Jolanta Laukaitiene12, Tomas Kazakevicius12, Vytautas Zabiela12, Vytautas Sileikis2, Aras Puodziukynas12 and Renaldas Jurkevicius12

Author Affiliations

1 Lithuanian University of Health Sciences, Kaunas, Lithuania

2 Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania

3 Department of Cardiology, Lithuanian University of Health Sciences, Kaunas Clinics, Eiveniu 2, LT-50009 Kaunas, Lithuania

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BMC Cardiovascular Disorders 2014, 14:55  doi:10.1186/1471-2261-14-55

Published: 29 April 2014

Abstract

Background

Approximately 30% of patients treated with cardiac resynchronization therapy (CRT) do not achieve favourable response. The purpose of the present study was to identify echocardiographic and clinical predictors of a positive response to CRT.

Methods

The study included 82 consecutive heart failure (HF) patients in New York Heart Association (NYHA) functional class III or IV with left bundle branch block (LBBB), QRS duration ≥ 120 ms and left ventricular ejection fraction (LVEF) ≤ 35%. Statistical analysis was performed using IBM SPSS statistical software (SPSS v.21.0 for Mac OS X). A p value < 0.05 was considered statistically significant.

Results

Echocardiographic response was established in 81.6% and clinical response was achieved in 82.9% of patients. Significant univariate predictors of favourable echocardiographic response after 12 months were smaller left ventricular end-diastolic diameter (LVEDD) (odds ratio [OR] 0.89; 95% confidence interval [CI] 0.82 - 0.97, p = 0.01), and smaller left ventricular end-systolic diameter (LVESD) (OR 0.91; 95% CI 0.85 - 0.98, p = 0.01). Lower uric acid concentration was associated with better echocardiographic response (OR 0.99; 95% CI 0.99 - 1.0, p = 0.01). Non-ischemic HF etiology (OR 4.89; 95% CI 1.39 - 17.15, p = 0.01) independently predicted positive clinical response. Multiple stepwise regression analysis demonstrated that LVEDD lower than 75 mm (OR 5.60; 95% confidence interval [CI] 1.36 - 18.61, p = 0.01) was the strongest independent predictor of favourable echocardiographic response.

Conclusions

Smaller left ventricular end-diastolic and end-systolic diameters and lower serum uric acid concentration were associated with better response to CRT. Left ventricular end-diastolic diameter and non-ischemic heart failure etiology were the strongest independent predictors of positive response to CRT.

Keywords:
Cardiac resynchronization therapy; Heart failure; Response