Diastolic filling pattern and left ventricular diameter predict response and prognosis after cardiac resynchronization therapy

Rainer Gradaus ^1*, Verena Stuckenborg ¹, Andreas Löher ², Julia Köbe ¹, Florian Reinke ¹, Stefan Gunia ¹, Christian Vahlhaus ¹, Günter Breithardt ¹ and Christian Bruch ¹

¹ University Hospital Munster, Department of Cardiology, Germany
² University Hospital Munster, Department of Thoracic and Cardiovascular Surgery, Germany

^* To whom correspondence should be addressed. E-mail: gradaus{at}uni-muenster.de.

Accepted 9 October 2007

Abstract

Objectives The purpose of this study was to investigate predisposing factors for cardiac resynchronization therapy (CRT) response.

Design Single center study.

Setting University hospital in Germany.

Patients 122 consecutive heart failure patients (65±11 years; ischemic/non-ischemic 41% / 55%; NYHA 3.1±0.3; LV-EF 22±7%; QRS-width 170±32 msec, QoL 43.5±19.2) with an indication for CRT and demonstrated left ventricular dyssynchrony by echocardiography including Tissue Doppler imaging.

Interventions Besides clinical parameters lab testing, ECG, echocardiography including Tissue Doppler imaging, invasive hemodynamics, parameters of quality-of-life and of exercise capacity were obtained before CRT implantation and during follow-up.

Main outcome measure Responders were predefined as improvement by one or more NYHA functional class or reduction of LV endsystolic volume by 10% or more during follow-up. Mean follow-up was 418 ± 350 days.

Results Overall, 70.5% of patients responded to CRT therapy. Responders had a significantly improved survival compared to non-responder (96.2% versus 45.5%, log-rank p<0.001). On univariate analysis, LV-EDD, LV-ESD, E/A ratio, a restrictive filling pattern, mean PA-pressure, PC-pressure, NT-proBNP, and VO2max were significant predictors of outcome. On multivariate analyses, LV-ESD (p=0.009; F=7.83), PC-pressure (p=0.015, F=6.61), and a restrictive filling pattern (p=0.026, F=5.707) remained significant predictors of response.

Conclusions Despite treatment according to present guidelines nearly 30% of patients had no benefit from CRT treatment in a clinical setting. On multivariate analyses, patients with an increased LV endsystolic diameter and concomitant diastolic dysfunction had a significantly worse outcome.

Keywords: cardiac resynchronization therapy, left ventricular diastolic dysfunction, prognosis

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