A Novel Index Combining Diastolic and Systolic Tissue Doppler Parameters
for Predicting Cardiac Resynchronization Therapy Response
Abstract
Objective:Identification of patients who are nonresponders to cardiac
resynchronization therapy (CRT) with the use of simple and objective
parameters may be helpful in tailoring treatment. The aim of this study
is to investigate whether E/(Ea×Sa) could be a predictor of CRT
nonresponders (E=early diastolic transmitral velocity, Ea=early
diastolic mitral annular velocity, Sa=systolic mitral annular velocity).
Methods:In total, 53 heart failure patients were evaluated for this
study, and 33 patients were included according to the study criteria.
Before and six months after CRT-D(CRT with a defibrillator)
implantation, E, Ea, and Sa were determined at the medial and lateral
mitral annular sites, and the average values were obtained. E/(Ea×Sa)
was calculated (medial, lateral, average). The patients were followed
for six months to monitor their CRT response. A responder was defined as
a patient with a reduction in end-systolic volume of <15% and
an increase in six-minute walking distance of 50 meters. Results:At a
six-month follow-up, 24(72.7%) of the 33 patients responded to CRT. At
the six-month follow-up, in the responder group, the E/Ea ratio, lateral
mitral, and average E/(Ea×Sa) indices were significantly reduced
(p<0.01 for all). The baseline lateral mitral, medial mitral,
and average E/(Ea×Sa) indices were significantly lower in the responder
group than in the nonresponder group (p≤0.01 for all). The ROC analysis
showed that all the E/(Ea×Sa) indices predict the CRT nonresponder
patients. The AUC values were 0.89(lateral E/(Ea×Sa)), 0.85(average
E/(Ea×Sa)), and 0.77(medial E/(Ea×Sa))(p≤0.01 for all). Conclusion:We
found that the E/(Ea×Sa) index is a novel predictor of CRT nonresponder
patients.