Validation of an echocardiographic multiparametric strategy to increase responders patients after cardiac resynchronization: a multicentre study
| Autor: | Frédéric Franceschi, Gilbert Habib, Hasnaa Belghiti, Jean-Claude Deharo, Antoine Deplagne, Erwan Donal, Pierre Dos Santos, Raymond Roudaut, Stéphane Lafitte, Julie Chabaneix, Pierre Bordachar, Jacques Clementy, Aude Mignot, Hannan Bougted, P. Reant, Christophe Leclercq, Amira Zaroui |
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| Přispěvatelé: | Département de cardiologie, CHU Bordeaux [Bordeaux]-Hôpital Haut-Lévêque [CHU Bordeaux], CHU Bordeaux [Bordeaux], Adaptation cardiovasculaire à l'ischemie, Université Bordeaux Segalen - Bordeaux 2-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de cardiologie et maladies vasculaires [Rennes] = Cardiac, Thoracic, and Vascular Surgery [Rennes], CHU Pontchaillou [Rennes], Service de cardiologie, Université de la Méditerranée - Aix-Marseille 2-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE) |
| Rok vydání: | 2009 |
| Předmět: |
Male
medicine.medical_treatment Mean QRS Duration 030204 cardiovascular system & hematology MESH: Epidemiologic Methods MESH: Stroke Volume Ventricular Dysfunction Left MESH: Aged 80 and over 0302 clinical medicine [INFO.INFO-TS]Computer Science [cs]/Signal and Image Processing Mitral valve MESH: Ventricular Dysfunction Left 030212 general & internal medicine Ultrasonography Aged 80 and over MESH: Aged MESH: Middle Aged Ejection fraction Cardiac Pacing Artificial Stroke volume Middle Aged medicine.anatomical_structure Echocardiography cardiovascular system Cardiology Female [SDV.IB]Life Sciences [q-bio]/Bioengineering Cardiology and Cardiovascular Medicine [SPI.SIGNAL]Engineering Sciences [physics]/Signal and Image processing Algorithms medicine.medical_specialty Cardiac resynchronization therapy Heart failure MESH: Algorithms MESH: Cardiac Pacing Artificial 03 medical and health sciences [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system Cardiac resynchronization Internal medicine medicine Humans cardiovascular diseases Systole Ventricular dyssynchrony Aged MESH: Humans business.industry Stroke Volume medicine.disease MESH: Male MESH: Heart Failure Epidemiologic Methods business MESH: Female |
| Zdroj: | European Heart Journal European Heart Journal, 2009, 30 (23), pp.2880-7. ⟨10.1093/eurheartj/ehn582⟩ European Heart Journal, Oxford University Press (OUP): Policy B, 2009, 30 (23), pp.2880-7. ⟨10.1093/eurheartj/ehn582⟩ |
| ISSN: | 1522-9645 0195-668X |
| Popis: | International audience; AIMS: We sought to develop and validate a multiparametric algorithm by applying previously validated criteria to predict cardiac resynchronization therapy (CRT) response in a multicentre study. Thirty per cent of patients treated by CRT fail to respond to the treatment. Although dyssynchrony by echocardiography has been used to improve the selection of patients, the complexity of myocardial contraction has generated a moderate improvement using any of several individual parameters. METHODS AND RESULTS: Two hundred end-stage heart failure patients [NYHA 3-4 and left ventricular ejection fraction (LVEF)120 ms were included. Echocardiography analysis focused on the following parameters: atrioventricular dyssynchrony, interventricular dyssynchrony, and intraventricular dyssynchrony that integrated radial (PSAX M-mode) and longitudinal [tissue Doppler imaging (TDI)] evaluations for spatial (wall to wall) and temporal (wall end-systole to mitral valve opening) dyssynchrony diagnosis. Following CRT implantation, patients were monitored for 6 months with functional and echo evaluations defining responders by a 15% reduction in end-systolic volume. Mean QRS duration and LVEF were 152 +/- 17 ms and 25 +/- 8%. There was a CRT response in 57% of patients, independent of QRS width. Mean prevalence of positive criteria was 34 +/- 8%. Feasibility and variability averages were 81 +/- 20% and 9 +/- 4%. In a single parametric approach, ranges of sensitivities and specificities were 18-65% and 45-84% with a mean of 41% and 66%. A multiparametric approach by focusing on criteria combination decreased the mean rate of false-positive results to 14 +/- 12%, 5 +/- 4%, 2 +/- 2%, and 1 +/- 2% from one to four parameters, respectively. More than three parameters were associated with a specificity above 90% and a positive predictive value above 65%. Reproducibility of this global strategy was 91%. CONCLUSION: A multiparametric echocardiographic strategy based on the association of conventional criteria is a better indicator of CRT response than the existing single parametric approaches. |
| Databáze: | OpenAIRE |
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