PMID- 16567286
OWN - NLM
STAT- MEDLINE
DCOM- 20060921
LR  - 20191210
IS  - 1547-5271 (Print)
IS  - 1547-5271 (Linking)
VI  - 3
IP  - 4
DP  - 2006 Apr
TI  - Prospective validation of stress echocardiography as an identifier of cardiac 
      resynchronization therapy responders.
PG  - 406-13
AB  - BACKGROUND: Cardiac resynchronization therapy (CRT) provides benefit for 
      congestive heart failure (CHF), but predictors of the clinical response are 
      debated. OBJECTIVE: The aim of this prospective study was to assess the 
      predictive role of dobutamine stress echocardiography (DSE) in identifying a 
      suitable candidate for CRT. METHODS: From March 2001 to December 2003, 71 CHF 
      patients were prospectively enrolled on the basis of four criteria: New York 
      Heart Association (NYHA) class III and IV; QRS > or =150 ms with a left bundle 
      branch block pattern, and left ventricular ejection fraction (LVEF) < or =35% 
      under optimal medical treatment. The combined endpoints were hospital readmission 
      for class IV CHF, heart transplant (HT), and CHF-related death. RESULTS: The 67 
      patients completing the study presented with the following characteristics: age 
      (70 +/- 10 years; 11 women); etiology (idiopathic in 44, ischemic in 23); NYHA 
      class (40 in class III and 27 in class IV); LVEF 26% (+/-5%); QRS duration (190 
      +/- 28 ms); 6-minute walk test 330 m (+/-108); peak oxygen uptake 10.7 (+/-3.3 
      mL/kg/min); mitral insufficiency in 42 (> or =III grade); interventricular (IV) 
      delay (62 +/- 21 ms); and intraventricular dyssynchrony in 30 patients. Over the 
      follow-up period of 12.1 +/- 8.7 months, 20 (29.9%) of 67 patients presented with 
      at least one hemodynamic event: hospitalization for CHF in 19 (28%) of 67, HT in 
      2 (3%) of 67, and CHF death in 7 (10%) 67. Univariate analysis identified NYHA 
      class (P = .03), LVEF (P = .015), IV dyssynchrony before (P = .038) and after CRT 
      (P = .0035), IV delay after CRT (P = .002), 6-minute walk distance (P = .01), and 
      DSE Res+ (P = .008) as significant predictors of clinical events. A receiver 
      operating curve established a cut-off value of 1.25 for the DSE responders (Res+: 
      34 patients at 10 microg/kg/min infusion rates), and the improvement at the 10 
      microg/kg/min level was 41% +/- 7% in Res+ and 29% +/- 8% in nonresponders 
      (P<.0001). With a cut-off value of 1.25-fold the LVEF increase, the DSE test 
      exhibits 70% sensitivity, 61.7% specificity, 43.8% positive predictive value, and 
      82.9% negative predictive value. Cox analysis identified IV dyssynchrony before 
      CRT (P = .01) and DSE Res+ (P = .003) as independent predictive factors. 
      CONCLUSIONS: Independent predictive factors of severe hemodynamic clinical 
      outcome in patients with CRT are IV dyssynchrony and DSE.
FAU - Da Costa, Antoine
AU  - Da Costa A
AD  - Division of Cardiology, University Jean Monnet of Saint-Etienne, Saint-Etienne, 
      France. dakosta@aol.com
FAU - Thevenin, Jerome
AU  - Thevenin J
FAU - Roche, Frederic
AU  - Roche F
FAU - Faure, Emmanuel
AU  - Faure E
FAU - Romeyer-Bouchard, Cecile
AU  - Romeyer-Bouchard C
FAU - Messier, Marc
AU  - Messier M
FAU - Convert, Gilles
AU  - Convert G
FAU - Barthelemy, Jean Claude
AU  - Barthelemy JC
FAU - Isaaz, Karl
AU  - Isaaz K
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Validation Study
PL  - United States
TA  - Heart Rhythm
JT  - Heart rhythm
JID - 101200317
SB  - IM
CIN - Heart Rhythm. 2006 Apr;3(4):414-5. PMID: 16567287
MH  - Aged
MH  - Aged, 80 and over
MH  - Analysis of Variance
MH  - Bundle-Branch Block/diagnostic imaging/therapy
MH  - *Cardiac Pacing, Artificial
MH  - *Echocardiography, Stress
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Conduction System/diagnostic imaging/*physiopathology/surgery
MH  - Heart Failure/*diagnostic imaging/physiopathology/*therapy
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Contraction
MH  - Oxygen Consumption
MH  - Pacemaker, Artificial
MH  - Predictive Value of Tests
MH  - Prospective Studies
MH  - Research Design
MH  - Stroke Volume
MH  - Treatment Outcome
MH  - Ventricular Dysfunction, Left/diagnostic imaging/therapy
EDAT- 2006/03/29 09:00
MHDA- 2006/09/22 09:00
CRDT- 2006/03/29 09:00
PHST- 2005/11/04 00:00 [received]
PHST- 2005/12/20 00:00 [accepted]
PHST- 2006/03/29 09:00 [pubmed]
PHST- 2006/09/22 09:00 [medline]
PHST- 2006/03/29 09:00 [entrez]
AID - S1547-5271(05)02472-0 [pii]
AID - 10.1016/j.hrthm.2005.12.017 [doi]
PST - ppublish
SO  - Heart Rhythm. 2006 Apr;3(4):406-13. doi: 10.1016/j.hrthm.2005.12.017.