Left ventricular end-systolic volume can predict 1-year hierarchical clinical composite end point in patients with cardiac resynchronization therapy

Jae Sun Uhm, Jaewon Oh, In Jeong Cho, Minsu Park, In Soo Kim, Moo Nyun Jin, Han Joon Bae, Hee Tae Yu, Tae Hoon Kim, Hui Nam Pak, Moon Hyoung Lee, Boyoung Joung, Seok Min Kang

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Abstract

Purpose: This study aimed to elucidate which echocardiographic criteria at three time points, for cardiac resynchronization therapy (CRT) response, are accurate in discriminating the hierarchical clinical composite end point (HCCEP). Materials and Methods: We included 120 patients (age, 66.1±12.6 years; men, 54.2%) who underwent CRT implantation for heart failure (HF). Echocardiography was performed before and at 3, 6, and 12 months after CRT implantation. The 1-year HCCEP included all-cause mortality, hospitalization for HF, and New York Heart Association functional class for 12 months. CRT response criteria were decrease in left ventricular (LV) end-systolic volume (LVESV) >15%, decrease in LV end-diastolic volume >15%, absolute increase in LV ejection fraction (LVEF) ≥5%, relative increase in LVEF ≥15%, and decrease in mitral regurgitation ≥1 grade. Temporal changes in CRT response rates, accuracy of CRT response criteria at each time and cutoff value for the discrimination of improvement in HCCEP, and agreements with improvement in HCCEP were analyzed. Results: HCCEP improvement rates were 65.8% in total group. In nonischemic group, CRT response rates according to all echocardiographic criteria significantly increased with time. In ischemic group, CRT response rate did not significantly change with time. In total group, ΔLVESV at 6 months (ΔLVESV6) had the most significant accuracy for the discrimination of HCCEP (area under the curve=0.781). The optimal cutoff value of ΔLVESV6 was 13.5% (sensitivity=0.719, specificity=0.719). ΔLVESV6 had fair agreement with HCCEP (κ=0.391, p<0.001). Conclusion: ΔLVESV6 is the most useful echocardiographic CRT response criterion for the prediction of 1-year HCCEP.

Original languageEnglish
Pages (from-to)48-55
Number of pages8
JournalYonsei medical journal
Volume60
Issue number1
DOIs
Publication statusPublished - 2019 Jan

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Cardiac Resynchronization Therapy
Stroke Volume
Heart Failure
Mitral Valve Insufficiency
Area Under Curve
Echocardiography
Hospitalization
Sensitivity and Specificity
Mortality

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Uhm, Jae Sun ; Oh, Jaewon ; Cho, In Jeong ; Park, Minsu ; Kim, In Soo ; Jin, Moo Nyun ; Bae, Han Joon ; Yu, Hee Tae ; Kim, Tae Hoon ; Pak, Hui Nam ; Lee, Moon Hyoung ; Joung, Boyoung ; Kang, Seok Min. / Left ventricular end-systolic volume can predict 1-year hierarchical clinical composite end point in patients with cardiac resynchronization therapy. In: Yonsei medical journal. 2019 ; Vol. 60, No. 1. pp. 48-55.
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title = "Left ventricular end-systolic volume can predict 1-year hierarchical clinical composite end point in patients with cardiac resynchronization therapy",
abstract = "Purpose: This study aimed to elucidate which echocardiographic criteria at three time points, for cardiac resynchronization therapy (CRT) response, are accurate in discriminating the hierarchical clinical composite end point (HCCEP). Materials and Methods: We included 120 patients (age, 66.1±12.6 years; men, 54.2{\%}) who underwent CRT implantation for heart failure (HF). Echocardiography was performed before and at 3, 6, and 12 months after CRT implantation. The 1-year HCCEP included all-cause mortality, hospitalization for HF, and New York Heart Association functional class for 12 months. CRT response criteria were decrease in left ventricular (LV) end-systolic volume (LVESV) >15{\%}, decrease in LV end-diastolic volume >15{\%}, absolute increase in LV ejection fraction (LVEF) ≥5{\%}, relative increase in LVEF ≥15{\%}, and decrease in mitral regurgitation ≥1 grade. Temporal changes in CRT response rates, accuracy of CRT response criteria at each time and cutoff value for the discrimination of improvement in HCCEP, and agreements with improvement in HCCEP were analyzed. Results: HCCEP improvement rates were 65.8{\%} in total group. In nonischemic group, CRT response rates according to all echocardiographic criteria significantly increased with time. In ischemic group, CRT response rate did not significantly change with time. In total group, ΔLVESV at 6 months (ΔLVESV6) had the most significant accuracy for the discrimination of HCCEP (area under the curve=0.781). The optimal cutoff value of ΔLVESV6 was 13.5{\%} (sensitivity=0.719, specificity=0.719). ΔLVESV6 had fair agreement with HCCEP (κ=0.391, p<0.001). Conclusion: ΔLVESV6 is the most useful echocardiographic CRT response criterion for the prediction of 1-year HCCEP.",
author = "Uhm, {Jae Sun} and Jaewon Oh and Cho, {In Jeong} and Minsu Park and Kim, {In Soo} and Jin, {Moo Nyun} and Bae, {Han Joon} and Yu, {Hee Tae} and Kim, {Tae Hoon} and Pak, {Hui Nam} and Lee, {Moon Hyoung} and Boyoung Joung and Kang, {Seok Min}",
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Left ventricular end-systolic volume can predict 1-year hierarchical clinical composite end point in patients with cardiac resynchronization therapy. / Uhm, Jae Sun; Oh, Jaewon; Cho, In Jeong; Park, Minsu; Kim, In Soo; Jin, Moo Nyun; Bae, Han Joon; Yu, Hee Tae; Kim, Tae Hoon; Pak, Hui Nam; Lee, Moon Hyoung; Joung, Boyoung; Kang, Seok Min.

In: Yonsei medical journal, Vol. 60, No. 1, 01.2019, p. 48-55.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Left ventricular end-systolic volume can predict 1-year hierarchical clinical composite end point in patients with cardiac resynchronization therapy

AU - Uhm, Jae Sun

AU - Oh, Jaewon

AU - Cho, In Jeong

AU - Park, Minsu

AU - Kim, In Soo

AU - Jin, Moo Nyun

AU - Bae, Han Joon

AU - Yu, Hee Tae

AU - Kim, Tae Hoon

AU - Pak, Hui Nam

AU - Lee, Moon Hyoung

AU - Joung, Boyoung

AU - Kang, Seok Min

PY - 2019/1

Y1 - 2019/1

N2 - Purpose: This study aimed to elucidate which echocardiographic criteria at three time points, for cardiac resynchronization therapy (CRT) response, are accurate in discriminating the hierarchical clinical composite end point (HCCEP). Materials and Methods: We included 120 patients (age, 66.1±12.6 years; men, 54.2%) who underwent CRT implantation for heart failure (HF). Echocardiography was performed before and at 3, 6, and 12 months after CRT implantation. The 1-year HCCEP included all-cause mortality, hospitalization for HF, and New York Heart Association functional class for 12 months. CRT response criteria were decrease in left ventricular (LV) end-systolic volume (LVESV) >15%, decrease in LV end-diastolic volume >15%, absolute increase in LV ejection fraction (LVEF) ≥5%, relative increase in LVEF ≥15%, and decrease in mitral regurgitation ≥1 grade. Temporal changes in CRT response rates, accuracy of CRT response criteria at each time and cutoff value for the discrimination of improvement in HCCEP, and agreements with improvement in HCCEP were analyzed. Results: HCCEP improvement rates were 65.8% in total group. In nonischemic group, CRT response rates according to all echocardiographic criteria significantly increased with time. In ischemic group, CRT response rate did not significantly change with time. In total group, ΔLVESV at 6 months (ΔLVESV6) had the most significant accuracy for the discrimination of HCCEP (area under the curve=0.781). The optimal cutoff value of ΔLVESV6 was 13.5% (sensitivity=0.719, specificity=0.719). ΔLVESV6 had fair agreement with HCCEP (κ=0.391, p<0.001). Conclusion: ΔLVESV6 is the most useful echocardiographic CRT response criterion for the prediction of 1-year HCCEP.

AB - Purpose: This study aimed to elucidate which echocardiographic criteria at three time points, for cardiac resynchronization therapy (CRT) response, are accurate in discriminating the hierarchical clinical composite end point (HCCEP). Materials and Methods: We included 120 patients (age, 66.1±12.6 years; men, 54.2%) who underwent CRT implantation for heart failure (HF). Echocardiography was performed before and at 3, 6, and 12 months after CRT implantation. The 1-year HCCEP included all-cause mortality, hospitalization for HF, and New York Heart Association functional class for 12 months. CRT response criteria were decrease in left ventricular (LV) end-systolic volume (LVESV) >15%, decrease in LV end-diastolic volume >15%, absolute increase in LV ejection fraction (LVEF) ≥5%, relative increase in LVEF ≥15%, and decrease in mitral regurgitation ≥1 grade. Temporal changes in CRT response rates, accuracy of CRT response criteria at each time and cutoff value for the discrimination of improvement in HCCEP, and agreements with improvement in HCCEP were analyzed. Results: HCCEP improvement rates were 65.8% in total group. In nonischemic group, CRT response rates according to all echocardiographic criteria significantly increased with time. In ischemic group, CRT response rate did not significantly change with time. In total group, ΔLVESV at 6 months (ΔLVESV6) had the most significant accuracy for the discrimination of HCCEP (area under the curve=0.781). The optimal cutoff value of ΔLVESV6 was 13.5% (sensitivity=0.719, specificity=0.719). ΔLVESV6 had fair agreement with HCCEP (κ=0.391, p<0.001). Conclusion: ΔLVESV6 is the most useful echocardiographic CRT response criterion for the prediction of 1-year HCCEP.

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