Association of apical rocking with superresponse

Authors: A Ghani PPHM Delnoy JJJ Smit JP Ottervanger AR Ramdat Misier A Adiyaman A Elvan

Publish Date: 2015/12/09

Volume: 24, Issue: 1, Pages: 39-46

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Abstract

Superresponders to cardiac resynchronisation therapy CRT show an exceptional improvement in left ventricular ejection fraction LVEF Previous studies showed that apical rocking was independently associated with echocardiographic response to CRT However little is known about the association between apical rocking and superresponse to CRTA cohort of 297 consecutive heart failure patients treated with primary indication for CRTD were included in an observational registry Apical rocking was defined as motion of the left ventricular LV apical myocardium perpendicular to the LV long axis ‘Superresponse’ was defined by the top quartile of LVEF response based on change from baseline to followup echocardiogram Bestsubset regression analysis identified predictors of LVEF superresponse to CRTApical rocking was present in 45  of patients Superresponders had an absolute mean LVEF increase of 27  LVEF 220  ± 57 at baseline and 490  ± 75 at followup Apical rocking was significantly more common in superresponders compared with nonsuperresponders 76 and 34  P  0001 In univariate analysis female gender OR 239 95  CI 138–411 lower LVEF at baseline OR 091 95  CI 087–095 nonischaemic aetiology OR 415 95  CI 233–739 and apical rocking OR 619 95  CI 340–1125 were associated with superresponse In multivariate analysis apical rocking was still strongly associated with superresponse OR 582 95  CI 268–1261 Superresponders showed an excellent clinical prognosis with a very low incidence of heart failure admission cardiac mortality and appropriate ICD therapyCardiac resynchronisation therapy with a defibrillator CRTD has proven to improve heart failure morbidity quality of life and survival in those with reduced left ventricular ejection fraction LVEF advanced heart failure symptoms and increased QRS duration 1 2 3 4 5 Recent studies have indicated superresponse in a proportion of patients treated with CRT 6 7 Identifying potential superresponders to CRT is an important issue because of their excellent prognosis Previous studies attempted to find easily identifiable clinical factors to predict superresponse to CRT Female gender body mass index BMI  30 kg/m2 left bundle branch block LBBB QRS duration  150 ms smaller left ventricular LV and left atrial LA dimensions shorter duration of heart failure symptoms and nonischaemic cardiomyopathy were factors associated with superresponse to CRT 8 9 10 11 albeit with a relatively weak relation There is an obvious need for a stronger predictor for these patients Apical rocking is an easily measured echocardiographic parameter and has been introduced as a promising predictor of CRT 12 13 14 However to our knowledge there are no data on the value of apical rocking as a predictor of superresponse to CRT Therefore the aim of the current study was to assess the value of apical rocking as an independent predictor of superresponse to CRT in a large cohort of patients treated with CRTD

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