Heart failure & cardiomyopathies
Global Myocardial Work Index Predicts Response to Biventricular Pacing in Patients with Non-Left Bundle Branch Block
Authors' conclusion
High GWI assessed by speckle-tracking echocardiography and a non-invasively estimated LV pressure curve was independently associated with a favourable response to CRT and improved outcomes in patients with non-LBBB. The use of this non-invasive approach for quantifying myocardial variability and residual contractility can be beneficial for assessing CRT candidates and allow for more accurate patient stratification. Further, large multicentre studies are required to validate these findings.
Study context
- Population
- Patients with non-left bundle branch block (non-LBBB) who underwent cardiac resynchronization therapy (CRT) implantationpatients with non-LBBB, of 267 patients who underwent CRT implantation
- Participants
- 54 patients
- Exposure
- Myocardial work estimated by pressure-strain loops on echocardiography for predicting response to CRT
- Respondersn = 18
- Outcome
- CRT response
- Follow-up
- Six months after implantation
Main finding
As reported in the abstract
Patients who responded to CRT
18 patients
33%
Observational data: associations, not effects.
Further findings
Baseline global work index (GWI) · significantly higher in the responder group
P = 0.010
Global work index (GWI) as predictor of CRT response (multivariable)
| Odds ratio (95% CI) | P value | ||
|---|---|---|---|
| GWIIndependent predictor | 1.109 (1.013–1.213) | P = 0.024 | |
| 0.512Odds ratio (log scale) |
All-cause mortality · median 37-month follow-up
| Hazard ratio (95% CI) | P value | ||
|---|---|---|---|
| GWI ≤ 456 mmHg%Multivariable | 2.882 (1.157–7.176) | P = 0.023 | |
| 0.10.31310Hazard ratio (log scale) |
| Outcome | Responders | Non-responders | P value |
|---|---|---|---|
| Absolute LVEF improvement | 5.5% ± 6.9% | 1.3% ± 7.5% | P = 0.021 |
- All-cause mortality — All-cause death
- 21 patients (39%)
Baseline left ventricular ejection fraction (LVEF) · before implantation
- Mean LVEF in total
- 27% ± 8%
ROC analysis of GWI for CRT response
- Cut-off value of GWI
- 456 mmHg%
- AUC
- 0.700, 95% CI 0.553-0.840; P = 0.019
Original publication
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