Journal of the American Heart Association · 2016
Incremental Value of Speckle Tracking Echocardiography to Predict Cardiac Resynchronization Therapy (CRT) Responders.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Seo Yoshihiro, Ishizu Tomoko, Machino-Ohtsuka Tomoko, Yamamoto Masayoshi, Machino Takeshi, Kuroki Kenji, Yamasaki Hiro, Sekiguchi Yukio, Nogami Akihiko, Aonuma Kazutaka
Аннотация
BACKGROUND: Speckle tracking echocardiography (STE) is reported as a useful method to predict cardiac resynchronization therapy (CRT) responders. This study aimed to identify the incremental value of a STE parameter to predict CRT responders.
METHODS AND RESULTS: We enrolled 171 patients from the Speckle Tracking imaging for the Assessment of cardiac Resynchronization Therapy (START) study. CRT responders were defined as patients with ≥15% reduction of left ventricular (LV) end-systolic volume at 6 months post-CRT. Based on multivariable logistic regression analysis, incremental values of STE were assessed by c-statistics, net reclassification improvement (NRI)/integrated discrimination improvement (IDI), and decision curve analysis. Six parameters (left bundle branch block or right ventricular pacing, use of beta-blocker, blood urea nitrogen ≤3.0 mg/dL, LV end-systolic diameter ≤50 mm, mitral regurgitation index ≤40%, and STE parameter standard deviation of time from QRS onset to first peak on the circumferential strain curves [TSD] ≥116 ms) were identified as the determinants. Compared to the multivariable logistic regression model without TSD (model 1), that with TSD (model 2) showed significant improvement to predict CRT responders: c-statistic (0.86 vs 0.77; P<0.001), NRI=0.19, P<0.001, and IDI=0.17, P<0.001. The decision curve of model 2 was higher than that of model 1 at threshold probabilities ≥0.2. Based on model 2, a START score was constructed. Compared to the Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy (MADIT-CRT) score, the decision curve of the START score was higher than that of the MADIT-CRT score at threshold probabilities ≥0.2.
CONCLUSIONS: Based on various statistical methods, this study revealed that STE had an incremental value to predict CRT responders.
METHODS AND RESULTS: We enrolled 171 patients from the Speckle Tracking imaging for the Assessment of cardiac Resynchronization Therapy (START) study. CRT responders were defined as patients with ≥15% reduction of left ventricular (LV) end-systolic volume at 6 months post-CRT. Based on multivariable logistic regression analysis, incremental values of STE were assessed by c-statistics, net reclassification improvement (NRI)/integrated discrimination improvement (IDI), and decision curve analysis. Six parameters (left bundle branch block or right ventricular pacing, use of beta-blocker, blood urea nitrogen ≤3.0 mg/dL, LV end-systolic diameter ≤50 mm, mitral regurgitation index ≤40%, and STE parameter standard deviation of time from QRS onset to first peak on the circumferential strain curves [TSD] ≥116 ms) were identified as the determinants. Compared to the multivariable logistic regression model without TSD (model 1), that with TSD (model 2) showed significant improvement to predict CRT responders: c-statistic (0.86 vs 0.77; P<0.001), NRI=0.19, P<0.001, and IDI=0.17, P<0.001. The decision curve of model 2 was higher than that of model 1 at threshold probabilities ≥0.2. Based on model 2, a START score was constructed. Compared to the Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy (MADIT-CRT) score, the decision curve of the START score was higher than that of the MADIT-CRT score at threshold probabilities ≥0.2.
CONCLUSIONS: Based on various statistical methods, this study revealed that STE had an incremental value to predict CRT responders.