The Barthel Index in Predicting Response to Cardiac Resynchronization Therapy and Clinical Outcomes in Patients With Heart Failure.

BACKGROUND

Cardiac resynchronization therapy (CRT) response in heart failure (HF) patients is multifactorial, with limited data on its association with activities of daily living assessed by the Barthel index (BI).

OBJECTIVE

This prospective observational study investigated the predictive value of BI for CRT response and long-term clinical outcomes in non-ischemic HF patients with left bundle branch block (LBBB).

METHODS

A total of 271 consecutive non-ischemic HF patients undergoing CRT with left ventricular ejection fraction (LVEF) ≤ 35% and LBBB were enrolled. BI was evaluated pre-implantation. The primary endpoint was CRT response (absolute LVEF improvement ≥ 5% at 6 months). The secondary composite endpoint included all-cause mortality and HF hospitalization (HFH).

RESULTS

Among 249 patients completing 6-month follow-up, the CRT response rate was 68.67%. Multivariate logistic regression identified BI (per 5-point increment; OR = 1.37, 95% CI:1.12-1.67, p = 0.002) as an independent predictor of CRT response, with an optimal cutoff of 95. Combining BI with left ventricular end-diastolic diameter and left bundle branch area pacing achieved the highest predictive efficacy (AUC = 0.78). Over a median 33.94-month follow-up, BI > 95 was associated with an 88% reduced risk of the composite endpoint (adjusted HR = 0.116, p < 0.001), driven primarily by marked HFH reduction. A non-significant trend toward lower all-cause mortality was observed, accompanied by sustained LVEF improvement (29.81% ± 5.01% to 51.71% ± 11.30%).

CONCLUSION

BI might be a simple, cost-effective independent predictor for CRT response and improved LVEF and prognosis in non-ischemic HF patients with LBBB.