Refining success of cardiac resynchronization therapy using a simple score predicting the amount of reverse ventricular remodelling: results from the Markers and Response to CRT (MARC) study

Alexander H Maass, Kevin Vernooy, Sofieke C Wijers, Jetske van 't Sant, Maarten J Cramer, Mathias Meine, Cornelis P Allaart, Frederik J De Lange, Frits W Prinzen, Bart Gerritse, Erna Erdtsieck, Coert O S Scheerder, Michael R S Hill, Marcoen Scholten, Mariëlle Kloosterman, Iris A H Ter Horst, Adriaan A Voors, Marc A Vos, Michiel Rienstra, Isabelle C Van Gelder

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Aims: Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in systolic heart failure patients with ventricular conduction delay. Variability of individual response to CRT warrants improved patient selection. The Markers and Response to CRT (MARC) study was designed to investigate markers related to response to CRT.

Methods and results: We prospectively studied the ability of 11 clinical, 11 electrocardiographic, 4 echocardiographic, and 16 blood biomarkers to predict CRT response in 240 patients. Response was measured by the reduction of indexed left ventricular end-systolic volume (LVESVi) at 6 months follow-up. Biomarkers were related to LVESVi change using log-linear regression on continuous scale. Covariates that were significant univariately were included in a multivariable model. The final model was utilized to compose a response score. Age was 67 ± 10 years, 63% were male, 46% had ischaemic aetiology, LV ejection fraction was 26 ± 8%, LVESVi was 75 ± 31 mL/m2, and QRS was 178 ± 23 ms. At 6 months LVESVi was reduced to 58 ± 31 mL/m2 (relative reduction of 22 ± 24%), 130 patients (61%) showed ≥ 15% LVESVi reduction. In univariate analysis 17 parameters were significantly associated with LVESVi change. In the final model age, QRSAREA (using vectorcardiography) and two echocardiographic markers (interventricular mechanical delay and apical rocking) remained significantly associated with the amount of reverse ventricular remodelling. This CAVIAR (CRT-Age-Vectorcardiographic QRSAREA -Interventricular Mechanical delay-Apical Rocking) response score also predicted clinical outcome assessed by heart failure hospitalizations and all-cause mortality.

Conclusions: The CAVIAR response score predicts the amount of reverse remodelling after CRT and may be used to improve patient selection. Clinical Trials: NCT01519908.

Original languageEnglish
Pages (from-to)e1-e10
JournalEuropace
Volume20
Issue number2
Early online date27 Feb 2017
DOIs
Publication statusPublished - 1 Feb 2018

Cite this

Maass, Alexander H ; Vernooy, Kevin ; Wijers, Sofieke C ; van 't Sant, Jetske ; Cramer, Maarten J ; Meine, Mathias ; Allaart, Cornelis P ; De Lange, Frederik J ; Prinzen, Frits W ; Gerritse, Bart ; Erdtsieck, Erna ; Scheerder, Coert O S ; Hill, Michael R S ; Scholten, Marcoen ; Kloosterman, Mariëlle ; Ter Horst, Iris A H ; Voors, Adriaan A ; Vos, Marc A ; Rienstra, Michiel ; Van Gelder, Isabelle C. / Refining success of cardiac resynchronization therapy using a simple score predicting the amount of reverse ventricular remodelling : results from the Markers and Response to CRT (MARC) study. In: Europace. 2018 ; Vol. 20, No. 2. pp. e1-e10.
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abstract = "Aims: Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in systolic heart failure patients with ventricular conduction delay. Variability of individual response to CRT warrants improved patient selection. The Markers and Response to CRT (MARC) study was designed to investigate markers related to response to CRT.Methods and results: We prospectively studied the ability of 11 clinical, 11 electrocardiographic, 4 echocardiographic, and 16 blood biomarkers to predict CRT response in 240 patients. Response was measured by the reduction of indexed left ventricular end-systolic volume (LVESVi) at 6 months follow-up. Biomarkers were related to LVESVi change using log-linear regression on continuous scale. Covariates that were significant univariately were included in a multivariable model. The final model was utilized to compose a response score. Age was 67 ± 10 years, 63{\%} were male, 46{\%} had ischaemic aetiology, LV ejection fraction was 26 ± 8{\%}, LVESVi was 75 ± 31 mL/m2, and QRS was 178 ± 23 ms. At 6 months LVESVi was reduced to 58 ± 31 mL/m2 (relative reduction of 22 ± 24{\%}), 130 patients (61{\%}) showed ≥ 15{\%} LVESVi reduction. In univariate analysis 17 parameters were significantly associated with LVESVi change. In the final model age, QRSAREA (using vectorcardiography) and two echocardiographic markers (interventricular mechanical delay and apical rocking) remained significantly associated with the amount of reverse ventricular remodelling. This CAVIAR (CRT-Age-Vectorcardiographic QRSAREA -Interventricular Mechanical delay-Apical Rocking) response score also predicted clinical outcome assessed by heart failure hospitalizations and all-cause mortality.Conclusions: The CAVIAR response score predicts the amount of reverse remodelling after CRT and may be used to improve patient selection. Clinical Trials: NCT01519908.",
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author = "Maass, {Alexander H} and Kevin Vernooy and Wijers, {Sofieke C} and {van 't Sant}, Jetske and Cramer, {Maarten J} and Mathias Meine and Allaart, {Cornelis P} and {De Lange}, {Frederik J} and Prinzen, {Frits W} and Bart Gerritse and Erna Erdtsieck and Scheerder, {Coert O S} and Hill, {Michael R S} and Marcoen Scholten and Mari{\"e}lle Kloosterman and {Ter Horst}, {Iris A H} and Voors, {Adriaan A} and Vos, {Marc A} and Michiel Rienstra and {Van Gelder}, {Isabelle C}",
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Maass, AH, Vernooy, K, Wijers, SC, van 't Sant, J, Cramer, MJ, Meine, M, Allaart, CP, De Lange, FJ, Prinzen, FW, Gerritse, B, Erdtsieck, E, Scheerder, COS, Hill, MRS, Scholten, M, Kloosterman, M, Ter Horst, IAH, Voors, AA, Vos, MA, Rienstra, M & Van Gelder, IC 2018, 'Refining success of cardiac resynchronization therapy using a simple score predicting the amount of reverse ventricular remodelling: results from the Markers and Response to CRT (MARC) study' Europace, vol. 20, no. 2, pp. e1-e10. https://doi.org/10.1093/europace/euw445

Refining success of cardiac resynchronization therapy using a simple score predicting the amount of reverse ventricular remodelling : results from the Markers and Response to CRT (MARC) study. / Maass, Alexander H; Vernooy, Kevin; Wijers, Sofieke C; van 't Sant, Jetske; Cramer, Maarten J; Meine, Mathias; Allaart, Cornelis P; De Lange, Frederik J; Prinzen, Frits W; Gerritse, Bart; Erdtsieck, Erna; Scheerder, Coert O S; Hill, Michael R S; Scholten, Marcoen; Kloosterman, Mariëlle; Ter Horst, Iris A H; Voors, Adriaan A; Vos, Marc A; Rienstra, Michiel; Van Gelder, Isabelle C.

In: Europace, Vol. 20, No. 2, 01.02.2018, p. e1-e10.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Refining success of cardiac resynchronization therapy using a simple score predicting the amount of reverse ventricular remodelling

T2 - results from the Markers and Response to CRT (MARC) study

AU - Maass, Alexander H

AU - Vernooy, Kevin

AU - Wijers, Sofieke C

AU - van 't Sant, Jetske

AU - Cramer, Maarten J

AU - Meine, Mathias

AU - Allaart, Cornelis P

AU - De Lange, Frederik J

AU - Prinzen, Frits W

AU - Gerritse, Bart

AU - Erdtsieck, Erna

AU - Scheerder, Coert O S

AU - Hill, Michael R S

AU - Scholten, Marcoen

AU - Kloosterman, Mariëlle

AU - Ter Horst, Iris A H

AU - Voors, Adriaan A

AU - Vos, Marc A

AU - Rienstra, Michiel

AU - Van Gelder, Isabelle C

PY - 2018/2/1

Y1 - 2018/2/1

N2 - Aims: Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in systolic heart failure patients with ventricular conduction delay. Variability of individual response to CRT warrants improved patient selection. The Markers and Response to CRT (MARC) study was designed to investigate markers related to response to CRT.Methods and results: We prospectively studied the ability of 11 clinical, 11 electrocardiographic, 4 echocardiographic, and 16 blood biomarkers to predict CRT response in 240 patients. Response was measured by the reduction of indexed left ventricular end-systolic volume (LVESVi) at 6 months follow-up. Biomarkers were related to LVESVi change using log-linear regression on continuous scale. Covariates that were significant univariately were included in a multivariable model. The final model was utilized to compose a response score. Age was 67 ± 10 years, 63% were male, 46% had ischaemic aetiology, LV ejection fraction was 26 ± 8%, LVESVi was 75 ± 31 mL/m2, and QRS was 178 ± 23 ms. At 6 months LVESVi was reduced to 58 ± 31 mL/m2 (relative reduction of 22 ± 24%), 130 patients (61%) showed ≥ 15% LVESVi reduction. In univariate analysis 17 parameters were significantly associated with LVESVi change. In the final model age, QRSAREA (using vectorcardiography) and two echocardiographic markers (interventricular mechanical delay and apical rocking) remained significantly associated with the amount of reverse ventricular remodelling. This CAVIAR (CRT-Age-Vectorcardiographic QRSAREA -Interventricular Mechanical delay-Apical Rocking) response score also predicted clinical outcome assessed by heart failure hospitalizations and all-cause mortality.Conclusions: The CAVIAR response score predicts the amount of reverse remodelling after CRT and may be used to improve patient selection. Clinical Trials: NCT01519908.

AB - Aims: Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in systolic heart failure patients with ventricular conduction delay. Variability of individual response to CRT warrants improved patient selection. The Markers and Response to CRT (MARC) study was designed to investigate markers related to response to CRT.Methods and results: We prospectively studied the ability of 11 clinical, 11 electrocardiographic, 4 echocardiographic, and 16 blood biomarkers to predict CRT response in 240 patients. Response was measured by the reduction of indexed left ventricular end-systolic volume (LVESVi) at 6 months follow-up. Biomarkers were related to LVESVi change using log-linear regression on continuous scale. Covariates that were significant univariately were included in a multivariable model. The final model was utilized to compose a response score. Age was 67 ± 10 years, 63% were male, 46% had ischaemic aetiology, LV ejection fraction was 26 ± 8%, LVESVi was 75 ± 31 mL/m2, and QRS was 178 ± 23 ms. At 6 months LVESVi was reduced to 58 ± 31 mL/m2 (relative reduction of 22 ± 24%), 130 patients (61%) showed ≥ 15% LVESVi reduction. In univariate analysis 17 parameters were significantly associated with LVESVi change. In the final model age, QRSAREA (using vectorcardiography) and two echocardiographic markers (interventricular mechanical delay and apical rocking) remained significantly associated with the amount of reverse ventricular remodelling. This CAVIAR (CRT-Age-Vectorcardiographic QRSAREA -Interventricular Mechanical delay-Apical Rocking) response score also predicted clinical outcome assessed by heart failure hospitalizations and all-cause mortality.Conclusions: The CAVIAR response score predicts the amount of reverse remodelling after CRT and may be used to improve patient selection. Clinical Trials: NCT01519908.

KW - Journal Article

U2 - 10.1093/europace/euw445

DO - 10.1093/europace/euw445

M3 - Article

VL - 20

SP - e1-e10

JO - Europace

JF - Europace

SN - 1099-5129

IS - 2

ER -