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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EContractile reserve and echocardiographic dyssynchrony predict early response to cardiac resynchronizatiuon therapy, according to findings from the Risk Stratification and Benefits with Cardiac Resynchronization Therapy trial [BENEFIT; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00996086\u0026amp;atom=%2Fspmdc%2F12%2F6%2F8.atom\u0022\u003ENCT00996086\u003C\/a\u003E], according to outcomes from the BENEFIT study.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EArrhythmias Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EContractile reserve and echocardiographic dyssynchrony predict early response to cardiac resynchronizatiuon therapy (CRT), according to findings from the Risk Stratification and Benefits with Cardiac Resynchronization Therapy trial [BENEFIT; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00996086\u0026amp;atom=%2Fspmdc%2F12%2F6%2F8.atom\u0022\u003ENCT00996086\u003C\/a\u003E]. John Gorcsan, MD, University of Pittsburgh, Pittsburgh, Pennsylvania, USA, presented outcomes from the study.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe BENEFIT Trial was a multicenter, prospective, longitudinal study to identify clinical and echocardiographic factors that predict response to CRT. Dr. Gorcsan noted that response to CRT is multifactorial and may be influenced by clinical, procedural, and echocardiographic variables. The objective of the BENEFIT study was to test the hypothesis that contractile reserve, assessed by low-dose dobutamine echo and echo-Doppler dyssynchrony, predicts clinical response to CRT and reverse remodeling.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe study enrolled a total of 227 patients from 26 sites. Their mean age was 65\u00b112 years (29% female), and all had New York Heart Association (NYHA) Class III-IV heart failure with QRS duration 157\u00b124 ms (all \u2265120 ms) and ejection fraction 29%\u00b19% (all \u226435%); 52% had ischemic heart disease.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EPrespecified cutoffs were used to assess contractile reserve, dyssynchrony, and speckle tracking radial strain for septal to posterior wall delay. Contractile reserve was determined by low-dose dobutamine echo wall motion score (WMS); the cutoff was an increase in WMS \u22650.2 with 10 \u03bcg\/kg per min. Dyssynchrony was determined by Doppler pre-ejection delay (PED); the cutoff was \u2265140 ms. The cutoff for speckle tracking radial strain for septal to posterior wall delay was \u2265130 ms.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EThree predefined CRT response endpoints were assessed at 6 months: improvement in NYHA class \u2265 1, increase in 6-min walk distance \u226510%, and decrease in end-systolic volume (ESV) \u226510%. Of 190 patients with 6-month follow-up available, 83% were a CRT responder by at least 1 criterion; 51% improved NYHA class; 47% improved 6-minute walk test; and 54% improved ESV.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EUnivariate analysis of 20 clinical and echo variables, PED, septal to posterior wall delay, and creatinine predicted both clinical and ESV response (all p\u0026lt;0.019). Of 134 patients with paired baseline and 6-month echocardiographs, contractile reserve and PED were additive in predicting ESV response (p=0.009; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). A forward multivariate model showed that contractile reserve, dyssynchrony by PED, and creatinine remained significantly associated with both clinical and ESV CRT response.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/6\/8\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Left Ventricular Reverse Remodeling at 6 Months.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-950395396\u0022 data-figure-caption=\u0022Left Ventricular Reverse Remodeling at 6 Months.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/6\/8\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/6\/8\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/6\/8\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14325\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-8\u0022 class=\u0022first-child\u0022\u003ELeft Ventricular Reverse Remodeling at 6 Months.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EPED=pre-ejection delay.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced with permission from J. Gorcsan, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-9\u0022\u003EContractile reserve by low-dose dobutamine echo and dyssynchrony by routine echo-Doppler are significantly associated with early clinical and reverse remodeling CRT response. These observations have important prognostic clinical implications.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EHowever, a study of patients who are randomized to CRT, based on echocardiographic dyssynchrony, has yet to be carried out. This makes it difficult to assign a cause-and-effect relationship with certainty. Although it is logical that echocardiographic indices of dyssynchrony can be strongly associated with outcome after CRT, most believe that it is premature to change patient selection for CRT to imaging-based echocardiographic criteria at the present time [Gorcsan J \u0026amp; Prinzen FW. \u003Cem\u003EHeart Rhythm\u003C\/em\u003E 2012].\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/12\/6\/8.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzndcp\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzndcp\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}