Discrepancy between echocardiographic and patient-reported health status response to cardiac resynchronization therapy: Results of the PSYHEART-CRT study

H. Versteeg, J. van 't Sant, M.J. Cramer, P.A.F.M. Doevendans, S.S. Pedersen, M.M. Meine

Research output: Contribution to journalArticleScientificpeer-review

13 Citations (Scopus)

Abstract

Aims
The current study examined the degree of agreement between echocardiographic and patient-reported health status response to CRT 6 months after implantation, and evaluated the differences in pre-implantation characteristics of patients with concordant and discordant echocardiographic and health status responses.
Methods and results
Consecutively implanted CRT-defibrillator patients (n = 109, mean age = 65.4 ± 10.1 years, 74 men) were recruited from the University Medical Center Utrecht, The Netherlands. Prior to implantation and 6 months post-implantation, all patients underwent echocardiography and completed the Kansas City Cardiomyopathy Questionnaire (KCCQ). Echocardiographic response was defined as a relative reduction of ≥15% in LV end-systolic volume; an improvement of ≥10 points in KCCQ score indicated a health status response. In the 54 patients with discordant responses, 25 (22.9%) had an echocardiographic response but no health status response and 29 (26.6%) had a health status response but no echocardiographic response. Patients with concordant and discordant responses differed on various pre-implantation characteristics, including sex, employment status, LV volumes, and pre-implantation KCCQ score. In multivariable analysis, pre-implantation KCCQ score [odds ratio (OR) = 0.91, 95% confidence interval (CI) = 0.88–0.95, P < 0.001] and QRS duration (OR = 1.03, 95% CI = 1.01–1.06, P = 0.009) were the only characteristics associated with health status response to CRT.
Conclusions
Our results show a large discrepancy between echocardiographic and patient-reported health status response to CRT. The most important predictor of health status response was the pre-implantation health status score. These results emphasize that disease-specific health status measures may have additional value over ‘objective’ measures of CRT response and should be incorporated in clinical practice.
Original languageEnglish
Pages (from-to)227-234
JournalEuropean Journal of Heart Failure
Volume16
DOIs
Publication statusPublished - 2014

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