The role of contractile reserve by stress test echocardiography for predicting cardiac resynchronization therapy responder: systematic review and meta-analysis

Achmad Lefi; Ivana Purnama Dewi; Kristin Purnama Dewi; Eka Prasetya Budi Mulia; Agus Subagjo; Budi Dharmadjati

doi:10.3889/oamjms.2021.5725

Authors

Achmad Lefi Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga University - Dr. Soetomo General Hospital, Surabaya, Indonesia
Ivana Purnama Dewi Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga University - Dr. Soetomo General Hospital, Surabaya, Indonesia; Faculty of Medicine, Duta Wacana Christian University, Yogyakarta, Indonesia
Kristin Purnama Dewi Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Airlangga University - Dr. Soetomo General Hospital, Surabaya, Indonesia
Eka Prasetya Budi Mulia Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga University - Dr. Soetomo General Hospital, Surabaya, Indonesia
Agus Subagjo Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga University - Dr. Soetomo General Hospital, Surabaya, Indonesia
Budi Dharmadjati Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga University - Dr. Soetomo General Hospital, Surabaya, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2021.5725

Keywords:

contractile reserve, cardiac resynchronization therapy, CRT responder, stress test echocardiography, dobutamine stress echocardiography, exercise test

Abstract

Introduction: Up to one-third of patients who received resynchronization devices do not experience full benefit of cardiac resynchronization therapy (CRT). Echocardiography plays an important role in heart failure patients treated with CRT. Contractile reserved is a strong prognostic factor to predict positive response to CRT (CRT responder).

Objective: We perform a systematic review and meta-analysis of published data to assess the relationship between contractile reserve (CR) and response to CRT.

Methods: We conduct a systematic search from major medical databases on all clinical trials published up to June 2020, written in English, full-text availability, and human subject. We used Newcastle-Ottawa Scale to measure the quality of evidence. We employed the Mantel–Haenszel random-effects meta-analysis of using RevMan 5.4.

Results: We identified 17 studies involving 1399 patients. The type of stress was either dobutamine (n=15) or exercise (n=2). The presence of CR was associated with a higher chance of CRT responder (OR 7.68, 95%CI 4.27–13.82, p<0.001) using a random-effects model. The ORs slightly differed when studies were analyzed separately based on the stress test type and definition of CR. Contractile reserve, assessed with dobutamine stress echocardiography (DSE), defined as an increase in LVEF (OR 5.10, 95% CI 2.29–11.32, P <0.00001) was numerically lower than defined as increased LV contractility (OR 6.86, 95% CI 3.36–12.88, P <0.00001). The presence of CR assessed with exercise stress test are associated with higher chance of CRT responder (OR 49.11, 95% CI 15.04–160.36, P <0.00001). From our meta-analysis, we found non-ischemic has better respond to CRT compare to patient with ischemic etiology (OR 0.41; 95% CI 0.31-0.55, P <0.01).

Conclusion: The presence of CR during stress test echocardiography with either dobutamine or exercise stress test is associated with a higher chance of CRT responder.

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References

Lozano I, Bocchiardo M, Achtelik M, Gaita F, Trappe H, Daoud E, et al. Impact of biventricular pacing on mortality in a randomized crossover study of patients with heart failure and ventricular arrhythmias. Pacing Clin Electrophysiol. 2000;23(11 Pt 2):1711-

https://doi.org/10.1111/j.1540-8159.2000.tb07001.x PMid:11139906 2. Abraham WT, Hayes DL. Cardiac resynchronization therapy for heart failure. Circulation. 2003;108(21):2596-603. https://doi.org/10.1161/01.cir.0000096580.26969.9a PMid:14638522

Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2016;37(27):2129-200. https://doi.org/10.1093/eurheartj/ehw128 PMid:27206819

Pitzalis MV, Iacoviello M, Romito R, Massari F, Rizzon B, Luzzi G, et al. Cardiac resynchronization therapy tailored by echocardiographic evaluation of ventricular asynchrony. J Am Coll Cardiol. 2002;40(9):1615-22. https://doi.org/10.1016/s0735-1097(02)02337-9 PMid:12427414

Hummel JP, Lindner JR, Belcik JT, Ferguson JD, Mangrum JM, Bergin JD, et al. Extent of myocardial viability predicts response to biventricular pacing in ischemic cardiomyopathy. Hear Rhythm. 2005;2(11):1211-7. https://doi.org/10.1016/j.hrthm.2005.07.027 PMid:16253911

Kawara T, Derksen R, de Groot JR, Coronel R, Tasseron S, Linnenbank AC, et al. Activation delay after premature stimulation in chronically diseased human myocardium relates to the architecture of interstitial fibrosis. Circulation. 2001;104(25):3069-75. https://doi.org/10.1161/hc5001.100833 PMid:11748102

Bax JJ, Wijns W, Cornel JH, Visser FC, Boersma E, Fioretti PM. Accuracy of currently available techniques for prediction of functional recovery after revascularization in patients with left ventricular dysfunction due to chronic coronary artery disease: Comparison of pooled data. J Am Coll Cardiol. 1997;30(6):1451- 60. https://doi.org/10.1016/s0735-1097(97)00352-5 PMid:9362401

Ciampi Q, Carpeggiani C, Michelassi C, Villari B, Picano E. Left ventricular contractile reserve by stress echocardiography as a predictor of response to cardiac resynchronization therapy in heart failure: A systematic review and meta-analysis. BMC Cardiovasc Disord. 2017;17(1):223. https://doi.org/10.1186/s12872-017-0657-4 PMid:28814264

Kloosterman M, Damman K, Van Veldhuisen DJ, Rienstra M, Maass AH. The importance of myocardial contractile reserve in predicting response to cardiac resynchronization therapy. Eur J Heart Fail. 2017;19(7):862-9. https://doi.org/10.1002/ejhf.768 PMid:28233406

Hutton B, Salanti G, Caldwell DM, Chaimani A, Schmid CH, Cameron C, et al. The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: Checklist and explanations. Ann Intern Med. 2015;162(11):777-84. https://doi.org/10.7326/m14-2385 PMid:26030634

Wells G, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-analyses; 2013.

Da Costa A, Thévenin J, Roche F, Faure E, RoméyerBouchard C, Messier M, et al. Prospective validation of stress echocardiography as an identifier of cardiac resynchronization therapy responders. Hear Rhythm. 2006;3(4):406-13. https://doi.org/10.1016/j.hrthm.2005.12.017 PMid:16567286

Ypenburg C, Sieders A, Bleeker GB, Holman ER, van der Wall EE, Schalij MJ, et al. Myocardial contractile reserve predicts improvement in left ventricular function after cardiac resynchronization therapy. Am Heart J. 2007;154(6):1160-5. https://doi.org/10.1016/j.ahj.2007.07.035 PMid:18035090

Lim P, Bars C, Mitchell-Heggs L, Roiron C, Elbaz N, Hamdaoui B, et al. Importance of contractile reserve for CRT. Europace. 2007;9(9):739-43. https://doi.org/10.1093/europace/eum117 PMid:17573360

Tuccillo B, Muto C, Iengo R, Accadia M, Rumolo S, Canciello M, et al. Presence of left ventricular contractile reserve, evaluated by means of dobutamine stress-echo test, is able to predict response to cardiac resynchronization therapy. J Interv Card Electrophysiol. 2008;23(2):121-6. https://doi.org/10.1007/s10840-008-9255-9 PMid:18587637

Rocchi G, Bertini M, Biffi M, Ziacchi M, Biagini E, Gallelli I, et al. Exercise stress echocardiography is superior to rest echocardiography in predicting left ventricular reverse remodelling and functional improvement after cardiac resynchronization therapy. Eur Heart J. 2008;30(1):89-97. https://doi.org/10.1093/eurheartj/ehn483 PMid:18987095

Lancellotti P, Senechal M, Moonen M, Donal E, Magne J, Nellessen E, et al. Myocardial contractile reserve during exercise predicts left ventricular reverse remodelling after cardiac resynchronization therapy. Eur J Echocardiogr. 2009;10(5):663- 8. https://doi.org/10.1093/ejechocard/jep033 PMid:19351652

Ciampi Q, Pratali L, Citro R, Piacenti M, Villari B, Picano E. Identification of responders to cardiac resynchronization therapy by contractile reserve during stress echocardiography. Eur J Heart Fail. 2009;11(5):489-96. https://doi.org/10.1093/eurjhf/hfp039 PMid:19324921

Sénéchal M, Lancellotti P, Magne J, Garceau P, Champagne J, Blier L, et al. Contractile reserve assessed using dobutamine echocardiography predicts left ventricular reverse remodeling after cardiac resynchronization therapy: Prospective validation in patients with left ventricular dyssynchrony. Echocardiography. 2010;27(6):668-76. https://doi.org/10.1111/j.1540-8175.2009.01106.x PMid:20345438

Muto C, Gasparini M, Neja CP, Iacopino S, Davinelli M, Zanon F, et al. Presence of left ventricular contractile reserve predicts midterm response to cardiac resynchronization therapyresults from the LOw dose DObutamine Stress-Echo test in cardiac resynchronization therapy (LODO-CRT) trial. Hear Rhythm. 2010;7(11):1600-5. https://doi.org/10.1016/j.hrthm.2010.07.036 PMid:20691283

Chaudhry FA, Shah A, Bangalore S, Derose J, Steinberg JS. Inotropic contractile reserve and response to cardiac resynchronization therapy in patients with markedly remodeled left ventricle. J Am Soc Echocardiogr. 2011;24(1):91-7. https://doi.org/10.1016/j.echo.2010.10.007 PMid:21126856

Altman RK, McCarty D, Chen-Tournoux AA, Tournoux FB, Riedl L, Orencole M, et al. Usefulness of low-dose dobutamine echocardiography to predict response and outcome in patients undergoing cardiac resynchronization therapy. Am J Cardiol. 2011;108(2):252-7. https://doi.org/10.1016/j.amjcard.2011.03.033 PMid:21550579

Gasparini M, Muto C, Iacopino S, Zanon F, Dicandia C, Distefano G, et al. Low-dose dobutamine test associated with interventricular dyssynchrony: A useful tool to identify cardiac resynchronization therapy responders: Data from the LOw dose DObutamine stress-echo test in Cardiac Resynchronization Therapy (LODO-CRT) phase 2 study. Am Heart J. 2011;163(3):422-9. https://doi.org/10.1016/j.ahj.2011.11.015 PMid:22424013

Pugllese M, Minardi G, Vitali A, Natale E, de Girolamo P, Zampi G, et al. Influence of myocardial viability on responsiveness to cardiac resynchronization in ischemic dilated cardiomyopathy: A prospective observational cohort study. Anadolu Kardiyol Derg. 2012;12(2):132-41. https://doi.org/10.5152/akd.2012.039 PMid:22281793

Stankovic I, Aarones M, Smith HJ, Vörös G, Kongsgaard E, Neskovic AN, et al. Dynamic relationship of left-ventricular dyssynchrony and contractile reserve in patients undergoing cardiac resynchronization therapy. Eur Heart J. 2013;35(1):48- 55. https://doi.org/10.1093/eurheartj/eht294 PMid:23918757

Mizia-Stec K, Wita K, Mizia M, Szwed H, NowalanyKozielska E, Chrzanowski Ł, et al. Preserved contractile reserve in a dobutamine test for the prediction of a response to resynchronisation therapy in ischemic and non-ischemic cardiomyopathy a multicenter ViaCRT study. Int J Cardiol. 2014;172(2):476-7. https://doi.org/10.1016/j.ijcard.2013.12.204 PMid:24456874

Murín P, Mitro P, Valocik G, Spurný P. Global myocardial contractile reserve assessed by high-dose dobutamine stress echocardiography predicts response to the cardiac resynchronization therapy. Echocardiography. 2014;32(3):490- 5. https://doi.org/10.1111/echo.12694 PMid:25059770

Płońska-Gościniak E, Kasprzak JD, Kukulski T, Mizia-Stec K, Nowalany-Kozielska E, Gąsior Z, et al. The role of low-dose dobutamine echocardiography in predicting response to biventricular pacing: Results from the multicentre viability in cardiac resynchronisation therapy (ViaCRT) study. Polish Arch Intern Med. 2016;126(12):989-94. https://doi.org/10.20452/pamw.3715 PMid:27958262

Young JB. Combined cardiac resynchronization and implantable cardioversion defibrillation in advanced chronic heart failure. JAMA. 2003;289(20):2685. https://doi.org/10.1001/jama.289.20.2685 PMid:12771115

Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L, et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med. 2005;352(15):1539-49. https://doi.org/10.1056/nejmoa050496 PMid:15753115

Spartalis M, Tzatzaki E, Spartalis E, Damaskos C, Athanasiou A, Livanis E, et al. The role of echocardiography in the optimization of cardiac resynchronization therapy: Current evidence and future perspectives. Open Cardiovasc Med J. 2017;11(1):133- 45. https://doi.org/10.2174/1874192401711010133 PMid:29387277

Papageorgiou N, Providência R, Lambiase PD, Tousoulis D, Lloyd G, Bhattacharyya S. Does presence of left ventricular contractile reserve improve response to cardiac resynchronization therapy? An updated meta-analysis. Int J Cardiol. 2018;252:224-8. https://doi.org/10.1016/j.ijcard.2017.09.034 PMid:29249433

Lancellotti P, Pellikka PA, Budts W, Chaudhry FA, Donal E, Dulgheru R, et al. The clinical use of stress echocardiography in non-ischemic heart disease: Recommendations from the European association of cardiovascular imaging and the American society of echocardiography. J Am Soc Echocardiogr. 2017;30(2):101-38. https://doi.org/10.1016/j.echo.2016.10.016 PMid:28164802