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. 2020 Aug 28:2020:3856294.
doi: 10.1155/2020/3856294. eCollection 2020.

A Predictive Model for Super-Response to Cardiac Resynchronization Therapy: The QQ-LAE Score

Xi Liu  1 , Yiran Hu  1   2 , Wei Hua  1 , Shengwen Yang  1 , Min Gu  1 , Hong-Xia Niu  1 , Li-Gang Ding  1 , Jing Wang  1 , Shu Zhang  1
Affiliations

A Predictive Model for Super-Response to Cardiac Resynchronization Therapy: The QQ-LAE Score

Xi Liu et al. Cardiol Res Pract. .

Abstract

Objectives: It is important to identify super-responders who can derive most benefits from cardiac resynchronization therapy (CRT). We aimed to establish a scoring model that can be used for predicting super-response to CRT.

Methods: We retrospectively reviewed 387 CRT patients. Multivariate logistic regression analysis was performed to identify predictors for super-response (defined as an absolute increase in left ventricular ejection fraction of ≥15% at 6-month follow-up) and to create a score model. Multivariate Cox proportional-hazard regression analysis was conducted to assess associations with the long-term endpoint (defined as cardiac death/heart transplant, heart failure (HF) hospitalization, or all-cause death) across the score categories at follow-up.

Results: Among 387 patients, 109 (28.2%) met super-response. In multivariable analysis, 5 independent predictors (QQ-LAE) were identified: prior no fragmented QRS (odds ratio (OR) = 3.10 (1.39, 6.94)), QRS duration ≥170 ms (OR = 2.37 (1.35, 4.12)), left bundle branch block (OR = 2.57 (1.04, 6.37)), left atrial diameter <45 mm (OR = 3.27 (1.81, 5.89)), and left ventricular end-diastolic dimension <75 mm (OR = 4.11 (1.99, 8.48)). One point was attributed to each predictor, and three score categories were identified. The proportion of super-response after 6-month CRT implantation in patients with scores 0-3, 4, and 5 was 14.6%, 40.3%, and 64.1%, respectively (P < 0.001). Patients with score 5 had an 88% reduction in the risk of cardiac death/heart transplant (P=0.042), a 71% reduction in the risk of HF hospitalization (P=0.048), and an 89% reduction in the risk of all-cause mortality (P=0.028) compared to patients with scores 0-3.

Conclusions: The QQ-LAE score can be used for prediction of super-response to CRT and selection of most suitable patients in clinical practices.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Receiver-operating characteristic curves of continuous variables predicting super-response at 6-month follow-up. (a) Receiver-operating characteristic curve of the history of HF. (b) Receiver-operating characteristic curve of QRS duration. (c) Receiver-operating characteristic curve of LAD. (d) Receiver-operating characteristic curve of LVEDD. AUC, area under the receiver-operating characteristic curve; CI, confidence interval; CRT, cardiac resynchronization therapy; HF, heart failure; LAD, left atrial diameter; LVEDD, left ventricular end-diastolic dimension.
Figure 2
Figure 2
Kaplan–Meier estimates of survival rate of (a) cardiac death/heart transplant, (b) HF hospitalization, and (c) all-cause death. HF, heart failure.
See this image and copyright information in PMC

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