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Discrepancy between echocardiographic and patient‐reported health status response to cardiac resynchronization therapy: results of the PSYHEART‐CRT study
Author(s) -
Versteeg Henneke,
van 't Sant Jetske,
Cramer Maarten J.,
Doevendans Pieter A.,
Pedersen Susanne S.,
Meine Mathias
Publication year - 2014
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.38
Subject(s) - medicine , cardiac resynchronization therapy , confidence interval , odds ratio , cardiology , heart failure , cardiomyopathy , ejection fraction
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.