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

Eur J Heart Fail. 2014 Feb;16(2):227-34. doi: 10.1002/ejhf.38. Epub 2013 Dec 11.

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.

Keywords: Cardiac resynchronization therapy; Echo; Health status; Response.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cardiac Resynchronization Therapy / methods*
  • Defibrillators, Implantable
  • Echocardiography
  • Female
  • Health Status*
  • Heart Failure / diagnostic imaging
  • Heart Failure / therapy*
  • Humans
  • Male
  • Middle Aged
  • Netherlands
  • Pacemaker, Artificial
  • Self Report*
  • Stroke Volume
  • Surveys and Questionnaires
  • Treatment Outcome