Echocardiographic Predictors of Long‐Term Survival in Patients Undergoing Cardiac Resynchronization Therapy: What Is the Optimal Metric?

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Since the publication of the MIRACLE trial in 2002, the reverse remodeling (RVR) effects of cardiac resynchronization therapy (CRT) have been well established.1 Such effects have been noted in patients with both symptomatic and minimally symptomatic heart failure.1 However, it has been consistently noted that not all patients appear to derive benefit from CRT. This observation has spurred numerous studies aiming to predict a favorable outcome following CRT.4 These studies, however, have used multiple definitions of response tied to various outcome measures (e.g., hospitalizations and survival), making comparability challenging.4 One of the most often used definitions of response is the observation of reverse ventricular remodeling (RVR), described variously by changes in left ventricular ejection fraction (LVEF), left ventricular end‐systolic volume (LVESV), and left ventricular end‐diastolic volume (LVEDV) as well as changes in LV diameters. To complicate matters further, the cut points for any of these measures have themselves varied.4 Thus, selection of the most appropriate measure and its cut point to guide assessment of CRT effect remains unclear and contentious.6 In the current study, using a nested model approach, we sought to determine which definition of RVR and cut point was the most appropriate predictor of treatment effect, defined by the hard endpoint of long‐term survival free of LVAD or heart transplant following CRT.
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