Predictors of Response to Cardiac Resynchronization Therapy in the Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy (MADIT-CRT)

Ilan Goldenberg; Arthur J Moss; W. Jackson Hall; Elyse Foster; Jeffrey J Goldberger; Peter Santucci; Timothy Shinn; Scott Solomon; Jonathan S Steinberg; David Wilber; Alon Barsheshet; Scott McNitt; Wojciech Zareba; Helmut Klein; MADIT-CRT Executive Comm

doi:10.1161/CIRCULATIONAHA.110.014324

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Predictors of Response to Cardiac Resynchronization Therapy in the Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy (MADIT-CRT)

Journal article

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Predictors of Response to Cardiac Resynchronization Therapy in the Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy (MADIT-CRT)

Ilan Goldenberg, Arthur J Moss, W. Jackson Hall, Elyse Foster, Jeffrey J Goldberger, Peter Santucci, Timothy Shinn, Scott Solomon, Jonathan S Steinberg, David Wilber, …

Circulation (New York, N.Y.), Vol.124(14), pp.1527-1536

2011-10-04

DOI: https://doi.org/10.1161/CIRCULATIONAHA.110.014324

PMID: 21900084

Abstract

Background— We hypothesized that combined assessment of factors that are associated with favorable reverse remodeling after cardiac resynchronization-defibrillator therapy (CRT-D) can be used to predict clinical response to the device. Methods and Results— The study population comprised 1761 patients enrolled in the Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy (MADIT-CRT). Best-subset regression analysis was performed to identify factors associated with echocardiographic response (defined as percent reduction in left ventricular end-diastolic volume 1 year after CRT-D implantation) and to create a response score. Cox proportional hazards regression analysis was used to evaluate the CRT-D versus defibrillator-only reduction in the risk of heart failure or death by the response score. Seven factors were identified as associated with echocardiographic response to CRT-D and made up the response score (female sex, nonischemic origin, left bundle-branch block, QRS ≥150 milliseconds, prior hospitalization for heart failure, left ventricular end-diastolic volume ≥125 mL/m 2 , and left atrial volume <40 mL/m 2 ). Multivariate analysis showed a 13% ( P <0.001) increase in the clinical benefit of CRT-D per 1-point increment in the response score (range, 0–14) and a significant direct correlation between risk reduction associated with CRT-D and response score quartiles: Patients in the first quartile did not derive a significant reduction in the risk of heart failure or death with CRT-D (hazard ratio=0.87; P =0.52); patients in the second and third quartiles derived 33% ( P =0.04) and 36% ( P =0.03) risk reductions, respectively; and patients in the upper quartile experienced a 69% ( P <0.001) risk reduction ( P for trend=0.005). Conclusion— Combined assessment of factors associated with reverse remodeling can be used for improved selection of patients for cardiac resynchronization therapy. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00180271.

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Collaboration types: Domestic collaboration
Citation topics: 1 Clinical & Life Sciences; 1.94 Cardiac Arrhythmia; 1.94.899 Cardiac Resynchronization Therapy
Web Of Science research areas: Cardiac & Cardiovascular Systems; Peripheral Vascular Disease
ESI research areas: Clinical Medicine

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Title: Predictors of Response to Cardiac Resynchronization Therapy in the Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy (MADIT-CRT)
Creators: Ilan Goldenberg - From the Heart Research Follow-Up Program (I.G., A.J.M., W.J.H., S.M., A.B., W.Z., H.K.) and Department of Biostatistics (W.J.H.), University of Rochester Medical Center, Rochester, NY; University of California Medical Center, San Francisco (E.F.); Northwestern University Feinberg School of Medicine, Chicago, IL (J.J.G.); Loyola University Medical Center, Maywood, IL (D.W., P.S.); Michigan Heart PC, Ypsilanti (T.S.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (S.D.S.); and St
Arthur J Moss - From the Heart Research Follow-Up Program (I.G., A.J.M., W.J.H., S.M., A.B., W.Z., H.K.) and Department of Biostatistics (W.J.H.), University of Rochester Medical Center, Rochester, NY; University of California Medical Center, San Francisco (E.F.); Northwestern University Feinberg School of Medicine, Chicago, IL (J.J.G.); Loyola University Medical Center, Maywood, IL (D.W., P.S.); Michigan Heart PC, Ypsilanti (T.S.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (S.D.S.); and St
W. Jackson Hall - From the Heart Research Follow-Up Program (I.G., A.J.M., W.J.H., S.M., A.B., W.Z., H.K.) and Department of Biostatistics (W.J.H.), University of Rochester Medical Center, Rochester, NY; University of California Medical Center, San Francisco (E.F.); Northwestern University Feinberg School of Medicine, Chicago, IL (J.J.G.); Loyola University Medical Center, Maywood, IL (D.W., P.S.); Michigan Heart PC, Ypsilanti (T.S.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (S.D.S.); and St
Elyse Foster - From the Heart Research Follow-Up Program (I.G., A.J.M., W.J.H., S.M., A.B., W.Z., H.K.) and Department of Biostatistics (W.J.H.), University of Rochester Medical Center, Rochester, NY; University of California Medical Center, San Francisco (E.F.); Northwestern University Feinberg School of Medicine, Chicago, IL (J.J.G.); Loyola University Medical Center, Maywood, IL (D.W., P.S.); Michigan Heart PC, Ypsilanti (T.S.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (S.D.S.); and St
Jeffrey J Goldberger - From the Heart Research Follow-Up Program (I.G., A.J.M., W.J.H., S.M., A.B., W.Z., H.K.) and Department of Biostatistics (W.J.H.), University of Rochester Medical Center, Rochester, NY; University of California Medical Center, San Francisco (E.F.); Northwestern University Feinberg School of Medicine, Chicago, IL (J.J.G.); Loyola University Medical Center, Maywood, IL (D.W., P.S.); Michigan Heart PC, Ypsilanti (T.S.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (S.D.S.); and St
Peter Santucci - From the Heart Research Follow-Up Program (I.G., A.J.M., W.J.H., S.M., A.B., W.Z., H.K.) and Department of Biostatistics (W.J.H.), University of Rochester Medical Center, Rochester, NY; University of California Medical Center, San Francisco (E.F.); Northwestern University Feinberg School of Medicine, Chicago, IL (J.J.G.); Loyola University Medical Center, Maywood, IL (D.W., P.S.); Michigan Heart PC, Ypsilanti (T.S.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (S.D.S.); and St
Timothy Shinn - From the Heart Research Follow-Up Program (I.G., A.J.M., W.J.H., S.M., A.B., W.Z., H.K.) and Department of Biostatistics (W.J.H.), University of Rochester Medical Center, Rochester, NY; University of California Medical Center, San Francisco (E.F.); Northwestern University Feinberg School of Medicine, Chicago, IL (J.J.G.); Loyola University Medical Center, Maywood, IL (D.W., P.S.); Michigan Heart PC, Ypsilanti (T.S.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (S.D.S.); and St
Scott Solomon - From the Heart Research Follow-Up Program (I.G., A.J.M., W.J.H., S.M., A.B., W.Z., H.K.) and Department of Biostatistics (W.J.H.), University of Rochester Medical Center, Rochester, NY; University of California Medical Center, San Francisco (E.F.); Northwestern University Feinberg School of Medicine, Chicago, IL (J.J.G.); Loyola University Medical Center, Maywood, IL (D.W., P.S.); Michigan Heart PC, Ypsilanti (T.S.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (S.D.S.); and St
Jonathan S Steinberg - From the Heart Research Follow-Up Program (I.G., A.J.M., W.J.H., S.M., A.B., W.Z., H.K.) and Department of Biostatistics (W.J.H.), University of Rochester Medical Center, Rochester, NY; University of California Medical Center, San Francisco (E.F.); Northwestern University Feinberg School of Medicine, Chicago, IL (J.J.G.); Loyola University Medical Center, Maywood, IL (D.W., P.S.); Michigan Heart PC, Ypsilanti (T.S.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (S.D.S.); and St
David Wilber - From the Heart Research Follow-Up Program (I.G., A.J.M., W.J.H., S.M., A.B., W.Z., H.K.) and Department of Biostatistics (W.J.H.), University of Rochester Medical Center, Rochester, NY; University of California Medical Center, San Francisco (E.F.); Northwestern University Feinberg School of Medicine, Chicago, IL (J.J.G.); Loyola University Medical Center, Maywood, IL (D.W., P.S.); Michigan Heart PC, Ypsilanti (T.S.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (S.D.S.); and St
Alon Barsheshet - From the Heart Research Follow-Up Program (I.G., A.J.M., W.J.H., S.M., A.B., W.Z., H.K.) and Department of Biostatistics (W.J.H.), University of Rochester Medical Center, Rochester, NY; University of California Medical Center, San Francisco (E.F.); Northwestern University Feinberg School of Medicine, Chicago, IL (J.J.G.); Loyola University Medical Center, Maywood, IL (D.W., P.S.); Michigan Heart PC, Ypsilanti (T.S.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (S.D.S.); and St
Scott McNitt - From the Heart Research Follow-Up Program (I.G., A.J.M., W.J.H., S.M., A.B., W.Z., H.K.) and Department of Biostatistics (W.J.H.), University of Rochester Medical Center, Rochester, NY; University of California Medical Center, San Francisco (E.F.); Northwestern University Feinberg School of Medicine, Chicago, IL (J.J.G.); Loyola University Medical Center, Maywood, IL (D.W., P.S.); Michigan Heart PC, Ypsilanti (T.S.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (S.D.S.); and St
Wojciech Zareba - From the Heart Research Follow-Up Program (I.G., A.J.M., W.J.H., S.M., A.B., W.Z., H.K.) and Department of Biostatistics (W.J.H.), University of Rochester Medical Center, Rochester, NY; University of California Medical Center, San Francisco (E.F.); Northwestern University Feinberg School of Medicine, Chicago, IL (J.J.G.); Loyola University Medical Center, Maywood, IL (D.W., P.S.); Michigan Heart PC, Ypsilanti (T.S.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (S.D.S.); and St
Helmut Klein - From the Heart Research Follow-Up Program (I.G., A.J.M., W.J.H., S.M., A.B., W.Z., H.K.) and Department of Biostatistics (W.J.H.), University of Rochester Medical Center, Rochester, NY; University of California Medical Center, San Francisco (E.F.); Northwestern University Feinberg School of Medicine, Chicago, IL (J.J.G.); Loyola University Medical Center, Maywood, IL (D.W., P.S.); Michigan Heart PC, Ypsilanti (T.S.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (S.D.S.); and St
MADIT-CRT Executive Comm
Publication Details: Circulation (New York, N.Y.), Vol.124(14), pp.1527-1536
Academic Unit: Miller School of Medicine; UMMG Dept of Medicine - Cardiovascular
Language: English
Resource Type: Journal article
PMID: 21900084
Record Identifier: 991031615024302976