Predictors of echocardiographic response in the Budapest-CRT upgrade trial.
Eperke Merkel, Richárd Masszi, Bálint Lakatos et al.
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In 30 seconds
This analysis of the randomized BUDAPEST-CRT Upgrade trial examined predictors of echocardiographic response among patients with HFrEF, an existing pacemaker or ICD, substantial RV pacing, and a wide paced QRS. Response was defined as at least a 15% reduction in LV end-systolic volume at 12 months. Of 275 patients with paired echocardiograms, 161 (59%) met this definition. Independent predictors included assignment to CRT-D rather than ICD upgrade, greater RV pacing burden, non-ischemic cardiomyopathy, and lateral LV lead position; CRT-D assignment had an OR of 5.57 (95% CI 2.56-12.12, p < 0.0001).
Key findings
- Among 275 patients with paired echocardiograms, 161 (59%) had a ≥ 15% reduction in LVESV at 12 months.
- CRT-D assignment independently predicted response versus ICD upgrade (OR 5.57, 95% CI 2.56-12.12, p < 0.0001).
- Greater RV pacing burden (OR 1.02 per %, 95% CI 1.00-1.04, p = 0.024) and non-ischemic cardiomyopathy (OR 2.50, 95% CI 1.15-5.26, p = 0.021) were independent predictors.
- Lateral LV lead position was associated with response (OR 8.79, 95% CI 1.28-60.39, p = 0.027).
Why it matters
The findings identify clinical and procedural characteristics associated with reverse remodelling after CRT-D upgrade in a population with substantial prior RV pacing. They may help frame expectations about echocardiographic response and inform assessment of patient selection and lead position, while the reported associations do not establish that these characteristics cause response.
What to keep in mind
Paired echocardiographic data were available for 275 of the 360 randomized patients, so the response analysis did not include the full trial cohort.