Cornell product as a predictor of CRT response in patients with pacing-induced cardiomyopathy
H Yokomori, K Nakamura, J Yamamoto, T Shimizu, M Asami, N Sahara, N Nemoto, H HaraAbstract
Background
Pacing-induced cardiomyopathy (PICM) can lead to heart failure due to right ventricular pacing dependency. Although upgrading to cardiac resynchronization therapy (CRT) has been reported to improve outcomes, predictors of CRT response in PICM remain unclear.
Purpose
To investigate whether the Cornell product can predict responders to CRT upgrade in patients with PICM.
Methods
Among 931 patients who underwent device implantation between 2017 and 2023 at two hospitals, 57 patients underwent CRT upgrade for PICM. Of these, 46 patients with available follow-up data were included in the analysis. CRT responder was defined as a ≥15% reduction in left ventricular end-systolic volume (LVESV) on transthoracic echocardiography. Cornell voltage was defined as RaVL + SV3 (mV), and Cornell product was calculated as Cornell voltage × QRS duration (ms·mV).
Results
The study population included 73.9% males, with a mean age of 68.0 ± 9.3 years. Pre-upgrade parameters were as follows: left ventricular ejection fraction (LVEF) 31.6 ± 12.4%, LVESV 131.1 ± 54.1 mL, paced QRS duration 175.7 ± 26.9ms, Cornell voltage 3.03 ± 1.12 mV, and Cornell product 539.1 ± 239.9 ms·mV. Twenty-seven patients (58.7%) were classified as responders. On univariate analysis, atrial fibrillation (p=0.035), paced QRS duration (p=0.0495), Cornell voltage (p=0.027), and Cornell product (p=0.014) were significantly associated with response. Multivariate analysis identified the absence of atrial fibrillation (OR 9.206, 95% CI 1.829–75.481, p=0.006) and higher Cornell product per 100 ms·mV increase (OR 1.624, 95% CI 1.061–2.485, p=0.030) as independent predictors of CRT response.
Conclusions
In patients with PICM undergoing CRT upgrade, baseline Cornell product may serve as an independent predictor of favorable response.