Novel echocardiography-derived haemodynamic forces analysis in cardiac resynchronization therapy: response prediction and long-term prognosis
R Tarantini, W Gerrits, C Chiu, S Rier, M J Cramer, M Ciarlantini, S Frittella, I Torre, F Van Slochteren, R Van Es, I Van Der Bilt, P Van Der Harst, M Meine, M GuglielmoAbstract
Abstract
Bacground: cardiac resynchronization therapy (CRT) improves survival and symptoms in selected patients with heart failure with reduced ejection fraction (HFrEF) and electro-mechanical dyssynchrony. However, up to 40% of patients do not respond to CRT despite meeting current guidelines criteria. Haemodynamic forces (HDF) analysis is a novel echocardiographic technique that estimates intraventricular pressure gradients from endocardial motion, providing a quantitative assessment of left ventricular flow-related mechanics and ventricular synchrony.
Purpose
to evaluate whether echocardiographic HDF parameters can predict response to CRT and long-term clinical outcomes, and to explore the impact of CRT on intraventricular force patterns.
Methods
this is a subanalysis of 127 patients from the multicenter MARC study (Markers and Response to CRT) who underwent CRT implantation according to the ESC guidelines was performed. The following HDF parameters were calculated: (1) apical-basal force, the longitudinal component oriented along the apex–base axis, (2) lateral-septal force, the transversal component of the left ventricle hemodynamic force, (3) the ratio of latero-septal to apical-basal force, index of dyssynchrony, (4) force vector angle, (5) systolic apical-basal force and (6) systolic force vector angle. HDF variables were measured from pre- and post-implant echocardiograms using dedicated software. Association between CRT response and HDF variables was assessed using binary logistic regression. CRT response was defined as a ≥15% reduction in left ventricular end-systolic volume (LVESV) at 6 months. The composite endpoint was all-cause mortality or cardiovascular hospitalization during long-term follow-up (median 7.6 years).
Results
in total, 81 patients (64%) were CRT responders. Responders had higher baseline systolic apical–basal force (5.5% vs 4.5%, p = 0.032). In multivariate analysis, systolic apical–basal force independently predicted CRT response (OR 1.21, p = 0.04). After CRT implantation, responders exhibited significant improvements in apical–basal force, vector angle alignment, and reduced transverse-to-longitudinal force ratio, indicating restoration of physiologic intraventricular flow. Baseline HDF systolic angle was independently associated with the composite endpoint (HR 0.94 per degree, p = 0.009), with an optimal prognostic cutoff of 77° identified via maximally selected rank statistics. Patients with angles >77° had significantly better event-free survival.
Conclusions
echocardiographic HDF analysis provides novel insights into left ventricular mechanics and predicts both CRT response and long-term outcomes. Higher systolic apical–basal force identifies patients more likely to achieve reverse remodeling, while systolic angle independently predicts survival and cardiovascular hospitalization, HDF assessment may serve as an integrative marker for optimizing CRT candidate selection and monitoring therapy efficacy.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.