Echocardiography-derived hemodynamic forces in cardiac resynchronization therapy: association with reverse remodeling and long-term outcomes - Scorecard - MDSpire
Clinical Scorecard: Hemodynamic Forces from Echocardiography in Cardiac Resynchronization Therapy: Links to Reverse Remodeling and Long-Term Prognosis
At a Glance
Category
Detail
Condition
Heart failure with reduced ejection fraction and electromechanical dyssynchrony in patients undergoing cardiac resynchronization therapy (CRT).
Key Mechanisms
Hemodynamic forces (HDF) reflect intraventricular pressure gradients and provide insight into left ventricular mechanics and force alignment.
Target Population
Patients undergoing de novo CRT implantation who meet the study’s eligibility criteria based on 2012 European Society of Cardiology guidelines, including New York Heart Association class II or III symptoms and stable sinus rhythm.
Care Setting
A multicenter observational study in the Netherlands, with echocardiographic assessments before CRT and at 6 months after implantation.
Key Highlights
This post hoc analysis includes 198 patients from the prospective MARC study.
Adding baseline systolic angle to established markers significantly improves model fit for CRT response but does not significantly improve discrimination.
CRT responders show significant improvements in HDF parameters at 6 months; nonresponders show no significant changes.
Baseline systolic angle is independently associated with the composite endpoint of all-cause mortality or cardiovascular hospitalization over a median follow-up of 9.3 years.
Lower baseline systolic angle is associated with worse event-free survival.
Guideline-Based Recommendations
Diagnosis
The article does not establish guideline-based recommendations for HDF assessment. The study defines CRT response as a ≥15% reduction in left ventricular end-systolic volume at 6 months.
Management
The findings do not establish HDF-guided treatment recommendations. Further research is needed to determine whether HDF parameters improve clinical risk prediction.
Monitoring & Follow-up
HDF parameters are assessed at baseline and 6 months after CRT. Improvements in responders suggest that serial assessment may describe mechanical changes alongside volumetric response, but routine clinical use is not established.
Risks
A lower baseline systolic angle is associated with worse long-term outcomes. The exploratory 69° threshold is derived within this cohort, lacks external validation, and is not intended to guide clinical decisions.
Patient & Prescribing Data
The analysis includes 198 patients; 120 (60.6%) demonstrate echocardiographic response at 6 months. Participants receive optimal guideline-directed medical therapy according to study eligibility criteria. This analysis does not establish medication or prescribing recommendations.
Clinical Best Practices
Interpret HDF findings as exploratory associations rather than established criteria for selecting CRT candidates or directing treatment.
HDF analysis requires high-quality apical images, careful endocardial border tracing, and accurate valve measurements.
Interpret small systolic angle differences cautiously: observed differences of approximately 1°–2° approach the technique’s measurement precision, and systolic angle has the lowest reproducibility among the HDF parameters.
Consider the selected study population and post hoc design when assessing applicability to contemporary patients.
Related Resources & Content
Laenens D, van der Bijl P, Stassen J, et al. Introduction to hemodynamic forces by echocardiography. Int J Cardiol. 2023;370:442–444.
Vallelonga F, Airale L, Tonti G, et al. Introduction to hemodynamic forces analysis: moving into the new frontier of cardiac deformation analysis. J Am Heart Assoc. 2021;10:e023417.
Laenens D, van der Bijl P, Galloo X, et al. Evolution of echocardiography-derived hemodynamic force parameters after cardiac resynchronization therapy. Am J Cardiol. 2023;209:138–145.
Maass AH, Vernooy K, Wijers SC, et al. Refining success of cardiac resynchronization therapy using a simple score predicting the amount of reverse ventricular remodelling: results from the Markers and Response to CRT (MARC) study. Europace. 2018;20:e1–e10.
Laenens D, Van Der Bijl P, Galloo X, et al. Association between echocardiography-derived haemodynamic force parameters and left ventricular reverse remodelling after cardiac resynchronization therapy. Eur Heart J Cardiovasc Imaging. 2024;25:1721–1733.
by Roberto Tarantini, Willem Gerrits, Cheyenne S.L. Chiu, Leonie Smit, Gilbert Heltzel, Luuk H.G.A. Hopman, Philippe C. Wouters, Maarten J. Cramer, Frebus J. van Slochteren, Rene van Es, Alexander H. Maass, Michiel Rienstra, Cornelis P. Allaart, Kevin Vernooy, Antonius M.W. van Stipdonk, Frederik J. de Lange, Dorien Laenens, Philippe van Rosendael, Jeroen J. Bax, Nina Ajmone Marsan
The proposed framework classified 30% of patients as high or extreme risk, compared with 12% classified as having severe or greater tricuspid regurgitation under established grading schemes.
