Pediatric/Adult Congenital Heart Disease -> Pediatric Cardiology D-PO03 - Poster Session III (ID 48) Poster

D-PO03-075 - Classic Pattern Dyssynchrony Score: A Novel Predictor Of Response To Cardiac Resynchronization Therapy In Pediatric And Congenital Heart Disease Patients (ID 1092)


Background: Predictors of response to cardiac resynchronization therapy (CRT) in pediatric and congenital heart disease (CHD) population remain elusive. Classic Pattern Dysynchrony (CPD) by echo has been shown to be a good predictor of response in adults. However, all four features of CPD (septal flash, lateral stretch, early septal contraction, late lateral contraction) are rarely identified in pediatric and CHD populations.
Objective: To assess the predictive value of a novel ‘CPD Score’ (Figure), an objective ordinal measure of degree of CPD.
Methods: Pediatric and CHD patients receiving CRT at a large single center (2004-2017) were identified. Response to CRT was defined as ≥10% increase in ejection fraction (EF) at 12 months. Conventional (binary) CPD was identified using multi-view 2D speckle-tracking. A ‘CPD Score’ was assigned using a custom algorithm on 4-chamber strain alone. The score ranged from 0-4, indicating the number of CPD criteria met. For comparison, four established echo markers of dyssynchrony were also assessed on m-mode, pulsed wave and tissue Doppler imaging.
Results: Of 91 eligible subjects (EF 36±14%, 72 (79%) CHD), EF improved in 62 (68%). Conventional CPD was identified in only 9 (10%) subjects. On multivariate analysis, only CPD Score was independently associated with outcome (OR 6.3 (95% CI 1.1-35), p=0.03). CPD Score was associated with response in both CHD (OR 2.1, p=0.007) and pediatric cardiomyopathy (OR 2.7, p=0.04) subgroups. Sensitivity/specificity for response was 61%/72% respectively for score of 2 and 29%/96% for score of 3.
Conclusion: The CPD Score is a novel tool which may be used to identify pediatric and CHD patients most likely to respond to CRT.