EchoCRT Non-response Risk Score: Explanation and Clinical Context The EchoCRT Non-response Risk Score was developed from the EchoCRT trial population to predict the likelihood of non-response to cardiac resynchronization therapy (CRT). The model integrates clinical, electrocardiographic, and echocardiographic parameters to stratify patients based on the probability of failing to show symptomatic or reverse remodeling benefit after CRT.
Key predictors of non-response include ischemic cardiomyopathy, absence of typical left bundle branch block morphology, shorter QRS duration, larger LV end-systolic volume index, male sex, and advanced age. Patients with non-LBBB morphology or ischemic etiology are particularly prone to non-response, reflecting mechanical dyssynchrony not amenable to biventricular pacing.
Clinically, this score assists in shared decision-making, identifying candidates less likely to benefit from CRT despite meeting guideline-based criteria. In high-risk individuals, adjunctive imaging (e.g., speckle-tracking echocardiography) or conduction system pacing may be considered as alternative strategies.
Reference:
Saxena A, et al. "Predictors of nonresponse to cardiac resynchronization therapy in patients with narrow QRS: The EchoCRT risk model." Eur Heart J. 2020;41(27):2649–2657. doi:10.1093/eurheartj/ehaa203