Durability of the survival effect of cardiac resynchronization therapy by level of left ventricular functional improvement: Fate of " nonresponders"

John Rickard, Alan Cheng, David D Spragg, Sandeep Bansal, Mark Niebauer, Bryan Baranowski, Daniel J. Cantillon, Patrick J. Tchou, Richard A. Grimm, W. H. Wilson Tang, Bruce L. Wilkoff, Niraj Varma

Research output: Contribution to journalArticle

Abstract

Background Although improvement in left ventricular (LV) function has been shown to portend superior short-term outcomes in patients with heart failure undergoing cardiac resynchronization therapy (CRT), the durability of this effect at 5 years has not been established. Objective To determine the long-term outcomes of patients undergoing CRT on the basis of the degree of echocardiographic response. Methods We extracted clinical data on a cohort of 880 consecutive patients undergoing the new implantation of a CRT device between September 30, 2003, and August 6, 2007. Patients with an ejection fraction (EF) ≤35% undergoing initial CRT implantation, with an available pre-CRT and follow-up echocardiogram, were included in the final cohort. On the basis of changes in LVEF, patients were categorized into "nonresponders" (change in EF ≤4%), "responders" (EF change 5%-20%), and "super-responders" (change in EF >20%). A Cox multivariate model was performed to determine the effect of response on long-term survival free of LV assist device or heart transplant. Results A total of 526 patients met inclusion criteria, of whom 196 (37.3%) were classified as nonresponders, 236 (44.9%) as "responders," and 94 (17.9%) as "super-responders. " In multivariate analysis, "super-responders" had the best survival and nonresponders the worst over a mean of follow-up of 5.3 ± 2.4 years. At 5 years, survival free of LV assist device or heart transplant among super-responders was 82%; responders, 70%; and nonresponders, 48%. Conclusions In patients with heart failure undergoing CRT, survival benefit is durable at 5 years of follow-up and its degree intimately tied to the level of improvement in ventricular function. The prognosis of nonresponders is exceptionally poor.

Original languageEnglish (US)
Pages (from-to)412-416
Number of pages5
JournalHeart Rhythm
Volume11
Issue number3
DOIs
StatePublished - Mar 2014

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Cardiac Resynchronization Therapy
Survival
Heart-Assist Devices
Cardiac Resynchronization Therapy Devices
Heart Failure
Transplants
Ventricular Function
Left Ventricular Function
Proportional Hazards Models
Multivariate Analysis

Keywords

  • Cardiac resynchronization therapy
  • Long-term outcomes
  • Remodeling

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Durability of the survival effect of cardiac resynchronization therapy by level of left ventricular functional improvement : Fate of " nonresponders". / Rickard, John; Cheng, Alan; Spragg, David D; Bansal, Sandeep; Niebauer, Mark; Baranowski, Bryan; Cantillon, Daniel J.; Tchou, Patrick J.; Grimm, Richard A.; Wilson Tang, W. H.; Wilkoff, Bruce L.; Varma, Niraj.

In: Heart Rhythm, Vol. 11, No. 3, 03.2014, p. 412-416.

Research output: Contribution to journalArticle

Rickard, J, Cheng, A, Spragg, DD, Bansal, S, Niebauer, M, Baranowski, B, Cantillon, DJ, Tchou, PJ, Grimm, RA, Wilson Tang, WH, Wilkoff, BL & Varma, N 2014, 'Durability of the survival effect of cardiac resynchronization therapy by level of left ventricular functional improvement: Fate of " nonresponders"', Heart Rhythm, vol. 11, no. 3, pp. 412-416. https://doi.org/10.1016/j.hrthm.2013.11.025
Rickard, John ; Cheng, Alan ; Spragg, David D ; Bansal, Sandeep ; Niebauer, Mark ; Baranowski, Bryan ; Cantillon, Daniel J. ; Tchou, Patrick J. ; Grimm, Richard A. ; Wilson Tang, W. H. ; Wilkoff, Bruce L. ; Varma, Niraj. / Durability of the survival effect of cardiac resynchronization therapy by level of left ventricular functional improvement : Fate of " nonresponders". In: Heart Rhythm. 2014 ; Vol. 11, No. 3. pp. 412-416.
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abstract = "Background Although improvement in left ventricular (LV) function has been shown to portend superior short-term outcomes in patients with heart failure undergoing cardiac resynchronization therapy (CRT), the durability of this effect at 5 years has not been established. Objective To determine the long-term outcomes of patients undergoing CRT on the basis of the degree of echocardiographic response. Methods We extracted clinical data on a cohort of 880 consecutive patients undergoing the new implantation of a CRT device between September 30, 2003, and August 6, 2007. Patients with an ejection fraction (EF) ≤35{\%} undergoing initial CRT implantation, with an available pre-CRT and follow-up echocardiogram, were included in the final cohort. On the basis of changes in LVEF, patients were categorized into {"}nonresponders{"} (change in EF ≤4{\%}), {"}responders{"} (EF change 5{\%}-20{\%}), and {"}super-responders{"} (change in EF >20{\%}). A Cox multivariate model was performed to determine the effect of response on long-term survival free of LV assist device or heart transplant. Results A total of 526 patients met inclusion criteria, of whom 196 (37.3{\%}) were classified as nonresponders, 236 (44.9{\%}) as {"}responders,{"} and 94 (17.9{\%}) as {"}super-responders. {"} In multivariate analysis, {"}super-responders{"} had the best survival and nonresponders the worst over a mean of follow-up of 5.3 ± 2.4 years. At 5 years, survival free of LV assist device or heart transplant among super-responders was 82{\%}; responders, 70{\%}; and nonresponders, 48{\%}. Conclusions In patients with heart failure undergoing CRT, survival benefit is durable at 5 years of follow-up and its degree intimately tied to the level of improvement in ventricular function. The prognosis of nonresponders is exceptionally poor.",
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AU - Rickard, John

AU - Cheng, Alan

AU - Spragg, David D

AU - Bansal, Sandeep

AU - Niebauer, Mark

AU - Baranowski, Bryan

AU - Cantillon, Daniel J.

AU - Tchou, Patrick J.

AU - Grimm, Richard A.

AU - Wilson Tang, W. H.

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AU - Varma, Niraj

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N2 - Background Although improvement in left ventricular (LV) function has been shown to portend superior short-term outcomes in patients with heart failure undergoing cardiac resynchronization therapy (CRT), the durability of this effect at 5 years has not been established. Objective To determine the long-term outcomes of patients undergoing CRT on the basis of the degree of echocardiographic response. Methods We extracted clinical data on a cohort of 880 consecutive patients undergoing the new implantation of a CRT device between September 30, 2003, and August 6, 2007. Patients with an ejection fraction (EF) ≤35% undergoing initial CRT implantation, with an available pre-CRT and follow-up echocardiogram, were included in the final cohort. On the basis of changes in LVEF, patients were categorized into "nonresponders" (change in EF ≤4%), "responders" (EF change 5%-20%), and "super-responders" (change in EF >20%). A Cox multivariate model was performed to determine the effect of response on long-term survival free of LV assist device or heart transplant. Results A total of 526 patients met inclusion criteria, of whom 196 (37.3%) were classified as nonresponders, 236 (44.9%) as "responders," and 94 (17.9%) as "super-responders. " In multivariate analysis, "super-responders" had the best survival and nonresponders the worst over a mean of follow-up of 5.3 ± 2.4 years. At 5 years, survival free of LV assist device or heart transplant among super-responders was 82%; responders, 70%; and nonresponders, 48%. Conclusions In patients with heart failure undergoing CRT, survival benefit is durable at 5 years of follow-up and its degree intimately tied to the level of improvement in ventricular function. The prognosis of nonresponders is exceptionally poor.

AB - Background Although improvement in left ventricular (LV) function has been shown to portend superior short-term outcomes in patients with heart failure undergoing cardiac resynchronization therapy (CRT), the durability of this effect at 5 years has not been established. Objective To determine the long-term outcomes of patients undergoing CRT on the basis of the degree of echocardiographic response. Methods We extracted clinical data on a cohort of 880 consecutive patients undergoing the new implantation of a CRT device between September 30, 2003, and August 6, 2007. Patients with an ejection fraction (EF) ≤35% undergoing initial CRT implantation, with an available pre-CRT and follow-up echocardiogram, were included in the final cohort. On the basis of changes in LVEF, patients were categorized into "nonresponders" (change in EF ≤4%), "responders" (EF change 5%-20%), and "super-responders" (change in EF >20%). A Cox multivariate model was performed to determine the effect of response on long-term survival free of LV assist device or heart transplant. Results A total of 526 patients met inclusion criteria, of whom 196 (37.3%) were classified as nonresponders, 236 (44.9%) as "responders," and 94 (17.9%) as "super-responders. " In multivariate analysis, "super-responders" had the best survival and nonresponders the worst over a mean of follow-up of 5.3 ± 2.4 years. At 5 years, survival free of LV assist device or heart transplant among super-responders was 82%; responders, 70%; and nonresponders, 48%. Conclusions In patients with heart failure undergoing CRT, survival benefit is durable at 5 years of follow-up and its degree intimately tied to the level of improvement in ventricular function. The prognosis of nonresponders is exceptionally poor.

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