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

John Rickard, Alan Cheng, David 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 1 2014

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Keywords

  • Cardiac resynchronization therapy
  • Long-term outcomes
  • Remodeling

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Rickard, J., Cheng, A., Spragg, D., Bansal, S., Niebauer, M., Baranowski, B., Cantillon, D. J., Tchou, P. J., Grimm, R. A., Wilson Tang, W. H., Wilkoff, B. L., & Varma, N. (2014). Durability of the survival effect of cardiac resynchronization therapy by level of left ventricular functional improvement: Fate of " nonresponders". Heart Rhythm, 11(3), 412-416. https://doi.org/10.1016/j.hrthm.2013.11.025