TY - JOUR
T1 - Durability of the survival effect of cardiac resynchronization therapy by level of left ventricular functional improvement
T2 - Fate of " nonresponders"
AU - Rickard, John
AU - Cheng, Alan
AU - Spragg, David
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.
AU - Wilkoff, Bruce L.
AU - Varma, Niraj
PY - 2014/3/1
Y1 - 2014/3/1
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.
KW - Cardiac resynchronization therapy
KW - Long-term outcomes
KW - Remodeling
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U2 - 10.1016/j.hrthm.2013.11.025
DO - 10.1016/j.hrthm.2013.11.025
M3 - Article
C2 - 24291412
AN - SCOPUS:84894586036
SN - 1547-5271
VL - 11
SP - 412
EP - 416
JO - Heart Rhythm
JF - Heart Rhythm
IS - 3
ER -