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Predictors and outcomes of "super-response" to cardiac resynchronization therapy.

Abstract：

BACKGROUND:Cardiac resynchronization therapy (CRT) has been shown to improve heart failure (HF) symptoms and survival. We hypothesized that a greater improvement in left-ventricular ejection fraction (LVEF) after CRT is associated with greater survival benefit. METHODS AND RESULTS:In 693 patients across 2 international centers, the improvement in LVEF after CRT was determined. Patients were grouped as non-/modest-, moderate-, or super-responders to CRT, defined as an absolute change in LVEF of ≤5%, 6-15%, and >15%, respectively. Changes in New York Heart Association (NYHA) functional class and left ventricular end-diastolic dimension (LVEDD) were assessed for each group. There were 395 non-/modest-, 186 moderate-, and 112 super-responders. Super-responders were more likely to be female and to have nonischemic cardiomyopathy, lower creatinine, and lower pulmonary artery systolic pressure than non-/modest- and moderate-responders. Super-responders were also more likely to have lower LVEF than non-/modest-responders. There was no difference in NYHA functional class, mitral regurgitation grade, or tricuspid regurgitation grade between groups. Improvement in NYHA functional class (-0.9 ± 0.9 vs -0.4 ± 0.8 [P < .001] and -0.6 ± 0.8 [P = .02]) and LVEDD (-8.7 ± 9.9 mm vs -0.5 ± 5.0 and -2.4 ± 5.8 mm [P < .001 for both]) was greatest in super-responders. Kaplan-Meier survival analysis revealed that super-responders achieved better survival compared with non-/modest- (P < .001) and moderate-responders (P = .049). CONCLUSIONS:Improvement in HF symptoms and survival after CRT is proportionate to the degree of improvement in LV systolic function. Super-response is more likely in women, those with nonischemic substrate, and those with lower pulmonary artery systolic pressure.

journal_name

J Card Fail

journal_title

Journal of cardiac failure

authors

Killu AM,Grupper A,Friedman PA,Powell BD,Asirvatham SJ,Espinosa RE,Luria D,Rozen G,Buber J,Lee YH,Webster T,Brooke KL,Hodge DO,Wiste HJ,Glikson M,Cha YM

doi

10.1016/j.cardfail.2014.03.001

subject

Has Abstract

pub_date

2014-06-01 00:00:00

pages

379-86

issue

eissn

1071-9164

issn

1532-8414

pii

S1071-9164(14)00094-3

journal_volume

pub_type

杂志文章,多中心研究

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Predictors and outcomes of "super-response" to cardiac resynchronization therapy.