Outcome of Super-responders to Cardiac Resynchronization Therapy Defined by Endpoint-derived Parameters of Left Ventricular Remodeling: a Two-center Retrospective Study

Overview

Journal Clin Res Cardiol

Specialty Cardiology & Vascular Diseases

Date 2014 Oct 11

PMID 25301085

Citations 3

Authors

David Hurlimann

Susann Schmidt

Burkhardt Seifert

Ardan M Saguner

Gerhard Hindricks

Thomas F Luscher

Frank Ruschitzka

Jan Steffel

Affiliations

Soon will be listed here.

Abstract

Aims: Various studies have attempted to identify super-responders to cardiac resynchronization therapy (CRT) by echocardiographic parameters of reverse remodeling. However, scientific evidence regarding those parameters is scarce. This study aimed at validating the definition of super-response to CRT based on the following frequently employed echocardiographic parameters: left ventricular ejection fraction (LVEF), end-diastolic volume index (EDVI), and end-systolic volume index (ESVI).

Methods And Results: We retrospectively investigated echocardiographic data and outcomes of 542 patients after CRT implantation. The primary endpoint comprised all-cause mortality, heart transplantation, ventricular assist device implantation (VAD), and hospitalization for heart failure. Secondary endpoints were hospitalization for heart failure, and the combination of all-cause mortality, heart transplantation and VAD. Two approaches were employed defining super-response based on improvement of echocardiographic parameters: one derived from the negative predictive value (NPV) for clinical endpoints, and second from best quartiles of improvement. Using the NPV method, an absolute 25 % increase in LVEF, a relative 38 % reduction in EDVI, and 46 % in ESVI were calculated as optimal cut-offs identifying 4.9, 18.5, and 21.3 % as super-responders. The best quartiles method resulted in lower cut-off values, i.e. 14 % increase in LVEF, 26 % reduction in EDVI, and 36 % in ESVI. All cut-offs except LVEF ≥ 25% were significantly associated with improved outcomes after 5 years (median follow-up 35.7 months).

Conclusions: NPV- and best quartile-based cut-offs validate previously applied empirical echocardiographic cut-offs to define super-response to CRT. These data provide evidence for using these empirical cut-offs in daily practice and facilitate inter-study comparability.

Citing Articles

Predictors of super-response to cardiac resynchronization therapy: the significance of heart failure medication, pre-implant left ventricular geometry and high percentage of biventricular pacing.

Jin H, Gu M, Hua W, Fan X, Niu H, Ding L J Geriatr Cardiol. 2018; 14(12):737-742.

PMID: 29581712 PMC: 5863051. DOI: 10.11909/j.issn.1671-5411.2017.12.003.

Clinical effects of long-term cardiac contractility modulation (CCM) in subjects with heart failure caused by left ventricular systolic dysfunction.

Muller D, Remppis A, Schauerte P, Schmidt-Schweda S, Burkhoff D, Rousso B Clin Res Cardiol. 2017; 106(11):893-904.

PMID: 28685207 PMC: 5655601. DOI: 10.1007/s00392-017-1135-9.

Sustained clinical benefit of cardiac resynchronization therapy in non-LBBB patients with prolonged PR-interval: MADIT-CRT long-term follow-up.

Stockburger M, Moss A, Klein H, Zareba W, Goldenberg I, Biton Y Clin Res Cardiol. 2016; 105(11):944-952.

PMID: 27318807 DOI: 10.1007/s00392-016-1003-z.

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