Characteristics and long-term outcome of echocardiographic super-responders to cardiac resynchronisation therapy: 'real world' experience from a single tertiary care centre. Issue 20 (6th August 2011)

• Record Type: Journal Article
• Authors: Steffel, Jan; Milosevic, Gligor; Hürlimann, Anja; Krasniqi, Nazmi; Namdar, Mehdi; Ruschitzka, Frank; Lüscher, Thomas F; Duru, Firat; Holzmeister, Johannes; Hürlimann, David
• Is Part Of: Heart. Volume 97:Issue 20(2011)
• Page Start: 1668
• Page End: 1674
• Publication Date: 2011-08-06
• Subjects: Cardiac resynchronisation therapy (CRT) -- super-responder -- echocardiography -- long-term survival arrhythmias -- pacemakers -- atrial fibrillation -- atrial flutter -- brugada -- endocardial map -- sick sinus syndrome -- radiofrequency ablation (RFA) -- implantable cardioverter defibrillator (ICD) -- cardiomyopathy restrictive -- syncope -- nuclear cardiology -- cardiomyopathy hypertrophic -- defibrillation -- sudden cardiac death -- EBM -- STEMI -- stable angina -- NSTEMI -- coronary artery disease (CAD) -- heart failure -- echocardiography -- tissue doppler -- heart failure treatment; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heartjnl-2011-300222
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Background: The individual benefit from cardiac resynchronisation therapy (CRT) varies largely among patients. Aims: To compare different definitions of echocardiographic super-response to CRT regarding their ability to predict the incidence of adverse events. Methods: Three definitions of super-response to CRT were evaluated in 110 consecutive patients with CRT implantation: (1) an absolute increase in ejection fraction of ≥10%; (2) a decrease in left ventricular end-systolic volume of ≥30%; and (3) a decrease in left ventricular end-diastolic volume of ≥20%. The primary endpoint was a combination of time to death, heart transplantation, ventricular assist device implantation and hospitalisation for heart failure. Secondary endpoints included time to first appropriate implantable cardioverter defibrillator (ICD) discharge during follow-up. Results: All three definitions of super-response were highly predictive of a reduced risk for reaching the primary combined endpoint (3-year estimators: 64%±7% vs 82%±7% for ejection fraction ≥10%; 63%±8% vs 92%±5% for end-systolic volume ≥30%; and 62%±8% vs 94%±4% for end-diastolic volume ≥20%; all p<0.001). In all three analyses, super-responders had a significantly shorter time from diagnosis of heart failure until the time point of CRT implantation. However, even super-responders, independent of the definition, did experience appropriate ICD discharges during follow-up. Conclusions: All three definitions of super-response are highly predictive for a favourable outcome after CRT. However, even patients with pronounced reverse left ventricular remodelling experience appropriate ICD discharges during follow-up.