Characteristics and long-term outcome of echocardiographic super-responders to cardiac resynchronisation therapy: ‘real world’ experience from a single tertiary care centre
- Jan Steffel,
- Gligor Milosevic,
- Anja Hürlimann,
- Nazmi Krasniqi,
- Mehdi Namdar,
- Frank Ruschitzka,
- Thomas F Lüscher,
- Firat Duru,
- Johannes Holzmeister,
- David Hürlimann
- Correspondence to David Hürlimann, Department of Cardiology, University Hospital Zurich, Ramistrasse 100, Zürich 8091, Switzerland;
Contributors JH and DH contributed equally to the study. JS: design of the study, statistical analysis, interpretation of data, writing of manuscript. GM: data collection and interpretation. AH: data collection and interpretation. NK: data collection and interpretation. MN: data collection and interpretation, writing of manuscript. FR: interpretation of data, writing of manuscript. TFL: interpretation of data, writing of manuscript. FD: interpretation of data, writing of manuscript. JH: interpretation of data, writing of manuscript. DH: design of the study, statistical analysis, interpretation of data, writing of manuscript.
- Accepted 14 June 2011
- Published Online First 6 August 2011
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.
- Cardiac resynchronisation therapy (CRT)
- long-term survival arrhythmias
- atrial fibrillation
- atrial flutter
- endocardial map
- sick sinus syndrome
- radiofrequency ablation (RFA)
- implantable cardioverter defibrillator (ICD)
- cardiomyopathy restrictive
- nuclear cardiology
- cardiomyopathy hypertrophic
- sudden cardiac death
- stable angina
- coronary artery disease (CAD)
- heart failure
- tissue doppler
- heart failure treatment
Competing interests NK: research and educational grants from Medtronic. MN: research and educational grant from Biotronik and St Jude Medical. FD: research grants from Medtronic, St Jude Medical, Biotronik, Boston Scientific. TFL: research grants from Biotronik, Medtronic and St Jude. FR: research grants and consulting fees from Biotronik, speaker honoraria from Biotronik and Boston Scientific. JH: consulting fees from St Jude Medical and Biotronik; research grants and speaker honoraria from Biotronik, St Jude Medical, Medtronic and Boston Scientific. DH: educational grants from Boston Scientific and Medtronic, speaker honoraria and consulting fees from St Jude Medical and Medtronic.
Provenance and peer review Not commissioned; externally peer reviewed.