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Characteristics and long-term outcome of echocardiographic super-responders to cardiac resynchronisation therapy: ‘real world’ experience from a single tertiary care centre
  1. Jan Steffel,
  2. Gligor Milosevic,
  3. Anja Hürlimann,
  4. Nazmi Krasniqi,
  5. Mehdi Namdar,
  6. Frank Ruschitzka,
  7. Thomas F Lüscher,
  8. Firat Duru,
  9. Johannes Holzmeister,
  10. David Hürlimann
  1. Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
  1. Correspondence to David Hürlimann, Department of Cardiology, University Hospital Zurich, Ramistrasse 100, Zürich 8091, Switzerland; david.huerlimann{at}


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)
  • 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
  • stable angina
  • coronary artery disease (CAD)
  • heart failure
  • echocardiography
  • tissue doppler
  • heart failure treatment

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  • 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.