PT  - JOURNAL ARTICLE
AU  - Jan Steffel
AU  - Gligor Milosevic
AU  - Anja Hürlimann
AU  - Nazmi Krasniqi
AU  - Mehdi Namdar
AU  - Frank Ruschitzka
AU  - Thomas F Lüscher
AU  - Firat Duru
AU  - Johannes Holzmeister
AU  - David Hürlimann
TI  - Characteristics and long-term outcome of echocardiographic super-responders to cardiac resynchronisation therapy: ‘real world’ experience from a single tertiary care centre
AID  - 10.1136/heartjnl-2011-300222
DP  - 2011 Oct 15
TA  - Heart
PG  - 1668--1674
VI  - 97
IP  - 20
4099  - http://heart.bmj.com/content/97/20/1668.short
4100  - http://heart.bmj.com/content/97/20/1668.full
SO  - Heart2011 Oct 15; 97
AB  - 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.