RT Journal Article
SR Electronic
T1 Characteristics and long-term outcome of echocardiographic super-responders to cardiac resynchronisation therapy: ‘real world’ experience from a single tertiary care centre
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 1668
OP 1674
DO 10.1136/heartjnl-2011-300222
VO 97
IS 20
A1 Jan Steffel
A1 Gligor Milosevic
A1 Anja Hürlimann
A1 Nazmi Krasniqi
A1 Mehdi Namdar
A1 Frank Ruschitzka
A1 Thomas F Lüscher
A1 Firat Duru
A1 Johannes Holzmeister
A1 David Hürlimann
YR 2011
UL http://heart.bmj.com/content/97/20/1668.abstract
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.