Characteristics and long-term outcome of echocardiographic super-responders to cardiac resynchronisation therapy: ‘real world’ experience from a single tertiary care centre

• Published in: Heart (British Cardiac Society) Vol. 97; no. 20; pp. 1668 - 1674
• Main Authors: Steffel, Jan, Milosevic, Gligor, Hürlimann, Anja, Krasniqi, Nazmi, Namdar, Mehdi, Ruschitzka, Frank, Lüscher, Thomas F, Duru, Firat, Holzmeister, Johannes, Hürlimann, David
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Cardiovascular Society 01.10.2011; BMJ Publishing Group; BMJ Publishing Group LTD
• Subjects: atrial fibrillation; atrial flutter; Biological and medical sciences; brugada; Cardiac arrhythmia; Cardiac resynchronisation therapy (CRT); Cardiac Resynchronization Therapy - methods; Cardiology. Vascular system; cardiomyopathy hypertrophic; cardiomyopathy restrictive; Cardiovascular disease; Cardiovascular system; coronary artery disease (CAD); defibrillation; Defibrillators, Implantable; EBM; Echocardiography; endocardial map; Female; Follow-Up Studies; Heart attacks; Heart failure; Heart Failure - diagnostic imaging; Heart Failure - physiopathology; Heart Failure - therapy; heart failure treatment; Heart Ventricles - diagnostic imaging; Heart Ventricles - physiopathology; Humans; implantable cardioverter defibrillator (ICD); Investigative techniques, diagnostic techniques (general aspects); long-term survival arrhythmias; Male; Medical sciences; Middle Aged; Mortality; NSTEMI; nuclear cardiology; pacemakers; Patients; radiofrequency ablation (RFA); Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Reproducibility of Results; Retrospective Studies; sick sinus syndrome; stable angina; STEMI; Stroke Volume - physiology; sudden cardiac death; super-responder; syncope; Time Factors; tissue doppler; Transplants & implants; Treatment Outcome; Ultrasonic investigative techniques; Ventricular Function - physiology; World; Sonography; Heart; Echocardiography; Prognosis; Characteristic; Instrumentation therapy; Long term; Care; Instrumental stimulation; Experience; Characteristics; Circulatory system; Cardiology; Responder
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/heartjnl-2011-300222

BackgroundThe individual benefit from cardiac resynchronisation therapy (CRT) varies largely among patients.AimsTo compare different definitions of echocardiographic super-response to CRT regarding their ability to predict the incidence of adverse events.MethodsThree 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.ResultsAll 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.ConclusionsAll 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.