Open AccessPredictors and long‐term outcome of super‐responders to cardiac resynchronization therapy
Author(s) -
Ghani Abdul,
Delnoy Peter Paul H.M.,
Adiyaman Ahmet,
Ottervanger Jan Paul,
Ramdat Misier Anand R.,
Smit Jaap Jan J.,
Elvan Arif
Publication year - 2017
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.22658
Subject(s) - medicine , mace , ejection fraction , cardiac resynchronization therapy , heart failure , hazard ratio , cardiology , qrs complex , population , myocardial infarction , confidence interval , percutaneous coronary intervention , environmental health
Background The level of improvement in left ventricular ejection fraction ( LVEF ) in super‐responders to cardiac resynchronization therapy ( CRT ) is exceptional. However, the long‐term prognosis remains unknown in a large population. Hypothesis Whether super‐responders haven good long‐term outcomes. Methods We registered 347 patients with primary CRT ‐D indication. Super‐response was defined by LVEF >50% at follow‐up echocardiogram. Best‐subset regression analysis identified predictors of super‐response. Endpoints were major adverse cardiac events ( MACE ; eg, all‐cause mortality or heart failure hospitalization, cardiac death, and appropriate ICD therapy). Results Fifty‐six (16%) patients with LVEF >50% were classified as super‐responders. Female sex ( OR : 3.06, 95% CI : 1.54‐6.05), nonischemic etiology ( OR : 2.70, 95% CI : 1.29‐5.68), higher LVEF at baseline ( OR : 1.07, 95% CI : 1.02‐1.13), and wider QRS duration ( OR : 1.17, 95% CI : 1.04‐1.32) were predictors of super‐response. Cumulative incidence of MACE at a median of 5.3 years was 18% in super‐responders, 22% in responders, and 51% in nonresponders ( P < 0.001). None of super responders died from cardiac death, compared to 9% of responders and 25% of non‐responders ( P < 0.001). None of super‐responders experienced appropriate ICD therapy, compared with 10% of responders and 21% of non‐responders ( P < 0.001). In super‐responders, the adjusted hazard ratio was 0.37 (95% CI : 0.19‐0.73) for MACE and 0.44 (95% CI : 0.20‐0.95) for total mortality, compared with non‐responders. Conclusions Female sex, non‐ischemic etiology, higher baseline LVEF , and wider QRS duration were independently associated with super‐response. Super‐response was associated with persistent excellent prognosis regarding survival and appropriate ICD therapy during long‐term follow‐up.