How to Define Cardiac Resynchronization Therapy Response

Tomassoni, Gery

doi:10.19102/icrm.2016.070003

Cited by 17 publications

(13 citation statements)

References 28 publications

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“…The definition of CRT response has varied in previous clinical trials [ 6 , 7 , 8 ]. However, the most common definition of CRT response includes echocardiographic parameters describing reverse remodeling [ 12 , 13 , 14 ], perhaps because echocardiographic data are more objective than symptoms, and some patients feel better after treatment and may experience placebo effects.…”

Section: Discussionmentioning

confidence: 99%

“…However, we believe that patients in actual clinical practice have a better response than that reported in the literature. There are various definitions of CRT response, and the response rate varies significantly according to the definition [ 6 , 7 , 8 ]. In general, two definitions have been used in most clinical trials, i.e., echocardiographic response and functional response.…”

Section: Introductionmentioning

confidence: 99%

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What Are the Expectations for Cardiac Resynchronization Therapy? A Validation of Two Response Definitions

Nakai

Ikeya

Kogawa

et al. 2021

JCM

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Background: The definition of response to cardiac resynchronization therapy (CRT) varies across clinical trials. There are two main definitions, i.e., echocardiographic response and functional response. We assessed which definition was more reasonable. Methods: In this study of 260 patients who had undergone CRT, an echocardiographic response was defined as a reduction in a left ventricular end-systolic volume of greater than or equal to 15% or an improvement in left ventricular ejection fraction of greater than or equal to 5%. A functional response was defined as an improvement of at least one class category in the New York Heart Association functional classification. We assessed the response to CRT at 6 months after device implantation, based on each definition, and investigated the relationship between response and clinical outcomes. Results: The echocardiographic response rate was 74.2%. The functional response rate was 86.9%. Non-responder status, based on both definitions, was associated with higher all-cause mortality. Cardiac death was only associated with functional non-responder status (hazard ratio (HR) 2.65, 95% confidence interval (CI) 1.19–5.46, p = 0.0186) and heart failure hospitalization (HR 2.78, 95% CI, 1.29–5.26, p = 0.0111). Conclusion: After CRT implantation, the functional response definition of CRT response is associated with a higher response rate and better clinical outcomes than that of the echocardiographic response definition, and therefore it is reasonable to use the functional definition to assess CRT response.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

What Are the Expectations for Cardiac Resynchronization Therapy? A Validation of Two Response Definitions

Nakai

Ikeya

Kogawa

et al. 2021

JCM

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“…However, it should be acknowledged that the reported response rates vary with the criteria used to assess the response. 20 The relatively small number of patients as well as the retrospective setting are limitations to this study particularly concerning our observations regarding CRT responses.…”

Section: Discussionmentioning

confidence: 94%

Timing of pacemaker and ICD implantation inLMNAmutation carriers

et al. 2021

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AimsLMNA-cardiomyopathy is often associated with pathology in the cardiac conduction system necessitating device implantations. The aim was to study the timing and types of device implantations and need for re-implantations in LMNA mutation carriers.MethodsWe studied the hospital records of 60 LMNA mutation carriers concerning device implantations and re-implantations and their indications. Data were collected until April 2019.ResultsThe median follow-up time from the first ECG recording to the last clinical follow-up, transplantation, or death was 7.7 (IQR=9.1) years. Altogether 61.7% (n=37) of the LMNA mutation carriers received a pacemaker or an implantable cardioverter defibrillator (ICD), and of them 27.0% (n=10) needed a device upgrade. Notably, in some patients the upgrade took place very soon after the first implantation. The first device was implanted at an average age of 47.9 years (SD=9.5), whereas the upgrade took place at an average age of 50.3 years (SD=8.1). Most upgrades were ICD implantations. Male patients underwent device upgrade more often and at a younger age than women. By the end of follow-up, 35.0% (n=21) of the patients fulfilled echocardiographic criteria for dilated cardiomyopathy, and 90.5% of them (n=19) needed pacemaker implantation.ConclusionMost LMNA mutation carriers underwent pacemaker implantation in this study. Due to the progressive nature of LMNA-cardiomyopathy, device upgrades are quite common. An ICD should be considered when the initial device implantation is planned in an LMNA mutation carrier.

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“…1 However, there is a lack of standard definition for CRT response and the spectrum of CRT response and reported response rates vary widely depending on the metrics used and whether or not a placebo effect is considered. [2][3][4] Regardless of the definition considered, however, nonresponse to CRT remains a significant problem. This manuscript presents five cases of nonresponse to CRT and will discuss the approaches used to overcome this problem in each.…”

Section: Introductionmentioning

confidence: 99%