Identification of 'super-responders' to cardiac resynchronization therapy: the importance of symptom duration and left ventricular geometry

Abstract

Patients in earlier phases of the cardiomyopathy, with a less altered ventricular geometry, seem to have a greater probability of becoming super-responders.

Comparação entre a ecocardiografia 2D e 3D na avaliação do remodelamento reverso após a TRC

“…In a study by Anthony et al 15 , patients in the earliest stages of cardiomyopathy and minor alterations in ventricular geometry were more likely to respond to CRT. Additionally, the evaluation of volumetric changes after CRT provides important predictive information about the clinical outcomes in the natural evolution of the disease, as demonstrated originally by Yu et al 16 and confirmed in a recent study by Ypenburg et al 17 .…”

Who Are the Super-Responders to Cardiac Resynchronization Therapy?

“…The results of this study corroborate that of others who also demonstrated hyper-responsive patterns in patients with less advanced heart disease. 5,6,12 In the MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy) study, in patients with mild symptoms of heart failure, the female gender, absence of infarction, LBBB, QRS > 150 ms, BMI < 30 kg/m 2 and reduced left atrial volume were predictors of SR. 8 Our study included a group of patients with very symptomatic CHF, with 64% of patients having been previously hospitalized for recently decompensated CHF. These differences in the population characteristics may explain some differences in the observed results.…”

“…2,3 Some authors have described groups of patients that progressed with higher responses than the expected ones, with normalization of left ventricular function, FC, and ventricular diameters, thus being called hyperresponders or Super-Responders (SR), ranging from 9 to 21% in several studies. [4][5][6] The characteristics of these patients have been assessed, and the super-response is interpreted as a possible cardiomyopathy induced by cardiac dyssynchrony, caused by the intra-ventricular conduction disorder. 7 Predictors of super-response are the female gender, non-ischemic heart disease (Chagas cardiomyopathy not included) and Left Bundle-Branch Block (LBBB).…”

A “superresponse” to cardiac resynchronization therapy in patients with chronic heart failure

“…В более поздних работах авторы также использовали динамику ФВ ЛЖ, как критерий «суперответа», однако целевой уровень ФВ ЛЖ менял-ся от исследования к исследованию [17][18][19]. До сих пор нет единого мнения о том, какого критерия следует при-держиваться при определении понятия «суперреспон-дер» [20][21][22][23]. В нашем исследовании, как и в ряде других крупных исследований, пациенты были отнесены в груп-пу «суперреспондеров», если через 6 мес после имплан-тации снижение КСО ЛЖ составило 30 % и более [16,24,25].…”