Prognostic effects of longitudinal changes in left ventricular ejection fraction with cardiac resynchronization therapy

Abstract

Aims Left ventricular ejection fraction (LVEF) is considered an indicator of cardiac resynchronization therapy (CRT). Longitudinal studies on the predictive value of LVEF are scarce. We aimed to comprehensively evaluate the prognostic role of LVEF in the outcomes of Chinese patients with CRT. Methods and results Three hundred ninety-two patients were divided into three tertiles of LVEF: ≤25%, 25-30%, and 30-35%, and four groups by LVEF changes: <0% (negative response); ≥0% and ≤5% (non-response); >5% and ≤15% (response); and >15% (super-response). One hundred six patients were super-responders. During a median follow-up of 3.6 years, 141 reached the composite endpoint. Odds ratios (ORs) for super-response depicted a reversed U-shaped relationship for baseline LVEF with a peak at 25-30%. Independent predictors of super-response were smaller left atrial diameter [odds ratio 0.897, 95% confidence interval (CI) 0.844-0.955, P = 0.001], smaller left ventricular end-diastolic diameter (OR 0.937, 95% CI 0.889-0.989, P = 0.018), and higher estimated glomerular filtration rate (OR 1.018, 95% CI 1.001-1.035, P = 0.042) in Tertile 1; atrial fibrillation (OR 0.278, 95% CI 0.086-0.901, P = 0.033), left bundle branch block (OR 4.096, 95% CI 1.046-16.037, P = 0.043), and left ventricular end-diastolic diameter (OR 0.929, 95% CI 0.876-0.986, P = 0.016) in Tertile 2; while female sex (OR 2.778, 95% CI 1.082-7.132, P = 0.034) and higher systolic blood pressure (OR 1.045, 95% CI 1.013-1.079, P = 0.006) in Tertile 3. An inverse association with the composite endpoint was found in Tertile 1 vs. Tertile 2 (hazard ratio 1.934, 95% CI 1.248-2.996, P = 0.003). The prognostic effects of CRT response in Tertile 3 and Tertile 1 varied significantly (P for trend = 0.017 and <0.001). Among three tertiles in super-responders, event-free survival was similar (P for trend = 0.143). Conclusions Left ventricular ejection fraction of 25-30% is associated with a better prognosis of super-response. Predictors of super-response are different for LVEF tertiles. CRT responses would have better prognostic performance than LVEF tertiles at baseline, which should be considered when clinicians screening eligible patients for CRT.

Frequency, predictors, and prognosis of heart failure with improved left ventricular ejection fraction: a single‐centre retrospective observational cohort study

“…Our study identified five variables that independently correlated with HFiEF: younger age, smaller LVEDD, beta‐blocker use, AF ablation, and CRT implantation were positive predictors. The result was consistent with a few other studies: our subjects with HFiEF were more likely to be younger 6,9 and treated with a beta‐blocker 9 and CRT implantation 13 . Moreover, smaller LVEDD was an independent factor that predicted a greater likelihood of LVEF improvement.…”

“…The result was consistent with a few other studies: our subjects with HFiEF were more likely to be younger 6,9 and treated with a beta-blocker 9 and CRT implantation. 13 Moreover, smaller LVEDD was an independent factor that predicted a greater likelihood of LVEF improvement. Otherwise, the novel findings of this study are that patients with AF ablation had greater odds of being in the HFiEF group.…”

Length of Hospitalization-Related Differences and Associated Long-Term Prognosis of Patients with Cardiac Resynchronization Therapy: A Propensity Score-Matched Cohort

“…The baseline patient characteristics are derived from the electronic medical record, including basic inpatient information, surgical records, and discharge summaries. The details of CRT implantation have been described in previous studies [ 9 ]. Demographic information (age, gender) was obtained by questionnaire.…”

Independent and Joint Association of Statin Therapy with Adverse Outcomes in Heart Failure Patients with Atrial Fibrillation Treated with Cardiac Resynchronization Therapy

“…The procedure of CRT implantation has been described in detail previously. 17 The inclusion and exclusion criteria for the study are shown in detail in Table S1 . The Ethics Committee approved this study of Fuwai Hospital, Chinese Academy of Medical Sciences (IRB2012-BG-006).…”