What happens to non-responders in cardiac resynchronization therapy?

Abstract

Introduction and Objectives:Left ventricular reverse remodeling (LVRR) is strongly related to the long-term prognosis of patients undergoing cardiac resynchronization therapy (CRT). The aim of this study was to assess the long-term clinical outcome of patients without LVRR at six months after CRT implantation and to determine the prognostic impact of clinical response in this population. Methods: We analyzed 178 consecutive patients who underwent successful CRT device implantation (age 64±11 years; 69% male; 89% in New York Heart Association [NYHA] functional class III; 35% with ischemic cardiomyopathy). Clinical status and echocardiographic parameters were determined before and six months after CRT implantation. We identified those without criteria for LVRR (≥10% increase in left ventricular ejection fraction with ≥15% reduction in left ventricular end-systolic diameter compared to baseline). Clinical responders were defined by a sustained improvement of at least one NYHA functional class. Results: At six-month assessment after CRT, 109 (61%) patients showed LVRR. During a mean follow-up of 56±21 months, 47 (26%) patients died, with higher mortality in the group without LVRR (36% vs. 20%, p=0.023). Clinical response was greater in patients with LVRR (88% vs. 55%, p<0.001). In patients without LVRR, clinical response to CRT was the strongest independent predictor of survival (hazard ratio: 0.120; 95% confidence interval: 0.039-0.366; p<0.001). Conclusion: Although patients without LVRR six months after CRT implantation had a worse prognosis, with higher all-cause mortality, clinical response can be an independent predictor of survival in this population. downloaded from http://www.elsevier.es, day 09/01/2018. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. Document downloaded from http://www.elsevier.es, day 09/01/2018. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. 886 P. Rio et al. PALAVRAS-CHAVE

QRS area as a predictor of cardiac resynchronization therapy response: A systematic review and meta‐analysis

“…30 From previous reports, higher mortality rates were found in CRT non-responders than the responder group. 5,30 Along with greater mortality, the qual-ity of life in this group of patients was also poorer. 30 Additional criteria using combined clinical characteristics, imaging, and other tools are, indeed, needed to be incorporated to reduce the proportion of non-responders.…”

“…4 Patients who are not responsive to resynchronization therapy carry greater mortality risk. 5,6 To improve the clinical response to resynchronization therapy and fill in the practice gap, better criteria are needed to identify non-responders. We hypothesize that the criteria derived from traditional ECG-QRS duration cannot differentiate responders from non-responders.…”

Arrhythmic and mortality outcomes in patients with dilated cardiomyopathy receiving cardiac resynchronization therapy without defibrillator

“…Rio et al. [ 10 ], reported that patients with LV reverse remodeling showed better clinical outcomes, with higher survival rates (80%vs. 64%, p = 0.023) and less hospitalizations due to HF (11%vs.…”

“…The factors mainly identified as contributors to lack of response to CRT are ischemic etiology, shorter QRS duration and less baseline mechanical dyssynchrony [ [11] , [12] , [13] ]. Non-ischemic cardiomyopathy and LBBB were associated with LV reverse remodeling [ 10 ].…”