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Long-term outcomes in nonprogressors to cardiac resynchronization therapy

Published:November 07, 2022DOI:https://doi.org/10.1016/j.hrthm.2022.10.029

      Background

      Among patients with heart failure undergoing cardiac resynchronization therapy (CRT), patients with a minimal change in left ventricular ejection fraction (LVEF) have recently been defined as “nonprogressors” rather than as “nonresponders.” Little is known regarding long-term outcomes of nonprogressors.

      Objective

      We sought to evaluate outcomes in patients undergoing CRT on the basis of echocardiographically determined response status.

      Methods

      We reviewed the medical charts of patients with an LVEF of ≤35% and a QRS duration of ≥120 ms undergoing CRT at the Cleveland Clinic, Johns Hopkins Hospital, and Johns Hopkins Bayview Medical Center between 2003 and 2014. Response to CRT was defined on the basis of LVEF change as follows: super-responders ≥20%, responders 6%–19%, nonprogressors 0%–5%, and progressors <0%. Survival free of left ventricular assist device (LVAD) and heart transplant was compared on the basis of response classification.

      Results

      A total of 1058 patients were included and had a mean follow-up 8.7 ± 5.4 years, over which time there were 606 end points (37 LVAD implants, 32 heart transplants, and 537 deaths). Survival free of LVAD and heart transplant differed significantly between response groups after CRT both in the mid-term (4 years) and in the long-term (8.7 ± 5.4 years), with super-responders achieving the best outcomes and progressors the worst (P < .001). In multivariate analysis, nonprogressors had superior outcomes to progressors (P = .02) at 4 years of follow-up. Over the duration of follow-up (8.7 ± 5.4 years), there was no significant difference in survival between those 2 groups (P = .18).

      Conclusion

      Nonprogressors to CRT have superior medium-term outcomes but similar long-term outcomes to progressors and inferior outcomes to responders and super-responders.

      Keywords

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      Linked Article

      • Redefining the Response to CRT – Mission Possible?
        Heart Rhythm
        • Preview
          Cardiac resynchronization therapy (CRT) is one of the most effective treatment modalities for patients with systolic heart failure and a wide QRS complex as it can improve survival, reduce hospitalization, and provide symptomatic relief (1). However, not all patients respond even when the therapy is indicated. Alternatively, a super response has been seen in select patients who have normalization or near normalization of the systolic function and elimination of symptoms. Definitions of CRT response vary widely and depend upon endpoints used.
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