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Redefining the Response to CRT – Mission Possible?

  • Michael V. Orlov
    Correspondence
    ADDRESS FOR CORRESPONDENCE: Michael V Orlov, MD, PhD, Division of Cardiology, St. Elizabeth’s Medical Center, 736 Cambridge Street, Boston, MA 02135.
    Affiliations
    Division of Cardiology, Steward St. Elizabeth’s Medical Center, Tufts University School of Medicine, Boston, MA, Boston University School of Medicine
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Published:November 22, 2022DOI:https://doi.org/10.1016/j.hrthm.2022.11.011
      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 (
      • Cleland J.G.F.
      • Bristow M.R.
      • Freemantle N.
      • et al.
      The effect of cardiac resynchronization without a defibrillator on morbidity and mortality: an individual patient data meta-analysis of COMPANION and CARE-HF.
      ). 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. Strict definitions of response including hemodynamic improvement, heart failure hospitalization, structural remodeling or mortality benefit have a lower response rate than “soft” response metrics, such as, clinical benefit, improved quality-of-life scores, or six-minute walk test results. To overcome these difficulties, the Composite Clinical Score has been used but even this is not free from confounders.
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