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Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
12:45

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing

Published on: December 11, 2017

Impact of clinical and echocardiographic response to cardiac resynchronization therapy on long-term survival

Matteo Bertini1, Ulas Höke, Rutger J van Bommel

  • 1Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands.

European Heart Journal. Cardiovascular Imaging
|December 11, 2012
PubMed

Insights

Echocardiographic response, specifically reduced left ventricular end-systolic volume, is a better predictor of long-term survival in heart failure patients receiving cardiac resynchronization therapy (CRT) than clinical improvement alone.

Area of Science:

  • Cardiology
  • Heart Failure Management
  • Medical Device Therapy

Background:

  • Mid-term responses to cardiac resynchronization therapy (CRT) in heart failure patients may differ in their long-term prognostic impact.
  • Evaluating clinical versus echocardiographic response is crucial for predicting long-term outcomes in CRT-treated heart failure.

Purpose of the Study:

  • To determine whether clinical or echocardiographic response to CRT is a superior predictor of long-term prognosis in heart failure patients.
  • To compare the predictive value of mid-term CRT response definitions on long-term survival.

Main Methods:

  • A cohort of 679 heart failure patients undergoing CRT implantation was analyzed.
  • Clinical response was defined as ≥1 NYHA class improvement, and echocardiographic response as ≥15% reduction in LV end-systolic volume at 6-month follow-up.
  • Patients were prospectively followed for all-cause mortality.

Main Results:

  • At 6 months, 77% showed clinical response and 62% showed echocardiographic response.
  • During a mean follow-up of 37 months, 21% of patients died.
  • Multivariable analysis revealed echocardiographic response (reduced LV end-systolic volume) as an independent predictor of superior survival (HR: 0.38; P < 0.001), unlike clinical response.

Conclusions:

  • Mid-term echocardiographic response, specifically LV reverse remodeling, is a stronger predictor of long-term survival in heart failure patients treated with CRT.
  • LV end-systolic volume reduction at 6 months post-CRT is more prognostic than clinical status improvement for long-term outcomes.
Abstract

Keywords:
Cardiac resynchronization therapyClinical responseEchocardiographic responsePrognosis

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