Long-term outcome of 'super-responder' patients to cardiac resynchronization therapy
Massimo Zecchin1, Alberto Proclemer, Silvia Magnani
1Cardiovascular Department, University and 'Ospedali Riuniti di Trieste' Hospital, Via Valdoni, 7, 34129 Trieste, Italy.
Insights
Long-term outcomes for cardiac resynchronization therapy (CRT) super-responders are excellent. However, some patients may still experience cardiac events, highlighting the need for better identification methods.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Cardiac resynchronization therapy (CRT) is a treatment for heart failure.
- Super-responders achieve significant improvement in left ventricular ejection fraction (LVEF) after CRT.
- Long-term outcomes and risks in this specific patient group require further investigation.
Purpose of the Study:
- To assess long-term clinical and echocardiographic changes in CRT super-responders.
- To determine the incidence of cardiac events in these patients.
- To identify factors associated with late cardiac events after CRT.
Main Methods:
- Retrospective analysis of 259 patients treated with CRT (CRT-D or CRT without defibrillator).
- Patients selected based on LVEF ≤0.35 at implantation and LVEF >0.50 at 1 or 2 years post-implantation.
- Long-term follow-up included clinical assessment, echocardiography, and analysis of cardiac events (HF hospitalization, sudden death, appropriate CRT-D interventions).
Main Results:
- 24% of patients (62/259) were identified as super-responders.
- Mean follow-up was 68 months; one cardiac death (HF) and eight cardiovascular events occurred.
- Late cardiac events were associated with LV end-systolic volume at the last evaluation.
Conclusions:
- Super-responders to CRT demonstrate excellent long-term outcomes.
- Cardiac events, particularly appropriate CRT-D interventions, can occur even with persistent high LVEF.
- Early identification of super-responders at risk for late events remains an unmet clinical challenge.
Aims:
To evaluate the long-term changes of clinical and echocardiographic parameters, the incidence of cardiac events and parameters associated with late cardiac events in 'super-responders' to cardiac resynchronization therapy (CRT) with [CRT defibrillator (CRT-D)] or without defibrillator back-up.
Methods And Results:
In all consecutive patients treated with CRT in two Italian centres (Trieste and Udine) with left ventricular ejection fraction (LVEF) ≤0.35 at implantation (Timp) and LVEF > 0.50 1 and/or 2 years (Tnorm) after implantation, the long-term outcome and the evolution of echocardiographic parameters were assessed; factors associated with a higher risk of cardiac events, defined as hospitalization or death for heart failure (HF), sudden death, or CRT-D appropriate interventions, were also analysed. Among the 259 patients evaluated, 62 (24%) had LVEF ≥ 0.50 at Tnorm (n = 44 with at 1 year, n = 18 at 2 years). During a mean follow-up of 68 ± 30 months, one cardiac death (for HF) and eight cardiovascular events (two hospitalization for HF and six appropriate CRT-D interventions) occurred. At the last echo evaluation (Tfup) performed 51 ± 26 months after Timp, LVEF was <0.50 in five patients (>0.45 in four of them). At univariable analysis, only LV end-systolic volume evaluated at Tfup was associated with a higher risk of cardiac events during follow-up.
Conclusion:
In 'super-responders' to CRT long-term outcome is excellent. However, cardiac events, mainly CRT-D appropriate interventions, can occur despite the persistence of LVEF > 0.50. Early identification of these patients is still an unsolved issue.
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