Incidence and predictors of super-response to cardiac resynchronization therapy
Manoj Kumar Rohit1, Darshan Krishnappa2
1Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Cardiac resynchronization therapy (CRT) benefits heart failure patients. Super-responders, with over 30% LVESV decrease, were identified, with dilated cardiomyopathy predicting a better response.
Area of Science:
- Cardiology
- Heart Failure Management
- Medical Devices
Background:
- Cardiac resynchronization therapy (CRT) improves outcomes in heart failure with reduced ejection fraction (HFrEF).
- A subset of patients, termed
Purpose of the Study:
- To determine the prevalence and clinical characteristics of CRT super-responders in an Indian and Asian population.
- To identify predictors of super-response to CRT in HFrEF patients.
Main Methods:
- Retrospective analysis of 58 patients undergoing CRT implantation.
- Assessment of ejection fraction and LVESV changes one year post-implantation.
- Stratification into non-responders, responders (>15% LVESV decrease), and super-responders (>30% LVESV decrease).
Main Results:
- Super-responders constituted 27.6% of the study cohort.
- Predictors of super-response included dilated cardiomyopathy (vs. ischemic), prior RV apical pacing, and absence of prior MI.
- Dilated cardiomyopathy was present in 93.7% of super-responders (p=0.01).
Conclusions:
- 27.6% of patients achieved super-response to CRT.
- Dilated cardiomyopathy, prior RV apical pacing, and no history of MI predict super-response.
- These findings aid in identifying Asian patients likely to benefit most from CRT.
Objectives:
Cardiac resynchronization therapy (CRT) has significantly improved management of patients with heart failure with reduced ejection fraction (HFrEF). A significant number of patients have a dramatic response and have been termed "super-responders". The characteristics of this subset of patients in Indian and Asian population have not been well studied. In this study, we sought to assess the prevalence and clinical characteristics of this cohort of patients.
Methods:
This was a retrospective study involving patients undergoing CRT. Changes in ejection fraction and LVESV at the end of one year of follow-up following device implantation were assessed, and patients were stratified into non-responders, responders, and super-responders. Responders had a 15-29% decrease in LVESV while super-responders had a >30% decrease in LVESV.
Results:
Of the 74 patients who had undergone CRT-P/CRT-D implantation, 16 patients did not have echocardiograms at the end of one year of follow-up and were excluded from the analysis. Thus, 58 patients were enrolled for analysis. We identified 16 patients (27.6%) to be super-responders, 26 patients (44.8%) to be responders, and 16 patients (27.6%) to be non-responders. Factors associated with a super-response were a diagnosis of dilated cardiomyopathy as against ischemic cardiomyopathy (93.7% vs 6.3%; p - 0.01), prior right ventricular (RV) apical pacing (25% vs 2.4%; p - 0.02) and absence of a prior history of myocardial infarction (MI) (0% vs 33.3%; p - 0.02).
Conclusion:
In our study, 27.6% of patients were super-responders, and a diagnosis of dilated cardiomyopathy, absence of a prior history of MI and prior RV apical pacing predicted a super-response to CRT.
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