Prognostic predictors and echocardiographic time course after device replacement in patients treated chronically with
Takahiko Nagase1, Maya Ishiguro2, Kei Mabuchi2
1Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu-shi, Tokyo, 183-0003, Japan. tnagase@shi.heart.or.jp.
Insights
Cardiac resynchronization therapy device replacement (CRT-r) non-responders face higher risks of death or heart failure. Echocardiographic response to CRT-r did not improve over time, highlighting the importance of baseline factors for long-term prognosis.
Area of Science:
- Cardiology
- Medical Devices
- Heart Failure Management
Background:
- Cardiac resynchronization therapy (CRT) is crucial for heart failure management.
- The prognostic predictors and echocardiographic response after CRT device replacement (CRT-r) are not well-defined.
Purpose of the Study:
- To evaluate predictors of death or heart failure hospitalization after CRT-r.
- To assess the echocardiographic response and time course in patients undergoing CRT-r.
Main Methods:
- Retrospective analysis of 60 patients undergoing CRT-r due to battery depletion.
- Patients categorized into CRT responders (≥15% LVESV reduction) and non-responders.
- Primary endpoint: composite of all-cause death or heart failure hospitalization; assessed changes in LVESV and LVEF.
Main Results:
- Higher incidence of the primary endpoint in non-responders (76%) compared to responders (23%) after a mean follow-up of 46 months (p < 0.001).
- No significant changes in LVESV or LVEF were observed post-CRT-r in either group.
- Multivariate analysis identified echocardiographic non-response, chronic kidney disease, atrial fibrillation, and NYHA class III/IV as independent predictors of adverse outcomes.
Conclusions:
- Residual echocardiographic non-response, comorbidities, and heart failure symptoms at CRT-r predict long-term prognosis.
- No significant improvement in echocardiographic response was observed after CRT-r.
Abstract:
The prognostic predictors of death or heart failure hospitalization and the echocardiographic response after initial cardiac resynchronization therapy (CRT) device replacement (CRT-r) remain unclear. We evaluated the predictors and the echocardiographic time course in patients after CRT-r. Consecutive 60 patients underwent CRT-r because of battery depletion. Patients were divided into two groups depending on the chronic echocardiographic response to CRT (left ventricular end-systolic volume [LVESV] reduction of ≥ 15%) at the time of CRT-r: CRT responders (group A; 35 patients) and CRT nonresponders (group B; 25 patients). The primary endpoint was a composite of death from any cause or heart failure hospitalization. Changes in LVESV and left ventricular ejection fraction (LVEF) after CRT-r were also analyzed. During the mean follow-up of 46 ± 33 months after CRT-r, the primary endpoint occurred more frequently in group B (group A versus group B; 8/35 [23%] patients versus 19/25 [76%] patients, p < 0.001). No significant changes in LVESV and LVEF were observed at the mean of 46 ± 29 months after CRT-r in both groups. A multivariate analysis identified echocardiographic nonresponse to CRT, chronic kidney disease, atrial fibrillation, and New York Heart Association functional class III or IV at the time of CRT-r as independent predictors of the primary endpoint in all patients. Residual echocardiographic nonresponse, comorbidities, and heart failure symptoms at the time of CRT-r predict the subsequent very long-term prognosis after CRT-r. No further echocardiographic response to CRT was found after CRT-r.
Related Concept Videos
01:30Cardiomyopathy II: Dilated Cardiomyopathy
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
01:22Heart Failure VI: Adjunct Therapies
01:29Cardiomyopathy V: Interprofessional Care
01:30Heart Failure IV: Classification and Diagnostic Evaluation