Long-term outcomes in nonprogressors to cardiac resynchronization therapy.
John Rickard1, Michael R Gold2, Divyang Patel1
1Cleveland Clinic Heart and Vascular Institute, Cleveland, Ohio.
Heart Rhythm
|November 10, 2022
Summary
Patients undergoing cardiac resynchronization therapy (CRT) who show minimal left ventricular ejection fraction (LVEF) improvement, termed nonprogressors, have better mid-term outcomes but similar long-term survival compared to progressors.
Area of Science:
- Cardiology
- Medical Devices
- Heart Failure Management
Background:
- Cardiac resynchronization therapy (CRT) is used for heart failure patients.
- Patients with minimal left ventricular ejection fraction (LVEF) change are now classified as nonprogressors.
- Long-term outcomes for nonprogressors after CRT are not well understood.
Purpose of the Study:
- To evaluate patient outcomes after CRT based on echocardiographically determined response status.
- To compare survival free of left ventricular assist device (LVAD) implantation and heart transplantation across different CRT response groups.
Main Methods:
- Retrospective chart review of 1058 patients with LVEF ≤35% and QRS duration ≥120 ms undergoing CRT.
- Response classification: super-responders (LVEF change ≥20%), responders (6%-19%), nonprogressors (0%-5%), and progressors (<0%).
- Comparison of survival free of LVAD and heart transplant at mid-term (4 years) and long-term (mean 8.7 years).
Main Results:
- Super-responders had the best outcomes, while progressors had the worst (P < .001).
- Nonprogressors showed superior mid-term outcomes compared to progressors (P = .02).
- No significant long-term survival difference was observed between nonprogressors and progressors (P = .18).
Conclusions:
- Nonprogressors to CRT exhibit superior medium-term outcomes.
- Long-term outcomes for nonprogressors are similar to progressors.
- Outcomes for nonprogressors are inferior to responders and super-responders.
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