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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

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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
PubMed

Insights

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.
Abstract

Keywords:
Cardiac resynchronization therapyNonprogressorsOutcomesStabilizersSurvival

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