Landmark Evolutions in Time and Indication for Cardiac Resynchronization Therapy: Results from a Multicenter
Jeroen Bijnens1, Sander Trenson1,2,3,4, Gabor Voros1,4
1Department of Cardiology, University Hospitals Leuven, 3000 Leuven, Belgium.
Insights
Cardiac resynchronization therapy (CRT) outcomes remained stable over time despite implantation rate increases. Patient characteristics, not CRT advancements, likely explain the consistent long-term survival for heart failure patients.
Area of Science:
- Cardiology
- Medical Devices
- Heart Failure Management
Background:
- Cardiac resynchronization therapy (CRT) is standard for heart failure with wide QRS.
- Long-term outcome data and implantation criteria require further investigation.
- CRT has seen significant evolution and increased adoption over two decades.
Purpose of the Study:
- To evaluate long-term outcomes of CRT over time.
- To analyze trends in CRT implantation rates and patient characteristics.
- To identify factors influencing CRT efficacy and patient survival.
Main Methods:
- Retrospective analysis of 2275 patients receiving CRT (2000-2019).
- Defined four time periods based on landmark trials and guidelines.
- Assessed composite endpoint of mortality, heart transplant, or LVAD implantation.
Main Results:
- The composite endpoint occurred in 29.2% of patients.
- Annual CRT implantation rates tripled over the study period.
- Adjusted analysis showed stable composite endpoint hazard ratios across time periods.
- Non-LBBB patterns and QRS duration < 130 ms were associated with higher hazard ratios.
Conclusions:
- Overall survival with CRT remained stable despite technological advancements.
- Shifting patient characteristics, rather than CRT innovations, may explain stable outcomes.
- Non-LBBB conduction and shorter QRS duration indicate poorer prognosis in CRT recipients.
Abstract:
Background: Cardiac resynchronization therapy (CRT) has evolved into an established therapy for patients with chronic heart failure and a wide QRS complex. Data on long-term outcomes over time are scarce and the criteria for implantation remain a subject of investigation. Methods: An international, multicenter, retrospective registry includes 2275 patients who received CRT between 30 November 2000 and 31 December 2019, with a mean follow-up of 3.6 ± 2.7 years. Four time periods were defined, based on landmark trials and guidelines. The combined endpoint was a composite of all-cause mortality, heart transplantation, or left ventricular assist device implantation. Results: The composite endpoint occurred in 656 patients (29.2%). The mean annual implantation rate tripled from 31.5 ± 17.4/year in the first period to 107.4 ± 62.4/year in the last period. In the adjusted Cox regression analysis, the hazard ratio for the composite endpoint was not statistically different between time periods. When compared to sinus rhythm with left bundle branch block (LBBB), a non-LBBB conduction pattern (sinus rhythm: HR 1.51, 95% CI 1.12-2.03; atrial fibrillation: HR 2.08, 95% CI 1.30-3.33) and a QRS duration below 130 ms (HR 1.64, 95% CI 1.29-2.09) were associated with a higher hazard ratio. Conclusions: Despite innovations, an adjusted regression analysis revealed stable overall survival over time, which can at least partially be explained by a shift in patient characteristics.
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