Harmonizing Heartbeats: The Mosaic of Cardiac Resynchronization Therapy Responders-A Comprehensive Exploration of
Elke Boxhammer1, Sophie Zauner1, Johannes Kraus1
1Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University Hospital of Salzburg, 5020 Salzburg, Austria.
Insights
Cardiac resynchronization-defibrillation (CRT-D) response definitions vary, impacting heart failure patient evaluation. Optimized criteria improve survival, guiding personalized CRT-D therapy.
Area of Science:
- Cardiology
- Biomedical Engineering
Background:
- Heart failure (HF) presents significant healthcare challenges, driving the need for advanced therapies like cardiac resynchronization-defibrillation (CRT-D).
- Current definitions of CRT-D response lack standardization, hindering effective clinical assessment and patient stratification.
- Diverse functional, echocardiographic, and laboratory metrics are used to define CRT-D response.
Purpose of the Study:
- To investigate various definitions of CRT-D response using functional, echocardiographic, and laboratory criteria.
- To evaluate the impact of different responder definitions on patient survival outcomes.
- To identify predictors of positive CRT-D response and extended survival.
Main Methods:
- A single-center study analyzed data from 132 patients receiving CRT-D.
- Responder criteria included changes in NYHA functional class, left ventricular ejection fraction (LVEF), and pro-brain natriuretic peptide (proBNP) levels.
- Statistical analyses involved Kaplan-Meier curves and Cox hazard regression to assess survival.
Main Results:
- Responder rates differed significantly across various definitions, highlighting patient heterogeneity.
- Patients meeting criteria for CRT-D response (NYHA decrease, LVEF increase, or proBNP decrease) showed improved 2- and 3-year survival rates (p < 0.050).
- Younger age, absence of recent myocardial infarction, normal right ventricular parameters, and certain drug therapies predicted positive CRT-D response. LVEF increase ≥ 5% and proBNP decrease ≥ 25% independently predicted longer survival.
Conclusions:
- CRT-D responder definitions are highly variable, necessitating a personalized, patient-centered approach to heart failure management.
- Factors such as right ventricular function, concomitant drug therapy, atrial fibrillation, and renal function influence CRT-D response.
- This study enhances understanding of CRT-D response variability and supports tailored HF treatment strategies.
Abstract:
Background: Heart failure (HF) remains a challenging healthcare issue necessitating innovative therapies like cardiac resynchronization-defibrillation therapy (CRT-D). However, the definition of a CRT-D response lacks uniformity, impeding effective clinical evaluation. This study explores diverse CRT-D responder definitions encompassing functional, echocardiographic and laboratory criteria. Materials & Methods: A single-center study involving 132 CRT-D patients scrutinized responder criteria including NYHA stage, LVEF increase and proBNP decrease. Statistical analyses such as Kaplan-Meier curves and Cox hazard regression were employed to evaluate responder characteristics and survival outcomes. Results: Responder rates varied across criteria, revealing nuanced patient profiles. CRT-D responders defined by NYHA decrease, LVEF increase or proBNP decrease exhibit improved survival rates after 2 and 3 years (p < 0.050). Young age, absence of recent myocardial infarction and normal right ventricular echocardiographic parameters emerge as predictors for positive response. In part, drug-based HF therapy correlates with increased responder rates. Cox regression identified LVEF ≥ 5% and proBNP decrease ≥ 25% as independent predictors of extended survival. Conclusions: CRT-D responder definitions exhibit considerable variability, emphasizing the need for a nuanced patient-centered approach. Factors like right ventricular function, drug therapy, atrial fibrillation and renal function influence responses. This study enriches our understanding of CRT-D response and contributes to the foundation for personalized HF management.
