Long-Term Nonprogression Is a Form of Response to Cardiac Resynchronization Therapy
Sander Trenson1, Peter C Kahr2, Bert Vandenberk3
1University Heart Center, University Hospital Zurich, Zurich, Switzerland; Cardiovascular Sciences, University Hospital Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, University Hospital Leuven, Leuven, Belgium.
Insights
Cardiac resynchronization therapy (CRT) nonprogressors, patients with no echocardiographic change, have better long-term survival than progressors. This poorly characterized group warrants further investigation for optimal heart failure management.
Area of Science:
- Cardiology
- Heart Failure Management
- Medical Device Therapy
Background:
- Cardiac resynchronization therapy (CRT) improves outcomes in select heart failure patients.
- A subset of patients, termed 'nonprogressors,' show no echocardiographic changes after CRT.
- Understanding nonprogressor outcomes is crucial for refining CRT patient selection and management.
Purpose of the Study:
- To investigate the long-term prognosis of heart failure patients identified as 'nonprogressors' after CRT.
- To compare the outcomes of nonprogressors with other response categories following CRT.
Main Methods:
- Retrospective cohort analysis of 391 patients undergoing CRT implantation.
- Patients categorized by echocardiographic response: super-responders (>15% LVEF increase), responders (>5% LVEF increase), nonprogressors (±5% LVEF change), and progressors (<-5% LVEF decrease).
- Primary composite outcome: all-cause death, ventricular assist device implantation, or heart transplantation, analyzed using Cox regression and Kaplan-Meier curves.
Main Results:
- 34% of patients (134/391) were classified as nonprogressors.
- Progressors had a significantly higher risk of the composite endpoint (adjusted HR: 2.26) compared to nonprogressors.
- Super-responders and responders demonstrated significantly better outcomes than nonprogressors.
Conclusions:
- Nonprogressors represent a significant, understudied group within CRT recipients.
- Long-term survival for nonprogressors is notably better than for progressors or negative responders.
- Further research is needed to fully characterize the nonprogressor cohort and their specific management needs.
Background:
Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in selected heart failure patients. A distinct subpopulation (so-called "nonprogressors") of patients shows neither amelioration nor worsening of echocardiographic parameters after CRT implantation.
Objectives:
The authors sought to investigate the long-term outcomes and prognosis of a distinct subpopulation of heart failure patients termed "nonprogressors," after CRT implantation.
Methods:
Retrospective single-center cohort analysis of 391 patients after CRT implantation. Based on echocardiography, patients were categorized into "super-responders" (Δ left ventricular ejection fraction [LVEF] >15% compared to baseline), "responders" (ΔLVEF >5% compared to baseline), "nonprogressors" (ΔLVEF ±5% compared to baseline), and "progressors" (ΔLVEF <-5% compared to baseline). The primary composite outcome was all-cause death, implantation of a ventricular assist device, or heart transplantation. Statistics included univariable and multivariable Cox proportional hazard regression analysis and Kaplan-Meier survival curves to explore outcome data.
Results:
A total of 391 patients (23% female, mean age 65 years, mean baseline LVEF 27%) were included. Postimplantation echocardiograms were performed after a mean of 37 months after CRT implantation. A total of 134 patients (34%) were nonprogressors. After a mean follow-up of another 57 months, progressors were significantly more likely to reach the composite endpoint of death, ventricular assist device implantation, or heart transplantation compared to nonprogressors (adjusted HR: 2.26 [95% CI: 1.35-3.78]; P = 0.002). Patients with positive echocardiographic response and super-response fared significantly better compared to nonprogressors.
Conclusions:
Nonprogressors form a relevant, to date poorly characterized group of CRT patients, whose long-term survival is significantly better compared to progressors or negative responders.
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