Predictors and outcomes of "super-response" to cardiac resynchronization therapy

Ammar M. Killu, Avishay Grupper, Paul A. Friedman, Brian D. Powell, Samuel J. Asirvatham, Raul E. Espinosa, David Luria, Guy Rozen, Jonathan Buber, Ying Hsiang Lee, Tracy Webster, Kelly L. Brooke, David O. Hodge, Heather J. Wiste, Michael Glikson, Yong Mei Cha

Research output: Contribution to journalArticlepeer-review

30 Scopus citations

Abstract

Background Cardiac resynchronization therapy (CRT) has been shown to improve heart failure (HF) symptoms and survival. We hypothesized that a greater improvement in left-ventricular ejection fraction (LVEF) after CRT is associated with greater survival benefit. Methods and Results In 693 patients across 2 international centers, the improvement in LVEF after CRT was determined. Patients were grouped as non-/modest-, moderate-, or super-responders to CRT, defined as an absolute change in LVEF of ≤ 5%, 6-15%, and >15%, respectively. Changes in New York Heart Association (NYHA) functional class and left ventricular end-diastolic dimension (LVEDD) were assessed for each group. There were 395 non-/modest-, 186 moderate-, and 112 super-responders. Super-responders were more likely to be female and to have nonischemic cardiomyopathy, lower creatinine, and lower pulmonary artery systolic pressure than non-/modest- and moderate-responders. Super-responders were also more likely to have lower LVEF than non-/modest-responders. There was no difference in NYHA functional class, mitral regurgitation grade, or tricuspid regurgitation grade between groups. Improvement in NYHA functional class (-0.9 ;plusmn; 0.9 vs -0.4 ;plusmn; 0.8 [P <.001] and -0.6 ;plusmn; 0.8 [P =.02]) and LVEDD (-8.7 ;plusmn; 9.9 mm vs -0.5 ;plusmn; 5.0 and -2.4 ;plusmn; 5.8 mm [P < 001 for both]) was greatest in super-responders. Kaplan-Meier survival analysis revealed that super-responders achieved better survival compared with non-/modest- (P < curren.001) and moderate-responders (P =.049). Conclusions Improvement in HF symptoms and survival after CRT is proportionate to the degree of improvement in LV systolic function. Super-response is more likely in women, those with nonischemic substrate, and those with lower pulmonary artery systolic pressure.

Original languageEnglish (US)
Pages (from-to)379-386
Number of pages8
JournalJournal of Cardiac Failure
Volume20
Issue number6
DOIs
StatePublished - Jun 2014

Keywords

  • Cardiac resynchronization
  • ICD
  • heart failure
  • pacemaker
  • treatment

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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