Response to cardiac resynchronization therapy predicts survival in heart failure: A single-center experience

Yong-Mei Cha, Robert F. Rea, Ming Wang, Win Kuang Shen, Samuel J Asirvatham, Paul Andrew Friedman, Thomas M. Munger, Raul Emilio Espinosa, David O. Hodge, David L. Hayes, Margaret May Redfield

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Single Center CRT. Objective: To determine whether survival after cardiac resynchronization therapy (CRT) is related to improvement in clinical or echocardiographic parameters. Background: In clinical trials, CRT improved symptoms, left ventricular (LV) structure, function, and survival. In clinical practice, response to CRT is highly variable and whether survival benefit is confined to those patients who experience improvement in clinical status or cardiac structure and function is unclear. Methods: This is a single-center study of patients receiving clinically indicated CRT between January 2002 and December 2004. Results: Of 309 patients (age 68 ± 11 years, 83% male) receiving CRT at our institution during the study period, 174 returned for follow-up and 127 had repeat echocardiography. Baseline clinical characteristics and survival were similar among those who did or did not return for follow-up. In paired analyses, New York Heart Association (NYHA) class (-0.56 ± 0.07, p < 0.0001), ejection fraction (EF, 6.3 ± 0.7%, P < 0.0001), LV dimension (-2.7 ± 0.6 mm, P < 0.0001), pulmonary artery systolic pressure (PASP, -4.6 ± 1.3 mm Hg, P = 0.0007), and MR severity grade (-0.20 ± 0.05, P = 0.0002) improved after CRT. Survival after CRT was associated with decrease in NYHA class (risk ratio [RR] = 0.43, P = 0.0004), increase in EF (RR = 0.94, P = 0.02), and decrease in PASP (RR = 0.96, P = 0.03). Change in EF and NYHA class were correlated (r = -0.46, P < 0.0001) and, adjusting for this covariance, change in NYHA (P = 0.04) but not EF (P = 0.12) was associated with improved survival. Conclusion: Patients who experience improved symptoms, ventricular function, and/or hemodynamics have better survival after CRT. These data enhance understanding of the relationship between CRT clinical response and survival benefit in clinical practice.

Original languageEnglish (US)
Pages (from-to)1015-1019
Number of pages5
JournalJournal of Cardiovascular Electrophysiology
Volume18
Issue number10
DOIs
StatePublished - Oct 2007

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Cardiac Resynchronization Therapy
Heart Failure
Survival
Odds Ratio
Ventricular Function
Left Ventricular Function
Pulmonary Artery
Echocardiography
Hemodynamics
Clinical Trials
Blood Pressure

Keywords

  • Cardiac resynchronization therapy
  • Cardiomyopathy
  • Heart failure
  • Pulmonary hypertension
  • Ventricular function

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology

Cite this

Response to cardiac resynchronization therapy predicts survival in heart failure : A single-center experience. / Cha, Yong-Mei; Rea, Robert F.; Wang, Ming; Shen, Win Kuang; Asirvatham, Samuel J; Friedman, Paul Andrew; Munger, Thomas M.; Espinosa, Raul Emilio; Hodge, David O.; Hayes, David L.; Redfield, Margaret May.

In: Journal of Cardiovascular Electrophysiology, Vol. 18, No. 10, 10.2007, p. 1015-1019.

Research output: Contribution to journalArticle

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abstract = "Single Center CRT. Objective: To determine whether survival after cardiac resynchronization therapy (CRT) is related to improvement in clinical or echocardiographic parameters. Background: In clinical trials, CRT improved symptoms, left ventricular (LV) structure, function, and survival. In clinical practice, response to CRT is highly variable and whether survival benefit is confined to those patients who experience improvement in clinical status or cardiac structure and function is unclear. Methods: This is a single-center study of patients receiving clinically indicated CRT between January 2002 and December 2004. Results: Of 309 patients (age 68 ± 11 years, 83{\%} male) receiving CRT at our institution during the study period, 174 returned for follow-up and 127 had repeat echocardiography. Baseline clinical characteristics and survival were similar among those who did or did not return for follow-up. In paired analyses, New York Heart Association (NYHA) class (-0.56 ± 0.07, p < 0.0001), ejection fraction (EF, 6.3 ± 0.7{\%}, P < 0.0001), LV dimension (-2.7 ± 0.6 mm, P < 0.0001), pulmonary artery systolic pressure (PASP, -4.6 ± 1.3 mm Hg, P = 0.0007), and MR severity grade (-0.20 ± 0.05, P = 0.0002) improved after CRT. Survival after CRT was associated with decrease in NYHA class (risk ratio [RR] = 0.43, P = 0.0004), increase in EF (RR = 0.94, P = 0.02), and decrease in PASP (RR = 0.96, P = 0.03). Change in EF and NYHA class were correlated (r = -0.46, P < 0.0001) and, adjusting for this covariance, change in NYHA (P = 0.04) but not EF (P = 0.12) was associated with improved survival. Conclusion: Patients who experience improved symptoms, ventricular function, and/or hemodynamics have better survival after CRT. These data enhance understanding of the relationship between CRT clinical response and survival benefit in clinical practice.",
keywords = "Cardiac resynchronization therapy, Cardiomyopathy, Heart failure, Pulmonary hypertension, Ventricular function",
author = "Yong-Mei Cha and Rea, {Robert F.} and Ming Wang and Shen, {Win Kuang} and Asirvatham, {Samuel J} and Friedman, {Paul Andrew} and Munger, {Thomas M.} and Espinosa, {Raul Emilio} and Hodge, {David O.} and Hayes, {David L.} and Redfield, {Margaret May}",
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T1 - Response to cardiac resynchronization therapy predicts survival in heart failure

T2 - A single-center experience

AU - Cha, Yong-Mei

AU - Rea, Robert F.

AU - Wang, Ming

AU - Shen, Win Kuang

AU - Asirvatham, Samuel J

AU - Friedman, Paul Andrew

AU - Munger, Thomas M.

AU - Espinosa, Raul Emilio

AU - Hodge, David O.

AU - Hayes, David L.

AU - Redfield, Margaret May

PY - 2007/10

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N2 - Single Center CRT. Objective: To determine whether survival after cardiac resynchronization therapy (CRT) is related to improvement in clinical or echocardiographic parameters. Background: In clinical trials, CRT improved symptoms, left ventricular (LV) structure, function, and survival. In clinical practice, response to CRT is highly variable and whether survival benefit is confined to those patients who experience improvement in clinical status or cardiac structure and function is unclear. Methods: This is a single-center study of patients receiving clinically indicated CRT between January 2002 and December 2004. Results: Of 309 patients (age 68 ± 11 years, 83% male) receiving CRT at our institution during the study period, 174 returned for follow-up and 127 had repeat echocardiography. Baseline clinical characteristics and survival were similar among those who did or did not return for follow-up. In paired analyses, New York Heart Association (NYHA) class (-0.56 ± 0.07, p < 0.0001), ejection fraction (EF, 6.3 ± 0.7%, P < 0.0001), LV dimension (-2.7 ± 0.6 mm, P < 0.0001), pulmonary artery systolic pressure (PASP, -4.6 ± 1.3 mm Hg, P = 0.0007), and MR severity grade (-0.20 ± 0.05, P = 0.0002) improved after CRT. Survival after CRT was associated with decrease in NYHA class (risk ratio [RR] = 0.43, P = 0.0004), increase in EF (RR = 0.94, P = 0.02), and decrease in PASP (RR = 0.96, P = 0.03). Change in EF and NYHA class were correlated (r = -0.46, P < 0.0001) and, adjusting for this covariance, change in NYHA (P = 0.04) but not EF (P = 0.12) was associated with improved survival. Conclusion: Patients who experience improved symptoms, ventricular function, and/or hemodynamics have better survival after CRT. These data enhance understanding of the relationship between CRT clinical response and survival benefit in clinical practice.

AB - Single Center CRT. Objective: To determine whether survival after cardiac resynchronization therapy (CRT) is related to improvement in clinical or echocardiographic parameters. Background: In clinical trials, CRT improved symptoms, left ventricular (LV) structure, function, and survival. In clinical practice, response to CRT is highly variable and whether survival benefit is confined to those patients who experience improvement in clinical status or cardiac structure and function is unclear. Methods: This is a single-center study of patients receiving clinically indicated CRT between January 2002 and December 2004. Results: Of 309 patients (age 68 ± 11 years, 83% male) receiving CRT at our institution during the study period, 174 returned for follow-up and 127 had repeat echocardiography. Baseline clinical characteristics and survival were similar among those who did or did not return for follow-up. In paired analyses, New York Heart Association (NYHA) class (-0.56 ± 0.07, p < 0.0001), ejection fraction (EF, 6.3 ± 0.7%, P < 0.0001), LV dimension (-2.7 ± 0.6 mm, P < 0.0001), pulmonary artery systolic pressure (PASP, -4.6 ± 1.3 mm Hg, P = 0.0007), and MR severity grade (-0.20 ± 0.05, P = 0.0002) improved after CRT. Survival after CRT was associated with decrease in NYHA class (risk ratio [RR] = 0.43, P = 0.0004), increase in EF (RR = 0.94, P = 0.02), and decrease in PASP (RR = 0.96, P = 0.03). Change in EF and NYHA class were correlated (r = -0.46, P < 0.0001) and, adjusting for this covariance, change in NYHA (P = 0.04) but not EF (P = 0.12) was associated with improved survival. Conclusion: Patients who experience improved symptoms, ventricular function, and/or hemodynamics have better survival after CRT. These data enhance understanding of the relationship between CRT clinical response and survival benefit in clinical practice.

KW - Cardiac resynchronization therapy

KW - Cardiomyopathy

KW - Heart failure

KW - Pulmonary hypertension

KW - Ventricular function

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