Predictors and long-term outcome of super-responders to cardiac resynchronization therapy.
Clin Cardiol
; 40(5): 292-299, 2017 May.
Article
em En
| MEDLINE
| ID: mdl-28294364
ABSTRACT
BACKGROUND:
The level of improvement in left ventricular ejection fraction (LVEF) in super-responders to cardiac resynchronization therapy (CRT) is exceptional. However, the long-term prognosis remains unknown in a large population.HYPOTHESIS:
Whether super-responders haven good long-term outcomes.METHODS:
We registered 347 patients with primary CRT-D indication. Super-response was defined by LVEF >50% at follow-up echocardiogram. Best-subset regression analysis identified predictors of super-response. Endpoints were major adverse cardiac events (MACE; eg, all-cause mortality or heart failure hospitalization, cardiac death, and appropriate ICD therapy).RESULTS:
Fifty-six (16%) patients with LVEF >50% were classified as super-responders. Female sex (OR 3.06, 95% CI 1.54-6.05), nonischemic etiology (OR 2.70, 95% CI 1.29-5.68), higher LVEF at baseline (OR 1.07, 95% CI 1.02-1.13), and wider QRS duration (OR 1.17, 95% CI 1.04-1.32) were predictors of super-response. Cumulative incidence of MACE at a median of 5.3 years was 18% in super-responders, 22% in responders, and 51% in nonresponders (P < 0.001). None of super responders died from cardiac death, compared to 9% of responders and 25% of non-responders (P < 0.001). None of super-responders experienced appropriate ICD therapy, compared with 10% of responders and 21% of non-responders (P < 0.001). In super-responders, the adjusted hazard ratio was 0.37 (95% CI 0.19-0.73) for MACE and 0.44 (95% CI 0.20-0.95) for total mortality, compared with non-responders.CONCLUSIONS:
Female sex, non-ischemic etiology, higher baseline LVEF, and wider QRS duration were independently associated with super-response. Super-response was associated with persistent excellent prognosis regarding survival and appropriate ICD therapy during long-term follow-up.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Contexto em Saúde:
6_ODS3_enfermedades_notrasmisibles
Base de dados:
MEDLINE
Assunto principal:
Volume Sistólico
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Cardioversão Elétrica
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Função Ventricular Esquerda
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Desfibriladores Implantáveis
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Disfunção Ventricular Esquerda
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Terapia de Ressincronização Cardíaca
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Dispositivos de Terapia de Ressincronização Cardíaca
Tipo de estudo:
Etiology_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Clin Cardiol
Ano de publicação:
2017
Tipo de documento:
Article