Key result
Delayed CRT responders match early responder prognosis, though longer HF history and suboptimal leads predict delay.
Why the study?
Clinical outcomes and mechanisms of delayed responses to cardiac resynchronization therapy remained unclear.
Do delayed responders to cardiac resynchronization therapy have similar long-term clinical outcomes compared to early responders?
Cohort (n=110)
Do delayed responders to cardiac resynchronization therapy have similar long-term clinical outcomes compared to early responders?
Patients who exhibit a delayed echocardiographic response to CRT achieve similar long-term survival and freedom from heart failure hospitalization as early responders.
Answers are grounded in this paper and cite their sources.
Delayed CRT responders may have comparable long-term outcomes; leaves open whether earlier intervention or lead optimization improves response in prospective studies.
INTRODUCTION: The clinical outcomes and mechanisms of delayed responses to cardiac resynchronization therapy (CRT) remain unclear. We aimed to investigate the differences in outcomes and gain insight into the mechanisms of early and delayed responses to CRT. METHODS: This retrospective study included 110 patients who underwent CRT implantation. Positive response to CRT was defined as ≥15% reduction of left ventricular (LV) end-systolic volume on echocardiography at 1 year (early phase) and 3 years (delayed phase) after implantation. The latest mechanical activation site (LMAS) of the LV was identified using two-dimensional speckle-tracking radial strain analysis. RESULTS: Seventy-eight (71%) patients exhibited an early response 1 year after CRT implantation. Of 32 non-responders in the early phase, 12 (38%) demonstrated a delayed response, and 20 (62%) were classified as non-responders after 3 years. During the follow-up time of 10.3 ± 0.5 years, the delayed and early responders had a similar prognosis of mortality and heart failure (HF) hospitalization. In contrast, non-responders had a worse prognosis. Multivariate analysis revealed that a longer duration (months) between initial HF hospitalization and CRT (odds ratio [OR]: 1.126; 95% confidence interval [CI]: 1.036-1.222; p = .005), non-exact concordance of LV lead location with LMAS (OR: 32.744; 95% CI: 1.101-973.518; p = .044), and pre-QRS duration (OR: 0.901; 95% CI: 0.827-0.981; p = .016) were independent predictors of delayed response to CRT compared with early response. CONCLUSION: The prognoses were similar regardless of the response time after CRT. A longer history of HF, suboptimal LV lead position, and shorter pre-QRS duration were related to delayed response than early response.
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Tsurumi et al. (2023) conducted a cohort in Heart failure requiring cardiac resynchronization therapy (n=110). Cardiac resynchronization therapy (delayed vs early response) vs. Early response or non-response was evaluated on Predictors of delayed response to CRT compared with early response (longer duration between initial HF hospitalization and CRT) (OR 1.126, 95% CI 1.036-1.222, p=0.005). Delayed and early responders to CRT had similar long-term prognosis, while a longer history of heart failure and suboptimal LV lead position predicted delayed response.
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