Echocardiographic disease progression after cardiac resynchronization therapy was associated with a significantly higher risk of death, VAD implantation, or heart transplantation compared to nonprogression (aHR 2.26).
Cohort (n=391)
No
Does echocardiographic nonprogression after CRT implantation improve long-term outcomes compared to progression in heart failure patients?
Heart failure patients who are 'nonprogressors' (ΔLVEF ±5%) after CRT implantation have significantly better long-term survival compared to progressors, indicating nonprogression is a form of positive response.
Effect estimate: aHR 2.26 (95% CI 1.35-3.78)
Absolute Event Rate: 53% vs 34%
p-value: p=0.002
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.
Trenson et al. (Sat,) conducted a cohort in Heart failure (n=391). Echocardiographic disease progression (ΔLVEF < -5%) vs. Echocardiographic nonprogression (ΔLVEF ±5%) was evaluated on Composite of all-cause death, ventricular assist device implantation, or heart transplantation (aHR 2.26, 95% CI 1.35-3.78, p=0.002). Echocardiographic disease progression after cardiac resynchronization therapy was associated with a significantly higher risk of death, VAD implantation, or heart transplantation compared to nonprogression (aHR 2.26).