Key result
Late best response to cardiac resynchronization therapy was associated with significantly lower long-term mortality compared to early response (3.2% vs 28.6%; HR 0.131).
Why the study?
Does a late best response to cardiac resynchronization therapy improve long-term survival compared to an early best response in patients with congestive heart failure?
Cohort (n=122)
Does a late best response to cardiac resynchronization therapy improve long-term survival compared to an early best response in patients with congestive heart failure?
Hazard Ratio: 0.131 (95% CI 0.032–0.53)
Absolute Event Rate: 3.2% vs 28.6%
p-value: p=0.004
In patients receiving cardiac resynchronization therapy, a late best echocardiographic response (>3 months) is associated with significantly greater reverse remodeling and lower long-term mortality compared to an early best response.
May inform post-CRT risk stratification; leaves open whether response timing should guide management or trials.
AIM: The aim was to evaluate clinical, morphological, functional features and mortality in patients with congestive heart failure (CHF) and different time of the best response to cardiac resynchronization therapy (CRT). MATERIALS AND METHODS: 122 patients (82.8% men) with NYHA functional class III-IV (mean age 54.8 ± 9.6 years) were enrolled. At baseline, 1, 3 months and each 6 months after implantation we evaluated clinical and echocardiographic parameters. In 28 patients the best decrease of left ventricular end-systolic volume (LVESV) was achieved up to 3 months (1.1 ± 0.9 months, I group–early response) and in 94 patients–after 3 months (22.6 ± 14.9 months, II group–late response). RESULTS: At baseline groups did not differ in main clinical characteristics, the proportion of atrial fibrillation, the presence of left bundle-branch block (LBBB), width of the QRS complex and parameters of mechanical dyssynchrony. Level of left ventricular ejection fraction (LVEF) and left ventricular volumes were comparable between groups. In the II group responders (decrease in LVESV ≥ 15%) were identified more frequently (90.4% vs. 60.7%; p=0.001), all patients with decrease of LVESV ≥ 30% (super responders) had late response. During follow-up period (33.2 ± 16.7 months) increase in LVEF and decrease in LVESV were more evident in patients with late response. In Kaplan-Meier analysis mortality in II group was significantly lower (3.2% vs 28.6%; p=0.001). Cox regression showed that LVESV (HR 1.012; 95% CI 1.004–1.021; P=0.005) and the time of response (HR 0.131; 95% CI 0.032– 0.530; P=0.004) were associated with long-term mortality. CONCLUSION: Patients with early response to CRT show significantly lower improvement in LVEF and LVESV compared to patients with late CRT response. Super respone to CRT in associated with late functional improvement. Early response and greater LVESV are associated with higher mortality rate.
No takes yet. Share an insight, caveat, or question.
Солдатова et al. (2017) conducted a cohort in Congestive heart failure (n=122). Late best response to cardiac resynchronization therapy (>3 months) vs. Early best response to cardiac resynchronization therapy (≤3 months) was evaluated on Long-term mortality (HR 0.131, 95% CI 0.032-0.530, p=0.004). Late best response to cardiac resynchronization therapy was associated with significantly lower long-term mortality compared to early response (3.2% vs 28.6%; HR 0.131).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: