Key result
Smaller left atrial diameter (42.8 vs 50.0 mm, P<0.0001) and milder mitral regurgitation (1.9 vs 2.6, P<0.0001) were independent predictors of super-response to cardiac resynchronization therapy.
Why the study?
Do baseline echocardiographic characteristics predict super-response to cardiac resynchronization therapy?
Case-Control (n=394)
Do baseline echocardiographic characteristics predict super-response to cardiac resynchronization therapy?
Less advanced left-sided structural involvement, specifically smaller left atrium and milder mitral regurgitation, independently predicts super-response to cardiac resynchronization therapy.
Should not yet guide CRT candidate selection; hypothesis-generating for super-response prediction in observational data.
AIMS: Cardiac resynchronization therapy (CRT) can result in profound reverse remodelling. The goal of this study was to identify factors predictive of such beneficial response. METHODS AND RESULTS: Super-response to CRT was defined as normalization or near normalization of left ventricular systolic function without recognized reversible causes of heart failure. In a retrospective study, we compared baseline demographic, electrocardiogram, and echocardiographic characteristics of super-responders (n = 21) with a population of unselected consecutive cardiac CRT patients (Control 1, n = 330) and another sex-, age-, and aetiology-matched control group (Control 2, n = 43). Compared with Control 1, super-responders had significantly smaller left ventricular end-diastolic diameter (65.4 ± 6.4 vs. 73.4 ± 9.3 mm, P = 0.0001), higher ejection fraction (0.25 ± 0.05 vs. 0.22 ± 0.04, P = 0.004), smaller degree of mitral regurgitation (MR; mean value 1.9 ± 0.9 vs. 2.6 ± 0.8, P = <0.0001), and smaller left atrium (LA; 42.8 ± 4.6 vs. 50.0 ± 6.5 mm, P < 0.0001). Septal flash and inter-ventricular mechanical dyssynchrony were both more frequent among super-responders than in Control 2 subjects (93.8 vs. 69.8%; P = 0.01, and 93.8 vs. 62.8%; P = 0.01, respectively). In a multivariate analysis, smaller LA diameter and milder MR remained independent predictors of super-response. CONCLUSION: Super-response to cardiac CRT was associated with less advanced left-sided structural involvement as described by echocardiography. In particular, smaller LA and milder MR were independent predictors of pronounced reverse remodelling.
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Stefan et al. (2012) conducted a case-control in Heart failure undergoing cardiac resynchronization therapy (n=394). Smaller left atrium and milder mitral regurgitation vs. Unselected and matched CRT patients was evaluated on Super-response to cardiac resynchronization therapy (p=<0.0001). Smaller left atrial diameter (42.8 vs 50.0 mm, P<0.0001) and milder mitral regurgitation (1.9 vs 2.6, P<0.0001) were independent predictors of super-response to cardiac resynchronization therapy.
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