Impact of clinical and echocardiographic response to cardiac resynchronization therapy on long-term survival.

Matteo Bertini, Ulas Höke, Rutger J. van Bommel, Arnold C.T. Ng, Miriam Shanks, Gaetano Nucifora, Dominique Auger, C. Jan Willem Borleffs, Eva P.M. van Rijnsoever, Lieselot van Erven, Martin J. Schalij, Nina Ajmone Marsan, Jeroen J. Bax, Victoria Delgado

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Abstract

Clinical or echocardiographic mid-term responses to cardiac resynchronization therapy (CRT) may have a different influence on a long-term prognosis of heart failure patients treated with CRT. The aim of the evaluation was to establish which definition of response to CRT, clinical or echocardiographic, best predicts long-term prognosis. A total of 679 heart failure patients treated with CRT were included. All the patients underwent a complete history and physical examination and transthoracic echocardiogram prior to CRT implantation and at 6-month follow-up. The clinical and echocardiographic responses to CRT were defined based on clinical improvement (≥1 NYHA class) and LV reverse remodelling (reduction in LV end-systolic volume ≥15%) at 6-month follow-up, respectively. All the patients were prospectively followed up for the occurrence of death. The mean age was 65 ± 11 years and 79% of the patients were male. At 6-month follow-up, 510 (77%) patients showed clinical response to CRT and 412 (62%) patients showed echocardiographic response to CRT. During a mean follow-up of 37 ± 22 months, 140 (21%) patients died. Clinical and echocardiographic responses to CRT were both significantly related to all-cause mortality on univariable analysis. However, on multivariable Cox-regression analysis only echocardiographic response to CRT was independently associated with superior survival (hazard ratio: 0.38; 95% CI: 0.27-0.50; P < 0.001). In a large population of heart failure patients treated with CRT, the reduction in LV end-systolic volume at the mid-term follow-up demonstrated to be a better predictor of long-term survival than improvement in the clinical status.

Original languageEnglish
Pages (from-to)774-781
Number of pages8
JournalEuropean Heart Journal Cardiovascular Imaging
Volume14
Issue number8
DOIs
Publication statusPublished - 1 Jan 2013

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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