Abstract 3183: The Responders of Cardiac Resynchronization Therapy Predicts Survival in Heart Failure
Background: While cardiac resynchronization therapy (CRT) has shown promise for improving quality of life, cardiac structure and function, little is known as to whether the clinical and cardiac functional improvements translate to improved survival.
Methods: The study cohort consists of 160 patients (pts) who received CRT or CRT-D and had subsequent follow-up at the Mayo Clinic between 1/2002 and 12/2004. Left ventricular (LV) diastolic dimension, LV ejection fraction (EF), pulmonary artery (PA) systolic pressure, the severity of mitral regurgitation and right ventricular systolic dysfunction were assessed by Echocardiograms, and NYHA class was determined pre and post-CRT. Survival data were obtained from National Social Security Registry and was calculated by the Kaplan-Meier method.
Results: The mean age of this cohort was 68 ± 11 (male 83%). Eighty eight of 160 pts demonstrated an improved NYHA class ≥0.5. Ninety one pts had an increase in LVEF ≥5% and 42 pts had a reduction of PA systolic pressure ≥5mmHg. The mortality was significantly lower in pts who had improvement in NYHA class, LVEF or PA systolic pressure (7/88, 13/91, 3/42) compared to non-responders (20/72, 9/31, 16/59) as shown in the figure⇓. There was no survival benefit in pts who had improved LV diastolic dimension, mitral regurgitation and right ventricular systolic dysfunction.
Conclusion: Improvement in NYHA class, LV systolic function, or a reduction in PA systolic pressure after CRT predicts a favorable long-term survival. This study further supports the importance of patient selection, lead placement, and device programming to insure a response.