Abstract 9141: Early Response to Cardiac Resynchronisation Therapy is Maintained to 9 Years Following Device Implant
Introduction: Cardiac resynchronisation therapy (CRT) results in mortality benefit in a subgroup of patients with chronic heart failure (HF). However, data examining the longevity of the effect is lacking as in most large CRT trials, follow-up does not extend beyond 2–3 years.
Hypothesis: We evaluated the durability of response to CRT, our hypothesis being that initial benefit would be maintained 9 years following device implant.
Methods: 45 patients (37 male, age 70.2±10.9yrs, 53% ischaemic) with NYHA grade III-IV HF, QRS ≥130ms, LVEF ≤35%, on optimal medical therapy underwent CRT before 2002 (73% CRT-P, 27% CRT-D). Variables known to predict mortality in HF were measured at baseline and compared with values at 1 year, 4 years and 9 years post-implant. Additionally, the cause of death for non-survivors was recorded.
Results: The mean follow-up period was 8 years 7 months±6.2 mths. During this period, 23/45 (53%) patients died. Of these, only 7/23 (30%) died due to HF. For survivors, the change in mortality predictors over time is shown in the table below. There were significant improvements in functional, ECG and echocardiographic predictors after 1 year, which were maintained to 9 years. In addition, biochemical predictors did not deteriorate.
Conclusions: Improvements observed during the initial years following CRT are maintained to 9 years in those that survive this long. Although just over half of patients died during follow-up, only a minority of deaths were attributable to HF. These results demonstrate a remarkable long-term sustained benefit from CRT and confirm the true value of this therapy in HF.
- © 2010 by American Heart Association, Inc.