Abstract 12011: Super-Responders to CRT: The Golden Hour Could be the Right Question
Aims: Despite the current selection criteria, individual response to cardiac resynchronization therapy (CRT) varies significantly. A minority of patients show an excellent clinical and functional improvement after CRT. These patients are called super-responders. The aim of our study was to identify predictors of becoming a super-responder after CRT and to assess the survival benefit associated with this response.
Methods and results: Eighty-nine consecutive patients in optimized medical therapy (mean age 69±9years, male 71%, NYHA 3.1±0.6, LVEF 26.8±6.3%) who underwent CRT were prospectively studied. Before CRT and 6-12-24-48 months after, clinical and echocardiographic evaluation were performed. Patients with a 12 months decrease in NYHA functional class ≥1 and an absolute increase of LVEF ≥5 were classified as clinical (CR) and functional responders (FR), respectively; an absolute improvement in LVEF>10 was used to define super-responders (SR). We observed 74, 43 and 26% of CR, FR and SR, respectively. In SR group the 85% was also CR, while in CR group only 29% was also SR. At baseline SR showed an higher prevalence of primitive etiology (39 vs 17%, p<0.01), a smaller mitral regurgitation degree (p<0.04), a less advanced diastolic dysfunction (p<0.01), smaller diameter (p<0.03), a lower pulmonary hypertension (p<0.01) and a shorter duration of heart failure symptoms (50±43 vs 129±85months, p<0.01). By logistic regression mitral regurgitation degree (OR 0.8, p 0.03), diastolic dysfunction (OR 0.9, p 0.05) and duration of HF symptoms (OR 0.5, p 0.01) were correlated with this super-response. During all follow-up SR group showed significant sustained symptomatic (48-months change in NYHA class from baseline -1.2±0.6, p<0.01) and functional improvement (48-moths LVEF change from baseline +22±6%, p<0.0001). Overall 48-months cardiac mortality was 14.7%; in responders subgroup we observed a 48-months cardiac mortality of 7.6% in CR, 9.1% in FR and 0% in SR.
Conclusion: Patients in earlier phases of the cardiomyopathy, with a less altered ventricular geometry and a more preserved diastolic filling, seem to have a greater probability of becoming SR. The SR long-term prognosis is strongly better than all other CRT responders patients, either CR either RF.
- © 2011 by American Heart Association, Inc.