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Outcome of super-responders to cardiac resynchronization therapy defined by endpoint-derived parameters of left ventricular remodeling: a two-center retrospective study

Hürlimann, David ; Schmidt, Susann ; Seifert, Burkhardt ; Saguner, Ardan ; Hindricks, Gerhard ; Lüscher, Thomas ; Ruschitzka, Frank ; Steffel, Jan

In: Clinical Research in Cardiology, 2015, vol. 104, no. 2, p. 136-144

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    Titre
    • Outcome of super-responders to cardiac resynchronization therapy defined by endpoint-derived parameters of left ventricular remodeling: a two-center retrospective study
    Auteur
    • Hürlimann, David. Department of Cardiology, Invasive Electrophysiology and Devices, University Heart Center Zurich, Zurich, Switzerland
    • Schmidt, Susann. Department of Cardiology, Invasive Electrophysiology and Devices, University Heart Center Zurich, Zurich, Switzerland
    • Seifert, Burkhardt. Division of Biostatistics, Institute for Social and Preventive Medicine, University of Zurich, Zurich, Switzerland
    • Saguner, Ardan. Department of Cardiology, Invasive Electrophysiology and Devices, University Heart Center Zurich, Zurich, Switzerland
    • Hindricks, Gerhard. Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany
    • Lüscher, Thomas. Department of Cardiology, Invasive Electrophysiology and Devices, University Heart Center Zurich, Zurich, Switzerland
    • Ruschitzka, Frank. Department of Cardiology, Invasive Electrophysiology and Devices, University Heart Center Zurich, Zurich, Switzerland
    • Steffel, Jan. Department of Cardiology, Invasive Electrophysiology and Devices, University Heart Center Zurich, Zurich, Switzerland
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • Clinical Research in Cardiology, 2015, vol. 104, no. 2, p. 136-144. Springer Berlin Heidelberg
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:331956
    Summary
    Aims: Various studies have attempted to identify super-responders to cardiac resynchronization therapy (CRT) by echocardiographic parameters of reverse remodeling. However, scientific evidence regarding those parameters is scarce. This study aimed at validating the definition of super-response to CRT based on the following frequently employed echocardiographic parameters: left ventricular ejection fraction (LVEF), end-diastolic volume index (EDVI), and end-systolic volume index (ESVI). Methods and results: We retrospectively investigated echocardiographic data and outcomes of 542 patients after CRT implantation. The primary endpoint comprised all-cause mortality, heart transplantation, ventricular assist device implantation (VAD), and hospitalization for heart failure. Secondary endpoints were hospitalization for heart failure, and the combination of all-cause mortality, heart transplantation and VAD. Two approaches were employed defining super-response based on improvement of echocardiographic parameters: one derived from the negative predictive value (NPV) for clinical endpoints, and second from best quartiles of improvement. Using the NPV method, an absolute 25% increase in LVEF, a relative 38% reduction in EDVI, and 46% in ESVI were calculated as optimal cut-offs identifying 4.9, 18.5, and 21.3% as super-responders. The best quartiles method resulted in lower cut-off values, i.e. 14% increase in LVEF, 26% reduction in EDVI, and 36% in ESVI. All cut-offs except LVEF ≥25% were significantly associated with improved outcomes after 5years (median follow-up 35.7months). Conclusions: NPV- and best quartile-based cut-offs validate previously applied empirical echocardiographic cut-offs to define super-response to CRT. These data provide evidence for using these empirical cut-offs in daily practice and facilitate inter-study comparability.