Predictors and long‐term outcome of super‐responders to cardiac resynchronization therapy

Abstract

Background The level of improvement in left ventricular ejection fraction (LVEF) in super‐responders to cardiac resynchronization therapy (CRT) is exceptional. However, the long‐term prognosis remains unknown in a large population. Hypothesis Whether super‐responders haven good long‐term outcomes. Methods We registered 347 patients with primary CRT‐D indication. Super‐response was defined by LVEF >50% at follow‐up echocardiogram. Best‐subset regression analysis identified predictors of super‐response. Endpoints were major adverse cardiac events (MACE; eg, all‐cause mortality or heart failure hospitalization, cardiac death, and appropriate ICD therapy). Results Fifty‐six (16%) patients with LVEF >50% were classified as super‐responders. Female sex (OR: 3.06, 95% CI: 1.54‐6.05), nonischemic etiology (OR: 2.70, 95% CI: 1.29‐5.68), higher LVEF at baseline (OR: 1.07, 95% CI: 1.02‐1.13), and wider QRS duration (OR: 1.17, 95% CI: 1.04‐1.32) were predictors of super‐response. Cumulative incidence of MACE at a median of 5.3 years was 18% in super‐responders, 22% in responders, and 51% in nonresponders (P < 0.001). None of super responders died from cardiac death, compared to 9% of responders and 25% of non‐responders (P < 0.001). None of super‐responders experienced appropriate ICD therapy, compared with 10% of responders and 21% of non‐responders (P < 0.001). In super‐responders, the adjusted hazard ratio was 0.37 (95% CI: 0.19‐0.73) for MACE and 0.44 (95% CI: 0.20‐0.95) for total mortality, compared with non‐responders. Conclusions Female sex, non‐ischemic etiology, higher baseline LVEF, and wider QRS duration were independently associated with super‐response. Super‐response was associated with persistent excellent prognosis regarding survival and appropriate ICD therapy during long‐term follow‐up.

Cessation of pacing in super‐responders of cardiac resynchronization therapy: A randomized controlled trial

“…Super-response to CRT has been previously reported to account for 15% to 30% of all patients receiving CRT. 3,5 In contrast, our study revealed that only 7.4% of CRT patients were categorized as superresponders. This is partially attributed to the strict criteria we adopted for the identification of randomization, and no severe adverse events occurred before the study was completed.…”

“…Super‐response to CRT has been previously reported to account for 15% to 30% of all patients receiving CRT . In contrast, our study revealed that only 7.4% of CRT patients were categorized as super‐responders.…”

“…Among patients receiving CRT, there is a subset of patients considered to have dramatic favorable response characterized by significant improvement in reverse remodeling leading to normal or near normal recovery of cardiac function, who are referred to as super‐responders to CRT . Furthermore, super‐response to CRT has been proved to be associated with favorable long‐term prognosis …”

“…super-response to CRT has been proved to be associated with favorable long-term prognosis. [4][5][6][7] Because super-responders are characterized by significant improvement of LVEF to near-normal level, the question arises whether these patients require continued biventricular pacing, especially on device replacement, as most of these patients no longer have an indication for CRT. Currently, there is scarce evidence to support the association between maintenance of the left ventricular (LV) function and persistent biventricular pacing.…”

Protein Phosphatase Inhibitor-1 Gene Therapy in a Swine Model of Nonischemic Heart Failure

“…Cardiac resynchronization therapy is one of the few effective approaches for treating nonischemic HF and improving LVEF, which is correlated with the improved prognosis (31). Unfortunately, however, not all patients are candidates for this therapy.…”