Predictors and Outcomes of “Super-response” to Cardiac Resynchronization Therapy
Abstract Background Cardiac resynchronization therapy (CRT) has been shown to improve heart failure (HF) symptoms and survival. We hypothesized that a greater improvement in left-ventricular ejection fraction (LVEF) after CRT is associated with greater survival benefit. Methods and Results In 693 pa...
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| Veröffentlicht in: | Journal of cardiac failure 2014-06, Vol.20 (6), p.379-386 |
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| creator | Killu, Ammar M., MBBS Grupper, Avishay, MD Friedman, Paul A., MD Powell, Brian D., MD Asirvatham, Samuel J., MD Espinosa, Raul E., MD Luria, David, MD Rozen, Guy, MD Buber, Jonathan, MD Lee, Ying-Hsiang, MD Webster, Tracy, RN Brooke, Kelly L., MS Hodge, David O., MS Wiste, Heather J., BA Glikson, Michael, MD Cha, Yong-Mei, MD |
| description | Abstract Background Cardiac resynchronization therapy (CRT) has been shown to improve heart failure (HF) symptoms and survival. We hypothesized that a greater improvement in left-ventricular ejection fraction (LVEF) after CRT is associated with greater survival benefit. Methods and Results In 693 patients across 2 international centers, the improvement in LVEF after CRT was determined. Patients were grouped as non-/modest-, moderate-, or super-responders to CRT, defined as an absolute change in LVEF of ≤5%, 6–15%, and >15%, respectively. Changes in New York Heart Association (NYHA) functional class and left ventricular end-diastolic dimension (LVEDD) were assessed for each group. There were 395 non-/modest-, 186 moderate-, and 112 super-responders. Super-responders were more likely to be female and to have nonischemic cardiomyopathy, lower creatinine, and lower pulmonary artery systolic pressure than non-/modest- and moderate-responders. Super-responders were also more likely to have lower LVEF than non-/modest-responders. There was no difference in NYHA functional class, mitral regurgitation grade, or tricuspid regurgitation grade between groups. Improvement in NYHA functional class (−0.9 ± 0.9 vs −0.4 ± 0.8 [ P |
| doi_str_mv | 10.1016/j.cardfail.2014.03.001 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1531953814</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S1071916414000943</els_id><sourcerecordid>1531953814</sourcerecordid><originalsourceid>FETCH-LOGICAL-c489t-736c08072ee6e35fcb345d3081dfbea7dc2d4f4dc9a8549df44dd182ea65dfbf3</originalsourceid><addsrcrecordid>eNqFkctuFDEQRS0EIiHwC1Ev2XRTbrtfGwQa8ZIiBZFhbXnKZcVDj93Y3UjDKh8CP5cvwaNJssiGlWtxqq58LmPnHCoOvH2zrVBHY7Ubqxq4rEBUAPwJO-WNqMtecvk0z9DxcuCtPGEvUtoCQC-he85OatmKWkg4ZeuvkYzDOcRUaG-Ky2XGsKNUBFvc3vy5WiaKZaQ0BZ_o9uZvMYdilZOdxuIbpb3H6xi8-61nF3yxvqaop_1L9szqMdGru_eMff_4Yb36XF5cfvqyen9RouyHuexEi9BDVxO1JBqLGyEbI6Dnxm5IdwZrI600OOi-kYOxUhrD-5p022TCijP2-nh3iuHnQmlWO5eQxlF7CktS2QUfGtFzmdH2iGIMKUWyaopup-NecVAHo2qr7o2qg1EFQmWjefH8LmPZ7Mg8rN0rzMC7I0D5p78cRZXQkcesNRLOygT3_4y3j07g6LxDPf6gPaVtWKLPHhVXqVagrg69HmrlMlc6SCH-Afb5ork</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1531953814</pqid></control><display><type>article</type><title>Predictors and Outcomes of “Super-response” to Cardiac Resynchronization Therapy</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Killu, Ammar M., MBBS ; Grupper, Avishay, MD ; Friedman, Paul A., MD ; Powell, Brian D., MD ; Asirvatham, Samuel J., MD ; Espinosa, Raul E., MD ; Luria, David, MD ; Rozen, Guy, MD ; Buber, Jonathan, MD ; Lee, Ying-Hsiang, MD ; Webster, Tracy, RN ; Brooke, Kelly L., MS ; Hodge, David O., MS ; Wiste, Heather J., BA ; Glikson, Michael, MD ; Cha, Yong-Mei, MD</creator><creatorcontrib>Killu, Ammar M., MBBS ; Grupper, Avishay, MD ; Friedman, Paul A., MD ; Powell, Brian D., MD ; Asirvatham, Samuel J., MD ; Espinosa, Raul E., MD ; Luria, David, MD ; Rozen, Guy, MD ; Buber, Jonathan, MD ; Lee, Ying-Hsiang, MD ; Webster, Tracy, RN ; Brooke, Kelly L., MS ; Hodge, David O., MS ; Wiste, Heather J., BA ; Glikson, Michael, MD ; Cha, Yong-Mei, MD</creatorcontrib><description>Abstract Background Cardiac resynchronization therapy (CRT) has been shown to improve heart failure (HF) symptoms and survival. We hypothesized that a greater improvement in left-ventricular ejection fraction (LVEF) after CRT is associated with greater survival benefit. Methods and Results In 693 patients across 2 international centers, the improvement in LVEF after CRT was determined. Patients were grouped as non-/modest-, moderate-, or super-responders to CRT, defined as an absolute change in LVEF of ≤5%, 6–15%, and >15%, respectively. Changes in New York Heart Association (NYHA) functional class and left ventricular end-diastolic dimension (LVEDD) were assessed for each group. There were 395 non-/modest-, 186 moderate-, and 112 super-responders. Super-responders were more likely to be female and to have nonischemic cardiomyopathy, lower creatinine, and lower pulmonary artery systolic pressure than non-/modest- and moderate-responders. Super-responders were also more likely to have lower LVEF than non-/modest-responders. There was no difference in NYHA functional class, mitral regurgitation grade, or tricuspid regurgitation grade between groups. Improvement in NYHA functional class (−0.9 ± 0.9 vs −0.4 ± 0.8 [ P < .001] and −0.6 ± 0.8 [ P = .02]) and LVEDD (−8.7 ± 9.9 mm vs −0.5 ± 5.0 and −2.4 ± 5.8 mm [ P < .001 for both]) was greatest in super-responders. Kaplan-Meier survival analysis revealed that super-responders achieved better survival compared with non-/modest- ( P < .001) and moderate-responders ( P = .049). Conclusions Improvement in HF symptoms and survival after CRT is proportionate to the degree of improvement in LV systolic function. Super-response is more likely in women, those with nonischemic substrate, and those with lower pulmonary artery systolic pressure.</description><identifier>ISSN: 1071-9164</identifier><identifier>EISSN: 1532-8414</identifier><identifier>DOI: 10.1016/j.cardfail.2014.03.001</identifier><identifier>PMID: 24632340</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Cardiac resynchronization ; Cardiac Resynchronization Therapy - mortality ; Cardiac Resynchronization Therapy - trends ; Cardiovascular ; Female ; Follow-Up Studies ; heart failure ; Heart Failure - diagnosis ; Heart Failure - mortality ; Heart Failure - therapy ; Humans ; ICD ; Male ; Middle Aged ; pacemaker ; Predictive Value of Tests ; Retrospective Studies ; Stroke Volume - physiology ; Survival Rate - trends ; treatment ; Treatment Outcome</subject><ispartof>Journal of cardiac failure, 2014-06, Vol.20 (6), p.379-386</ispartof><rights>Elsevier Inc.</rights><rights>2014 Elsevier Inc.</rights><rights>Copyright © 2014 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c489t-736c08072ee6e35fcb345d3081dfbea7dc2d4f4dc9a8549df44dd182ea65dfbf3</citedby><cites>FETCH-LOGICAL-c489t-736c08072ee6e35fcb345d3081dfbea7dc2d4f4dc9a8549df44dd182ea65dfbf3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1071916414000943$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24632340$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Killu, Ammar M., MBBS</creatorcontrib><creatorcontrib>Grupper, Avishay, MD</creatorcontrib><creatorcontrib>Friedman, Paul A., MD</creatorcontrib><creatorcontrib>Powell, Brian D., MD</creatorcontrib><creatorcontrib>Asirvatham, Samuel J., MD</creatorcontrib><creatorcontrib>Espinosa, Raul E., MD</creatorcontrib><creatorcontrib>Luria, David, MD</creatorcontrib><creatorcontrib>Rozen, Guy, MD</creatorcontrib><creatorcontrib>Buber, Jonathan, MD</creatorcontrib><creatorcontrib>Lee, Ying-Hsiang, MD</creatorcontrib><creatorcontrib>Webster, Tracy, RN</creatorcontrib><creatorcontrib>Brooke, Kelly L., MS</creatorcontrib><creatorcontrib>Hodge, David O., MS</creatorcontrib><creatorcontrib>Wiste, Heather J., BA</creatorcontrib><creatorcontrib>Glikson, Michael, MD</creatorcontrib><creatorcontrib>Cha, Yong-Mei, MD</creatorcontrib><title>Predictors and Outcomes of “Super-response” to Cardiac Resynchronization Therapy</title><title>Journal of cardiac failure</title><addtitle>J Card Fail</addtitle><description>Abstract Background Cardiac resynchronization therapy (CRT) has been shown to improve heart failure (HF) symptoms and survival. We hypothesized that a greater improvement in left-ventricular ejection fraction (LVEF) after CRT is associated with greater survival benefit. Methods and Results In 693 patients across 2 international centers, the improvement in LVEF after CRT was determined. Patients were grouped as non-/modest-, moderate-, or super-responders to CRT, defined as an absolute change in LVEF of ≤5%, 6–15%, and >15%, respectively. Changes in New York Heart Association (NYHA) functional class and left ventricular end-diastolic dimension (LVEDD) were assessed for each group. There were 395 non-/modest-, 186 moderate-, and 112 super-responders. Super-responders were more likely to be female and to have nonischemic cardiomyopathy, lower creatinine, and lower pulmonary artery systolic pressure than non-/modest- and moderate-responders. Super-responders were also more likely to have lower LVEF than non-/modest-responders. There was no difference in NYHA functional class, mitral regurgitation grade, or tricuspid regurgitation grade between groups. Improvement in NYHA functional class (−0.9 ± 0.9 vs −0.4 ± 0.8 [ P < .001] and −0.6 ± 0.8 [ P = .02]) and LVEDD (−8.7 ± 9.9 mm vs −0.5 ± 5.0 and −2.4 ± 5.8 mm [ P < .001 for both]) was greatest in super-responders. Kaplan-Meier survival analysis revealed that super-responders achieved better survival compared with non-/modest- ( P < .001) and moderate-responders ( P = .049). Conclusions Improvement in HF symptoms and survival after CRT is proportionate to the degree of improvement in LV systolic function. Super-response is more likely in women, those with nonischemic substrate, and those with lower pulmonary artery systolic pressure.</description><subject>Aged</subject><subject>Cardiac resynchronization</subject><subject>Cardiac Resynchronization Therapy - mortality</subject><subject>Cardiac Resynchronization Therapy - trends</subject><subject>Cardiovascular</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>heart failure</subject><subject>Heart Failure - diagnosis</subject><subject>Heart Failure - mortality</subject><subject>Heart Failure - therapy</subject><subject>Humans</subject><subject>ICD</subject><subject>Male</subject><subject>Middle Aged</subject><subject>pacemaker</subject><subject>Predictive Value of Tests</subject><subject>Retrospective Studies</subject><subject>Stroke Volume - physiology</subject><subject>Survival Rate - trends</subject><subject>treatment</subject><subject>Treatment Outcome</subject><issn>1071-9164</issn><issn>1532-8414</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkctuFDEQRS0EIiHwC1Ev2XRTbrtfGwQa8ZIiBZFhbXnKZcVDj93Y3UjDKh8CP5cvwaNJssiGlWtxqq58LmPnHCoOvH2zrVBHY7Ubqxq4rEBUAPwJO-WNqMtecvk0z9DxcuCtPGEvUtoCQC-he85OatmKWkg4ZeuvkYzDOcRUaG-Ky2XGsKNUBFvc3vy5WiaKZaQ0BZ_o9uZvMYdilZOdxuIbpb3H6xi8-61nF3yxvqaop_1L9szqMdGru_eMff_4Yb36XF5cfvqyen9RouyHuexEi9BDVxO1JBqLGyEbI6Dnxm5IdwZrI600OOi-kYOxUhrD-5p022TCijP2-nh3iuHnQmlWO5eQxlF7CktS2QUfGtFzmdH2iGIMKUWyaopup-NecVAHo2qr7o2qg1EFQmWjefH8LmPZ7Mg8rN0rzMC7I0D5p78cRZXQkcesNRLOygT3_4y3j07g6LxDPf6gPaVtWKLPHhVXqVagrg69HmrlMlc6SCH-Afb5ork</recordid><startdate>20140601</startdate><enddate>20140601</enddate><creator>Killu, Ammar M., MBBS</creator><creator>Grupper, Avishay, MD</creator><creator>Friedman, Paul A., MD</creator><creator>Powell, Brian D., MD</creator><creator>Asirvatham, Samuel J., MD</creator><creator>Espinosa, Raul E., MD</creator><creator>Luria, David, MD</creator><creator>Rozen, Guy, MD</creator><creator>Buber, Jonathan, MD</creator><creator>Lee, Ying-Hsiang, MD</creator><creator>Webster, Tracy, RN</creator><creator>Brooke, Kelly L., MS</creator><creator>Hodge, David O., MS</creator><creator>Wiste, Heather J., BA</creator><creator>Glikson, Michael, MD</creator><creator>Cha, Yong-Mei, MD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20140601</creationdate><title>Predictors and Outcomes of “Super-response” to Cardiac Resynchronization Therapy</title><author>Killu, Ammar M., MBBS ; Grupper, Avishay, MD ; Friedman, Paul A., MD ; Powell, Brian D., MD ; Asirvatham, Samuel J., MD ; Espinosa, Raul E., MD ; Luria, David, MD ; Rozen, Guy, MD ; Buber, Jonathan, MD ; Lee, Ying-Hsiang, MD ; Webster, Tracy, RN ; Brooke, Kelly L., MS ; Hodge, David O., MS ; Wiste, Heather J., BA ; Glikson, Michael, MD ; Cha, Yong-Mei, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c489t-736c08072ee6e35fcb345d3081dfbea7dc2d4f4dc9a8549df44dd182ea65dfbf3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Aged</topic><topic>Cardiac resynchronization</topic><topic>Cardiac Resynchronization Therapy - mortality</topic><topic>Cardiac Resynchronization Therapy - trends</topic><topic>Cardiovascular</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>heart failure</topic><topic>Heart Failure - diagnosis</topic><topic>Heart Failure - mortality</topic><topic>Heart Failure - therapy</topic><topic>Humans</topic><topic>ICD</topic><topic>Male</topic><topic>Middle Aged</topic><topic>pacemaker</topic><topic>Predictive Value of Tests</topic><topic>Retrospective Studies</topic><topic>Stroke Volume - physiology</topic><topic>Survival Rate - trends</topic><topic>treatment</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Killu, Ammar M., MBBS</creatorcontrib><creatorcontrib>Grupper, Avishay, MD</creatorcontrib><creatorcontrib>Friedman, Paul A., MD</creatorcontrib><creatorcontrib>Powell, Brian D., MD</creatorcontrib><creatorcontrib>Asirvatham, Samuel J., MD</creatorcontrib><creatorcontrib>Espinosa, Raul E., MD</creatorcontrib><creatorcontrib>Luria, David, MD</creatorcontrib><creatorcontrib>Rozen, Guy, MD</creatorcontrib><creatorcontrib>Buber, Jonathan, MD</creatorcontrib><creatorcontrib>Lee, Ying-Hsiang, MD</creatorcontrib><creatorcontrib>Webster, Tracy, RN</creatorcontrib><creatorcontrib>Brooke, Kelly L., MS</creatorcontrib><creatorcontrib>Hodge, David O., MS</creatorcontrib><creatorcontrib>Wiste, Heather J., BA</creatorcontrib><creatorcontrib>Glikson, Michael, MD</creatorcontrib><creatorcontrib>Cha, Yong-Mei, MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of cardiac failure</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Killu, Ammar M., MBBS</au><au>Grupper, Avishay, MD</au><au>Friedman, Paul A., MD</au><au>Powell, Brian D., MD</au><au>Asirvatham, Samuel J., MD</au><au>Espinosa, Raul E., MD</au><au>Luria, David, MD</au><au>Rozen, Guy, MD</au><au>Buber, Jonathan, MD</au><au>Lee, Ying-Hsiang, MD</au><au>Webster, Tracy, RN</au><au>Brooke, Kelly L., MS</au><au>Hodge, David O., MS</au><au>Wiste, Heather J., BA</au><au>Glikson, Michael, MD</au><au>Cha, Yong-Mei, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predictors and Outcomes of “Super-response” to Cardiac Resynchronization Therapy</atitle><jtitle>Journal of cardiac failure</jtitle><addtitle>J Card Fail</addtitle><date>2014-06-01</date><risdate>2014</risdate><volume>20</volume><issue>6</issue><spage>379</spage><epage>386</epage><pages>379-386</pages><issn>1071-9164</issn><eissn>1532-8414</eissn><abstract>Abstract Background Cardiac resynchronization therapy (CRT) has been shown to improve heart failure (HF) symptoms and survival. We hypothesized that a greater improvement in left-ventricular ejection fraction (LVEF) after CRT is associated with greater survival benefit. Methods and Results In 693 patients across 2 international centers, the improvement in LVEF after CRT was determined. Patients were grouped as non-/modest-, moderate-, or super-responders to CRT, defined as an absolute change in LVEF of ≤5%, 6–15%, and >15%, respectively. Changes in New York Heart Association (NYHA) functional class and left ventricular end-diastolic dimension (LVEDD) were assessed for each group. There were 395 non-/modest-, 186 moderate-, and 112 super-responders. Super-responders were more likely to be female and to have nonischemic cardiomyopathy, lower creatinine, and lower pulmonary artery systolic pressure than non-/modest- and moderate-responders. Super-responders were also more likely to have lower LVEF than non-/modest-responders. There was no difference in NYHA functional class, mitral regurgitation grade, or tricuspid regurgitation grade between groups. Improvement in NYHA functional class (−0.9 ± 0.9 vs −0.4 ± 0.8 [ P < .001] and −0.6 ± 0.8 [ P = .02]) and LVEDD (−8.7 ± 9.9 mm vs −0.5 ± 5.0 and −2.4 ± 5.8 mm [ P < .001 for both]) was greatest in super-responders. Kaplan-Meier survival analysis revealed that super-responders achieved better survival compared with non-/modest- ( P < .001) and moderate-responders ( P = .049). Conclusions Improvement in HF symptoms and survival after CRT is proportionate to the degree of improvement in LV systolic function. Super-response is more likely in women, those with nonischemic substrate, and those with lower pulmonary artery systolic pressure.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>24632340</pmid><doi>10.1016/j.cardfail.2014.03.001</doi><tpages>8</tpages></addata></record> |
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| subjects | Aged Cardiac resynchronization Cardiac Resynchronization Therapy - mortality Cardiac Resynchronization Therapy - trends Cardiovascular Female Follow-Up Studies heart failure Heart Failure - diagnosis Heart Failure - mortality Heart Failure - therapy Humans ICD Male Middle Aged pacemaker Predictive Value of Tests Retrospective Studies Stroke Volume - physiology Survival Rate - trends treatment Treatment Outcome |
| title | Predictors and Outcomes of “Super-response” to Cardiac Resynchronization Therapy |
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