Predictors and Clinical Outcomes of Transient Responders to Cardiac Resynchronization Therapy

Background Left ventricular end‐systolic volume (LVESV) changes at 6 months and clinical status are useful for assessing responses to cardiac resynchronization therapy (CRT). Regression of the LVESV following CRT has not been described beyond 6 months. This study aimed to assess the proportion, predictors, and clinical outcomes of responders whose LVESVs had regressed. Methods We retrospectively analyzed 104 consecutive CRT patients. A responder was defined as a patient with a relative reduction in the LVESV ≥15% at 6 months after CRT. Fifty‐six responders participated in this study. A transient responder was defined as a responder without a relative reduction in the LVESV ≥15% at 2 years after CRT or who died of cardiac events during the 24‐month follow‐up period. Results Of the 56 responders, 16 (29%) were transient responders. Multivariable logistic regression analysis showed that chronic atrial fibrillation (odds ratio [OR] = 19.2, 95% confidence interval [CI] [1.93, 190], P = 0.012) and amiodarone usage (OR = 60.9, 95% CI [4.18, 886], P = 0.003) were independent predictors of transient responses. Hospitalizations for heart failure were significantly higher among the transient responders than among the lasting responders during a mean follow‐up period of 7.6 years (log‐rank P < 0.001), and all‐cause mortality tended to be higher among the transient responders (log‐rank P = 0.093). Conclusions One‐third of the responders were transient responders at 2 years after CRT, and their long‐term prognoses were poor. Careful attention should be paid to maintain the reduction in LVESV especially in patients with chronic AF.