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Impact of clinical and echocardiographic response to cardiac resynchronization therapy on long-term survival.

European heart journal cardiovascular Imaging, ISSN: 2047-2412, Vol: 14, Issue: 8, Page: 774-781
2013
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Article Description

Clinical or echocardiographic mid-term responses to cardiac resynchronization therapy (CRT) may have a different influence on a long-term prognosis of heart failure patients treated with CRT. The aim of the evaluation was to establish which definition of response to CRT, clinical or echocardiographic, best predicts long-term prognosis. A total of 679 heart failure patients treated with CRT were included. All the patients underwent a complete history and physical examination and transthoracic echocardiogram prior to CRT implantation and at 6-month follow-up. The clinical and echocardiographic responses to CRT were defined based on clinical improvement (≥1 NYHA class) and LV reverse remodelling (reduction in LV end-systolic volume ≥15%) at 6-month follow-up, respectively. All the patients were prospectively followed up for the occurrence of death. The mean age was 65 ± 11 years and 79% of the patients were male. At 6-month follow-up, 510 (77%) patients showed clinical response to CRT and 412 (62%) patients showed echocardiographic response to CRT. During a mean follow-up of 37 ± 22 months, 140 (21%) patients died. Clinical and echocardiographic responses to CRT were both significantly related to all-cause mortality on univariable analysis. However, on multivariable Cox-regression analysis only echocardiographic response to CRT was independently associated with superior survival (hazard ratio: 0.38; 95% CI: 0.27-0.50; P < 0.001). In a large population of heart failure patients treated with CRT, the reduction in LV end-systolic volume at the mid-term follow-up demonstrated to be a better predictor of long-term survival than improvement in the clinical status.

Bibliographic Details

Bertini, Matteo; Höke, Ulas; van Bommel, Rutger J; Ng, Arnold C T; Shanks, Miriam; Nucifora, Gaetano; Auger, Dominique; Borleffs, C Jan Willem; van Rijnsoever, Eva P M; van Erven, Lieselot; Schalij, Martin J; Marsan, Nina Ajmone; Bax, Jeroen J; Delgado, Victoria

Oxford University Press (OUP)

Medicine

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