Echocardiographic, Electrocardiographic Changes and Clinical Outcomes of Patients Who Respond to Cardiac Resynchronization Therapy after One Year
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Background: Response to cardiac resynchronization therapy (CRT) is commonly assessed after 6 or 12 months. We evaluated subsequent echocardiographic changes, serial QRS duration, and clinical outcomes in patients showing delayed responses to CRT after 12 months. Methods: Among all patients who received CRT in Seoul St. Mary’s Hospital, 36 one-year survivors were enrolled. Indicators of a positive CRT response were ≥ 15% reduction in left ventricular end-systolic volume (LVESV) or ≥ 10% increase in left ventricular ejection fraction (LVEF) on any follow up echocardiogram. We defined the early responders as patients responding before one year, the late responders as patients responding after one year, and the non-responders as patients who did not respond on any follow-up echocardiogram. Results: We identified 17 early responders, 10 late responders, and 9 non-responders. The late responders showed modest improvement in LVESV and LVEF at two years after CRT. QRS duration was shortened the day after CRT in all three groups. Narrowed QRS was maintained for two years in early and late responders, whereas it was continuously prolonged over time in non-responders. Incidence of all-cause death or heart failure hospitalization was comparable between early and late responders, while non-responders showed worst prognosis. Conclusion: Patients responding to CRT after one year show modest echocardiographic improvement but clinical outcome is similar to early responders. Shorter baseline QRS duration and long-term maintenance of QRS duration shortening are important features of the late responders to CRT.
Abstract
Background: Response to cardiac resynchronization therapy (CRT) is commonly assessed after 6 or 12 months. We evaluated subsequent echocardiographic changes, serial QRS duration, and clinical outcomes in patients showing delayed responses to CRT after 12 months. Methods: Among all patients who received CRT in Seoul St. Mary’s Hospital, 36 one-year survivors were enrolled. Indicators of a positive CRT response were ≥ 15% reduction in left ventricular end-systolic volume (LVESV) or ≥ 10% increase in left ventricular ejection fraction (LVEF) on any follow up echocardiogram. We defined the early responders as patients responding before one year, the late responders as patients responding after one year, and the non-responders as patients who did not respond on any follow-up echocardiogram. Results: We identified 17 early responders, 10 late responders, and 9 non-responders. The late responders showed modest improvement in LVESV and LVEF at two years after CRT. QRS duration was shortened the day after CRT in all three groups. Narrowed QRS was maintained for two years in early and late responders, whereas it was continuously prolonged over time in non-responders. Incidence of all-cause death or heart failure hospitalization was comparable between early and late responders, while non-responders showed worst prognosis. Conclusion: Patients responding to CRT after one year show modest echocardiographic improvement but clinical outcome is similar to early responders. Shorter baseline QRS duration and long-term maintenance of QRS duration shortening are important features of the late responders to CRT.
참고문헌 (16)
- St John Sutton MG, "Effect of cardiac resynchronization therapy on left ventricular size and function in chronic heart failure", Circulation, 107, pp.1985~1990 (2003)
- Yu CM, "Left ventricular reverse remodeling but not clinical improvement predicts long-term survival after cardiac resynchronization therapy", Circulation, 112, pp.1580~1586 (2005)
- Chung ES, "Results of the Predictors of Response to CRT (PROSPECT) trial", Circulation, 117, pp.2608~2616 (2008)
- Friedman DJ, "Progressive ventricular dysfunction among nonresponders to cardiac resynchronization therapy: baseline predictors and associated clinical out comes", Heart Rhythm, 11, pp.1991~1998 (2014)
- Marfella R, "Circulating microRNA changes in heart failure patients treated with cardiac resynchronization therapy: responders vs. non-responders", Eur J Heart Fail, 15, pp.1277~1288 (2013)
- Ghio S, "Long-term left ventricular reverse remodelling with cardiac resynchronization therapy: results from the CARE-HF trial", Eur J Heart Fail, 11, pp.480~488 (2009)
- van’t Sant J, "Volumetric response beyond six months of cardiac resynchronization therapy and clinical outcome", PLoS One, 10, pp.e0124323~ (2015)
- Molhoek SG, "QRS duration and shortening to predict clinical response to cardiac resynchronization therapy in patients with end-stage heart failure", Pacing Clin Electrophysiol, 27, pp.308~313 (2004)
- Abraham WT, "Multicenter InSync Randomized Clinical Evaluation. Cardiac resynchronization in chronic heart failure", N Engl J Med, 346, pp.1845~1853 (2002)
- Birnie DH, "The problem of non-response to cardiac resynchronization therapy", Curr Opin Cardiol, 21, pp.20~26 (2006)
- Bleeker GB, "Clinical versus echocardiographic parameters to assess response to cardiac resynchronization therapy", Am J Cardiol, 97, pp.260~263 (2006)
- Burns KV, "Long-term echocardiographic response to cardiac resynchronization therapy in initial nonresponders", JACC Heart Fail, 3, pp.990~997 (2015)
- Zhang J, "QRS duration shortening predicts left ventricular reverse remodelling in patients with dilated cardiomyopathy after cardiac resynchronization therapy", Acta Cardiol, 70, pp.307~313 (2015)
- Brabham WW, "The role of AV and VV optimization for CRT", J Arrhythm, 29, pp.153~161 (2013)
- Ellenbogen KA, "Primary results from the SmartDelay determined AV optimization: a comparison to other AV delay methods used in cardiac resynchronization therapy (SMART-AV) trial: a randomized trial comparing empirical", Circulation, 122, pp.2660~2668 (2010)
- Kosmala W, "Meta-analysis of effects of optimization of cardiac resynchronization therapy on left ventricular function, exercise capacity, and quality of life in patients with heart failure", Am J Cardiol, 113, pp.988~994 (2014)