Characterization of super-response to cardiac resynchronization therapy

John Rickard, Dharam J. Kumbhani, Zoran Popovic, David Verhaert, Mahesh Manne, Daniel Sraow, Bryan Baranowski, David O. Martin, Bruce D. Lindsay, Richard A. Grimm, Bruce L. Wilkoff, Patrick Tchou

Research output: Contribution to journalArticle

72 Citations (Scopus)

Abstract

Background: In patients with chronic systolic heart failure who undergo cardiac resynchronization therapy (CRT), improvements in left ventricular ejection fraction (LVEF) and reductions in left ventricular volume are generally modest. A minority of patients experience a dramatic response to CRT (super-responders), but the attributes associated with these patients have not been fully characterized. Objective: The purpose of this study was to identify baseline clinical attributes of super-responders and to assess the survival benefit associated with this response. Methods: We reviewed clinical, echocardiographic, and ECG data from a cohort of 233 patients undergoing new implantation of a CRT device between December 2001 and November 2006. All patients had a baseline LVEF ≤40% and New York Heart Association class II to IV symptoms on standard medical therapy. Patients whose absolute LVEF improved by ≥20% were termed super-responders. A multivariate model was constructed to determine factors predictive of super-response, and an assessment of mortality was made. Results: In this cohort of 233 patients, 32 (13.7%) met criteria for super-response. In univariate analysis, super-responders were more likely to be female and have a native left bundle branch block, lower preimplant brain natriuretic peptide and red cell distribution width levels, and smaller baseline left ventricular volumes with trends toward having more nonischemic cardiomyopathy and midventricular lead positions. In multivariate analysis, only left bundle branch block remained significantly associated with super-response. Super-responders had a considerably lower incidence of mortality compared to non-super-responders (9.4% vs 43.2%, P = .006) at mean follow-up of 5.5 ± 1.2 years. Conclusion: Baseline left bundle branch block is strongly associated with super-response to CRT. Super-responders derive better long-term outcomes with CRT than do non-super-responders.

Original languageEnglish (US)
Pages (from-to)885-889
Number of pages5
JournalHeart Rhythm
Volume7
Issue number7
DOIs
StatePublished - Jul 2010

Fingerprint

Cardiac Resynchronization Therapy
Bundle-Branch Block
Stroke Volume
Cardiac Resynchronization Therapy Devices
Systolic Heart Failure
Erythrocyte Indices
Mortality
Brain Natriuretic Peptide
Cardiomyopathies
Electrocardiography
Multivariate Analysis
Survival
Incidence

Keywords

  • Cardiac resynchronization therapy
  • Left bundle branch block
  • Resynchronization
  • Super-response

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Rickard, J., Kumbhani, D. J., Popovic, Z., Verhaert, D., Manne, M., Sraow, D., ... Tchou, P. (2010). Characterization of super-response to cardiac resynchronization therapy. Heart Rhythm, 7(7), 885-889. https://doi.org/10.1016/j.hrthm.2010.04.005

Characterization of super-response to cardiac resynchronization therapy. / Rickard, John; Kumbhani, Dharam J.; Popovic, Zoran; Verhaert, David; Manne, Mahesh; Sraow, Daniel; Baranowski, Bryan; Martin, David O.; Lindsay, Bruce D.; Grimm, Richard A.; Wilkoff, Bruce L.; Tchou, Patrick.

In: Heart Rhythm, Vol. 7, No. 7, 07.2010, p. 885-889.

Research output: Contribution to journalArticle

Rickard, J, Kumbhani, DJ, Popovic, Z, Verhaert, D, Manne, M, Sraow, D, Baranowski, B, Martin, DO, Lindsay, BD, Grimm, RA, Wilkoff, BL & Tchou, P 2010, 'Characterization of super-response to cardiac resynchronization therapy', Heart Rhythm, vol. 7, no. 7, pp. 885-889. https://doi.org/10.1016/j.hrthm.2010.04.005
Rickard, John ; Kumbhani, Dharam J. ; Popovic, Zoran ; Verhaert, David ; Manne, Mahesh ; Sraow, Daniel ; Baranowski, Bryan ; Martin, David O. ; Lindsay, Bruce D. ; Grimm, Richard A. ; Wilkoff, Bruce L. ; Tchou, Patrick. / Characterization of super-response to cardiac resynchronization therapy. In: Heart Rhythm. 2010 ; Vol. 7, No. 7. pp. 885-889.
@article{a9e26e5369234e159b5dd96277d19ab6,
title = "Characterization of super-response to cardiac resynchronization therapy",
abstract = "Background: In patients with chronic systolic heart failure who undergo cardiac resynchronization therapy (CRT), improvements in left ventricular ejection fraction (LVEF) and reductions in left ventricular volume are generally modest. A minority of patients experience a dramatic response to CRT (super-responders), but the attributes associated with these patients have not been fully characterized. Objective: The purpose of this study was to identify baseline clinical attributes of super-responders and to assess the survival benefit associated with this response. Methods: We reviewed clinical, echocardiographic, and ECG data from a cohort of 233 patients undergoing new implantation of a CRT device between December 2001 and November 2006. All patients had a baseline LVEF ≤40{\%} and New York Heart Association class II to IV symptoms on standard medical therapy. Patients whose absolute LVEF improved by ≥20{\%} were termed super-responders. A multivariate model was constructed to determine factors predictive of super-response, and an assessment of mortality was made. Results: In this cohort of 233 patients, 32 (13.7{\%}) met criteria for super-response. In univariate analysis, super-responders were more likely to be female and have a native left bundle branch block, lower preimplant brain natriuretic peptide and red cell distribution width levels, and smaller baseline left ventricular volumes with trends toward having more nonischemic cardiomyopathy and midventricular lead positions. In multivariate analysis, only left bundle branch block remained significantly associated with super-response. Super-responders had a considerably lower incidence of mortality compared to non-super-responders (9.4{\%} vs 43.2{\%}, P = .006) at mean follow-up of 5.5 ± 1.2 years. Conclusion: Baseline left bundle branch block is strongly associated with super-response to CRT. Super-responders derive better long-term outcomes with CRT than do non-super-responders.",
keywords = "Cardiac resynchronization therapy, Left bundle branch block, Resynchronization, Super-response",
author = "John Rickard and Kumbhani, {Dharam J.} and Zoran Popovic and David Verhaert and Mahesh Manne and Daniel Sraow and Bryan Baranowski and Martin, {David O.} and Lindsay, {Bruce D.} and Grimm, {Richard A.} and Wilkoff, {Bruce L.} and Patrick Tchou",
year = "2010",
month = "7",
doi = "10.1016/j.hrthm.2010.04.005",
language = "English (US)",
volume = "7",
pages = "885--889",
journal = "Heart Rhythm",
issn = "1547-5271",
publisher = "Elsevier",
number = "7",

}

TY - JOUR

T1 - Characterization of super-response to cardiac resynchronization therapy

AU - Rickard, John

AU - Kumbhani, Dharam J.

AU - Popovic, Zoran

AU - Verhaert, David

AU - Manne, Mahesh

AU - Sraow, Daniel

AU - Baranowski, Bryan

AU - Martin, David O.

AU - Lindsay, Bruce D.

AU - Grimm, Richard A.

AU - Wilkoff, Bruce L.

AU - Tchou, Patrick

PY - 2010/7

Y1 - 2010/7

N2 - Background: In patients with chronic systolic heart failure who undergo cardiac resynchronization therapy (CRT), improvements in left ventricular ejection fraction (LVEF) and reductions in left ventricular volume are generally modest. A minority of patients experience a dramatic response to CRT (super-responders), but the attributes associated with these patients have not been fully characterized. Objective: The purpose of this study was to identify baseline clinical attributes of super-responders and to assess the survival benefit associated with this response. Methods: We reviewed clinical, echocardiographic, and ECG data from a cohort of 233 patients undergoing new implantation of a CRT device between December 2001 and November 2006. All patients had a baseline LVEF ≤40% and New York Heart Association class II to IV symptoms on standard medical therapy. Patients whose absolute LVEF improved by ≥20% were termed super-responders. A multivariate model was constructed to determine factors predictive of super-response, and an assessment of mortality was made. Results: In this cohort of 233 patients, 32 (13.7%) met criteria for super-response. In univariate analysis, super-responders were more likely to be female and have a native left bundle branch block, lower preimplant brain natriuretic peptide and red cell distribution width levels, and smaller baseline left ventricular volumes with trends toward having more nonischemic cardiomyopathy and midventricular lead positions. In multivariate analysis, only left bundle branch block remained significantly associated with super-response. Super-responders had a considerably lower incidence of mortality compared to non-super-responders (9.4% vs 43.2%, P = .006) at mean follow-up of 5.5 ± 1.2 years. Conclusion: Baseline left bundle branch block is strongly associated with super-response to CRT. Super-responders derive better long-term outcomes with CRT than do non-super-responders.

AB - Background: In patients with chronic systolic heart failure who undergo cardiac resynchronization therapy (CRT), improvements in left ventricular ejection fraction (LVEF) and reductions in left ventricular volume are generally modest. A minority of patients experience a dramatic response to CRT (super-responders), but the attributes associated with these patients have not been fully characterized. Objective: The purpose of this study was to identify baseline clinical attributes of super-responders and to assess the survival benefit associated with this response. Methods: We reviewed clinical, echocardiographic, and ECG data from a cohort of 233 patients undergoing new implantation of a CRT device between December 2001 and November 2006. All patients had a baseline LVEF ≤40% and New York Heart Association class II to IV symptoms on standard medical therapy. Patients whose absolute LVEF improved by ≥20% were termed super-responders. A multivariate model was constructed to determine factors predictive of super-response, and an assessment of mortality was made. Results: In this cohort of 233 patients, 32 (13.7%) met criteria for super-response. In univariate analysis, super-responders were more likely to be female and have a native left bundle branch block, lower preimplant brain natriuretic peptide and red cell distribution width levels, and smaller baseline left ventricular volumes with trends toward having more nonischemic cardiomyopathy and midventricular lead positions. In multivariate analysis, only left bundle branch block remained significantly associated with super-response. Super-responders had a considerably lower incidence of mortality compared to non-super-responders (9.4% vs 43.2%, P = .006) at mean follow-up of 5.5 ± 1.2 years. Conclusion: Baseline left bundle branch block is strongly associated with super-response to CRT. Super-responders derive better long-term outcomes with CRT than do non-super-responders.

KW - Cardiac resynchronization therapy

KW - Left bundle branch block

KW - Resynchronization

KW - Super-response

UR - http://www.scopus.com/inward/record.url?scp=77953869650&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77953869650&partnerID=8YFLogxK

U2 - 10.1016/j.hrthm.2010.04.005

DO - 10.1016/j.hrthm.2010.04.005

M3 - Article

C2 - 20382271

AN - SCOPUS:77953869650

VL - 7

SP - 885

EP - 889

JO - Heart Rhythm

JF - Heart Rhythm

SN - 1547-5271

IS - 7

ER -