AI Article Synopsis

  • The study assessed cardiac resynchronization therapy (CRT) responses in patients from six to 14 months post-implantation, focusing on those who shifted from responder to non-responder status.
  • Out of 105 patients, 71% were responders at six months, but 16% became late non-responders by 14 months, often linked to factors like ischemic cardiomyopathy and higher BNP levels.
  • The findings suggest that evaluating patient response beyond six months may provide better insights into long-term clinical outcomes, as 14-month responses were more predictive of major adverse cardiac events than those at six months.

Article Abstract

Aims: Response to cardiac resynchronization therapy (CRT) is often assessed six months after implantation. Our objective was to assess the number of patients changing from responder to non-responder between six and 14 months, so-called late non-responders, and compare them to patients who were responder both at six and 14 months, so-called stable responders. Furthermore, we assessed predictive values of six and 14-month response concerning clinical outcome.

Methods: 105 patients eligible for CRT were enrolled. Clinical, laboratory, ECG, and echocardiographic parameters and patient-reported health status (Kansas City Cardiomyopathy Questionnaire [KCCQ]) were assessed before, and six and 14 months after implantation. Response was defined as ≥15% LVESV decrease as compared to baseline. Major adverse cardiac events (MACE) were registered until 24 months after implantation. Predictive values of six and 14-month response for MACE were examined.

Results: In total, 75 (71%) patients were six-month responders of which 12 (16%) patients became late non-responder. At baseline, late non-responders more often had ischemic cardiomyopathy and atrial fibrillation, higher BNP and less dyssynchrony compared to stable responders. At six months, late non-responders showed significantly less LVESV decrease, and higher creatinine levels. Mean KCCQ scores of late non-responders were lower than those of stable responders at every time point, with the difference being significant at 14 months. The 14 months response was a better predictor of MACE than six months response.

Conclusions: The assessment of treatment outcomes after six months of CRT could be premature and response rates beyond might better correlate to long-term clinical outcome.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4416763PMC
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0124323PLOS

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