Progressive ventricular dysfunction among nonresponders to cardiac resynchronization therapy: baseline predictors and associated clinical outcomes.

Abstract

BACKGROUND:

Cardiac resynchronization therapy (CRT) nonresponders have poor outcomes. The significance of progressive ventricular dysfunction among nonresponders remains unclear.

OBJECTIVE:

We sought to define predictors of and clinical outcomes associated with progressive ventricular dysfunction despite CRT.

METHODS:

We conducted an analysis of 328 patients undergoing CRT with defibrillator for standard indications. On the basis of 6-month echocardiograms, we classified patients as responders (those with a ≥5% increase in ejection fraction) and progressors (those with a ≥5% decrease in ejection fraction), and all others were defined as nonprogressors. Coprimary end points were 3-year (1) heart failure, left ventricular assist device (LVAD), transplantation, or death and (2) ventricular tachycardia (VT) or ventricular fibrillation (VF).

RESULTS:

Multivariable predictors of progressive ventricular dysfunction were aldosterone antagonist use (hazard ratio [HR] 0.23; P = .008), prior valve surgery (HR 3.3; P = .005), and QRS duration (HR 0.98; P = .02). More favorable changes in ventricular function were associated with lower incidences of heart failure, LVAD, transplantation, or death (70% vs 54% vs 33%; P < .0001) and VT or VF (66% vs 38% vs 28%; P = .001) for progressors, nonprogressors, and responders, respectively. After multivariable adjustment, progressors remained at increased risk of heart failure, LVAD, transplantation, or death (HR 2.14; P = .0029) and VT or VF (HR 2.03; P = .046) as compared with nonprogressors. Responders were at decreased risk of heart failure, LVAD, transplantation, or death (HR 0.44; P < .0001) and VT or VF (0.51; P = .015) as compared with nonprogressors.

CONCLUSION:

Patients with progressive deterioration in ventricular function despite CRT represent a high-risk group of nonresponders at increased risk of worsened clinical outcomes.

• Authors: Daniel J Friedman, Gaurav A Upadhyay, Alefiyah Rajabali, Robert K Altman, Mary Orencole, Kimberly A Parks, Stephanie A Moore, Mi Young Park, Michael H Picard, Jeremy N Ruskin, Jagmeet P Singh, E Kevin Heist
• Journal: Heart rhythm (Heart Rhythm) Vol. 11 Issue 11 Pg. 1991-8 (Nov 2014) ISSN: 1556-3871 [Electronic] United States
• PMID: 25106864 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Topics

• Aged
• Cardiac Resynchronization Therapy
• Disease Progression
• Echocardiography
• Endpoint Determination
• Female
• Humans
• Male
• Myocardial Ischemia (diagnostic imaging, mortality, physiopathology)
• Prospective Studies
• Risk Factors
• Treatment Failure
• Ventricular Fibrillation (diagnostic imaging, mortality, physiopathology, therapy)