Predictors of Super-Response to Cardiac Resynchronization Therapy and Associated Improvement in Clinical Outcome: The MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy) Study

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• 作者：Jonathan C. Hsu ; MD^鈦?/sup> ; ^{jhsu@medicine.ucsf.edu} ; Scott D. Solomon ; MD^&dagger ; ; Mikhail Bourgoun ; MD^&dagger ; ; Scott McNitt ; MS^&Dagger ; ; Ilan Goldenberg ; MD^&Dagger ; ; Helmut Klein ; MD^&Dagger ; ; Arthur J. Moss ; MD^&Dagger ; ; Elyse Foster ; MD^鈦?/sup> ; MADIT-CRT Executive Committee
• 关键词：cardiac resynchronization therapy ; heart failure ; pacing ; super-response
• 刊名：Journal of the American College of Cardiology
• 出版年：2012
• 期刊代码：201_07351097
• 类别：med
• 出版时间：19-26 June, 2012
• 卷：59
• 期：25
• 页码：2366-2373
• 文件大小：860 K

摘要

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Objectives

The authors investigated predictors of left ventricular ejection fraction (LVEF) super-response to cardiac resynchronization therapy with defibrillator (CRT-D) and whether super-response translated into improved event-free survival in patients with mildly symptomatic heart failure (HF).

Background

Few data exist on predictors of super-response to CRT-D and associated morbidity and mortality in mildly symptomatic HF populations.

Methods

Patients were assigned to CRT-D with paired echocardiograms at baseline and at 12 months (n = 752). Super-response was defined by the top quartile of LVEF change. Best-subset regression analysis identified predictors of LVEF super-response. Kaplan-Meier survival analysis and Cox proportional hazards regression were performed to investigate associations of response category with development of nonfatal HF event or all-cause death.

Results

All 191 super-responders experienced an LVEF increase of 鈮?4.5%(mean LVEF increase 17.5 卤 2.7%). Six predictors were associated with LVEF super-response to CRT-D therapy: female sex (odds ratio [OR]: 1.96; p = 0.001), no prior myocardial infarction (OR: 1.80; p = 0.005), QRS duration 鈮?50 ms (OR: 1.79; p = 0.007), left bundle branch block (OR: 2.05; p = 0.006), body mass index <30 kg/m² (OR: 1.51; p = 0.035), and smaller baseline left atrial volume index (OR: 1.47; p < 0.001). Cumulative probability of HF or all-cause death at 2 years was 4%in super-responders, 11%in responders, and 26%in hypo-responders (log-rank p < 0.001 overall). In multivariate analysis, hyporesponse was associated with increased risk of HF or all-cause death, compared with super-response (hazard ratio: 5.25; 95%confidence interval: 2.01 to 13.74; p = 0.001).

Conclusions

Six baseline factors predicted LVEF super-response in CRT-D-treated patients with mild HF. Super-response was associated with reduced risk of subsequent cardiac events. (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy [MADIT-CRT]; )