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Volumetric Response beyond Six Months of Cardiac Resynchronization Therapy and Clinical Outcome
Authors:Jetske van ’t Sant  Aernoud T L Fiolet  Iris A H ter Horst  Maarten J Cramer  Mirjam H Mastenbroek  Wouter M van Everdingen  Thomas P Mast  Pieter A Doevendans  Henneke Versteeg  Mathias Meine
Institution:1Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands;2Department of Medical and Clinical Psychology, CoRPS—Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands;University of Minnesota, UNITED STATES
Abstract:AimsResponse 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.Methods105 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.ResultsIn 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.ConclusionsThe 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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