Decreased likelihood of response to cardiac resynchronization in patients with severe heart failure

• Published in: European journal of heart failure 2010-03, Vol.12 (3), p.283-287
• Main Authors: Vidal, Bàrbara, Delgado, Victoria, Mont, Lluís, Poyatos, Sílvia, Silva, Etelvino, Ángeles Castel, María, Tolosana, José M., Berruezo, Antonio, Brugada, Josep, Sitges, Marta
• Format: Article
• Language: English
• Subjects: Advanced heart failure stage; Aged; Cardiac Pacing, Artificial; Cardiac resynchronization therapy; Cohort Studies; Confidence Intervals; Disease Progression; Female; Heart Failure - diagnostic imaging; Heart Failure - therapy; Humans; Logistic Models; Male; Multivariate Analysis; Non-response; Odds Ratio; Quality of Life; Sensitivity and Specificity; Severity of Illness Index; Surveys and Questionnaires; Time Factors; Treatment Outcome; Ultrasonography; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - therapy
• ISSN: 1388-9842; 1879-0844
• DOI: 10.1093/eurjhf/hfq003

Aims We hypothesized that a very advanced stage of dilated cardiomyopathy is associated with lower response to cardiac resynchronization therapy (CRT). Methods and results A consecutive cohort of 147 patients was studied before device implantation and at 12 months follow-up. All patients were in NYHA functional class III-IV and had left-ventricular (LV) systolic dysfunction (LV ejection fraction 24 ± 7%) and a wide QRS (171 ± 29 ms). A patient who was alive without heart transplantation and had improved by at least 10% in the 6 min walking test at 12 months follow-up was considered a clinical responder. Fifty-four patients (36%) did not respond to CRT (15 cardiac deaths, 4 heart transplantations). Quality of life indicators (>41 points), LV end-diastolic volumes (>200 mL) and mitral regurgitant orifice area (>16 mm2) at baseline were independent predictors of response to CRT. Patients were assigned 1 point for each predictive parameter. Patients with higher scores showed a significantly higher likelihood of non-response to CRT (χ2 = 12 891, P = 0.005). Conclusion The results show that non-responder patients have a more advanced stage of the disease, which suggests that CRT should be indicated earlier in the disease process.