TY - JOUR
T1 - Progressive ventricular dysfunction among nonresponders to cardiac resynchronization therapy
T2 - Baseline predictors and associated clinical outcomes
AU - Friedman, Daniel J.
AU - Upadhyay, Gaurav A.
AU - Rajabali, Alefiyah
AU - Altman, Robert K.
AU - Orencole, Mary
AU - Parks, Kimberly A.
AU - Moore, Stephanie A.
AU - Park, Mi Young
AU - Picard, Michael H.
AU - Ruskin, Jeremy N.
AU - Singh, Jagmeet P.
AU - Heist, E. Kevin
N1 - Publisher Copyright:
© 2014 Heart Rhythm Society
PY - 2014/11
Y1 - 2014/11
N2 - 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.
AB - 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.
KW - Biventricular pacing
KW - Cardiac resynchronization therapy
KW - Cardiomyopathy
KW - Heart failure
KW - Remodeling
KW - Ventricular fibrillation
KW - Ventricular tachycardia
UR - http://www.scopus.com/inward/record.url?scp=84938682534&partnerID=8YFLogxK
U2 - 10.1016/j.hrthm.2014.08.005
DO - 10.1016/j.hrthm.2014.08.005
M3 - Article
C2 - 25106864
AN - SCOPUS:84938682534
SN - 1547-5271
VL - 11
SP - 1991
EP - 1998
JO - Heart Rhythm
JF - Heart Rhythm
IS - 11
ER -