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

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

Research output: Contribution to journalArticlepeer-review

14 Scopus citations

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.

Original languageEnglish
Pages (from-to)1991-1998
Number of pages8
JournalHeart Rhythm
Volume11
Issue number11
DOIs
StatePublished - Nov 2014
Externally publishedYes

Keywords

  • Biventricular pacing
  • Cardiac resynchronization therapy
  • Cardiomyopathy
  • Heart failure
  • Remodeling
  • Ventricular fibrillation
  • Ventricular tachycardia

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