Pacing and clinical electrophysiology : PACE · 2017
Predictors and Clinical Outcomes of Transient Responders to Cardiac Resynchronization Therapy.
СтатьяНазвание и аннотация: Перевод в очереди
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Ichibori Hirotoshi, Fukuzawa Koji, Kiuchi Kunihiko, Matsumoto Akinori, Konishi Hiroki, Imada Hiroshi, Hyogo Kiyohiro, Kurose Jun, Tatsumi Kazuhiro, Tanaka Hidekazu, Hirata Ken-Ichi
Аннотация
BACKGROUND: Left ventricular end-systolic volume (LVESV) changes at 6 months and clinical status are useful for assessing responses to cardiac resynchronization therapy (CRT). Regression of the LVESV following CRT has not been described beyond 6 months. This study aimed to assess the proportion, predictors, and clinical outcomes of responders whose LVESVs had regressed.
METHODS: We retrospectively analyzed 104 consecutive CRT patients. A responder was defined as a patient with a relative reduction in the LVESV ≥15% at 6 months after CRT. Fifty-six responders participated in this study. A transient responder was defined as a responder without a relative reduction in the LVESV ≥15% at 2 years after CRT or who died of cardiac events during the 24-month follow-up period.
RESULTS: Of the 56 responders, 16 (29%) were transient responders. Multivariable logistic regression analysis showed that chronic atrial fibrillation (odds ratio [OR] = 19.2, 95% confidence interval [CI] [1.93, 190], P = 0.012) and amiodarone usage (OR = 60.9, 95% CI [4.18, 886], P = 0.003) were independent predictors of transient responses. Hospitalizations for heart failure were significantly higher among the transient responders than among the lasting responders during a mean follow-up period of 7.6 years (log-rank P < 0.001), and all-cause mortality tended to be higher among the transient responders (log-rank P = 0.093).
CONCLUSIONS: One-third of the responders were transient responders at 2 years after CRT, and their long-term prognoses were poor. Careful attention should be paid to maintain the reduction in LVESV especially in patients with chronic AF.
METHODS: We retrospectively analyzed 104 consecutive CRT patients. A responder was defined as a patient with a relative reduction in the LVESV ≥15% at 6 months after CRT. Fifty-six responders participated in this study. A transient responder was defined as a responder without a relative reduction in the LVESV ≥15% at 2 years after CRT or who died of cardiac events during the 24-month follow-up period.
RESULTS: Of the 56 responders, 16 (29%) were transient responders. Multivariable logistic regression analysis showed that chronic atrial fibrillation (odds ratio [OR] = 19.2, 95% confidence interval [CI] [1.93, 190], P = 0.012) and amiodarone usage (OR = 60.9, 95% CI [4.18, 886], P = 0.003) were independent predictors of transient responses. Hospitalizations for heart failure were significantly higher among the transient responders than among the lasting responders during a mean follow-up period of 7.6 years (log-rank P < 0.001), and all-cause mortality tended to be higher among the transient responders (log-rank P = 0.093).
CONCLUSIONS: One-third of the responders were transient responders at 2 years after CRT, and their long-term prognoses were poor. Careful attention should be paid to maintain the reduction in LVESV especially in patients with chronic AF.
Предметные рубрики MeSH
AgedCardiac Resynchronization TherapyCausalityChronic DiseaseComorbidityDisease-Free SurvivalFemaleHeart FailureHumansJapanLongitudinal StudiesMalePrevalencePrognosisReproducibility of ResultsRetrospective StudiesRisk FactorsSensitivity and SpecificityStroke VolumeSurvival RateTreatment OutcomeVentricular Dysfunction, Left