AIMS: Various studies have attempted to identify super-responders to cardiac resynchronization therapy (CRT) by echocardiographic parameters of reverse remodeling. However, scientific evidence regarding those parameters is scarce. This study aimed at validating the definition of super-response to CRT based on the following frequently employed echocardiographic parameters: left ventricular ejection fraction (LVEF), end-diastolic volume index (EDVI), and end-systolic volume index (ESVI). METHODS AND RESULTS: We retrospectively investigated echocardiographic data and outcomes of 542 patients after CRT implantation. The primary endpoint comprised all-cause mortality, heart transplantation, ventricular assist device implantation (VAD), and hospitalization for heart failure. Secondary endpoints were hospitalization for heart failure, and the combination of all-cause mortality, heart transplantation and VAD. Two approaches were employed defining super-response based on improvement of echocardiographic parameters: one derived from the negative predictive value (NPV) for clinical endpoints, and second from best quartiles of improvement. Using the NPV method, an absolute 25 % increase in LVEF, a relative 38 % reduction in EDVI, and 46 % in ESVI were calculated as optimal cut-offs identifying 4.9, 18.5, and 21.3 % as super-responders. The best quartiles method resulted in lower cut-off values, i.e. 14 % increase in LVEF, 26 % reduction in EDVI, and 36 % in ESVI. All cut-offs except LVEF ≥ 25% were significantly associated with improved outcomes after 5 years (median follow-up 35.7 months). CONCLUSIONS: NPV- and best quartile-based cut-offs validate previously applied empirical echocardiographic cut-offs to define super-response to CRT. These data provide evidence for using these empirical cut-offs in daily practice and facilitate inter-study comparability.
AIMS: Various studies have attempted to identify super-responders to cardiac resynchronization therapy (CRT) by echocardiographic parameters of reverse remodeling. However, scientific evidence regarding those parameters is scarce. This study aimed at validating the definition of super-response to CRT based on the following frequently employed echocardiographic parameters: left ventricular ejection fraction (LVEF), end-diastolic volume index (EDVI), and end-systolic volume index (ESVI). METHODS AND RESULTS: We retrospectively investigated echocardiographic data and outcomes of 542 patients after CRT implantation. The primary endpoint comprised all-cause mortality, heart transplantation, ventricular assist device implantation (VAD), and hospitalization for heart failure. Secondary endpoints were hospitalization for heart failure, and the combination of all-cause mortality, heart transplantation and VAD. Two approaches were employed defining super-response based on improvement of echocardiographic parameters: one derived from the negative predictive value (NPV) for clinical endpoints, and second from best quartiles of improvement. Using the NPV method, an absolute 25 % increase in LVEF, a relative 38 % reduction in EDVI, and 46 % in ESVI were calculated as optimal cut-offs identifying 4.9, 18.5, and 21.3 % as super-responders. The best quartiles method resulted in lower cut-off values, i.e. 14 % increase in LVEF, 26 % reduction in EDVI, and 36 % in ESVI. All cut-offs except LVEF ≥ 25% were significantly associated with improved outcomes after 5 years (median follow-up 35.7 months). CONCLUSIONS: NPV- and best quartile-based cut-offs validate previously applied empirical echocardiographic cut-offs to define super-response to CRT. These data provide evidence for using these empirical cut-offs in daily practice and facilitate inter-study comparability.
Authors: Jeroen J Bax; Arend F L Schinkel; Eric Boersma; Abdou Elhendy; Vittoria Rizzello; Alexander Maat; Jos R T C Roelandt; Ernst E van der Wall; Don Poldermans Journal: Circulation Date: 2004-09-14 Impact factor: 29.690
Authors: Claudia Ypenburg; Rutger J van Bommel; C Jan Willem Borleffs; Gabe B Bleeker; Eric Boersma; Martin J Schalij; Jeroen J Bax Journal: J Am Coll Cardiol Date: 2009-02-10 Impact factor: 24.094
Authors: John Rickard; Dharam J Kumbhani; Zoran Popovic; David Verhaert; Mahesh Manne; Daniel Sraow; Bryan Baranowski; David O Martin; Bruce D Lindsay; Richard A Grimm; Bruce L Wilkoff; Patrick Tchou Journal: Heart Rhythm Date: 2010-04-08 Impact factor: 6.343
Authors: Cheuk-Man Yu; Gabe B Bleeker; Jeffrey Wing-Hong Fung; Martin J Schalij; Qing Zhang; Ernst E van der Wall; Yat-Sun Chan; Shun-Ling Kong; Jeroen J Bax Journal: Circulation Date: 2005-09-06 Impact factor: 29.690
Authors: John J V McMurray; Stamatis Adamopoulos; Stefan D Anker; Angelo Auricchio; Michael Böhm; Kenneth Dickstein; Volkmar Falk; Gerasimos Filippatos; Cândida Fonseca; Miguel Angel Gomez-Sanchez; Tiny Jaarsma; Lars Køber; Gregory Y H Lip; Aldo Pietro Maggioni; Alexander Parkhomenko; Burkert M Pieske; Bogdan A Popescu; Per K Rønnevik; Frans H Rutten; Juerg Schwitter; Petar Seferovic; Janina Stepinska; Pedro T Trindade; Adriaan A Voors; Faiez Zannad; Andreas Zeiher; Jeroen J Bax; Helmut Baumgartner; Claudio Ceconi; Veronica Dean; Christi Deaton; Robert Fagard; Christian Funck-Brentano; David Hasdai; Arno Hoes; Paulus Kirchhof; Juhani Knuuti; Philippe Kolh; Theresa McDonagh; Cyril Moulin; Bogdan A Popescu; Zeljko Reiner; Udo Sechtem; Per Anton Sirnes; Michal Tendera; Adam Torbicki; Alec Vahanian; Stephan Windecker; Theresa McDonagh; Udo Sechtem; Luis Almenar Bonet; Panayiotis Avraamides; Hisham A Ben Lamin; Michele Brignole; Antonio Coca; Peter Cowburn; Henry Dargie; Perry Elliott; Frank Arnold Flachskampf; Guido Francesco Guida; Suzanna Hardman; Bernard Iung; Bela Merkely; Christian Mueller; John N Nanas; Olav Wendelboe Nielsen; Stein Orn; John T Parissis; Piotr Ponikowski Journal: Eur J Heart Fail Date: 2012-08 Impact factor: 15.534
Authors: Kristina Wasmer; Julia Köbe; Dietrich Andresen; Ralf Zahn; Stefan G Spitzer; Joachim Jehle; Johannes Brachmann; Christoph Stellbrink; Eimo Martens; Matthias Hochadel; Jochen Senges; Helmut Klein; Lars Eckardt Journal: Clin Res Cardiol Date: 2013-03-30 Impact factor: 5.460
Authors: S Adam Strickberger; Jamie Conti; Emile G Daoud; Edward Havranek; Mandeep R Mehra; Ileana L Piña; James Young Journal: Circulation Date: 2005-04-26 Impact factor: 29.690
Authors: Thomas Schau; Walter Koglek; Josef Brandl; Martin Seifert; Jürgen Meyhöfer; Michael Neuss; Georg Grimm; Robert Bitschnau; Christian Butter Journal: Clin Res Cardiol Date: 2012-09-23 Impact factor: 5.460
Authors: Martin Stockburger; Arthur J Moss; Helmut U Klein; Wojciech Zareba; Ilan Goldenberg; Yitschak Biton; Scott McNitt; Valentina Kutyifa Journal: Clin Res Cardiol Date: 2016-06-18 Impact factor: 5.460
Authors: D Müller; A Remppis; P Schauerte; S Schmidt-Schweda; D Burkhoff; B Rousso; D Gutterman; J Senges; G Hindricks; K-H Kuck Journal: Clin Res Cardiol Date: 2017-07-06 Impact factor: 5.460