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A “superresponse” to cardiac resynchronization therapy in patients with chronic heart failure

Kuznetsov V. A., Melnikov N. N., Krinochkin D. V., Soldatova A. M., Enina T. N.
Affiliate of the Federal State Budgetary Institution, “Research Institute of Cardiology” at the Siberian Branch of the Russian Academy of Medical Sciences, “Tyumen Cardiology Center”, Melnikayte 111, Tyumen 625026

Keywords: resynchronization therapy, CHF

DOI: 10.18087/rhfj.2015.3.2069

Background. Cardiac resynchronization therapy (CRT) is an up-to-date method for treatment of CHF patients. However, approximately one third of patients do not appropriately respond to this therapy. At the same time in some patients, CRT results in pronounced reverse remodeling with restoration of normal heart contractility. Aim. To identify clinical and morpho-functional features of CHF patients with a “superresponse” to CRT and to find possible predictors of the “superresponse” to CRT. Materials and methods. Clinical examination and EchoCG with determination of dyssynchrony parameters were performed for 59 patients (88% males; mean age, 52.9±9.0) with NYHA FC II-IV CHF and cardiomyopathy of ischemic (54%) and non-ischemic (46%) origin at baseline and at 6 months of cardiostimulator implantation. Based on time-related decreases in LV end-systolic volume (ESV) the patients were divided into two groups: group I (n=20) with a more than 30% decrease in LV ESV (“superresponders”) and group II (n=39) with a less than 30% decrease in LV ESV. Results. In both groups, we observed statistically significant decreases in CHF FC and LV ESV and an increase in LV EF. At baseline, “superresponders” had more pronounced manifestations of mechanical dyssynchrony; SDI, aortic pre-ejection period, mechanical interventricular delay, septolateral delay, and interventricular delay measured using tissue Doppler were significantly greater. In a multivariant analysis, the duration of aortic pre-ejection period was independently associated with the “superresponse” (OR, 1.03; 95% CI, 1.007–1.055; р=0.011). A ROC analysis (AUC=0.753; p=0.002) showed a cut-off point at 0.378 where the sensitivity and specificity for the prediction of “superresponse” to CRT were 73.7% and 75%, respectively. Conclusion. More pronounced dyssynchrony in CHF patients was associated with the “superresponse” to CRT. The EchoCG duration of aortic pre-ejection period was an independent predictor of the “superresponse” to CRT.
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Kuznetsov V. A., Melnikov N. N., Krinochkin D. V., Soldatova A. M., Enina T. N. A “superresponse” to cardiac resynchronization therapy in patients with chronic heart failure. Russian Heart Failure Journal. 2015;16 (3):131–136

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