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Survival of chronic heart failure patients with different time to the maximum response to cardiac resynchronization therapy

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

Keywords: prognosis, resynchronization therapy, CHF

DOI: 10.18087/rhfj.2015.6.2141

Background. The experience of implanting resynchronizing devices has demonstrated that the response to cardiac resynchronizing therapy (CRT) and the time to the optimum response are rather individual. Data on correlation of the time to the optimum response with patient survival are not available. Aim. To identify clinical and morpho-functional features of CHF patients with different time to the optimum response to CRT and to evaluate patient survival in relation to the time to the maximum response. Material and methods. The study included 106 patients (males, 83 %) with NYHA FC II–IV CHF (mean age, 54.7±9.9). Clinical examination and EchoCG were performed at baseline, at 1 and 3 months, and then every 6 months. Mean follow-up duration was 34.9±16.1 months. Time of the greatest decrease in LV end-systolic volume (ESV) was considered the time to the optimum response to CRT. Patients with the time to the optimum response within the first three months after implantation were included into the first group (group I, fast peak response, n=26) and patients with the peak response after more than three months – into the second group (group II, delayed peak response, n=80). Results. The proportion of responders was significantly higher in group II than in group I (90 % vs. 61.5 %, р=0.001); furthermore, all patients with a more than 30 % decrease in LV ESV (superresponders) had a delayed maximum response. LV ESV was reduced and LV EF was increased in both groups; however, these changes were significantly more pronounced in patients of group II. Overall survival was 74.1 % in group I and 96.2 % in group II (log-rank test, p<0.001). According to results of the Cox regression analysis, both LV ESV (HR, 1.004; 95 % CI, 1.005–1.024; р=0.002) and time to the optimum response (HR, 5.677; 95 % CI, 1.332–24.193; р=0.019) significantly correlated with survival during the follow-up period. Conclusion. Patients with a delayed peak response better responded to CRT, which was evident as greater proportions of responders and superresponders in this group as well as better time-related changes in LV ESV and LV EF. Fast peak response to CRT and higher baseline values of LV ESV were associated with higher mortality in the remote follow-up period.
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Kuznetsov V. A., Soldatova A. M., Krinochkin D. V., Enina T. N.Survival of chronic heart failure patients with different time to the maximum response to cardiac resynchronization therapy. Russian Heart Failure Journal. 2015;16 (6):339–343

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