2017

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2017/№3

Cardiac resynchronisation therapy in patients with congestive heart failure: whether we should expect for an "early" response?

Kuznetsov V. A., Soldatova A. M., Krinochkin D. V., Enina T. N.
"Tyumen Cardiology Science Center", Branch of the Federal State Budgetary Science Institution "Tomsk National Research Medical Center of the Russian Academy of Sciences", Melnikayte 111, Tyumen 625026

Keywords: resynchronization therapy, chronic heart failure, response to resynchronization therapy

DOI: 10.18087/rhfj.2017.3.2341

Background. Responses to cardiac resynchronization therapy (CRT) and the timing of a response are rather individual. Furthermore, a rapid functional response is not always associated with good survival in the remote follow-up period. Aim. To identify clinical and morphology and function features of CHF patients with different time of the best response to CRT and to evaluate patients’ survival depending on the time of peak response. Materials and methods. The study included 122 patients (82.8% men and 17.2% women) with NYHA FC II-IV CHF aged 54.8±9.6. Clinical examination and EchoCG were performed at baseline, 1 month, 3 months, and then every 6 months. Mean follow-up duration was 33.2±16.7 months. The time of maximum decrease in LV end-systolic volume (ESV) was taken as the time of best response to CRT. Patients with the best response occurring within the first three months following the implantation were included into the first observation group (group 1, fast peak response; n=28), after three months – the second group (group 2, delayed peak response, n=94). Results. In group 2, the percentage of responders was higher than in group 1 (90.4% vs. 60.7%; р=0.001); furthermore, all patients with a decrease in LV ESV by more than 30% (super-responders) had a delayed peak response. Both groups showed decreased LV ESV and increased LV EF; however, these changes were more pronounced for patients of group 2. General survival was 71.4% in group 1 and 96.8% in group 2 (Log Rank test p<0.001). According to Cox regression data, the baseline value of LV ESV (HR 1.012; 95% CI, 1.004–1.021; р=0.005) and the time of best response (HR 0.131; 95% CI, 0.032–0.530; р=0.004) were significantly correlated with survival in the observation period. Conclusion. Patients with a delayed peak response better responded to CRT. Their response was characterized with a greater number of responders and super-responders as well as better dynamics of LV ESV and LV EF. Fast occurrence of the peak response to CRT and higher baseline values of LV ESV correlated with a higher mortality rate in the remote observation period.
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Kuznetsov V. A., Soldatova A. M., Krinochkin D. V., Enina T. N. Cardiac resynchronisation therapy in patients with congestive heart failure: whether we should expect for an “early” response? Russian Heart Failure Journal. 2017;18(3):172–177

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