Outcomes of Patients Poorly Responsive to CRT

Nov 19, 2019
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Authors:
Varma N, Boehmer J, Bhargava K, et al.
Citation:
Evaluation, Management, and Outcomes of Patients Poorly Responsive to Cardiac Resynchronization Device Therapy. J Am Coll Cardiol 2019;74:2588-2603.
Summary By:
Fred Morady, MD, FACC

Study Questions:

What are the characteristics and clinical course of heart failure (HF) patients who do not respond to cardiac resynchronization therapy (CRT)?

Methods:

The subjects of this study were 1,524 patients (mean age 68 years, mean ejection fraction 29%, New York Heart Association functional class III in 68%) enrolled in the international ADVANCE CRT registry. The response to CRT was assessed at 6 months, without prespecified criteria. Registry participants were allowed to use either clinical response, echocardiographic criteria, and/or functional testing to classify a patient as a nonresponder to CRT.

Results:

The response to CRT was determined in 1,327 patients. The nonresponse rate using the site-specific criteria was 20%. Compared to CRT responders, the nonresponders were older, had more comorbidities, more often had ischemic cardiomyopathy, less often had left bundle branch block, and had a lower mean percentage of CRT pacing. The nonresponders less often were followed by HF specialists. Approximately 40% of nonresponders did not receive any additional HF therapy. Hospitalizations and deaths were more common in the nonresponders than in the responders.

Conclusions:

The nonresponder rate after CRT is approximately 20%. Many nonresponders are managed passively, without a change in pharmacologic therapy or management by an HF specialist.

Perspective:

Given the higher risk of hospitalizations and death in CRT nonresponders than in responders, the results of this study suggest a strong need for a more aggressive approach to HF management and more frequent involvement of an HF specialist in the care of CRT nonresponders.

Clinical Topics: Arrhythmias and Clinical EP, Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Echocardiography/Ultrasound

Keywords: Arrhythmias, Cardiac, Bundle-Branch Block, Cardiac Resynchronization Therapy, Cardiomyopathies, Comorbidity, Echocardiography, Heart Failure, Specialization, Stroke Volume


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