Ghani Abdul, Delnoy Peter Paul H M, Adiyaman Ahmet, Ottervanger Jan Paul, Ramdat Misier Anand R, Smit Jaap Jan J, Elvan Arif
Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands.
Clin Cardiol. 2017 May;40(5):292-299. doi: 10.1002/clc.22658. Epub 2017 Mar 14.
The level of improvement in left ventricular ejection fraction (LVEF) in super-responders to cardiac resynchronization therapy (CRT) is exceptional. However, the long-term prognosis remains unknown in a large population.
Whether super-responders haven good long-term outcomes.
We registered 347 patients with primary CRT-D indication. Super-response was defined by LVEF >50% at follow-up echocardiogram. Best-subset regression analysis identified predictors of super-response. Endpoints were major adverse cardiac events (MACE; eg, all-cause mortality or heart failure hospitalization, cardiac death, and appropriate ICD therapy).
Fifty-six (16%) patients with LVEF >50% were classified as super-responders. Female sex (OR: 3.06, 95% CI: 1.54-6.05), nonischemic etiology (OR: 2.70, 95% CI: 1.29-5.68), higher LVEF at baseline (OR: 1.07, 95% CI: 1.02-1.13), and wider QRS duration (OR: 1.17, 95% CI: 1.04-1.32) were predictors of super-response. Cumulative incidence of MACE at a median of 5.3 years was 18% in super-responders, 22% in responders, and 51% in nonresponders (P < 0.001). None of super responders died from cardiac death, compared to 9% of responders and 25% of non-responders (P < 0.001). None of super-responders experienced appropriate ICD therapy, compared with 10% of responders and 21% of non-responders (P < 0.001). In super-responders, the adjusted hazard ratio was 0.37 (95% CI: 0.19-0.73) for MACE and 0.44 (95% CI: 0.20-0.95) for total mortality, compared with non-responders.
Female sex, non-ischemic etiology, higher baseline LVEF, and wider QRS duration were independently associated with super-response. Super-response was associated with persistent excellent prognosis regarding survival and appropriate ICD therapy during long-term follow-up.
心脏再同步治疗（CRT）的超反应者左心室射血分数（LVEF）的改善程度异常显著。然而，大量人群的长期预后仍不清楚。
超反应者是否具有良好的长期预后。
我们登记了347例原发性CRT-D适应症患者。超反应定义为随访超声心动图时LVEF>50%。最佳子集回归分析确定了超反应的预测因素。终点为主要不良心脏事件（MACE；如全因死亡率或心力衰竭住院、心源性死亡和适当的ICD治疗）。
56例（16%）LVEF>50%的患者被归类为超反应者。女性（OR：3.06，95%CI：1.54-6.05）、非缺血性病因（OR：2.70,95%CI：1.29-5.68）、基线时较高的LVEF（OR：1.07,95%CI：1.02-1.13）和较宽的QRS时限（OR：1.17,95%CI：1.04-1.32）是超反应的预测因素。超反应者中位随访5.3年时MACE的累积发生率为18%，反应者为22%，无反应者为51%（P<0.001）。超反应者无一例死于心源性死亡，而反应者为9%，无反应者为25%（P<0.001）。超反应者无一例接受适当的ICD治疗，而反应者为10%，无反应者为21%（P<0.001）。与无反应者相比，超反应者MACE的调整后风险比为0.37（95%CI：0.19-0.73），总死亡率的调整后风险比为0.44（95%CI：0.20-0.95）。
女性、非缺血性病因、较高的基线LVEF和较宽的QRS时限与超反应独立相关。超反应与长期随访期间生存和适当ICD治疗方面持续良好的预后相关。
