Author + information
To analyze the relationship between clinical, functional parameters, response to CRT and long-term mortality in patients with congestive heart failure (CHF) treated with CRT.
85 CRT patients (mean age 55.1±9.9 years, 81.2% men) with CHF (53% ischemic and 47% non-ischemic etiology) II-IV NYHA functional class were enrolled. At baseline, 1month, 3 months and each 6 months after implantation we evaluated clinical and echocardiographic parameters. Response to CRT was evaluated as the best decrease of left ventricular end-systolic volume (LVESV) (follow-up period 28.9±27.8 months). According to long-term outcome patients were divided into: I group - survived patients (n=47) and II group – died patients (n=38).
Percentage of super-responders (decrease of LVESV≥30%) significantly differed between groups (38.3% in I group vs 7.9% in II group; p=0.001). In survived patients female gender (p=0.020), history of myocardial infarction (MI) (p=0.005) were observed more frequently, also in this group LVESV (p<0.001) and left ventricular end-diastolic volume (p=0.001) were higher, PR interval was longer (p=0.001), left ventricular ejection fraction (LVEF) was lower. Presence of LBBB and width of QRS complex did not differ between groups.
Cox regression showed that LVESV (HR 1.012; 95% CI 1.006–1.018; p<0.001), PR interval (HR 1.012; 95% CI 1.005–1.020; p=0.001) and absence of prior MI (HR 0.332; 95% CI 0.161–0.683; p=0.003) were associated with long-term mortality.
Super-response to CRT is associated with better survival in long-term period. LVESV, history of MI and PR interval can be used as independent predictors of long-term mortality but not LBBB.