J Cardiovasc Ultrasound.  2017 Jun;25(2):63-69. 10.4250/jcu.2017.25.2.63.

Echocardiographic, Electrocardiographic Changes and Clinical Outcomes of Patients Who Respond to Cardiac Resynchronization Therapy after One Year

• Choi Y
• Byeon J
• Jung MH
• Jung HO
• Youn HJ

• KMID: 2385077
• DOI: http://doi.org/10.4250/jcu.2017.25.2.63

Abstract

BACKGROUND
Response to cardiac resynchronization therapy (CRT) is commonly assessed after 6 or 12 months. We evaluated subsequent echocardiographic changes, serial QRS duration, and clinical outcomes in patients showing delayed responses to CRT after 12 months.
METHODS
Among all patients who received CRT in Seoul St. Mary's Hospital, 36 one-year survivors were enrolled. Indicators of a positive CRT response were ≥ 15% reduction in left ventricular end-systolic volume (LVESV) or ≥ 10% increase in left ventricular ejection fraction (LVEF) on any follow up echocardiogram. We defined the early responders as patients responding before one year, the late responders as patients responding after one year, and the non-responders as patients who did not respond on any follow-up echocardiogram.
RESULTS
We identified 17 early responders, 10 late responders, and 9 non-responders. The late responders showed modest improvement in LVESV and LVEF at two years after CRT. QRS duration was shortened the day after CRT in all three groups. Narrowed QRS was maintained for two years in early and late responders, whereas it was continuously prolonged over time in non-responders. Incidence of all-cause death or heart failure hospitalization was comparable between early and late responders, while non-responders showed worst prognosis.
CONCLUSION
Patients responding to CRT after one year show modest echocardiographic improvement but clinical outcome is similar to early responders. Shorter baseline QRS duration and long-term maintenance of QRS duration shortening are important features of the late responders to CRT.

Keyword

Cardiac resynchronization therapy; QRS duration; Echocardiography; Prognosis

MeSH Terms

Cardiac Resynchronization Therapy*
Echocardiography*
Electrocardiography*
Follow-Up Studies
Heart Failure
Hospitalization
Humans
Incidence
Prognosis
Seoul
Stroke Volume
Survivors

Figure

• 

  Fig. 1 Serial changes in LVESV and LVEF in the three groups. Values represent medians (25–75th percentiles).*p < 0.05 compared to baseline. LVESV was significantly increased in non-responder group and reduced in early and late responder groups at 24 months (A). LVEF was significantly improved in early and late responder groups and not changed in non-responder group at 24 months (B). LVESV: left ventricular end-systolic volume, LVEF: left ventricular ejection fraction.

• 

  Fig. 2 Absolute changes in LVESV (A) and LVEF (B) at two years compared to the baseline values in the three groups. Values represent mean with standard deviation. LVESV: left ventricular end-systolic volume, LVEF: left ventricular ejection fraction.

• 

  Fig. 3 Serial changes in QRS duration in the three groups. Values represent medians (25–75th percentiles). Baseline values are pre-implantation QRS duration, and one day indicates the day after CRT implantation. *p < 0.05 compared to baseline. QRS duration remained shortened at 24 months in early and late responders. In non-responders, QRS duration at 24 months was not significantly different to the pre-implant value. CRT: cardiac resynchronization therapy.

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