TY - JOUR T1 - What happens to non-responders in cardiac resynchronization therapy? JO - Revista Portuguesa de Cardiologia T2 - AU - Rio,Pedro AU - Oliveira,Mário Martins AU - Cunha,Pedro Silva AU - da Silva,Manuel Nogueira AU - Branco,Luísa Moura AU - Galrinho,Ana AU - Soares,Rui AU - Feliciano,Joana AU - Pimenta,Ricardo AU - Ferreira,Rui Cruz SN - 08702551 M3 - 10.1016/j.repc.2017.02.017 DO - 10.1016/j.repc.2017.02.017 UR - https://www.revportcardiol.org/pt-what-happens-non-responders-in-cardiac-articulo-S0870255116303705 AB - Introduction and ObjectivesLeft ventricular reverse remodeling (LVRR) is strongly related to the long-term prognosis of patients undergoing cardiac resynchronization therapy (CRT). The aim of this study was to assess the long-term clinical outcome of patients without LVRR at six months after CRT implantation and to determine the prognostic impact of clinical response in this population. MethodsWe analyzed 178 consecutive patients who underwent successful CRT device implantation (age 64±11 years; 69% male; 89% in New York Heart Association [NYHA] functional class III; 35% with ischemic cardiomyopathy). Clinical status and echocardiographic parameters were determined before and six months after CRT implantation. We identified those without criteria for LVRR (≥10% increase in left ventricular ejection fraction with ≥15% reduction in left ventricular end-systolic diameter compared to baseline). Clinical responders were defined by a sustained improvement of at least one NYHA functional class. ResultsAt six-month assessment after CRT, 109 (61%) patients showed LVRR. During a mean follow-up of 56±21 months, 47 (26%) patients died, with higher mortality in the group without LVRR (36% vs. 20%, p=0.023). Clinical response was greater in patients with LVRR (88% vs. 55%, p<0.001). In patients without LVRR, clinical response to CRT was the strongest independent predictor of survival (hazard ratio: 0.120; 95% confidence interval: 0.039-0.366; p<0.001). ConclusionAlthough patients without LVRR six months after CRT implantation had a worse prognosis, with higher all-cause mortality, clinical response can be an independent predictor of survival in this population. ER -