Document Detail


Predictors of super-response to cardiac resynchronization therapy and associated improvement in clinical outcome: the MADIT-CRT (multicenter automatic defibrillator implantation trial with cardiac resynchronization therapy) study.
MedLine Citation:
PMID:  22698490     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: The authors investigated predictors of left ventricular ejection fraction (LVEF) super-response to cardiac resynchronization therapy with defibrillator (CRT-D) and whether super-response translated into improved event-free survival in patients with mildly symptomatic heart failure (HF).
BACKGROUND: Few data exist on predictors of super-response to CRT-D and associated morbidity and mortality in mildly symptomatic HF populations.
METHODS: Patients were assigned to CRT-D with paired echocardiograms at baseline and at 12 months (n = 752). Super-response was defined by the top quartile of LVEF change. Best-subset regression analysis identified predictors of LVEF super-response. Kaplan-Meier survival analysis and Cox proportional hazards regression were performed to investigate associations of response category with development of nonfatal HF event or all-cause death.
RESULTS: All 191 super-responders experienced an LVEF increase of ≥14.5% (mean LVEF increase 17.5 ± 2.7%). Six predictors were associated with LVEF super-response to CRT-D therapy: female sex (odds ratio [OR]: 1.96; p = 0.001), no prior myocardial infarction (OR: 1.80; p = 0.005), QRS duration ≥150 ms (OR: 1.79; p = 0.007), left bundle branch block (OR: 2.05; p = 0.006), body mass index <30 kg/m(2) (OR: 1.51; p = 0.035), and smaller baseline left atrial volume index (OR: 1.47; p < 0.001). Cumulative probability of HF or all-cause death at 2 years was 4% in super-responders, 11% in responders, and 26% in hypo-responders (log-rank p < 0.001 overall). In multivariate analysis, hyporesponse was associated with increased risk of HF or all-cause death, compared with super-response (hazard ratio: 5.25; 95% confidence interval: 2.01 to 13.74; p = 0.001).
CONCLUSIONS: Six baseline factors predicted LVEF super-response in CRT-D-treated patients with mild HF. Super-response was associated with reduced risk of subsequent cardiac events. (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy [MADIT-CRT]; NCT00180271).
Authors:
Jonathan C Hsu; Scott D Solomon; Mikhail Bourgoun; Scott McNitt; Ilan Goldenberg; Helmut Klein; Arthur J Moss; Elyse Foster;
Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  59     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-06-15     Completed Date:  2012-08-20     Revised Date:  2013-01-07    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2366-73     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Affiliation:
Division of Cardiology, Department of Medicine, University of California-San Francisco, 94143, USA. jhsu@medicine.ucsf.edu
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00180271
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Cardiac Resynchronization Therapy / methods*
Confounding Factors (Epidemiology)
Defibrillators, Implantable*
Disease-Free Survival
Echocardiography
Female
Follow-Up Studies
Heart Failure / mortality,  physiopathology*,  therapy*
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Predictive Value of Tests
Proportional Hazards Models
Risk Factors
Severity of Illness Index
Stroke Volume*
Time Factors
Treatment Outcome
Ventricular Function, Left*
Investigator
Investigator/Affiliation:
David J Wilber / ; David S Cannom / ; James P Daubert / ; Steven L Higgins / ; Mark Estes / ; Mark A Pfeffer / ; Henry Greenberg /
Comments/Corrections
Comment In:
J Am Coll Cardiol. 2012 Jun 19;59(25):2374-7   [PMID:  22698491 ]
J Am Coll Cardiol. 2012 Nov 20;60(21):2258; author reply 2258-9   [PMID:  23153851 ]

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