Download INAHRS3

Predictors of Super-Responder to Cardiac Resynchronization Therapy in
Advanced Heart Failure Patients
A. Hafiedz A. Kartamihardja1; Anggia Lubis2; Irlandi M. Suseno1; Riesma V. Sari1; Vekky Sariowan2; Fonny Meiliana Tedjo2; Dian
Munawar1; Beny Hartono2; Muhammad Munawar2; Chaerul Achmad1; Augustine Purnomowati1; Toni Mustahsani Aprami1
1
2
Hasan Sadikin General Hospital/Medical Faculty of Padjajaran University, Bandung, Indonesia
Binawaluya Cardiac Center, Jakarta, Indonesia
Introduction
Cardiac resynchronization therapy (CRT) has been demonstrated as a beneficial therapy option in certain
subgroups of chronic heart failure (HF) patients by improving left ventricular (LV) function, survival, and
symptoms. Some group of patient show such important clinical improvement and reverse remodelling after
CRT. These patients have been so-called super-responders. Therefore our main objective is to identify
predictors of super-responder after CRT in advanced HF patients.
Methods
This is a retrospective, single center study. Patients advanced HF during period of January 2008 until
December 2015 were assigned to CRT with paired echocardiograms at baseline and up to 12 months after
implantation (n =55) are enrolled in this study. Patients with a two-fold or more increase of left ventricular
ejection fraction (LVEF), or > 15% increase of LVEF, or a final LVEF 45% were identified as superresponders. Bivariate and multivariate analysis using logistic regression analysis were used in this study.
Results
In the periods of the study, there were 76 patients advanced heart failure (HF) underwent CRT implantation,
and 55 patient were eligible for this study. The male/female ratio was 4.5 and their average age was 54.3
+/- 2.7 years. Fifty one of them were still alive at the end of the study. Eight of them were underwent
epicardial implantation of the left ventricular lead (14.5%). There were 19 super-responders patients
(34.5%). Bivariate analysis demonstrated that 3 predictors were associated with super-responder to CRT
therapy: non-ischemic etiology (odds Ratio [OR] was 11.55 and 95% CI was 3.05 and 43.79 p= <0.001);
QRS duration ( OR was 1.05 and 95% CI was 1.02 and 1.08, p = 0.001); and left bundle branch block ( OR
was 8.4, 95%CI was 2,36 and 29,89, p= 0.001). Multivariate analysis showed non-ischemic etiology
(OR=7.28 and 95% CI was 1.77 and 30.05 p= 0.006) and left bundle branch block (OR was 6.14 and 95%
CI was 1.54 and 24.55, p= 0.010) were associated with super-responder to CRT therapy.
Conclusion
Non-ischemic etiology and left bundle branch block may predict super-responder group of advance heart
failure patients who undergo CRT implantation.