Volumetric response beyond six months of cardiac resynchronization therapy and clinical outcome

Jetske van 't Sant, Aernoud T L Fiolet, Iris A H Ter Horst, Maarten J Cramer, M.H. Mastenbroek, Wouter M van Everdingen, Thomas P Mast, Pieter A Doevendans, H. Versteeg, Mathias Meine

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Abstract

Aims:

Response to cardiac resynchronization therapy (CRT) is often assessed six months after implantation. Our objective was to assess the number of patients changing from responder to non-responder between six and 14 months, so-called late non-responders, and compare them to patients who were responder both at six and 14 months, so-called stable responders. Furthermore, we assessed predictive values of six and 14-month response concerning clinical outcome.

Methods: 

105 patients eligible for CRT were enrolled. Clinical, laboratory, ECG, and echocardiographic parameters and patient-reported health status (Kansas City Cardiomyopathy Questionnaire [KCCQ]) were assessed before, and six and 14 months after implantation. Response was defined as ≥15% LVESV decrease as compared to baseline. Major adverse cardiac events (MACE) were registered until 24 months after implantation. Predictive values of six and 14-month response for MACE were examined.

Results: 

In total, 75 (71%) patients were six-month responders of which 12 (16%) patients became late non-responder. At baseline, late non-responders more often had ischemic cardiomyopathy and atrial fibrillation, higher BNP and less dyssynchrony compared to stable responders. At six months, late non-responders showed significantly less LVESV decrease, and higher creatinine levels. Mean KCCQ scores of late non-responders were lower than those of stable responders at every time point, with the difference being significant at 14 months. The 14 months response was a better predictor of MACE than six months response.

Conclusions: 

The assessment of treatment outcomes after six months of CRT could be premature and response rates beyond might better correlate to long-term clinical outcome.

Original languageEnglish
Article numbere0124323
JournalPLoS ONE
Volume10
Issue number5
DOIs
Publication statusPublished - 2015

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Cardiac resynchronization therapy
Clinical laboratories
Electrocardiography
Creatinine
Health

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van 't Sant, J., Fiolet, A. T. L., Ter Horst, I. A. H., Cramer, M. J., Mastenbroek, M. H., van Everdingen, W. M., ... Meine, M. (2015). Volumetric response beyond six months of cardiac resynchronization therapy and clinical outcome. PLoS ONE, 10(5), [e0124323]. https://doi.org/10.1371/journal.pone.0124323
van 't Sant, Jetske ; Fiolet, Aernoud T L ; Ter Horst, Iris A H ; Cramer, Maarten J ; Mastenbroek, M.H. ; van Everdingen, Wouter M ; Mast, Thomas P ; Doevendans, Pieter A ; Versteeg, H. ; Meine, Mathias. / Volumetric response beyond six months of cardiac resynchronization therapy and clinical outcome. In: PLoS ONE. 2015 ; Vol. 10, No. 5.
@article{90f74f0e78c342bfa66cdf4ee427debb,
title = "Volumetric response beyond six months of cardiac resynchronization therapy and clinical outcome",
abstract = "Aims:Response to cardiac resynchronization therapy (CRT) is often assessed six months after implantation. Our objective was to assess the number of patients changing from responder to non-responder between six and 14 months, so-called late non-responders, and compare them to patients who were responder both at six and 14 months, so-called stable responders. Furthermore, we assessed predictive values of six and 14-month response concerning clinical outcome.Methods: 105 patients eligible for CRT were enrolled. Clinical, laboratory, ECG, and echocardiographic parameters and patient-reported health status (Kansas City Cardiomyopathy Questionnaire [KCCQ]) were assessed before, and six and 14 months after implantation. Response was defined as ≥15{\%} LVESV decrease as compared to baseline. Major adverse cardiac events (MACE) were registered until 24 months after implantation. Predictive values of six and 14-month response for MACE were examined.Results: In total, 75 (71{\%}) patients were six-month responders of which 12 (16{\%}) patients became late non-responder. At baseline, late non-responders more often had ischemic cardiomyopathy and atrial fibrillation, higher BNP and less dyssynchrony compared to stable responders. At six months, late non-responders showed significantly less LVESV decrease, and higher creatinine levels. Mean KCCQ scores of late non-responders were lower than those of stable responders at every time point, with the difference being significant at 14 months. The 14 months response was a better predictor of MACE than six months response.Conclusions: The assessment of treatment outcomes after six months of CRT could be premature and response rates beyond might better correlate to long-term clinical outcome.",
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van 't Sant, J, Fiolet, ATL, Ter Horst, IAH, Cramer, MJ, Mastenbroek, MH, van Everdingen, WM, Mast, TP, Doevendans, PA, Versteeg, H & Meine, M 2015, 'Volumetric response beyond six months of cardiac resynchronization therapy and clinical outcome', PLoS ONE, vol. 10, no. 5, e0124323. https://doi.org/10.1371/journal.pone.0124323

Volumetric response beyond six months of cardiac resynchronization therapy and clinical outcome. / van 't Sant, Jetske; Fiolet, Aernoud T L; Ter Horst, Iris A H; Cramer, Maarten J; Mastenbroek, M.H.; van Everdingen, Wouter M; Mast, Thomas P; Doevendans, Pieter A; Versteeg, H.; Meine, Mathias.

In: PLoS ONE, Vol. 10, No. 5, e0124323, 2015.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Volumetric response beyond six months of cardiac resynchronization therapy and clinical outcome

AU - van 't Sant, Jetske

AU - Fiolet, Aernoud T L

AU - Ter Horst, Iris A H

AU - Cramer, Maarten J

AU - Mastenbroek, M.H.

AU - van Everdingen, Wouter M

AU - Mast, Thomas P

AU - Doevendans, Pieter A

AU - Versteeg, H.

AU - Meine, Mathias

PY - 2015

Y1 - 2015

N2 - Aims:Response to cardiac resynchronization therapy (CRT) is often assessed six months after implantation. Our objective was to assess the number of patients changing from responder to non-responder between six and 14 months, so-called late non-responders, and compare them to patients who were responder both at six and 14 months, so-called stable responders. Furthermore, we assessed predictive values of six and 14-month response concerning clinical outcome.Methods: 105 patients eligible for CRT were enrolled. Clinical, laboratory, ECG, and echocardiographic parameters and patient-reported health status (Kansas City Cardiomyopathy Questionnaire [KCCQ]) were assessed before, and six and 14 months after implantation. Response was defined as ≥15% LVESV decrease as compared to baseline. Major adverse cardiac events (MACE) were registered until 24 months after implantation. Predictive values of six and 14-month response for MACE were examined.Results: In total, 75 (71%) patients were six-month responders of which 12 (16%) patients became late non-responder. At baseline, late non-responders more often had ischemic cardiomyopathy and atrial fibrillation, higher BNP and less dyssynchrony compared to stable responders. At six months, late non-responders showed significantly less LVESV decrease, and higher creatinine levels. Mean KCCQ scores of late non-responders were lower than those of stable responders at every time point, with the difference being significant at 14 months. The 14 months response was a better predictor of MACE than six months response.Conclusions: The assessment of treatment outcomes after six months of CRT could be premature and response rates beyond might better correlate to long-term clinical outcome.

AB - Aims:Response to cardiac resynchronization therapy (CRT) is often assessed six months after implantation. Our objective was to assess the number of patients changing from responder to non-responder between six and 14 months, so-called late non-responders, and compare them to patients who were responder both at six and 14 months, so-called stable responders. Furthermore, we assessed predictive values of six and 14-month response concerning clinical outcome.Methods: 105 patients eligible for CRT were enrolled. Clinical, laboratory, ECG, and echocardiographic parameters and patient-reported health status (Kansas City Cardiomyopathy Questionnaire [KCCQ]) were assessed before, and six and 14 months after implantation. Response was defined as ≥15% LVESV decrease as compared to baseline. Major adverse cardiac events (MACE) were registered until 24 months after implantation. Predictive values of six and 14-month response for MACE were examined.Results: In total, 75 (71%) patients were six-month responders of which 12 (16%) patients became late non-responder. At baseline, late non-responders more often had ischemic cardiomyopathy and atrial fibrillation, higher BNP and less dyssynchrony compared to stable responders. At six months, late non-responders showed significantly less LVESV decrease, and higher creatinine levels. Mean KCCQ scores of late non-responders were lower than those of stable responders at every time point, with the difference being significant at 14 months. The 14 months response was a better predictor of MACE than six months response.Conclusions: The assessment of treatment outcomes after six months of CRT could be premature and response rates beyond might better correlate to long-term clinical outcome.

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DO - 10.1371/journal.pone.0124323

M3 - Article

C2 - 25933068

VL - 10

JO - PLoS ONE

JF - PLoS ONE

SN - 1932-6203

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M1 - e0124323

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van 't Sant J, Fiolet ATL, Ter Horst IAH, Cramer MJ, Mastenbroek MH, van Everdingen WM et al. Volumetric response beyond six months of cardiac resynchronization therapy and clinical outcome. PLoS ONE. 2015;10(5). e0124323. https://doi.org/10.1371/journal.pone.0124323