Po-02-017 characterization of patients who stabilize after cardiac resynchronization therapy

Cardiac resynchronization therapy (CRT) is an effective treatment in appropriately selected patients with heart failure. While a subset responds well, a large proportion either stabilizes or deteriorates. We examined the predictors and outcomes of patients who do not demonstrate a reduction in left ventricular end-systolic volume (LVESV) >15% at 6 months; however, who do stabilize between 6 and 12 months (reduction in LVESV 0-15%). The MORE-CRT MPP study is a prospective, randomized, multicenter study. All patients (n = 5803) initially received conventional biventricular (BiV) CRT for 6 months. At this stage, echocardiographic non-responders (i.e., are reduction in LVESV < 15%) were randomized to either continued conventional BiV pacing, or MultiPoint pacing. This post-hoc analysis evaluated the BiV pacing group only. This group was split into i) the stabilization group (reduction in LVESV between 0-15% at 6- and 12-months follow-ups); ii) deterioration group (increase in LVESV >0% at 6 and 12 months). Of the 464 patients in the analysis, 51.2% (n=238) stabilized, and 48.8% (n=226) deteriorated following CRT implant. On multivariable analysis, increased left ventricular ejection fraction (LVEF) and increased QRS duration/left ventricular end-diastolic volume (LVEDV) ratio at baseline were statistically significant for predicting deterioration (see table). Freedom from heart failure hospitalization was similar in both groups until 6 months, and there was a significant separation of the Kaplan-Meier curves after 6 months (p<0.001) (see figure). Patients with an increased LVEF and higher QRSd/LVEDV ratio (i.e., higher degree of dyssynchrony relative to heart size) were more likely to deteriorate than to stabilize following conventional BiV CRT. The risk of heart failure hospitalization in both groups remained similar at 6 months, however, significantly worsened if there was an echo deterioration following CRT. This suggests the need for longer follow up when evaluating clinical endpoints following CRT.Tabled 1Univariate and multivariate Cox regression model to predict likelihood of deterioration to cardiac resynchronization therapy (CRT).ParametersUnivariable Analysis (n=464)Multivariable Analysis (n=383)OR [95% CI]p-valueOR [95% CI]p-valueAge0.979 [0.961, 0.997]0.01960.98 [0.96, 1.00]0.1296COPD (Yes vs No)0.699 [0.393, 1.244]0.2234Diabetes (Yes vs No)0.750 [0.512, 1.098]0.139Female vs Male1.011 [0.649, 1.577]0.96031.13 [0.67, 1.93]0.644Hypertension (Yes vs No)0.811 [0.556, 1.180]0.2735Ischaemic vs Non-Ischaemic0.732 [0.508, 1.055]0.0939LBBB vs Non-LBBB1.617 [1.077, 2.429]0.02061.52 [0.98, 2.36]0.0626LVEF0.938 [0.913, 0.963]<.00010.95 [0.92, 0.98]0.0007NYHA I/II vs NYHA III/IV1.180 [0.819, 1.699]0.3745QRS duration/LVEDV ratio1.007 [0.999, 1.014]0.08890.43 [0.19, 0.98]0.0439Renal disease (Yes vs No)0.724 [0.451, 1.161]0.1799 Open table in a new tab