Long-Term Echocardiographic Response to Cardiac Resynchronization Therapy in Initial Nonresponders

OBJECTIVES The aim of this study was to investigate the frequency and clinical implications of a delayed echocardiographic response to cardiac resynchronization therapy (CRT). BACKGROUND Long-term prognosis for CRT patients is routinely based on the assessment of echocardiograms after 6 to 12 months of therapy. Some patients, however, may require a Longer period of therapy before echocardiographic improvements are detectable. METHODS This observational study included all patients with heart failure (HF) receiving a CRT device at a single center from 2003 to 2011. Eligible patients met current indications and had technically adequate echocardiograms from before implantation, approximately 1 year after implantation (mid-term), and >= 3 years after implantation (long-term). A positive echocardiographic response to CRT was defined as a reduction in left ventricular end-systolic volume >= 15%. All-cause mortality was compared for patients in 3 response groups: mid-term responders, Long-term responders, and nonresponders. RESULTS During this study, 294 patients met the study criteria. Of the 120 patients who were nonresponders after 1 year, 52 (43%) experienced a delayed positive response. Delayed, Long-term responders had mortality and hospitalization rates similar to mid-term responders and significantly Lower than nonresponders. CONCLUSIONS Among patients surviving at Least 3 years after implantation of a CRT device and with echocardiographic follow-up, a significant portion of nonresponders after 1 year of CRT experience a delayed echocardiographic response after a longer period of time. Survival and hospitalization rates were similar for all echocardiographic responders, regardless of the time at which the response occurred. (J Am Coll Cardiol HF 2015;3:990-7) (C) 2015 by the American College of Cardiology Foundation.