Decreased Left Ventricular Systolic Function during the Late Phase after Response to Cardiac Resynchronization Therapy.

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Heart rhythm Pub Date : 2025-02-06 DOI:10.1016/j.hrthm.2025.02.002

Tomoya Iwawaki, Yasuya Inden, Satoshi Yanagisawa, Kiichi Miyamae, Hiroyuki Miyazawa, Takayuki Goto, Shun Kondo, Masaya Tachi, Masafumi Shimojo, Yukiomi Tsuji, Toyoaki Murohara

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引用次数: 0

Abstract

Background: Cardiac resynchronization therapy (CRT) improves cardiac function in patients with heart failure (HF) and dyssynchrony. However, a subset of responders develops a delayed decline in left ventricular (LV) systolic function, referred to as "delayed negative reverse remodeling (DNRR)."

Objective: This study aimed to investigate the characteristics and prognosis of DNRR in CRT responders.

Methods: A total of 203 patients undergoing CRT device implantation were analyzed. Among them, 100 responders were identified based on a ≥5% absolute LV ejection fraction (LVEF) increase and a ≥15% relative LV end-systolic volume (LVESV) reduction at 6 months post-CRT. DNRR was defined as a ≥5% absolute decrease in LVEF at 1 year after treatment response determination.

Results: Of the responders, 22 (22.0%) exhibited DNRR, while 78 (78.0%) were classified as non-DNRR. The DNRR group showed a decline in LVEF from 41.2±8.3% to 32.7±9.6% (p<0.001), while the non-DNRR group showed improvement from 42.8±9.5% to 46.2±10.5% (p<0.001). Multivariate analysis identified LVESV ≥100 mL (odds ratio [OR]: 3.575, p=0.041), paced QRS duration ≥150 ms (OR: 4.427, p=0.023), synchronized LV pacing <85% (OR: 5.753, p=0.043) at 6 months post-CRT, and intraventricular conduction disturbance (OR: 5.593, p=0.018) as independent predictors of DNRR. The DNRR group had significantly worse outcomes, including cardiac death and HF-related hospitalization, compared to the non-DNRR group.

Conclusion: Despite an initial response to CRT, a subset of HF patients developed DNRR, which correlated with worse clinical outcomes. Identifying risk factors associated with DNRR may help optimize CRT management and improve long-term patient care.

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来源期刊

Heart rhythm 医学-心血管系统

CiteScore

10.50

自引率

5.50%

发文量

1465

审稿时长

24 days

期刊介绍： HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability. HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community. The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.