Featured Research

from universities, journals, and other organizations

Impact of clinical and echocardiographic response to cardiac resynchronization therapy (CRT) on long-term survival

Date:
August 28, 2011
Source:
European Society of Cardiology (ESC)
Summary:
The echocardiographic response (reduction of left ventricular end-systolic volume) evaluated at 6 months follow-up, demonstrated to be a better predictor of long-term mortality than improvement in clinical status in a large population of CRT patients. Therefore, assessment of occurrence of left ventricular reverse remodeling at mid-term follow-up may be an adequate surrogate end point in heart failure patients treated with CRT.

The echocardiographic response (reduction of left ventricular end-systolic volume) evaluated at 6 months follow-up, demonstrated to be a better predictor of long-term mortality than improvement in clinical status in a large population of CRT patients. Therefore, assessment of occurrence of left ventricular reverse remodeling at mid-term follow-up may be an adequate surrogate end point in heart failure patients treated with CRT.

The efficacy of cardiac resynchronization therapy (CRT) has been demonstrated with significant reductions in mortality and morbidity of heart failure patients. However, many studies have evaluated the efficacy of CRT by means of improvement in heart failure symptoms (clinical response) or reduction in left ventricular volumes (left ventricular reverse remodeling) and improvement in left ventricular function (echocardiographic response) at mid-term follow-up (3 or 6 months after CRT implantation). Based on these surrogate end points, the efficacy of CRT may change significantly and, consequentially, definition of response to CRT is still debated. Ideally, these surrogate end points should determine a significant reduction in mortality. Accordingly, the present evaluation investigated which definition of CRT response at mid-term follow-up (clinical improvement or left ventricular reverse remodeling) best predicts long-term mortality.

A total of 663 advanced heart failure patients were followed-up for the occurrence of all-cause mortality. At 6 months follow-up, the clinical and echocardiographic responses to CRT were evaluated. Clinical response to CRT was defined as a reduction in New York Heart Association functional class of at least 1 point whereas echocardiographic response to CRT was defined by a reduction in left ventricular end-systolic volume of at least 15%. Based on these definitions, 510 (77%) patients showed clinical response and 412 (62%) patients showed echocardiographic response to CRT. During a mean follow-up of 3722 months, 140 (21%) patients died.

Clinical and echocardiographic CRT responses were both significantly related to all-cause mortality. However, only echocardiographic response to CRT was independently associated with a superior survival. In particular, a patient who did not show echocardiographic response had a risk of death three times higher than a patient showing a good echocardiographic response (hazard ratio 0.38; 95% confidence intervals,0.27-0.50; p<0.001).

The research shows the probability of all-cause mortality which differed significantly between the 2 groups dichotomized based on the echocardiographic response (left ventricular reverse remodeling). A cumulative 1%, 4% and 8% of the patients with LV reverse remodeling died by 12, 24 and 36 months follow-up, respectively. In contrast, a respective 8%, 19% and 27% of the patients without LV reverse remodeling died during the same time period (log-rank p <0.001).

The present findings have important implications in the design process of clinical trials, since the use of biological markers in the prevention and progression of heart failure (such as changes in left ventricular volumes and function) allow investigators to make a prompt evaluation of heart failure therapies and help to understand the biologic processes underlying the disease and the mechanisms of the therapy. In addition, the use of these surrogate end points permits smaller sample size, shorter trial duration and reduced costs.

In conclusion, the echocardiographic response (reduction of left ventricular end-systolic volume) evaluated at 6 months follow-up demonstrated to be a better predictor of long-term mortality than improvement in clinical status in a large population of CRT patients. Therefore, assessment of occurrence of left ventricular reverse remodeling at mid-term follow-up may be an adequate surrogate end point in heart failure patients treated with CRT.


Story Source:

The above story is based on materials provided by European Society of Cardiology (ESC). Note: Materials may be edited for content and length.


Cite This Page:

European Society of Cardiology (ESC). "Impact of clinical and echocardiographic response to cardiac resynchronization therapy (CRT) on long-term survival." ScienceDaily. ScienceDaily, 28 August 2011. <www.sciencedaily.com/releases/2011/08/110828101752.htm>.
European Society of Cardiology (ESC). (2011, August 28). Impact of clinical and echocardiographic response to cardiac resynchronization therapy (CRT) on long-term survival. ScienceDaily. Retrieved August 1, 2014 from www.sciencedaily.com/releases/2011/08/110828101752.htm
European Society of Cardiology (ESC). "Impact of clinical and echocardiographic response to cardiac resynchronization therapy (CRT) on long-term survival." ScienceDaily. www.sciencedaily.com/releases/2011/08/110828101752.htm (accessed August 1, 2014).

Share This




More Health & Medicine News

Friday, August 1, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Ebola Vaccine Might Be Coming, But Where's It Been?

Ebola Vaccine Might Be Coming, But Where's It Been?

Newsy (Aug. 1, 2014) Health officials are working to fast-track a vaccine — the West-African Ebola outbreak has killed more than 700. But why didn't we already have one? Video provided by Newsy
Powered by NewsLook.com
Study Links Certain Birth Control Pills To Breast Cancer

Study Links Certain Birth Control Pills To Breast Cancer

Newsy (Aug. 1, 2014) Previous studies have made the link between birth control and breast cancer, but the latest makes the link to high-estrogen oral contraceptives. Video provided by Newsy
Powered by NewsLook.com
House Republicans Vote to Sue Obama Over Healthcare Law

House Republicans Vote to Sue Obama Over Healthcare Law

Reuters - US Online Video (July 31, 2014) The Republican-led House of Representatives votes to sue President Obama, accusing him of overstepping his executive authority in making changes to the Affordable Care Act. Mana Rabiee reports. Video provided by Reuters
Powered by NewsLook.com
Uganda on Alert for Ebola but No Confirmed Cases

Uganda on Alert for Ebola but No Confirmed Cases

AFP (July 31, 2014) Uganda's health minister said on Thursday that there are no confirmed cases of Ebola in the country, but that it remained on alert for cases of the deadly virus. Uganda has suffered Ebola outbreaks in the past, most recently in 2012. Duration: 00:59 Video provided by AFP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins