European Heart Journal Advance Access originally published online on August 30, 2009
European Heart Journal
2009 30(20):2470-2477; doi:10.1093/eurheartj/ehp368
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Characteristics of heart failure patients associated with good and poor response to cardiac resynchronization therapy: a PROSPECT (Predictors of Response to CRT) sub-analysis
1 Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
2 The Ohio State University Heart Center, Columbus, OH, USA
3 The Lindner Clinical Trial Center, The Christ Hospital, Cincinnati, OH, USA
4 Division of Cardiology, The Heart Rhythm Center, St John Hospital and Medical Center, Detroit, MI, USA
5 GVM Hospitals of Care and Research, Cotignola, Italy
6 Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
7 Medtronic Bakken Research Center, Maastricht, The Netherlands
8 Divisione di Cardiologia, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
Received 28 July 2009; revised 10 August 2009; accepted 13 August 2009; online publish-ahead-of-print 30 August 2009.
* Corresponding author. Tel: +31 71 5262020, Fax: +31 71 5266809, Email: j.j.bax{at}lumc.nl
See page 2436 for the commentary on this article (doi:10.1093/eurheartj/ehp367)
Aims: Predictors of Response to Cardiac Resynchronization Therapy (CRT) (PROSPECT) was the first large-scale, multicentre clinical trial that evaluated the ability of several echocardiographic measures of mechanical dyssynchrony to predict response to CRT. Since response to CRT may be defined as a spectrum and likely influenced by many factors, this sub-analysis aimed to investigate the relationship between baseline characteristics and measures of response to CRT.
Methods and results: A total of 286 patients were grouped according to relative reduction in left ventricular end-systolic volume (LVESV) after 6 months of CRT: super-responders (reduction in LVESV 
30%), responders (reduction in LVESV 15–29%), non-responders (reduction in LVESV 0–14%), and negative responders (increase in LVESV). In addition, three subgroups were formed according to clinical and/or echocardiographic response: +/+ responders (clinical improvement and a reduction in LVESV 15%), +/– responders (clinical improvement or a reduction in LVESV 15%), and –/– responders (no clinical improvement and no reduction in LVESV 15%). Differences in clinical and echocardiographic baseline characteristics between these subgroups were analysed. Super-responders were more frequently females, had non-ischaemic heart failure (HF), and had a wider QRS complex and more extensive mechanical dyssynchrony at baseline. Conversely, negative responders were more frequently in New York Heart Association class IV and had a history of ventricular tachycardia (VT). Combined positive responders after CRT (+/+ responders) had more non-ischaemic aetiology, more extensive mechanical dyssynchrony at baseline, and no history of VT.
Conclusion: Sub-analysis of data from PROSPECT showed that gender, aetiology of HF, QRS duration, severity of HF, a history of VT, and the presence of baseline mechanical dyssynchrony influence clinical and/or LV reverse remodelling after CRT. Although integration of information about these characteristics would improve patient selection and counselling for CRT, further randomized controlled trials are necessary prior to changing the current guidelines regarding patient selection for CRT.
Key Words: Cardiac resynchronization therapy • Heart failure • Echocardiography • Clinical trial • Reverse remodelling
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