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Steffel, J; Milosevic, G; Hürlimann, A; Krasniqi, N; Namdar, M; Ruschitzka, F; Lüscher, T F; Duru, F; Holzmeister, J; Hürlimann, D (2011). Characteristics and long-term outcome of echocardiographic super-responders to cardiac resynchronisation therapy: 'real world' experience from a single tertiary care centre. Heart, 97(20):1668-1674.

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The individual benefit from cardiac resynchronisation therapy (CRT) varies largely among patients.

To compare different definitions of echocardiographic super-response to CRT regarding their ability to predict the incidence of adverse events.

Three definitions of super-response to CRT were evaluated in 110 consecutive patients with CRT implantation: (1) an absolute increase in ejection fraction of ≥ 10%; (2) a decrease in left ventricular end-systolic volume of ≥ 30%; and (3) a decrease in left ventricular end-diastolic volume of ≥ 20%. The primary endpoint was a combination of time to death, heart transplantation, ventricular assist device implantation and hospitalisation for heart failure. Secondary endpoints included time to first appropriate implantable cardioverter defibrillator (ICD) discharge during follow-up.

All three definitions of super-response were highly predictive of a reduced risk for reaching the primary combined endpoint (3-year estimators: 64% ± 7% vs 82% ± 7% for ejection fraction ≥ 10%; 63% ± 8% vs 92% ± 5% for end-systolic volume ≥ 30%; and 62% ± 8% vs 94% ± 4% for end-diastolic volume ≥ 20%; all p<0.001). In all three analyses, super-responders had a significantly shorter time from diagnosis of heart failure until the time point of CRT implantation. However, even super-responders, independent of the definition, did experience appropriate ICD discharges during follow-up.

All three definitions of super-response are highly predictive for a favourable outcome after CRT. However, even patients with pronounced reverse left ventricular remodelling experience appropriate ICD discharges during follow-up.


22 citations in Web of Science®
25 citations in Scopus®
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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Center for Integrative Human Physiology
04 Faculty of Medicine > University Hospital Zurich > Clinic for Cardiology
Dewey Decimal Classification:570 Life sciences; biology
610 Medicine & health
Deposited On:08 Jan 2012 10:52
Last Modified:05 Apr 2016 15:17
Publisher:BMJ Publishing Group
Publisher DOI:10.1136/heartjnl-2011-300222
PubMed ID:21821856

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