title: Identification of 'super-responders' to cardiac resynchronization therapy: the importance of symptom duration and left ventricular geometry.
abstract: OBJECTIVE
  Some patients show such an important clinical improvement and reverse remodelling after cardiac resynchronization therapy (CRT) that anatomy and function approach normal. These patients have been called 'super-responders'. The aim of our study was to identify predictors of becoming a super-responder after CRT.
  
  
  RESULTS
  Eighty-seven consecutive patients who underwent CRT were prospectively studied. Before CRT and 6 months after, clinical and echocardiographic evaluation was performed. Patients with a decrease in New York Heart Association functional class >or=1, a two-fold or more increase of left ventricular ejection fraction (LVEF) or a final LVEF >45%, and a decrease in LV end-systolic volume >15% were classified as super-responders. There were 12% super-responders. At baseline, there were no significant differences between super-responders and the other patients, except for the fact that super-responders had significantly smaller mitral regurgitation and LV end-diastolic diameter (LVEDD) and a shorter duration of heart failure symptoms. Mitral regurgitation jet area, LVEDD, and duration of heart failure symptoms were correlated with this super-response. Moreover, an evolution of symptoms for <12 months was an independent predictor of super-response to CRT.
  
  
  CONCLUSIONS
  Patients in earlier phases of the cardiomyopathy, with a less altered ventricular geometry, seem to have a greater probability of becoming super-responders.
authors.affiliation: Department of Cardiology, Coimbra University Hospital and Medical School, Avenida Bissaya Barreto, 3000-076 Coimbra, Portugal. natalia.antonio@gmail.com
authors.forename: Natália
authors.initials: N
authors.lastname: António
authors.forename: Rogério
authors.initials: R
authors.lastname: Teixeira
authors.forename: Lourenço
authors.initials: L
authors.lastname: Coelho
authors.forename: Carolina
authors.initials: C
authors.lastname: Lourenço
authors.forename: Pedro
authors.initials: P
authors.lastname: Monteiro
authors.forename: Miguel
authors.initials: M
authors.lastname: Ventura
authors.forename: João
authors.initials: J
authors.lastname: Cristóvão
authors.forename: Luís
authors.initials: L
authors.lastname: Elvas
authors.forename: Lino
authors.initials: L
authors.lastname: Gonçalves
authors.forename: Luís A
authors.initials: LA
authors.lastname: Providência
mesh_terms: D002304:Cardiac Pacing, Artificial / Q000706:statistics & numerical data*; D002311:Cardiomyopathy, Dilated / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011174:Portugal / Q000453:epidemiology; D011379:Prognosis; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*