title: Characteristics and long-term outcome of echocardiographic super-responders to cardiac resynchronisation therapy: 'real world' experience from a single tertiary care centre.
abstract: BACKGROUND
  The individual benefit from cardiac resynchronisation therapy (CRT) varies largely among patients.
  
  
  OBJECTIVE
  To compare different definitions of echocardiographic super-response to CRT regarding their ability to predict the incidence of adverse events.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Cardiology, University Hospital Zurich, Ramistrasse 100, Zürich 8091, Switzerland.
authors.forename: Jan
authors.initials: J
authors.lastname: Steffel
authors.forename: Gligor
authors.initials: G
authors.lastname: Milosevic
authors.forename: Anja
authors.initials: A
authors.lastname: Hürlimann
authors.forename: Nazmi
authors.initials: N
authors.lastname: Krasniqi
authors.forename: Mehdi
authors.initials: M
authors.lastname: Namdar
authors.forename: Frank
authors.initials: F
authors.lastname: Ruschitzka
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Lüscher
authors.forename: Firat
authors.initials: F
authors.lastname: Duru
authors.forename: Johannes
authors.initials: J
authors.lastname: Holzmeister
authors.forename: David
authors.initials: D
authors.lastname: Hürlimann
mesh_terms: D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D017147:Defibrillators, Implantable; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology*; D013997:Time Factors; D016896:Treatment Outcome; D016276:Ventricular Function / Q000502:physiology*