title: Clinical characteristics and predictors of super-response to cardiac resynchronization therapy: a combination of predictive factors.
abstract: BACKGROUND
  Patients with greater improvement of cardiac function after cardiac resynchronization therapy (CRT) implantation are identified as "super-responders." However, it remains unclear which kind of preimplant assessments could accurately predict outcomes after CRT. Thus, we aimed to examine the essential predicting factors for super-response to CRT, and to construct an accurate predictable model.
  
  
  METHODS
  We retrospectively analyzed the CRT patients who underwent implantation at Nagoya University Hospital. Super-responders are defined as those who show a relative reduction in left ventricular end-systolic volume ≥30% after 6 months of CRT.
  
  
  RESULTS
  Eighty patients (mean age, 67.8 ± 10.2 years) were included. Twenty-two patients received upgrading procedure to CRT implantation. Six months after the implantation, 29 patients (36%) were super-responders. Multiple logistic regression analysis shows that consistent right ventricular pacing with a previous device (odds ratio [OR] 7.28, 95% confidence interval [CI] 1.52-34.9; P = 0.013), lack of prior history of ventricular arrhythmia (OR 5.32, 95% CI 1.52-18.6; P = 0.009), and smaller left atrial diameter (LAD) (OR 0.92, 95% CI 0.86-0.98; P = 0.014) are independent predictors for CRT super-responders. The use of a combination of these predictive factors could increase the certainty with which a greater response to CRT is predicted and the presence of such a combination could improve prognosis.
  
  
  CONCLUSIONS
  Greater response to biventricular pacing occurs more frequently in patients with consistent right ventricular pacing, lack of prior history of ventricular arrhythmia, and smaller LAD. An association between patient background characteristics and a super-response to CRT was also identified.
authors.affiliation: Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Cardiology, Chunichi Hospital, Aichi, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yanagisawa
authors.forename: Yasuya
authors.initials: Y
authors.lastname: Inden
authors.forename: Masayuki
authors.initials: M
authors.lastname: Shimano
authors.forename: Naoki
authors.initials: N
authors.lastname: Yoshida
authors.forename: Masaya
authors.initials: M
authors.lastname: Fujita
authors.forename: Shiou
authors.initials: S
authors.lastname: Ohguchi
authors.forename: Shinji
authors.initials: S
authors.lastname: Ishikawa
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kato
authors.forename: Satoshi
authors.initials: S
authors.lastname: Okumura
authors.forename: Aya
authors.initials: A
authors.lastname: Miyoshi
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Nagao
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Makoto
authors.initials: M
authors.lastname: Hirai
authors.forename: Toyoaki
authors.initials: T
authors.lastname: Murohara
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D011379:Prognosis; D012074:Remission Induction; D012189:Retrospective Studies
keywords: cardiac resynchronization therapy; right ventricular pacing; super-responder; upgrading; ventricular arrhythmia