title: Association of apical rocking with super-response to cardiac resynchronisation therapy.
abstract: BACKGROUND
  Super-responders to cardiac resynchronisation therapy (CRT) show an exceptional improvement in left ventricular ejection fraction (LVEF). Previous studies showed that apical rocking was independently associated with echocardiographic response to CRT. However, little is known about the association between apical rocking and super-response to CRT.
  
  
  OBJECTIVE
  To determine the independent association of LV apical rocking with super-response to CRT in a large cohort.
  
  
  METHODS
  A cohort of 297 consecutive heart failure patients treated with primary indication for CRT-D were included in an observational registry. Apical rocking was defined as motion of the left ventricular (LV) apical myocardium perpendicular to the LV long axis. 'Super-response' was defined by the top quartile of LVEF response based on change from baseline to follow-up echocardiogram. Best-subset regression analysis identified predictors of LVEF super-response to CRT.
  
  
  RESULTS
  Apical rocking was present in 45 % of patients. Super-responders had an absolute mean LVEF increase of 27 % (LVEF 22.0 % ± 5.7 at baseline and 49.0 % ± 7.5 at follow-up). Apical rocking was significantly more common in super-responders compared with non-super-responders (76 and 34 %, P < 0.001). In univariate analysis, female gender (OR 2.39, 95 % CI 1.38-4.11), lower LVEF at baseline (OR 0.91 95 % CI 0.87-0.95), non-ischaemic aetiology (OR 4.15, 95 % CI 2.33-7.39) and apical rocking (OR 6.19, 95 % CI 3.40-11.25) were associated with super-response. In multivariate analysis, apical rocking was still strongly associated with super-response (OR 5.82, 95 % CI 2.68-12.61). Super-responders showed an excellent clinical prognosis with a very low incidence of heart failure admission, cardiac mortality and appropriate ICD therapy.
  
  
  CONCLUSIONS
  Apical rocking is independently associated with super-response to CRT.
authors.affiliation: Department of Cardiology, Isala, Dr. Van Heesweg 2, 8025 AB, Zwolle, The Netherlands. v.r.c.derks@isala.nl.
authors.forename: A
authors.initials: A
authors.lastname: Ghani
authors.affiliation: Department of Cardiology, Isala, Dr. Van Heesweg 2, 8025 AB, Zwolle, The Netherlands.
authors.forename: P P H M
authors.initials: PP
authors.lastname: Delnoy
authors.affiliation: Department of Cardiology, Isala, Dr. Van Heesweg 2, 8025 AB, Zwolle, The Netherlands.
authors.forename: J J J
authors.initials: JJ
authors.lastname: Smit
authors.affiliation: Department of Cardiology, Isala, Dr. Van Heesweg 2, 8025 AB, Zwolle, The Netherlands.
authors.forename: J P
authors.initials: JP
authors.lastname: Ottervanger
authors.affiliation: Department of Cardiology, Isala, Dr. Van Heesweg 2, 8025 AB, Zwolle, The Netherlands.
authors.forename: A R
authors.initials: AR
authors.lastname: Ramdat Misier
authors.affiliation: Department of Cardiology, Isala, Dr. Van Heesweg 2, 8025 AB, Zwolle, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Adiyaman
authors.affiliation: Department of Cardiology, Isala, Dr. Van Heesweg 2, 8025 AB, Zwolle, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Elvan
keywords: Apical rocking; Cardiac resynchronisation therapy; Prognosis; Super-response