Does ‘super-responder’ patients to cardiac resynchronization therapy still have indications for neuro-hormonal antagonists? Evidence from long-term follow-up in a single center

• 来源期刊: 老年心脏病学杂志（英文版）
• 年，卷（期）: 2019,（3）
• 页码范围: 251-258
• 页数: 8页
• 语种: 英文
• DOI: 10.11909/j.issn.1671-5411.2019.03.015

摘要

Background Whether cardiac resynchronization therapy super-responders (CRT-SRs) still have indications for neuro-hormonal antagonists or not remains uninvestigated.Methods We reviewed clinical data from 376 patients who underwent CRT implantation in Fuwai Hospital from 2009 to 2015 and followed up to 2017.CRT-SRs were defined by an improvement of the New York Heart Association functional class and left ventricular ejection fraction to ≥ 50％ in absolute values at 6-month follow-up.All CRT-SRs were assigned into two groups on the basis of whether persistently receiving neuro-horrnonal antagonists (NHA) (defined as angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and β-blockers) after 6-month follow-up and then we compared long-term outcome.Results A total of 60 patients met criteria for super-response.One of thirteen (7.7％) CRT-SRs without NHA had all-cause death,which also occurred in 2 of 47 (4.3％) in CRT-SRs with NHA (P =0.526).However,3 of 13 (23.1％) CRT-SRs without NHA had heart failure (HF) hospitalization,1 of 47 (2.1％) CRT-SRs with NHA had this endpoint (P =0.040).Besides,subgroup analysis indicated that,for ischemic etiology group,CRT-SRs receiving NHA had considerably lower incidence of HF hospitalization than those without NHA (0 vs.75％,P =0.014),which was not observed in non-ischemic etiology group (2.6％ vs.0,P =1.000) during long-term follow-up.Conclusions Our study found that for ischemic etiology,compared with CRT-SRs with NHA,CRT-SRs without NHA were associated with a higher risk of HF hospitalization.However,for non-ischemic etiology,we found that CRT-SRs with NHA or without NHA at follow-up were associated with similar outcomes,which needed further investigation by prospective trials.