Swiss Medical Weekly (Apr 2017)

“Real world” experience in cardiac resynchronisation therapy at a Swiss tertiary care centre: update 2016

  • Stephan Winnik,
  • Christian Elsener,
  • Burkhardt Seifert,
  • Christoph Starck,
  • Agnes Straub,
  • Ardan M. Saguner,
  • Alexander Breitenstein,
  • Nazmi Krasniqi,
  • Markus J. Wilhelm,
  • Laurent Haegeli,
  • Firat Duru,
  • Stefano Benussi,
  • Francesco Maisano,
  • Thomas F. Lüscher,
  • Johannes Holzmeister,
  • David Hürlimann,
  • Frank Ruschitzka,
  • Jan Steffel

DOI
https://doi.org/10.4414/smw.2017.14425
Journal volume & issue
Vol. 147, no. 1516

Abstract

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BACKGROUND Based on a reduction in morbidity and mortality, cardiac resynchronisation therapy (CRT) has evolved as a standard therapy for patients with advanced heart failure. OBJECTIVE To provide insight into patient demographics, safety, echocardiographic remodelling and long-term follow-up of patients treated with CRT in a “real-world” setting at a Swiss tertiary care centre. METHODS Patients implanted with a CRT device at the University Heart Centre Zurich between 2000 and 2015 were consecutively enrolled. Initial clinical and echocardiographic therapy response as well as long-term follow-up for mortality (defined as all-cause death, heart transplantation or ventricular assist device implantation) and hospitalisation for heart failure were assessed. RESULTS A total of 418 patients with a median age of 66 years at the time of CRT implantation (78% male) were enrolled. Serious peri-interventional complications (from the time of implantation up to 14 days thereafter) were rare and included systemic infections in 2.4%, pneumothorax in 3.3% and haematoma requiring revision in 2.2% of cases. Overall, the Kaplan-Meier estimate for 5-year freedom from the composite endpoint (hospitalisation for heart failure or mortality) was 55.8%; the Kaplan-Meier estimate for 5-year freedom from mortality was 64.1%. CRT was associated with a significant symptomatic improvement and left ventricular reverse remodelling. ​ Overall, 3.9% of patients did not respond to cardiac resynchronisation therapy (decline in left ventricular ejection fraction [LVEF] >5%), whereas 35.1% experienced neither a continued decline nor a relevant improvement of LVEF (±5%). In the remaining 61% of patients we observed an improvement in LVEF of more than 5%. Forty percent and 31% of patients were super responders, defined as an absolute LVEF improvement of ≥10% and by a relative reduction of left ventricular end-diastolic volume index by 20% or more. Super-response to CRT was associated with a significant benefit in terms of survival and rehospitalisation rates. CONCLUSION Our data are consistent with large multicentre trials and indicate that CRT is similarly effective in a real-world setting in Switzerland.

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