Determinants of left ventricular function improvement for cardiac resynchronization therapy candidates

Jung Ae Hong, Sang Eun Lee, Seon Ok Kim, Min Seok Kim, Hae Young Lee, Hyun Jai Cho, Jin Oh Choi, Eun Seok Jeon, Kyung Kuk Hwang, Shung Chull Chae, Sang Hong Baek, Seok Min Kang, Dong Ju Choi, Byung Su Yoo, Kye Hun Kim, Myeong Chan Cho, Byung Hee Oh, Jae Joong Kim

Research output: Contribution to journalArticlepeer-review


Aims: A waiting period of more than 3 months is recommended for patients before undergoing cardiac resynchronization therapy (CRT). However, due to an anticipated high mortality rate, early implementation of CRT might be beneficial for some patients. We aimed to evaluate the rate and the probability of left ventricular (LV) function improvement and their predictors in patients with heart failure (HF) with indications for CRT. Methods and results: From March 2011 to February 2014, a total of 5625 hospitalized patients for acute HF were consecutively enrolled in 10 tertiary hospitals. Among them, we analysed 1792 patients (mean age 63.96 ± 15.42 years, female 63.1%) with left ventricular ejection fraction (LVEF) ≤ 35% at the baseline echocardiography and divided them into three groups: 144 with left bundle branch block (LBBB), 136 with wide QRS complexes without LBBB, and 1512 not having these findings (control). We compared and analysed these three groups for improvement of LV function at follow-up echocardiography. In patients who met CRT indications (patients with LBBB or wide QRS complexes without LBBB), logistic regression was performed to identify risk factors for no improvement of LV. No improvement of LV was defined as LVEF ≤ 35% at follow-up echocardiography or the composite adverse outcomes: death, heart transplantation, extracorporeal membrane oxygenation, or use of a ventricular assist device before follow-up echocardiography. A classification tree was established using the binary recursive partitioning method to predict the outcome of patients who met CRT indications. In a median follow-up of 11 months, LVEF improvement was observed in 24.3%, 15.4%, and 40.5% of patients with LBBB, wide QRS complexes without LBBB, and control, respectively. Patients meeting CRT indications had higher 3 month mortality rates than the control (24.6% vs. 17.7%, P = 0.002). Multivariable logistic regression analysis revealed that large LV end-systolic dimension [odds ratio (OR) 1.10, 95% confidence interval (CI) 1.05–1.15, P < 0.001], low LVEF (OR 0.92, 95% CI 0.87–0.98, P = 0.006), diabetes requiring insulin (OR 6.49, 95% CI 2.53–19.33, P < 0.001), and suboptimal medical therapy (OR 6.85, 95% CI 3.21–15.87, P < 0.001) were significant factors predictive of no improvement. A decision tree analysis was consistent with these results. Conclusions: Patients with CRT indications had higher mortality during their follow-up compared with control. LV function improvement was rare in this population, especially when they had some risk factors. These results suggest that the uniform waiting period before CRT implantation could be reconsidered and individualized.

Original languageEnglish
Pages (from-to)283-292
Number of pages10
JournalESC Heart Failure
Issue number1
Publication statusPublished - 2022 Feb

Bibliographical note

Funding Information:
This research was supported by grants from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute(KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (HR21C0198), the Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea (2018IL0774‐1), and the Korea Centers for Disease Control and Prevention (2016‐ER6303‐01)

Publisher Copyright:
© 2021 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine


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