Factors Associated with Non-Response to Cardiac Resynchronization Therapy: Insights from a Real-World, Single-Center Study
2025-03-30 9:15Factors Associated with Non-Response to Cardiac Resynchronization Therapy: Insights from a Real-World, Single-Center Study
Factors Associated with Non-Response to Cardiac Resynchronization Therapy: Insights from a Real-World, Single-Center Study
Christian Mabiza Kutoloka 1, Marc Balekelay Tshilanda 1, Alexandre Doucy2, Michael Mannessier 2, Noel Onembo Otshudi1, Yannick Mundendi Samafundu1, Jean Robert Rissassi Makulo1, Treasure Swambulu Mvunzi1, Raphael Kola Otshudi1, Brady Madioko Makanzu1, Fabien Mbala Kintoki1, Nathan Bimbi Buila 1, Benjamin Longo-Mbenza 1, Jean-René M'buyamba-Kabangu 1, Bernard Phanzu Kianu1
- Cardiology department, University of Kinshasa, Kinshasa, Democratic Republic of the Congo.
- Cardiology department, Rhythmology unit, Saint Quentin Hospital Center, Saint Quentin France
Background & objectives. Cardiac resynchronization therapy (CRT) is proposed to patients with heart failure and symptomatic severe left ventricular dysfunction with wide QRS. Despite its proven benefits, a significant percentage of patients do not respond positively to CRT based on the assessed criteria. The objective of the present study was to determine the frequency of non-response to CRT and to identify associated factors in patients with heart failure who underwent CRT implantation. Methods. A historical cohort study was conducted on heart failure patients who received CRT at the Saint-Quentin Hospital Center (CHSQ) from January 1, 2020, to September 30, 2022. Parameters of interest included demographic, clinical, laboratory, electrocardiographic, echocardiographic, and magnetic resonance imaging data, biological markers, and follow-up outcomes. Non-response to CRT was defined as the absence of improvement in left ventricular ejection fraction (LVEF) of more than 10 % six months after CRT. Multivariate logistic regression was used to investigate factors associated with non-response to CRT. Results. Of 82 patients, 29 (35.4 %) were classified as non-responders. Mean LVEF increased from 27.5 % to 40 % after CRT. Factors associated with non-response included: MRI fibrosis (aOR=3.99; p=0.007), male gender (aOR=3.04; p=0.006), low and medium initial dose of sacubitril-valsartan respectively (aOR=3.02; p=0.013; aOR=2.03; p=0.032) and history of ischemic heart disease (aOR=2.4; p=0.037). Conclusion. Non-response to CRT is very common and is attributed to specific patient history, underlying clinical, behavioral, and pathophysiological conditions. Hence, the importance of improving patient selection and implementing personalized treatment strategies.
Keywords : Cardiac resynchronization therapy, heart failure, non-response, predictors, echocardiography, biomarkers.
Received on October 4, 2024
Accepted on February 7, 2025
