Early Occurrence of Heart Failure Hospitalization or Ventricular Arrhythmia Re-Define the Long-Term Prognosis After CRT

Toth, AZ; Nagy, L; Szabo, KM; Racz, V; Kiss, A; Sandorfi, G; Borbely, A; Nagy, TL; Csanadi, Z

doi:10.1002/ehf2.15274

Early Occurrence of Heart Failure Hospitalization or Ventricular Arrhythmia Re-Define the Long-Term Prognosis After Cardiac Resynchronization Therapy (CRT)

ESC Heart FailPublished 19 Mar 2025Novel classification based on echocardiographic left ventricular (LV) reverse remodelling and HHF/ventricular arrhythmia (VA) occurrence within 1-year post-CRT

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Authors' conclusion

Long-term survival can be predicted based on the change in LVEF and on the occurrence of an HHF/VA event within 1-year after CRT-D implantation. Stabilized patients have significantly better prognosis as compared with the worsened group. Patients with strikingly poor prognosis can be identified using this assessment method.

Study context

Population: Patients implanted with a CRT defibrillator (CRT-D)by echocardiographic response

Comparison: Long-term survival free of heart transplantation or LV assist device implantation across LV ejection fraction (LVEF)-response categories with or without an HHF/VA event within 1-year post-implantation
Respondersn = One hundred nineteen
Non-progressorsn = 79reference
Progressorsn = 69reference
Outcome: Long-term event-free survival by echocardiographic response

Methodological detailssingle department, 2010–2020

Single department
2010–2020

Main finding

As reported in the abstract

Hazard ratio

0.51

P = 0.002

responders vs non-progressors

Hazard ratio

0.34

P < 0.0001

responders vs progressors

Hazard ratio

0.63

P = 0.03

non-progressors vs progressors

Further findings

Median survival by improved, stabilized and worsened groups — improved vs stabilized

HR 0.53 · P = 0.006

Improvedmedian survival 102.3 months

Stabilizedmedian survival 62.0 months

Worsenedmedian survival 24.4 months

Outcome	HR	P value
Long-term prognosis with versus without an HHF/VA event within each groupWith HHF/VA event vs without HHF/VA event	0.47	P = 0.03
Long-term prognosis with versus without an HHF/VA event within each groupWith HHF/VA event vs without HHF/VA event · non-progressors	0.31	P = 0.0001
Long-term prognosis with versus without an HHF/VA event within each groupWith HHF/VA event vs without HHF/VA event · progressors	0.38	P = 0.0004
Survival between subgroups used for recategorizationResponders with no event vs non-progressors with no event · recategorized as improved	0.69	P = 0.09
Survival between subgroups used for recategorizationResponders with any event vs progressors with no event · stabilized	0.98	P = 0.88
Survival between subgroups used for recategorizationNon-progressors with any event vs progressors with any event · worsened	0.87	P = 0.63
Median survival by improved, stabilized and worsened groupsStabilized vs worsened	0.41	P < 0.0001
Median survival by improved, stabilized and worsened groupsImproved vs worsened	0.21	P < 0.0001

Long-term prognosis with versus without an HHF/VA event within each group: responders; direction as printed ("superior with versus without")

Original publication

Early Occurrence of Heart Failure Hospitalization or Ventricular Arrhythmia Re-Define the Long-Term Prognosis After CRT. ESC Heart Fail. Published 19 March 2025. doi:10.1002/ehf2.15274

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