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CRT Super-responder — EECC MCQ

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ModerateHeart FailureCRT Super-responderEECC

A 72-year-old woman with HFrEF (LVEF 30%) and LBBB (QRS 160 ms) undergoes CRT-D implantation. At 6-month follow-up, LVEF has improved to 48% and she is NYHA class I. She is classified as a CRT 'super-responder'. What defines a super-responder?

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Correct answer: A — LVEF improvement to near-normal (≥45-50%) with significant symptom improvement (≥2 NYHA class improvement or return to NYHA I); occurs in approximately 20-30% of CRT recipients

Explanation lettering: D = shown as B · B = shown as C · C = shown as D

A is correct. A CRT 'super-responder' has an exceptional clinical and echocardiographic response after cardiac resynchronisation: marked reverse remodelling with recovery of LVEF to near-normal values, commonly ≥45–50%, plus major symptomatic improvement such as ≥2 NYHA class improvement or return to NYHA class I. This patient’s LVEF has risen from 30% to 48% and she is NYHA class I, so she meets the definition. Non-ischaemic aetiology, female sex, LBBB and a broad QRS predict super-response but are not required. Biventricular pacing >95% is a delivery/optimisation target, not the definition. A ≥5% LVEF rise, survival after implantation, or implantation success alone does not define super-response. Super-responders comprise approximately 20–30% of CRT recipients in typical cohorts.

Reference: Vătășescu RG, et al. Predictors for Super-Responders in Cardiac Resynchronization Therapy. American Journal of Therapeutics. 2024;31(1):e13-e23. doi:10.1097/MJT.0000000000001692. https://pubmed.ncbi.nlm.nih.gov/38231577/