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Dynamics"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Cardiac resynchronization therapy (CRT) response is commonly assessed at 6 months using left ventricular end-systolic volume (LVESV) and clinical endpoints. However, response may continue to evolve beyond this time point, with some initial non-responders subsequently improving or stabilizing. This study aimed to characterize changes in echocardiographic response from 6 to 12 months, identify predictors of these trajectories, and assess their relationship with longer-term clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>This post hoc analysis of the MORE-CRT MPP trial included patients receiving conventional biventricular pacing only. Patients were classified as non-responders (&amp;lt;15% LVESV reduction at 6 and 12 months), early responders (&amp;gt;15% reduction at 6 months), or delayed responders (&amp;lt;15% reduction at 6 months but &amp;gt;15% at 12 months). Six-month non-responders were further classified as stabilized (LVESV reduction at 12 months) or deteriorated (LVESV increase at 12 months). Heart failure hospitalization or death was analysed using restricted mean survival time and adjusted accelerated failure time models. Among 2732 patients (69.4% male; 62.8% non-ischaemic), event-free survival differed between early, delayed, and non-responders (P &amp;lt; 0.001). Non-responders had 52% shorter event-free survival than early responders (P &amp;lt; 0.001), and 38% shorter than delayed responders (P = 0.025). Early and delayed responders had similar outcomes (P = 0.221). Among non-responders, 39.0% stabilized and 61.0% deteriorated; outcomes diverged after 6 months (P &amp;lt; 0.001). The deterioration group had 59% shorter event-free survival (P &amp;lt; 0.001). Ischaemic aetiology, non-LBBB, and lower baseline LVEF predicted delayed response.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Delayed responders demonstrated similarly favourable clinical outcomes to early responders over the duration of follow-up. These findings support 12-month assessment and trajectory-based definitions of CRT response.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/europace\/euag209","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T11:08:55Z","timestamp":1786100935000},"source":"Crossref","is-referenced-by-count":0,"title":["Redefining response to cardiac resynchronization therapy: a\n                    <i>post hoc<\/i>\n                    analysis of the MORE-CRT MPP trial"],"prefix":"10.1093","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6140-068X","authenticated-orcid":false,"given":"Vishal","family":"Mehta","sequence":"first","affiliation":[{"name":"School of Biomedical Engineering and Imaging Sciences, Rayne Institute , 4th Floor Lambeth Wing, St Thomas\u2019s Hospital, Westminster Bridge Road, London SE1 7EH ,","place":["UK"]},{"name":"Guy\u2019s and St Thomas\u2019s NHS Foundation Trust , St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7893-0708","authenticated-orcid":false,"given":"Nadeev","family":"Wijesuriya","sequence":"additional","affiliation":[{"name":"Guy\u2019s and St Thomas\u2019s NHS Foundation Trust , St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5588-4451","authenticated-orcid":false,"given":"Felicity","family":"De Vere","sequence":"additional","affiliation":[{"name":"School of Biomedical Engineering and Imaging Sciences, Rayne Institute , 4th Floor Lambeth Wing, St Thomas\u2019s Hospital, Westminster Bridge Road, London SE1 7EH ,","place":["UK"]},{"name":"Guy\u2019s and St Thomas\u2019s NHS Foundation Trust , St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3925-2913","authenticated-orcid":false,"given":"Sandra","family":"Howell","sequence":"additional","affiliation":[{"name":"School of Biomedical Engineering and Imaging Sciences, Rayne Institute , 4th Floor Lambeth Wing, St Thomas\u2019s Hospital, Westminster Bridge Road, London SE1 7EH ,","place":["UK"]},{"name":"Guy\u2019s and St Thomas\u2019s NHS Foundation Trust , St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2805-3043","authenticated-orcid":false,"given":"Mark K","family":"Elliott","sequence":"additional","affiliation":[{"name":"School of Biomedical Engineering and Imaging Sciences, Rayne Institute , 4th Floor Lambeth Wing, St Thomas\u2019s Hospital, Westminster Bridge Road, London SE1 7EH ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0098-4129","authenticated-orcid":false,"given":"Alphonsus","family":"Liew","sequence":"additional","affiliation":[{"name":"School of Biomedical Engineering and Imaging Sciences, Rayne Institute , 4th Floor Lambeth Wing, St Thomas\u2019s Hospital, Westminster Bridge Road, London SE1 7EH ,","place":["UK"]},{"name":"Guy\u2019s and St Thomas\u2019s NHS Foundation Trust , St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4612-6982","authenticated-orcid":false,"given":"Steven A","family":"Niederer","sequence":"additional","affiliation":[{"name":"School of Biomedical Engineering and Imaging Sciences, Rayne Institute , 4th Floor Lambeth Wing, St Thomas\u2019s Hospital, Westminster Bridge Road, London SE1 7EH ,","place":["UK"]},{"name":"National Heart and Lung 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,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2296-2596","authenticated-orcid":false,"given":"Niraj","family":"Varma","sequence":"additional","affiliation":[{"name":"Cardiology Department, Cleveland Clinic , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3066-8947","authenticated-orcid":false,"given":"Marianne","family":"Gwechenberger","sequence":"additional","affiliation":[{"name":"Cardiology Department, Medical University of Vienna , Vienna ,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9820-4815","authenticated-orcid":false,"given":"Giuseppe","family":"Boriani","sequence":"additional","affiliation":[{"name":"Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia , Modena ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4399-5568","authenticated-orcid":false,"given":"Christophe","family":"Leclercq","sequence":"additional","affiliation":[{"name":"Cardiology Department, CHRU Pontchaillou , Rennes ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3930-1957","authenticated-orcid":false,"given":"Christopher A","family":"Rinaldi","sequence":"additional","affiliation":[{"name":"School of Biomedical Engineering and Imaging Sciences, Rayne Institute , 4th Floor Lambeth Wing, St Thomas\u2019s Hospital, Westminster Bridge Road, London SE1 7EH ,","place":["UK"]},{"name":"Guy\u2019s and St Thomas\u2019s NHS Foundation Trust , St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH ,","place":["UK"]},{"name":"Cardiology Department, Cleveland Clinic , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,10]]},"reference":[{"key":"2026083109115055200_euag209-B1","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1002\/clc.22043","article-title":"Characteristics of responders to cardiac resynchronization therapy: the impact of echocardiographic left ventricular volume","volume":"35","author":"Park","year":"2012","journal-title":"Clin Cardiol"},{"key":"2026083109115055200_euag209-B2","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1054\/jcaf.2001.25652","article-title":"Proposal for a new clinical end point to evaluate the efficacy of drugs and devices in the treatment of chronic heart failure","volume":"7","author":"Packer","year":"2001","journal-title":"J Card Fail"},{"key":"2026083109115055200_euag209-B3","first-page":"1463","article-title":"Avoiding non-responders to cardiac resynchronization therapy: a practical 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