Discussion
This was the first study to investigate the impact of the corticosteroid
therapy on the efficacy of an upgrade to CRT therapy in patients with
CS. Previous studies showed that a high echocardiographic response to
CRT therapy was associated with a good long-term
prognosis.9, 10
The present study demonstrated that the echocardiographic response to an
upgrade to CRT was lower in patients with CS than in those with other
etiologies of NICM. The patients with CS who had taken corticosteroids
before the upgrade to CRT (group 1) demonstrated the lowest
echocardiographic response. However, the cumulative freedom from
hospitalizations from worsening heart failure and cardiovascular death
did not significantly differ between the patients with CS and those with
other etiologies. In particular, the group 1 patients presented with the
lowest cardiovascular death and hospitalizations.