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Serdoz LV, Daleffe E, Merlo M, Zecchin M, Barbati G, Pecora D, Pinamonti B, Fantoni C, Lupo P, Di Lenarda A, Sinagra G, Cappato R. Predictors for restoration of normal left ventricular function in response to cardiac resynchronization therapy measured at time of implantation. Am J Cardiol 2011; 108:75-80. [PMID: 21529746 DOI: 10.1016/j.amjcard.2011.02.347] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 02/16/2011] [Accepted: 02/16/2011] [Indexed: 11/25/2022]
Abstract
There are no parameters predicting the individual probability of "full response" to cardiac resynchronization therapy (CRT). The aim of this work was to find prognostic factors of full clinical and echocardiographic responses (i.e., ≥50% left ventricular ejection fraction [LVEF] and New York Heart Association class I) after 1 year of CRT. This was a prospective follow-up study that involved 2 hospitals. Patients (n = 75) with advanced heart failure (64 ± 9 years of age, 87% men, LVEF 24 ± 7%) who received CRT were followed for 17 ± 9 months. Univariate and multivariate regression analyses were used to identify predictors of full CRT response. A nomogram predicting the individual probability of full CRT response during follow-up was calculated. There were 13 patients with restoration of normal LVEF versus 62 without (mean LVEF 56% ± 5% vs 31% ± 8%, respectively, p <0.001). Predictors of full response included cause of heart disease, baseline QRS width, and degree of QRS shortening in response to CRT. Patients with nonischemic heart disease, baseline QRS width ≤150 ms, and QRS shortening ≥40 ms in response to CRT had a >75% probability of restoration of normal LVEF. In conclusion, our nomogram using a combination of cause, baseline QRS width, and degree of QRS shortening in response to CRT allows assessment of individual probability of full response. This observation awaits further confirmation from larger series.
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Sitges M, Mont L. Identificación de candidatos óptimos para terapia de resincronización cardiaca: una búsqueda incesante. Med Clin (Barc) 2011; 137:113-4. [DOI: 10.1016/j.medcli.2010.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2010] [Accepted: 12/23/2010] [Indexed: 10/18/2022]
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53
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Rodríguez-Almodóvar A, Mesa Rubio D, Durán Torralba C, Ruiz Ortiz M, Delgado Ortega M, López Granados A. Caracterización del paciente hiperrespondedor a la terapia de resincronización cardiaca. Med Clin (Barc) 2011; 137:108-10. [DOI: 10.1016/j.medcli.2010.09.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 09/08/2010] [Accepted: 09/09/2010] [Indexed: 11/29/2022]
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54
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Huizar JF, Ellenbogen KA. Hyperresponders to cardiac resynchronization therapy: timing is everything… but size still matters! J Cardiovasc Electrophysiol 2011; 22:912-4. [PMID: 21385266 DOI: 10.1111/j.1540-8167.2011.02040.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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55
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Needleman M, Berger RD. Response to cardiac resynchronization therapy: Substrate matters. Heart Rhythm 2011; 8:383-4. [DOI: 10.1016/j.hrthm.2010.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Indexed: 11/25/2022]
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ADELSTEIN EVAN, SCHWARTZMAN DAVID, GORCSAN III JOHN, SABA SAMIR. Predicting Hyperresponse Among Pacemaker-Dependent Nonischemic Cardiomyopathy Patients Upgraded to Cardiac Resynchronization. J Cardiovasc Electrophysiol 2011; 22:905-11. [DOI: 10.1111/j.1540-8167.2011.02018.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Castellant P, Orhan E, Bertault-Valls V, Fatemi M, Etienne Y, Blanc JJ. Is "hyper response" to cardiac resynchronization therapy in patients with nonischemic cardiomyopathy a recovery, a remission, or a control? Ann Noninvasive Electrocardiol 2011; 15:321-7. [PMID: 20946554 DOI: 10.1111/j.1542-474x.2010.00387.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Some patients treated by cardiac resynchronization therapy (CRT) recover "normal" left ventricular (LV) function and functional status. However, whether this "normalization" persists or reverts over time remains unknown. The aim of the present study was to evaluate the long-term outcomes of LV function in patients hyper responder to CRT. METHODS Eleven consecutive patients with nonischemic dilated cardiomyopathy, sinus rhythm, left bundle branch block (LBBB), New York Heart Association (NYHA) class III or IV, and optimal pharmacological treatment were hyper responder as they fulfilled concurrently the two following criteria: functional recovery (NYHA class I or II) and normalization of LV ejection fraction (LVEF). RESULTS After a mean follow-up of 65 ± 30 months between CRT implantation and last evaluation LVEF improved from 26 ± 9 to 59 ± 6% (P < 0.0001). One patient died from pulmonary embolism 31 months after implantation. Three patients exhibited LVEF ≤ 50% at their last follow-up visit (two at 40% and one at 45%). In eight patients, brief cessation of pacing was feasible (three were pacemaker-dependent). Mean QRS duration decreased from 181 ± 23 ms to 143 ± 22 ms (P = 0.006). In one patient, pacing was interrupted for 2 years and LVEF decreased markedly (from 65% to 31%) but returned to normal after a few months when pacing was resumed. CONCLUSION In hyper responder patients, "normalization" of LV function after CRT persists as long as pacing is maintained with an excellent survival.
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Affiliation(s)
- Philippe Castellant
- Department of Cardiology, Hôpital de la Cavale Blanche, Brest University Hospital, Boulevard Tanguy Prigent, Brest Cedex, France
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Hori Y, Tada H, Nakamura K, Naito S, Nakata Y, Goto K, Imamoto J, Yokokawa M, Tanaka Y, Funabashi N, Aonuma K, Komuro I, Taniguchi K, Oshima S. Presence of structural heart disease and left ventricular dysfunction predict hospitalizations for new-onset heart failure after right ventricular apical pacing. Europace 2010; 13:230-6. [DOI: 10.1093/europace/euq443] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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59
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Spragg DD, Dong J, Fetics BJ, Helm R, Marine JE, Cheng A, Henrikson CA, Kass DA, Berger RD. Optimal Left Ventricular Endocardial Pacing Sites for Cardiac Resynchronization Therapy in Patients With Ischemic Cardiomyopathy. J Am Coll Cardiol 2010; 56:774-81. [PMID: 20797490 DOI: 10.1016/j.jacc.2010.06.014] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2010] [Revised: 06/09/2010] [Accepted: 06/15/2010] [Indexed: 10/19/2022]
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Rickard J, Kumbhani DJ, Popovic Z, Verhaert D, Manne M, Sraow D, Baranowski B, Martin DO, Lindsay BD, Grimm RA, Wilkoff BL, Tchou P. Characterization of super-response to cardiac resynchronization therapy. Heart Rhythm 2010; 7:885-9. [DOI: 10.1016/j.hrthm.2010.04.005] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Accepted: 04/02/2010] [Indexed: 11/15/2022]
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61
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Reant P, Zaroui A, Donal E, Mignot A, Bordachar P, Deplagne A, Solnon A, Ritter P, Daubert JC, Clementy J, Leclercq C, Roudaut R, Habib G, Lafitte S. Identification and characterization of super-responders after cardiac resynchronization therapy. Am J Cardiol 2010; 105:1327-35. [PMID: 20403487 DOI: 10.1016/j.amjcard.2009.12.058] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Revised: 12/04/2009] [Accepted: 12/04/2009] [Indexed: 11/25/2022]
Abstract
Cardiac resynchronization therapy (CRT) has been shown to induce a spectacular effect on left ventricular (LV) function in certain patients. Our aim was to analyze and characterize the super-responders (SRs) to CRT using echocardiography in 186 patients with a conventional indication according to the European Society Cardiology guidelines. The investigation took place before and 6 months after implantation. CRT-SRs were defined by an improvement of the New York Heart Association functional class and LV ejection fraction to > or = 50% in absolute values associated with a relative LV end-systolic volume reduction of > or = 15%. Of the 186 patients, 18 (9.7%) were identified as CRT-SRs and had a significantly lower prevalence of ischemic etiology (11%), lower LV dimensions, lower left atrial volume, and greater global longitudinal strain at baseline. Receiver operating characteristics curves identified global longitudinal strain as the strongest parameter for predicting CRT-SRs, with a cutoff value of -12% (area under the curve 0.87, sensitivity 71%, and specificity 85%, p <0.01). In conclusion, in the present retrospective study, only a left atrial volume <55 ml and global longitudinal strain < or = -12% were independent predictors of CRT-SRs.
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Long-term follow-up of “reversible” dilated cardiomyopathy with improvement of cardiac sympathetic nerve activity after cardiac resynchronization therapy (CRT). J Cardiol Cases 2010; 1:e56-e62. [DOI: 10.1016/j.jccase.2009.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Revised: 06/22/2009] [Accepted: 07/27/2009] [Indexed: 11/21/2022] Open
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63
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Padeletti L, Valleggi A, Vergaro G, Lucà F, Rao CM, Perrotta L, Cappelli F, L'Abbate A, Passino C, Emdin M. Concordant versus discordant left bundle branch block in heart failure patients: novel clinical value of an old electrocardiographic diagnosis. J Card Fail 2010; 16:320-6. [PMID: 20350699 DOI: 10.1016/j.cardfail.2009.12.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Revised: 12/04/2009] [Accepted: 12/09/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Over the last 50 years left bundle branch block (LBBB) has been defined as homophasic (concordant: cLBBB) or heterophasic (discordant: dLBBB) when associated with a positive or negative T wave in leads I and V5-V6, respectively. LBBB is recognized as an adverse prognostic factor in heart failure (HF). The prevalence and clinical significance of cLBBB and dLBBB in HF patients are unknown. METHODS AND RESULTS A total of 897 consecutive systolic HF patients (age 65 +/- 13 years, left ventricular ejection fraction [LVEF], 34 +/- 10%) underwent clinical characterization, electrocardiographic evaluation for LBBB diagnosis and classification, and follow-up for cardiac events (median 37 months, range 1-84). LBBB was diagnosed in 232 patients (26%), cLBBB in 71 (31%), and dLBBB in 161 (69%). The dLBBB patients were older than those with cLBBB, and presented with lower LVEF, greater left ventricular telediastolic diameter and left ventricular mass index, higher level of brain natriuretic peptide, N-terminal pro-brain natriuretic peptide, renin activity, and norepinephrine (all P < .05). At Kaplan-Meier analysis, LBBB (P = .003) and dLBBB (P = .036) were associated with a worse prognosis when the composite end point of sudden death and implantable cardioverter defibrillator shock was considered. CONCLUSIONS In systolic HF, dLBBB is associated with a worse clinical, neurohormonal, and prognostic profile. LBBB classification could represent a useful tool in routine clinical evaluation.
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Affiliation(s)
- Luigi Padeletti
- Postgraduate School of Cardiology, University of Florence, Florence, Italy
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64
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Tops LF, Schalij MJ, Bax JJ. The effects of right ventricular apical pacing on ventricular function and dyssynchrony implications for therapy. J Am Coll Cardiol 2009; 54:764-76. [PMID: 19695453 DOI: 10.1016/j.jacc.2009.06.006] [Citation(s) in RCA: 271] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Revised: 06/16/2009] [Accepted: 06/17/2009] [Indexed: 10/20/2022]
Abstract
Cardiac pacing is the only effective treatment for patients with sick sinus syndrome and atrioventricular conduction disorders. In cardiac pacing, the endocardial pacing lead is typically positioned at the right ventricular (RV) apex. At the same time, there is increasing indirect evidence, derived from large pacing mode selection trials and observational studies, that conventional RV apical pacing may have detrimental effects on cardiac structure and left ventricular function, which are associated with the development of heart failure. These detrimental effects may be related to the abnormal electrical and mechanical activation pattern of the ventricles (or ventricular dyssynchrony) caused by RV apical pacing. Still, it remains uncertain if the deterioration of left ventricular function as noted in a proportion of patients receiving RV apical pacing is directly related to acutely induced left ventricular dyssynchrony. The upgrade from RV pacing to cardiac resynchronization therapy may partially reverse the deleterious effects of RV pacing. It has even been suggested that selected patients with a conventional pacemaker indication should receive cardiac resynchronization therapy to avoid the deleterious effects. This review will provide a contemporary overview of the available evidence on the detrimental effects of RV apical pacing. Furthermore, the available alternatives for patients with a standard pacemaker indication will be discussed. In particular, the role of cardiac resynchronization therapy and alternative RV pacing sites in these patients will be reviewed.
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Affiliation(s)
- Laurens F Tops
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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Varma N. Left ventricular conduction delays and relation to QRS configuration in patients with left ventricular dysfunction. Am J Cardiol 2009; 103:1578-85. [PMID: 19463519 DOI: 10.1016/j.amjcard.2009.01.379] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Revised: 01/31/2009] [Accepted: 01/31/2009] [Indexed: 11/28/2022]
Abstract
Left ventricular activation delay (LVAT) >100 ms may determine response to cardiac resynchronization therapy, but its prevalence and relation to QRS configuration are unknown. QRS duration and LVAT in control subjects (n = 30) were compared with those in patients with heart failure (HF; LV ejection fraction 23 +/- 8%, n = 120) with a QRS duration <120 ms (NQRS(HF), n = 35) or > or = 120 ms (left bundle branch block [LBBB(HF)], n = 54; right bundle branch block [RBBB(HF)], n = 31). LVAT was estimated by interval from QRS onset to basal inferolateral LV depolarization. In controls, QRS duration was 82 +/- 13 ms and LVAT was 55 +/- 18 ms. LVAT was always <100 ms. In patients with NQRS(HF), QRS duration (104 +/- 10 ms) and LVAT (82 +/- 22 ms) were prolonged versus controls (p <0.001). LVAT exceeded 100 ms in 8 of 35 patients. In patients with LBBB(HF), QRS duration (161 +/- 29 ms) and LVAT (136 +/- 33 ms) were prolonged compared with controls and patients with NQRS(HF) (p <0.001). LVAT exceeded 100 ms in 47 of 54 patients. In patients with RBBB(HF), QRS duration did not differ from that in patients with LBBB(HF), but LVAT (100 +/- 24 ms) was shorter (p <0.001). In 17 of 31 patients with RBBB(HF) LVAT was <100 ms (82 +/- 12), similar to those with NQRS(HF) (p = NS), indicating no LV conduction delay. However, in 7 of 31, LVAT (135 +/- 13 ms) was similar to that in patients with LBBB(HF) (p = NS). LVAT correlation with QRS duration varied (control p = 0.004, NQRS(HF) p = 0.15, RBBB(HF) p = 0.01, LBBB(HF) p <0.001). In conclusion, LV conduction delays in patients with HF varied with QRS configuration and duration, exceeding 100 ms in only 23% of patients with narrow QRS configuration and 45% with RBBB(HF) compared with 87% with LBBB(HF). Fewer than 25% of patients with RBBB(HF) demonstrated delays equivalent to those in patients with LBBB(HF.) These variations may affect efficacy to cardiac resynchronization therapy.
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Affiliation(s)
- Niraj Varma
- Cardiac Electrophysiology, Cleveland Clinic, Cleveland, Ohio, USA.
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Long-Term Prognosis After Cardiac Resynchronization Therapy Is Related to the Extent of Left Ventricular Reverse Remodeling at Midterm Follow-Up. J Am Coll Cardiol 2009; 53:483-90. [DOI: 10.1016/j.jacc.2008.10.032] [Citation(s) in RCA: 328] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2008] [Revised: 10/15/2008] [Accepted: 10/19/2008] [Indexed: 11/18/2022]
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Antonio N, Teixeira R, Coelho L, Lourenco C, Monteiro P, Ventura M, Cristovao J, Elvas L, Goncalves L, Providencia LA. Identification of 'super-responders' to cardiac resynchronization therapy: the importance of symptom duration and left ventricular geometry. Europace 2009; 11:343-9. [DOI: 10.1093/europace/eup038] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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68
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Castellant P, Fatemi M, Orhan E, Etienne Y, Blanc JJ. Patients with non-ischaemic dilated cardiomyopathy and hyper-responders to cardiac resynchronization therapy: characteristics and long-term evolution. Europace 2009; 11:350-5. [DOI: 10.1093/europace/eup035] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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69
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Affiliation(s)
- Michael O. Sweeney
- From the Brigham and Women’s Hospital (M.O.S.), Harvard Medical School, Boston, Mass; and the Department of Physiology (F.W.P.), Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Frits W. Prinzen
- From the Brigham and Women’s Hospital (M.O.S.), Harvard Medical School, Boston, Mass; and the Department of Physiology (F.W.P.), Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
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