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Abreu A, Oliveira M, Silva Cunha P, Santa Clara H, Portugal G, Gonçalves Rodrigues I, Santos V, Morais L, Selas M, Soares R, Branco L, Ferreira R, Mota Carmo M. Does permanent atrial fibrillation modify response to cardiac resynchronization therapy in heart failure patients? Rev Port Cardiol 2017; 36:687-694. [DOI: 10.1016/j.repc.2017.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 02/01/2017] [Accepted: 02/21/2017] [Indexed: 11/30/2022] Open
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Does permanent atrial fibrillation modify response to cardiac resynchronization therapy in heart failure patients? REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2017.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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103
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Long-Term Survival of Patients With Left Bundle Branch Block Who Are Hypo-Responders to Cardiac Resynchronization Therapy. Am J Cardiol 2017; 120:825-830. [PMID: 28688704 DOI: 10.1016/j.amjcard.2017.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 05/17/2017] [Accepted: 06/05/2017] [Indexed: 11/24/2022]
Abstract
Guidelines support cardiac resynchronization therapy with a defibrillator (CRT-D) in mild heart failure (HF) patients with left bundle branch block (LBBB). However, not all patients demonstrate echocardiographic or clinical response to CRT-D. We aimed to evaluate the long-term outcomes of echocardiographic hypo-responders and clinical hypo-responders to CRT-D with LBBB in the Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy. Five-hundred thirty-four patients with LBBB in the CRT-D arm were followed for 5.6 years (median). Clinical hypo-response was defined as HF event in the first year after CRT-D implantation. Echocardiographic hypo-response was defined as ≤35% reduction (median) in left ventricular end-systolic volume 1 year after CRT-D implantation without evidence of clinical hypo-response. Echocardiographic and clinical response was observed in 257 patients (48%). Two-hundred fifty patients (47%) were echocardiographic hypo-responders and 27 patients (5%) were clinical hypo-responders. Echocardiographic hypo-responders had increased risk of all-cause mortality compared with echocardiographic + clinical responders (hazard ratio [HR] 2.85, 95% confidence interval [CI]: 1.37 to 5.94, p = 0.005). Clinical hypo-responders had increased risk of mortality compared with echocardiographic + clinical responders (HR 7.49, 95% CI: 2.88 to 19.48, p <0.0001) and compared with echocardiographic hypo-responders (HR 2.63, 95% CI: 1.17 to 5.92, p = 0.020). In conclusion, during long-term follow-up, patients with mild HF and LBBB who have echocardiographic hypo-response to CRT, with or without clinical signs of worsening HF, have increased risk of mortality. This study emphasizes the prognostic significance of echocardiographic assessment of left ventricular volume after CRT implantation in LBBB patients with mild HF.
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104
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Robust and automatic diagnosis of the intraventricular mechanical dyssynchrony for the left ventricle in cardiac magnetic resonance images. Int J Comput Assist Radiol Surg 2017; 12:1471-1480. [DOI: 10.1007/s11548-017-1574-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 03/20/2017] [Indexed: 10/19/2022]
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105
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McAloon CJ, Ali D, Hamborg T, Banerjee P, O'Hare P, Randeva H, Osman F. Extracellular cardiac matrix biomarkers in patients with reduced ejection fraction heart failure as predictors of response to cardiac resynchronisation therapy: a systematic review. Open Heart 2017; 4:e000639. [PMID: 28878953 PMCID: PMC5574440 DOI: 10.1136/openhrt-2017-000639] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 06/26/2017] [Accepted: 07/13/2017] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Cardiac resynchronisation therapy (CRT) is an effective therapy for selected patients with heart failure (HF); however, a significant non-response rate exists. We examined current evidence on extracellular cardiac matrix (ECM) biomarkers in predicting response following CRT. METHODS Complete literature review of PubMed, Ovid SP MEDLINE, Cochrane Library and TRIP, reference lists, international cardiology conferences and ongoing studies between December 1999 and December 2015 conducted according to prospectively registered study selection and analysis criteria (PROSPERO:CRD42016025864) was performed. All observational and randomised control trials (RCT) were included if they tested prespecified ECM biomarkers' ability to predict CRT response. Risk of bias assessment and data extraction determined pooling of included studies was not feasible due to heterogeneity of the selected studies. RESULTS A total of 217 studies were screened; six (five prospective cohort and one RCT substudy) were included in analysis with 415 participants in total. Study sizes varied (n=55-260), cohort characteristics contrasted (male: 67.8%-83.6%, ischaemic aetiology: 40.2%-70.3%) and CRT response definitions differed (three clinical/functional, three echocardiographic). Consistent observation in all ECM biomarker behaviour before and after CRT implantation was not observed between studies. Lower type I and type III collagen synthesis biomarkers (N-terminal propeptides of type I and III procollagens) expression demonstrated replicated ability to predict reverse left ventricular remodelling. CONCLUSION Collagen synthesis biomarkers offer the most potential as ECM biomarkers for predicting CRT response. Heterogeneity between these studies was large and limited the ability to pool and compare results numerically. Use of different response definitions was one of the biggest challenges.
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Affiliation(s)
- Christopher J McAloon
- Department of Cardiology, University Hospital Coventry, Coventry, UK
- Department of Medicine, Warwick Medical School, University of Warwick, Coventry, UK
| | - Danish Ali
- Department of Cardiology, University Hospital Coventry, Coventry, UK
- Department of Medicine, Warwick Medical School, University of Warwick, Coventry, UK
| | - Thomas Hamborg
- Department of Medicine, Warwick Medical School, University of Warwick, Coventry, UK
| | - Prithwish Banerjee
- Department of Cardiology, University Hospital Coventry, Coventry, UK
- Department of Medicine, Warwick Medical School, University of Warwick, Coventry, UK
- Department of Life Sciences, Coventry University, Coventry, UK
| | - Paul O'Hare
- Department of Medicine, Warwick Medical School, University of Warwick, Coventry, UK
| | - Harpal Randeva
- Department of Medicine, Warwick Medical School, University of Warwick, Coventry, UK
| | - Faizel Osman
- Department of Cardiology, University Hospital Coventry, Coventry, UK
- Department of Medicine, Warwick Medical School, University of Warwick, Coventry, UK
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106
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Novel Pacing Strategies for Heart Failure Management. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2017; 19:64. [DOI: 10.1007/s11936-017-0561-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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107
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Stankovic I, Belmans A, Prinz C, Ciarka A, Maria Daraban A, Kotrc M, Aarones M, Szulik M, Winter S, Neskovic AN, Kukulski T, Aakhus S, Willems R, Fehske W, Penicka M, Faber L, Voigt JU. The association of volumetric response and long-term survival after cardiac resynchronization therapy. Eur Heart J Cardiovasc Imaging 2017; 18:1109-1117. [DOI: 10.1093/ehjci/jex188] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 06/26/2017] [Indexed: 01/22/2023] Open
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108
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Bai RJ, Ren SH, Jiang HJ, Li JP, Liu XC, Xue LM. Accuracy of Multi-Slice Spiral Computed Tomography for Preoperative Tumor Node Metastasis (TNM) Staging of Colorectal Carcinoma. Med Sci Monit 2017; 23:3470-3479. [PMID: 28715364 PMCID: PMC5528007 DOI: 10.12659/msm.902649] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background With the advances in imaging technologies, multi-slice spiral computed tomography (MSCT) has demonstrated superiority in the diagnosis and staging of colorectal carcinoma. In the current study, preoperative TNM staging of colorectal carcinoma by using MSCT was conducted and compared with the corresponding postoperative pathological examination findings, in order to evaluate the accuracy of preoperative MSCT for TNM staging. Material/Methods Combinations of biphasic or triphasic enhanced-phase MSCT scans were obtained for 76 patients with colorectal carcinoma, and the TNM stage was determined based on imaging reconstruction from various angles and perspectives to display the size, location, and affected range of tumors. The preoperative TNM stage was compared with the postoperative pathological stage, and the consistency between the 2 methods was tested by the κ test using SPSS 17.0 software. Results Among the different combinations of enhanced-phase MSCT scanning, triphasic MSCT imaging, comprising the arterial, portal venous, and delayed phases, showed the highest accuracy rates, at 81.6% (62/76), 82.89% (63/76), and 96.1% (73/76) for T, N, and M staging, respectively, with κ values of 0.72, 0.65, and 0.56, respectively, indicating consistency with the postoperative pathological staging. Conclusions Combined MSCT scanning comprising the arterial phase, portal venous phase, and delayed phase showed satisfying consistency with the postoperative pathological analysis results for TNM staging of colorectal carcinoma. Thus, MSCT is an important clinical value for improving the accuracy of TNM staging and for planning the appropriate colorectal cancer treatment.
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Affiliation(s)
- Rong-Jie Bai
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China (mainland)
| | - Shao-Hua Ren
- Department of Radiology, The First Hospital of Harbin, Harbin, Heilongjiang, China (mainland)
| | - Hui-Jie Jiang
- Department of Radiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China (mainland)
| | - Jin-Ping Li
- Department of Radiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China (mainland)
| | - Xiao-Cheng Liu
- Department of Radiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China (mainland)
| | - Li-Ming Xue
- Department of Radiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China (mainland)
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109
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Sundaram V, Sahadevan J, Waldo AL, Stukenborg GJ, Reddy YNV, Asirvatham SJ, Mackall JA, Intini A, Wilson B, Simon DI, Bilchick KC. Implantable Cardioverter-Defibrillators With Versus Without Resynchronization Therapy in Patients With a QRS Duration >180 ms. J Am Coll Cardiol 2017; 69:2026-2036. [PMID: 28427578 DOI: 10.1016/j.jacc.2017.02.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 02/02/2017] [Accepted: 02/10/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND More than 20% of Medicare beneficiaries receiving cardiac resynchronization therapy defibrillators (CRT-D) have a very wide (≥180 ms) QRS complex duration (QRSD). Outcomes of CRT-D in these patients are not well-established because they have been underrepresented in clinical trials. OBJECTIVES This study examined outcomes in patients with CRT-D in a very wide QRSD with left bundle branch block (LBBB) versus those without LBBB. METHODS Medicare patients from the Implantable Cardioverter Defibrillator Registry (January 1, 2005, through April 30, 2006) with a CRT-D and confirmed Class I or IIa indications for CRT-D were matched to implantable cardioverter-defibrillator (ICD) patients without CRT despite having Class I or IIa indications for CRT. Mortality and heart failure hospitalizations longer than 4 years with CRT-D versus standard ICDs based on a QRSD and morphology were analyzed. RESULTS We analyzed 24,960 patients. Among those with LBBB, patients with a QRSD ≥180 ms had a greater adjusted survival benefit with CRT-D versus standard ICD (hazard ration [HR] for death: 0.65; 95% confidence interval [CI]: 0.59 to 0.72) compared with those having a QRSD 120 to 149 ms (HR: 0.85; 95% CI: 0.80 to 0.92) and 150 to 179 ms (HR: 0.87; 95% CI: 0.81 to 0.93). CRT-D versus ICD was associated with an improvement in survival in those with LBBB and a QRSD ≥180 ms (adjusted HR for death: 0.78; 95% CI: 0.68 to 0.91), but not in those with LBBB and a QRSD 150 to 179 ms (adjusted HR for death: 1.06; 95% CI: 0.95 to 1.19). CONCLUSIONS Improvements in both survival and heart failure hospitalizations with CRT-D were greatest in patients with a QRSD ≥180 ms with or without LBBB, whereas patients with a QRSD 150 to 179 ms without LBBB had no improvement in survival with CRT-D, and those with a QRSD 150 to 179 ms and LBBB had only a modest improvement.
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Affiliation(s)
- Varun Sundaram
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio; Royal Brompton and Harefield Hospitals, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Jayakumar Sahadevan
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio; Department of Medicine, Louis Stokes Veteran Affairs Medical Center, Cleveland, Ohio.
| | - Albert L Waldo
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - George J Stukenborg
- Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Yogesh N V Reddy
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | | | - Judith A Mackall
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Anselma Intini
- Department of Medicine, Louis Stokes Veteran Affairs Medical Center, Cleveland, Ohio
| | - Brigid Wilson
- Department of Medicine, Louis Stokes Veteran Affairs Medical Center, Cleveland, Ohio
| | - Daniel I Simon
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Kenneth C Bilchick
- Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, Virginia
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Yang N, Liang ZG, Wang ZJ, Liu H, Chi C, Tian YF, Qi SH, Wang BY, Han W. Combined myocardial deformation to predict cardiac resynchronization therapy response in nonischemic cardiomyopathy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:986-994. [PMID: 28691201 DOI: 10.1111/pace.13151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 06/18/2017] [Accepted: 06/27/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND 20-30% of patients do not benefit from cardiac resynchronization therapy (CRT) when the established selection criteria were applied. We hypothesized that a combined assessment of mechanical dyssynchrony, myocardial deformation, and diastolic function would identify patients who would benefit most from CRT. METHOD In 36 CRT patients, clinical evaluation and echocardiography were performed before and after CRT. Patients were classified into three subgroups according to their amount of response: echocardiographic responders, clinical responders, and nonresponders. Radial dyssynchrony and left ventricular (LV) global longitudinal, radial, and circumferential peak strain was assessed by speckle-tracking image. Diastolic function was quantified by conventional echocardiography. RESULT In addition to left bundle branch block, nonspecific intraventricular conduction disturbance with intraventricular dyssynchrony could also improve LV remodeling. Echocardiographic responders had better global longitudinal strain, global circumferential peak strain, and global radial strain at baseline which significantly increased at 12-month follow-up. An improvement in estimates of LV filling pressure and a decrease in mitral regurgitation and left atrial dimensions were observed only in echocardiographic responders to CRT. Patients with clinical but without echocardiographic response showed a significant improvement in atrioventricular (AV) synchrony and a nonsignificant improvement in other parameters. The nonresponder group did not improve the AV and intraventricular dyssynchrony. CRT could not improve restrictive filling pattern with normal filling time. Overall, those patients with AV and intraventricular dyssynchrony and those with best contractile function and short diastolic filling time of restrictive filling pattern at baseline demonstrated the greatest benefit from CRT. CONCLUSIONS Mechanical dyssynchrony, contractile function, and filling pattern are important determinants of the benefits in CRT.
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Affiliation(s)
- Ning Yang
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P. R. China
| | - Zhao-Guang Liang
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P. R. China
| | - Zhao-Jun Wang
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P. R. China
| | - Hui Liu
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P. R. China
| | - Chao Chi
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P. R. China
| | - Yan-Feng Tian
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P. R. China
| | - Shu-Han Qi
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P. R. China
| | - Bi-Yu Wang
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P. R. China
| | - Wei Han
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P. R. China
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111
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McAloon CJ, Theodoreson MD, Hayat S, Osman F. Cardiac resynchronization therapy and its role in the management of heart failure. Br J Hosp Med (Lond) 2017; 78:312-319. [PMID: 28614025 DOI: 10.12968/hmed.2017.78.6.312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The prevalence of heart failure is increasing and it is associated with significant mortality and morbidity. Optimal medical therapy improves outcome, but heart failure continues to have a substantial impact on both the individual patient and wider society. Over the last two decades, cardiac resynchronization therapy has revolutionized the treatment of selected patients who have heart failure. Cardiac resynchronization therapy significantly reduces mortality and hospitalization through reverse cardiac remodelling. This review informs non-specialists about cardiac resynchronization therapy and for which patients it should be considered.
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Affiliation(s)
- Christopher J McAloon
- Cardiology Research Fellow, Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX and Translational & Experimental Medicine, University of Warwick Medical School, Coventry
| | - Mark D Theodoreson
- Core Medical Trainee Year One, Department of Cardiology, University Hospitals Bristol NHS Trust, Bristol Heart Institute, Bristol
| | - Sajad Hayat
- Consultant Cardiologist and Electrophysiologist, Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry
| | - Faizel Osman
- Consultant Cardiologist and Electrophysiologist, Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry and Translational & Experimental Medicine, University of Warwick Medical School, Coventry
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112
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Predictors of response to cardiac resynchronization therapy: A prospective cohort study. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2016.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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113
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Abreu A, Oliveira M, Silva Cunha P, Santa Clara H, Santos V, Portugal G, Rio P, Soares R, Moura Branco L, Alves M, Papoila AL, Ferreira R, Mota Carmo M. Predictors of response to cardiac resynchronization therapy: A prospective cohort study. Rev Port Cardiol 2017; 36:417-425. [PMID: 28554585 DOI: 10.1016/j.repc.2016.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 10/11/2016] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION Cardiac resynchronization therapy (CRT) has modified the prognosis of chronic heart failure (HF) with left ventricular systolic dysfunction. However, 30% of patients do not have a favorable response. The big question is how to determine predictors of response. AIMS To identify baseline characteristics that might influence echocardiographic response to CRT. METHODS AND RESULTS We performed a prospective single-center hospital-based cohort study of consecutive HF patients selected to CRT (NYHA class II-IV, left ventricular ejection fraction (LVEF) <35% and QRS complex ≥120 ms). Responders were defined as those with a ≥5% absolute increase in LVEF at six months. Clinical, electrocardiographic, laboratory, echocardiographic, autonomic, endothelial and cardiopulmonary function parameters were assessed before CRT device implantation. Logistic regression models were used. Seventy-nine patients were included, 54 male (68.4%), age 68.1 years (standard deviation 10.2), 19 with ischemic etiology (24%). At six months, 51 patients (64.6%) were considered responders. Although by univariate analysis baseline tricuspid annular plane systolic excursion (TAPSE) and serum creatinine were significantly different in responders, on multivariate analysis only TAPSE was independently associated with response, with higher values predicting a positive response to CRT (OR=1.13; 95% CI: 1.02-1.26; p=0.020). TAPSE ≥15 mm was strongly associated with response, and TAPSE <15 mm with non-response (p=0.005). Responders had no TAPSE values below 10 mm. CONCLUSION From a range of clinical and technical baseline characteristics, multivariate analysis only identified TAPSE as an independent predictor of CRT response, with TAPSE <15 mm associated with non-response. This study highlights the importance of right ventricular dysfunction in CRT response. ClinicalTrials.gov identifier: NCT02413151.
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Affiliation(s)
- Ana Abreu
- Cardiology Department, Hospital Santa Marta, Central Lisbon Hospital Center, CHLC, Lisbon, Portugal.
| | - Mário Oliveira
- Cardiology Department, Hospital Santa Marta, Central Lisbon Hospital Center, CHLC, Lisbon, Portugal
| | - Pedro Silva Cunha
- Cardiology Department, Hospital Santa Marta, Central Lisbon Hospital Center, CHLC, Lisbon, Portugal
| | - Helena Santa Clara
- Exercise and Health Laboratory, CIPER, Faculty of Human Kinetics, University of Lisbon, Portugal
| | - Vanessa Santos
- Exercise and Health Laboratory, CIPER, Faculty of Human Kinetics, University of Lisbon, Portugal
| | - Guilherme Portugal
- Cardiology Department, Hospital Santa Marta, Central Lisbon Hospital Center, CHLC, Lisbon, Portugal
| | - Pedro Rio
- Cardiology Department, Hospital Santa Marta, Central Lisbon Hospital Center, CHLC, Lisbon, Portugal
| | - Rui Soares
- Cardiology Department, Hospital Santa Marta, Central Lisbon Hospital Center, CHLC, Lisbon, Portugal
| | - Luísa Moura Branco
- Cardiology Department, Hospital Santa Marta, Central Lisbon Hospital Center, CHLC, Lisbon, Portugal
| | - Marta Alves
- Research Unit, Central Lisbon Hospital Center, CHLC, Lisbon, Portugal
| | - Ana Luísa Papoila
- Research Unit, Central Lisbon Hospital Center, CHLC, Lisbon, Portugal
| | - Rui Ferreira
- Cardiology Department, Hospital Santa Marta, Central Lisbon Hospital Center, CHLC, Lisbon, Portugal
| | - Miguel Mota Carmo
- CEDOC, Faculty of Medical Sciences, University Nova, Lisbon, Portugal
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Packer M. Development and Evolution of a Hierarchical Clinical Composite End Point for the Evaluation of Drugs and Devices for Acute and Chronic Heart Failure: A 20-Year Perspective. Circulation 2017; 134:1664-1678. [PMID: 27881506 DOI: 10.1161/circulationaha.116.023538] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Traditional approaches to the assessment of new treatments for heart failure have generally evaluated individual components of the syndrome at fixed points in time or have relied on surrogate physiological measures that are poorly correlated with the clinical status of patients. Conventional time-to-event trials that focus on morbidity and mortality represent an important methodological advance, but they generally assign undue weight to clinical events of less importance and are insensitive to difference in functional capacity among individuals who do not experience a clinical event during follow-up. Twenty years ago, a hierarchical clinical composite was developed to address these limitations; it aims to assess the clinical course of patients as a physician would in practice by combining a symptomatic assessment of the patient at each visit with an evaluation of the clinical stability of the patient between visits. The composite does not generate a numeric score by summing arbitrarily assigned weights to certain symptoms or events; instead, the composite ranks relevant measures and outcomes according to clinical priority. In doing so, the clinical composite minimizes the biases created by noncompleting patients in the assessment of symptoms or exercise tolerance while expanding the range of patients who contribute to the treatment difference in a typical morbidity and mortality trial. When applied appropriately, the hierarchical clinical composite end point has reliably distinguished effective from ineffective treatments. The composite may have particular advantages in the evaluation of new devices and transcatheter interventions in chronic heart failure and of new drugs for acute heart failure. Recent modifications enhance its discriminant characteristics and its ability to accurately assess the efficacy of novel interventions for heart failure.
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Affiliation(s)
- Milton Packer
- From Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX.
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115
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Rickard J, Baranowski B, Wilson Tang WH, Grimm RA, Niebauer M, Cantillion D, Wilkoff BL, Varma N. Echocardiographic Predictors of Long-Term Survival in Patients Undergoing Cardiac Resynchronization Therapy: What Is the Optimal Metric? J Cardiovasc Electrophysiol 2017; 28:410-415. [PMID: 28176410 DOI: 10.1111/jce.13175] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 01/16/2017] [Accepted: 01/17/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Multiple definitions of reverse ventricular remodeling (RVR) employing various changes in left ventricular end-systolic (LVESV) or diastolic volumes (LVEDVs) or left ventricular ejection fraction (LVEF) have been used in determining cardiac resynchronization therapy (CRT) response, making comparability across studies difficult. We compared different metrics to each other, and in combination, in terms of association with long-term outcomes. METHODS We collected clinical and echocardiographic data on 436 patients undergoing CRT. LVEF was assessed via a combined volumetric and visual assessment. Volumes were manually traced. Using a nested multivariate model of a priori determined predictors of long-term survival free of left ventricular assist device (LVAD) or heart transplant, multiple definitions of RVR were added to the model individually to determine which provided the best model fit. RESULTS Over a mean follow-up of 5.4 ± 2.3 years, there were 198 endpoints (10 LVADs, 15 heart transplants, and 173 deaths). When added to a nested model controlling for multiple potential confounders, all definitions of RVR were significantly associated with improved survival. Changes in LVEF and LVESV were superior to changes in LVEDV. A combination metric of an LVEF improvement ≥ 5% and LVESV reduction ≥ 10% was the best overall metric for model fit. CONCLUSIONS Changes in LVESV and LVEF are better predictors of long-term outcome following CRT compared to changes in LVEDV. Adding an assessment of LVEF to reduction in LVESV ≥ 10% provided the best overall definition for RVR in predicting CRT outcomes.
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Affiliation(s)
- John Rickard
- Division of Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bryan Baranowski
- Division of Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - W H Wilson Tang
- Division of Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Richard A Grimm
- Division of Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mark Niebauer
- Division of Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Daniel Cantillion
- Division of Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bruce L Wilkoff
- Division of Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Niraj Varma
- Division of Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
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116
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Abstract
Randomized, controlled trials have shown that cardiac resynchronization therapy (CRT) is beneficial in patients with heart failure, impaired left ventricular (LV) systolic function, and a wide QRS complex. Other studies have shown that targeting the LV pacing site can also improve patient outcomes. Cardiovascular magnetic resonance (CMR) is a radiation-free imaging modality that provides unparalleled spatial resolution. In addition, emerging data suggest that targeted LV lead deployment over viable myocardium improves the outcome of patients undergoing CRT. This review explores the role of CMR in the preoperative workup of patients undergoing CRT.
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Petrovic M, Petrovic M, Milasinovic G, Vujisic Tesic B, Trifunovic D, Petrovic O, Nedeljkovic I, Petrovic I, Banovic M, Boricic-Kostic M, Petrovic J, Arena R, Popovic D. Gauging the response to cardiac resynchronization therapy: The important interplay between predictor variables and definition of a favorable outcome. Echocardiography 2017; 34:371-375. [PMID: 28075037 DOI: 10.1111/echo.13453] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AIMS Selection of patients who are viable candidates for cardiac resynchronization therapy (CRT), prediction of the response to CRT as well as an optimal definition of a favorable response, all require further exploration. The purpose of this study was to evaluate the interplay between the prediction of the response to CRT and the definition of a favorable outcome. METHODS Seventy patients who received CRT were included. All patients met current guideline criteria for CRT. Forty-three echocardiographic parameters were evaluated before CRT and at 1, 3, 6, and 12 months. M-mode, 2D echocardiography, and Doppler imaging were used to quantify left ventricular (LV) systolic and diastolic function, mitral regurgitation, right ventricular systolic function, pulmonary artery pressure, and myocardial mechanical dyssynchrony. The following definitions of a favorable CRT response were used: left ventricular ejection fraction (LVEF) improvement more >5% acutely following CRT, LVEF improvement >20% at 12-month follow-up, and a LV end-systolic volume (LVESV) decrease >15% at 12-month follow-up. RESULTS For the LVEF improvement >5%, the best predictor was isovolumetric relaxation time (IVRT; P=.035). For improvement of LVEF >20%, the best predictors were left ventricular stroke index (LVSI; P=.044) and left ventricular fractional shortening (LVFS; P=.031). For the drop in left ventricular systolic volume (LVESV >15%), the best predictor was septal-to-lateral wall delay (ΔT) (P=.043, RR=1.023, 95% CI for RR=1.001-1.045). CONCLUSION The definition of a favorable CRT response influenced the optimal predictor variable(s). Standardization of defining a favorable response to CRT is needed to guide clinical decision making processes.
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Affiliation(s)
- Milan Petrovic
- Clinic of Cardiology, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marija Petrovic
- Clinic of Cardiology, Clinical Center of Serbia, Belgrade, Serbia
| | - Goran Milasinovic
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Pacemaker Center, Clinical Center of Serbia, Belgrade, Serbia
| | - Bosiljka Vujisic Tesic
- Clinic of Cardiology, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Danijela Trifunovic
- Clinic of Cardiology, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Olga Petrovic
- Clinic of Cardiology, Clinical Center of Serbia, Belgrade, Serbia
| | - Ivana Nedeljkovic
- Clinic of Cardiology, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivana Petrovic
- Clinic of Cardiology, Clinical Center of Serbia, Belgrade, Serbia
| | - Marko Banovic
- Clinic of Cardiology, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Jelena Petrovic
- Clinic of Cardiology, Clinical Center of Serbia, Belgrade, Serbia
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Dejana Popovic
- Clinic of Cardiology, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
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119
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Luparelli M, Buccheri D, Corrado E, Ajello L, Bentivegna R, Ciaramitaro G, Assennato P, Coppola G. The importance of being “responder” in cardiac resynchronization therapy. Int J Cardiol 2016; 223:838-841. [DOI: 10.1016/j.ijcard.2016.08.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 08/07/2016] [Indexed: 10/21/2022]
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120
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Miller EO, Malhotra S, Schwartz RG. Quantitative Radionuclide Assessment of Cardiac Dyssynchrony: Breakthrough in Patient Selection for Cardiac Resynchronization Therapy for Refractory Heart Failure? J Nucl Med 2016; 57:1840-1842. [PMID: 27754903 DOI: 10.2967/jnumed.116.177113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 09/21/2016] [Indexed: 01/06/2023] Open
Affiliation(s)
- Erica O Miller
- Cardiology Division, Department of Medicine, University of Rochester Medical Center Rochester, Rochester, New York
| | - Saurabh Malhotra
- Division of Cardiovascular Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York; and
| | - Ronald G Schwartz
- Cardiology Division, Department of Medicine, University of Rochester Medical Center Rochester, Rochester, New York .,Nuclear Medicine Division, Department of Imaging Sciences, University of Rochester Medical Center Rochester, Rochester, New York
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121
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The Role of Cardiovascular Magnetic Resonance in Cardiac Resynchronization Therapy. Card Electrophysiol Clin 2016; 7:619-33. [PMID: 26596807 DOI: 10.1016/j.ccep.2015.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Randomized, controlled trials have shown that cardiac resynchronization therapy (CRT) is beneficial in patients with heart failure, impaired left ventricular (LV) systolic function, and a wide QRS complex. Other studies have shown that targeting the LV pacing site can also improve patient outcomes. Cardiovascular magnetic resonance (CMR) is a radiation-free imaging modality that provides unparalleled spatial resolution. In addition, emerging data suggest that targeted LV lead deployment over viable myocardium improves the outcome of patients undergoing CRT. This review explores the role of CMR in the preoperative workup of patients undergoing CRT.
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122
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Fumagalli S, Pieragnoli P, Ricciardi G, Mascia G, Mascia F, Michelotti F, Mascioli G, Beltrami M, Padeletti M, Nesti M, Marchionni N, Padeletti L. Cardiac resynchronization therapy improves functional status and cognition. Int J Cardiol 2016; 219:212-7. [DOI: 10.1016/j.ijcard.2016.06.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 06/07/2016] [Indexed: 01/08/2023]
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123
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Kosztin A, Széplaki G, Kovács A, Földes G, Szokodi I, Vivien Nagy K, Kutyifa V, Fórizs É, Végh EM, Gellér L, Becker D, Aradi D, Merkely B. Impact of CT-apelin and NT-proBNP on identifying non-responders to cardiac resynchronization therapy. Biomarkers 2016; 22:279-286. [PMID: 27471876 DOI: 10.1080/1354750x.2016.1217931] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | - Gábor Széplaki
- Heart and Vascular Center Semmelweis University, Budapest, Hungary
| | - Attila Kovács
- Heart and Vascular Center Semmelweis University, Budapest, Hungary
| | - Gábor Földes
- Heart and Vascular Center Semmelweis University, Budapest, Hungary
- National Heart and Lung Institute Imperial College, London, United Kingdom
| | - István Szokodi
- Heart Institute, Medical School, University of Pécs, Pécs, Hungary
| | | | - Valentina Kutyifa
- Heart and Vascular Center Semmelweis University, Budapest, Hungary
- University of Rochester, Medical Center, Rochester, NY, USA
| | - Éva Fórizs
- Heart and Vascular Center Semmelweis University, Budapest, Hungary
| | - Eszter M. Végh
- Heart and Vascular Center Semmelweis University, Budapest, Hungary
| | - László Gellér
- Heart and Vascular Center Semmelweis University, Budapest, Hungary
| | - Dávid Becker
- Heart and Vascular Center Semmelweis University, Budapest, Hungary
| | - Dániel Aradi
- Heart and Vascular Center Semmelweis University, Budapest, Hungary
- Heart Center, Balatonfüred, Hungary
| | - Béla Merkely
- Heart and Vascular Center Semmelweis University, Budapest, Hungary
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124
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McALOON CJ, Anderson BM, Dimitri W, Panting J, Yusuf S, Bhudia SK, Osman F. Long-Term Follow-Up of Isolated Epicardial Left Ventricular Lead Implant Using a Minithoracotomy Approach for Cardiac Resynchronization Therapy. Pacing Clin Electrophysiol 2016; 39:1052-1060. [PMID: 27501471 DOI: 10.1111/pace.12932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 07/20/2016] [Accepted: 07/31/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Transvenous left ventricular (LV) lead placement for cardiac resynchronization therapy is unsuccessful in 5-10% of reported cases. These patients may benefit from isolated surgical placement of an epicardial LV lead via minithoracotomy approach. AIM To evaluate the success of this approach at long-term follow-up. METHODS Retrospective evaluation of all consecutive patients undergoing isolated epicardial LV lead placement after failed transvenous attempt over a 6-year period. Data collected on baseline parameters, procedural details, and outcome at follow-up (hospital stay, complications, mortality, and clinical response). RESULTS Forty-two patients underwent epicardial lead implant. Five died within 1 year (11.9%): two (4.8%) died within 30-days post op (one from intraoperative hemorrhage, the other from multiple organ failure); 39 (95.1%) were admitted to the high dependency unit and transferred to the ward <24 hours. Median hospital stay was 3.4 ± 1.9 days. The overall complication rate was 17.5% (n = 7): 15.0% (n = 6) short term and 2.5% (n = 1) long term; these included three (7.5%) LV noncapture events all treated with reprogramming. There were two (5.0%) wound infections requiring oral antibiotics and two (5.0%) device infections requiring intravenous antibiotics (one had device resiting, the other developed septic shock requiring intensive care admission). Assessment of clinical response was possible in 34 (81.0%) at follow-up: 21 (61.8%) were responders and 13 (28.2%) nonresponders with no significant differences between these groups; no clinical predictors of response were identified. CONCLUSION Isolated epicardial LV lead implant using minithoracotomy is relatively safe and effective at successful LV pacing. Response rate and postoperative recovery at long-term follow-up are reasonable in these high-risk patients.
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Affiliation(s)
| | | | - Wadih Dimitri
- Department of Cardiology, University Hospital Coventry, Coventry, UK
| | - Jonathan Panting
- Department of Cardiology, Good Hope Hospital, Heart of England NHS Trust, Birmingham, UK
| | - Shamil Yusuf
- Department of Cardiology, Good Hope Hospital, Heart of England NHS Trust, Birmingham, UK
| | - Sunil K Bhudia
- Department of Cardiology, University Hospital Coventry, Coventry, UK
| | - Faizel Osman
- Department of Cardiology, University Hospital Coventry, Coventry, UK.
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125
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Zanon F, Marcantoni L, Baracca E, Pastore G, Lanza D, Fraccaro C, Picariello C, Conte L, Aggio S, Roncon L, Pacetta D, Badie N, Noventa F, Prinzen FW. Optimization of left ventricular pacing site plus multipoint pacing improves remodeling and clinical response to cardiac resynchronization therapy at 1 year. Heart Rhythm 2016; 13:1644-51. [DOI: 10.1016/j.hrthm.2016.05.015] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Indexed: 11/29/2022]
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126
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Mazurek M, Jędrzejczyk-Patej E, Lenarczyk R, Liberska A, Przybylska-Siedlecka K, Kozieł M, Morawski S, Podolecki T, Kowalczyk J, Pruszkowska P, Pluta S, Sokal A, Kowalski O, Kalarus Z. Do we need to monitor the percentage of biventricular pacing day by day? Int J Cardiol 2016; 221:81-9. [PMID: 27400302 DOI: 10.1016/j.ijcard.2016.06.075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 05/13/2016] [Accepted: 06/21/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Incidence and clinical significance of transient, daily fluctuations of biventricular pacing percentage (CRT%) remain unknown. We assessed the value of daily remote monitoring in identifying prognostically critical burden of low CRT%. METHODS AND RESULTS Prospective, single-centre registry encompassed 304 consecutive heart failure patients with cardiac resynchronization therapy defibrillators (CRT-D). Patients with 24-h episodes of CRT% loss<95% were assigned to quartiles depending on cumulative time spent in low CRT%: quartile 1 (1-8days), 2 (9-20days), 3 (21-60days) and quartile 4 (>60days). During median follow-up of 35months 51,826 transmissions were analysed, including 15,029 in 208 (68.4%) patients with episodes of low CRT%. Overall, mean CRT%≥95% vs. <95% resulted in a 4-fold lower mortality (17.3 vs. 68.2%; p<0.001). Fifty-four percent of patients experienced episodes of CRT% loss, despite 85.6% having mean CRT%≥95%. Mortality was lowest in quartile 1 (7.7%), while longer periods of CRT% loss resulted in significantly higher death rates (25.0 vs. 34.6 vs. 57.7%; quartiles 2-4 respectively, p<0.001), despite mean CRT% still being ≥95% in quartiles 1-3. Cumulative low CRT% burden was the independent risk factor for death (HR 1.013; 95% CI 1.006-1.021; p<0.001). Mortality rose by 1.3 and 49% with every additional day and quartile of CRT% loss, respectively. CONCLUSIONS Daily remote monitoring allows one to detect 24-h episodes of CRT% loss<95% in over two-thirds of CRT-D recipients during median observation of 3years. Cumulative low CRT% burden (in days) independently predicts mortality before mean CRT% drop.
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Affiliation(s)
- Michał Mazurek
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Medical University, Silesian Centre for Heart Diseases, Zabrze, Poland.
| | - Ewa Jędrzejczyk-Patej
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Medical University, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Radosław Lenarczyk
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Medical University, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Agnieszka Liberska
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Medical University, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Katarzyna Przybylska-Siedlecka
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Medical University, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Monika Kozieł
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Medical University, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Stanisław Morawski
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Medical University, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Tomasz Podolecki
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Medical University, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Jacek Kowalczyk
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Medical University, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Patrycja Pruszkowska
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Medical University, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Sławomir Pluta
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Medical University, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Adam Sokal
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Medical University, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Oskar Kowalski
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Medical University, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Zbigniew Kalarus
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Medical University, Silesian Centre for Heart Diseases, Zabrze, Poland
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Lipar L, Srivathsan K, Scott LR. Short-term outcome of cardiac resynchronization therapy - a comparison between newly implanted and chronically right ventricle-paced patients. Int J Cardiol 2016; 219:195-9. [PMID: 27327506 DOI: 10.1016/j.ijcard.2016.06.054] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 06/13/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) is considered as a standard adjunct therapy in symptomatic patients with congestive heart failure (CHF) who have a prolonged QRS. There is an increasing number of patients who do not receive de novo CRT devices but are upgraded from right ventricular (RV) pacing to biventricular stimulation. We wanted to evaluate the benefit of CRT in patients with chronic RV pacing in comparison to previously non-paced heart failure patients. METHODS One hundred and sixty-five patients who had their device newly implanted (group I) and 116 who were upgraded from previously implanted RV pacing systems (group II) at Mayo Clinic Hospital were retrospectively analyzed. Clinical and echocardiographic response to CRT was evaluated. Mean follow-up time was 290±250days. RESULTS Baseline characteristics did not differ between the two groups of patients. Clinical response rate was identical in Groups I and II (65 vs. 65%, respectively; P=0.98) and echocardiographic response rate was similar in both groups of patients (64 vs. 62%; P=0.80). Post-implant QRS increased in group I and was reduced in group II (5 (27.4) vs. -20.0 (33.9) ms; P<0.001). NYHA class improvement (-0.7 (0.6) vs. -0.7 (0.6), P=0.81), LV ejection fraction increase (9.2 (12.9) vs. 8.2 (9.9)%; P=0.55) and LV end-systolic volume reduction (-34.5 (50.7) vs. -25.7 (47.4)%; P=0.28) were comparable in both groups. CONCLUSIONS Chronically RV-paced patients who receive CRT have similar short-term benefits when compared with patients with new CRT implantations.
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Affiliation(s)
- Luka Lipar
- Mayo Clinic Hospital, 5777 East Mayo Boulevard, Phoenix, AZ 85054, United States.
| | - Komandoor Srivathsan
- Mayo Clinic Hospital, 5777 East Mayo Boulevard, Phoenix, AZ 85054, United States.
| | - Luis Roberto Scott
- Mayo Clinic Hospital, 5777 East Mayo Boulevard, Phoenix, AZ 85054, United States.
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Marek J, Gandalovičová J, Kejřová E, Pšenička M, Linhart A, Paleček T. Echocardiography and cardiac resynchronization therapy. COR ET VASA 2016. [DOI: 10.1016/j.crvasa.2015.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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129
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Wilton SB, Exner DV, Wyse DG, Yetisir E, Wells G, Tang AS, Healey JS. Frequency and Outcomes of Postrandomization Atrial Tachyarrhythmias in the Resynchronization/Defibrillation in Ambulatory Heart Failure Trial. Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.115.003807. [DOI: 10.1161/circep.115.003807] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 03/22/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Stephen B. Wilton
- From the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada (S.B.W., D.V.E., D.G.W.); University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada (E.Y., G.W.); Department of Medicine, Western University, London, United Kingdom (A.S.L.T.); and Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H.)
| | - Derek V. Exner
- From the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada (S.B.W., D.V.E., D.G.W.); University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada (E.Y., G.W.); Department of Medicine, Western University, London, United Kingdom (A.S.L.T.); and Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H.)
| | - D. George Wyse
- From the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada (S.B.W., D.V.E., D.G.W.); University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada (E.Y., G.W.); Department of Medicine, Western University, London, United Kingdom (A.S.L.T.); and Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H.)
| | - Elizabeth Yetisir
- From the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada (S.B.W., D.V.E., D.G.W.); University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada (E.Y., G.W.); Department of Medicine, Western University, London, United Kingdom (A.S.L.T.); and Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H.)
| | - George Wells
- From the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada (S.B.W., D.V.E., D.G.W.); University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada (E.Y., G.W.); Department of Medicine, Western University, London, United Kingdom (A.S.L.T.); and Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H.)
| | - Anthony S.L. Tang
- From the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada (S.B.W., D.V.E., D.G.W.); University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada (E.Y., G.W.); Department of Medicine, Western University, London, United Kingdom (A.S.L.T.); and Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H.)
| | - Jeffrey S. Healey
- From the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada (S.B.W., D.V.E., D.G.W.); University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada (E.Y., G.W.); Department of Medicine, Western University, London, United Kingdom (A.S.L.T.); and Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H.)
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Sommer A, Kronborg MB, Nørgaard BL, Poulsen SH, Bouchelouche K, Böttcher M, Jensen HK, Jensen JM, Kristensen J, Gerdes C, Mortensen PT, Nielsen JC. Multimodality imaging-guided left ventricular lead placement in cardiac resynchronization therapy: a randomized controlled trial. Eur J Heart Fail 2016; 18:1365-1374. [PMID: 27087019 DOI: 10.1002/ejhf.530] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 02/25/2016] [Accepted: 03/03/2016] [Indexed: 12/13/2022] Open
Abstract
AIM Left ventricular (LV) lead position at the latest mechanically activated non-scarred myocardial LV region confers improved response to cardiac resynchronization therapy (CRT). We conducted a double-blind, randomized controlled trial to evaluate the clinical benefit of multimodality imaging-guided LV lead placement in CRT. METHODS AND RESULTS Patients were allocated (1:1) to imaging-guided LV lead placement using cardiac computed tomography (CT) venography, 99m Technetium myocardial perfusion imaging, and speckle-tracking echocardiography radial strain to target the optimal coronary sinus (CS) branch closest to the non-scarred myocardial segment with latest mechanical activation (imaging group, n = 89) or to routine LV lead implantation in a posterolateral region with late electrical activation (control group, n = 93). The primary endpoint was clinical non-response to CRT [≥1 of the following after 6 months: (1) death, (2) heart failure hospitalization, or (3) no improvement in New York Heart Association class and <10% increase in 6-min walk distance]. Secondary outcomes included LV remodelling and the combination of all-cause mortality and hospitalization owing to heart failure during 1.8 ± 0.9 years. Analysis was intention-to-treat. In the imaging group, fewer patients reached the primary endpoint (26% vs. 42%, P = 0.02). More patients in the imaging group had the LV lead placed in the optimal CS branch (83% vs. 65%, P = 0.01). There were no between-group differences in reverse LV remodelling or the combined endpoint of death or hospitalizations for heart failure. CONCLUSIONS Multimodality imaging-guided LV lead placement towards the CS branch closest to latest mechanically activated non-scarred myocardial LV segment reduces the proportion of clinical non-responders to CRT. Larger long-term multicentre studies are needed.
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Affiliation(s)
- Anders Sommer
- Department of Cardiology, Aarhus University Hospital, Skejby, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus N, Denmark.
| | - Mads Brix Kronborg
- Department of Cardiology, Aarhus University Hospital, Skejby, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus N, Denmark
| | - Bjarne Linde Nørgaard
- Department of Cardiology, Aarhus University Hospital, Skejby, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus N, Denmark
| | - Steen Hvitfeldt Poulsen
- Department of Cardiology, Aarhus University Hospital, Skejby, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus N, Denmark
| | - Kirsten Bouchelouche
- Department of Nuclear Medicine, Aarhus University Hospital, Skejby, Aarhus N, Denmark
| | - Morten Böttcher
- Department of Cardiology, Herning Hospital, Herning, Denmark
| | - Henrik Kjaerulf Jensen
- Department of Cardiology, Aarhus University Hospital, Skejby, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus N, Denmark
| | - Jesper Møller Jensen
- Department of Cardiology, Aarhus University Hospital, Skejby, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus N, Denmark
| | - Jens Kristensen
- Department of Cardiology, Aarhus University Hospital, Skejby, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus N, Denmark
| | - Christian Gerdes
- Department of Cardiology, Aarhus University Hospital, Skejby, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus N, Denmark
| | - Peter Thomas Mortensen
- Department of Cardiology, Aarhus University Hospital, Skejby, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus N, Denmark
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Skejby, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus N, Denmark
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Khan SG, Klettas D, Kapetanakis S, Monaghan MJ. Clinical utility of speckle-tracking echocardiography in cardiac resynchronisation therapy. Echo Res Pract 2016; 3:R1-R11. [PMID: 27249816 PMCID: PMC5402657 DOI: 10.1530/erp-15-0032] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 03/08/2016] [Indexed: 11/08/2022] Open
Abstract
Cardiac resynchronisation therapy (CRT) can profoundly improve outcome in selected patients with heart failure; however, response is difficult to predict and can be absent in up to one in three patients. There has been a substantial amount of interest in the echocardiographic assessment of left ventricular dyssynchrony, with the ultimate aim of reliably identifying patients who will respond to CRT. The measurement of myocardial deformation (strain) has conventionally been assessed using tissue Doppler imaging (TDI), which is limited by its angle dependence and ability to measure in a single plane. Two-dimensional speckle-tracking echocardiography is a technique that provides measurements of strain in three planes, by tracking patterns of ultrasound interference ('speckles') in the myocardial wall throughout the cardiac cycle. Since its initial use over 15 years ago, it has emerged as a tool that provides more robust, reproducible and sensitive markers of dyssynchrony than TDI. This article reviews the use of two-dimensional and three-dimensional speckle-tracking echocardiography in the assessment of dyssynchrony, including the identification of echocardiographic parameters that may hold predictive potential for the response to CRT. It also reviews the application of these techniques in guiding optimal LV lead placement pre-implant, with promising results in clinical improvement post-CRT.
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Affiliation(s)
- Sitara G Khan
- King's College London British Heart Foundation Centre, London, UK Department of Cardiology, King's College Hospital, London, UK
| | | | | | - Mark J Monaghan
- King's College London British Heart Foundation Centre, London, UK Department of Cardiology, King's College Hospital, London, UK
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132
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123I-mIBG imaging predicts functional improvement and clinical outcome in patients with heart failure and CRT implantation. Int J Cardiol 2016; 207:107-9. [DOI: 10.1016/j.ijcard.2016.01.131] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 01/05/2016] [Indexed: 11/19/2022]
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133
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Xiong Q, Lu B, Ye H, Wu X, Zhang T, Li Y. The Diagnostic Value of Neuropathy Symptom and Change Score, Neuropathy Impairment Score and Michigan Neuropathy Screening Instrument for Diabetic Peripheral Neuropathy. Eur Neurol 2015; 74:323-7. [PMID: 26684759 DOI: 10.1159/000441449] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 10/04/2015] [Indexed: 11/19/2022]
Abstract
AIMS This study aims to evaluate the diagnostic capabilities of neuropathy symptom and change (NSC) score, neuropathy impairment score (NIS) and Michigan neuropathy screening instrument (MNSI) in diagnosing diabetic peripheral neuropathy (DPN). METHODS A total of 131 patients with type II diabetes received NSC, NIS and MNSI scoring systems. Electromyography/nerve conduction velocity (EMG/NCV) test was taken as gold standard. Correlations between EMG/NCV test and the 3 scorings, and their sensitivity, specificity, positive and negative predictive values, accuracy and kappa (x03BA;) value were analyzed. RESULTS The prevalence of DPN was 43.5% according to EMG/NCV findings. EMG/NCV test was significantly positive correlated with all the 3 scorings, highest with NIS scoring (r = 0.653, p < 0.001). Compared with EMG/NCV test, NSC score was most sensitive (85.96%) but least specific (77.03%); NIS score had lower sensitivity (59.65%) but best specificity (98.65%) and accuracy (81.68%). Both had high concordance with EMG/NCV test (x03BA; = 0.61). Sensitivity, specificity and accuracy of MNSI were highest (70.18, 98.65 and 80.15%) at the cutoff values of >1.0, >2.5 and >1.5, respectively (x03BA; = 0.58). CONCLUSIONS Both NSC and NIS were accurate and reliable diagnostic methods for DPN. The combined application of NSC and NIS was recommended in DPN diagnosis.
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Affiliation(s)
- Qian Xiong
- Department of Endocrinology, Jing'an District Central Hospital (Fudan University Affiliated Huashan Hospital Jing'an Branch), Shanghai, China
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134
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Abstract
This review discusses the state of the art of knowledge to help decision making in patients who are candidates for cardiac resynchronization therapy (CRT) and to analyze the long-term total and cardiac mortality, sudden death, and CRT with a defibrillator intervention rate, as well as the evolution of echocardiographic parameters in patients with a left ventricular (LV) ejection fraction of greater than 50% after CRT implantation. Owing to normalization of LV function in super-responders, the need for a persistent defibrillator backup is also considered.
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Affiliation(s)
| | - Daniele Muser
- Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Domenico Facchin
- University Hospital Santa Maria della Misericordia, Udine 33100, Italy
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135
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Prognostic implication of baseline PR interval in cardiac resynchronization therapy recipients. Heart Rhythm 2015; 12:2256-62. [DOI: 10.1016/j.hrthm.2015.06.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Indexed: 11/20/2022]
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136
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Huntsinger ME, Rabara R, Peralta I, Doshi RN. Current Technology to Maximize Cardiac Resynchronization Therapy Benefit for Patients With Symptomatic Heart Failure. AACN Adv Crit Care 2015. [DOI: 10.4037/nci.0000000000000113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The incidence of heart failure (HF) continues to increase, affecting millions of people in the United States each year. Cardiac resynchronization therapy (CRT) has been used and studied for patients with symptomatic HF for more than 20 years. The purpose of this article is to review technologies and developments to help maximize CRT for patients with symptomatic HF. Although most interventions to optimize CRT are physician directed, nurses also have an important role in the care and education of patients with symptomatic HF and can affect clinical outcomes. Therefore, nurses’ understanding of CRT and measures to maximize this lifesaving therapy is critical in HF management.
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Affiliation(s)
- Mary Eng Huntsinger
- Mary Eng Huntsinger is Cardiac Electrophysiology Nurse Practitioner, Keck Hospital of USC, 1510 San Pablo Blvd, Suite 322, Los Angeles, CA 90033 . Roselou Rabara is Heart Failure Nurse Practitioner, Keck Hospital of USC, Los Angeles, California. Irene Peralta is Registered Nurse, Keck Hospital of USC, Los Angeles, California. Rahul N. Doshi is Director of Electrophysiology, University of Southern California Keck School of Medicine, Los Angeles
| | - Roselou Rabara
- Mary Eng Huntsinger is Cardiac Electrophysiology Nurse Practitioner, Keck Hospital of USC, 1510 San Pablo Blvd, Suite 322, Los Angeles, CA 90033 . Roselou Rabara is Heart Failure Nurse Practitioner, Keck Hospital of USC, Los Angeles, California. Irene Peralta is Registered Nurse, Keck Hospital of USC, Los Angeles, California. Rahul N. Doshi is Director of Electrophysiology, University of Southern California Keck School of Medicine, Los Angeles
| | - Irene Peralta
- Mary Eng Huntsinger is Cardiac Electrophysiology Nurse Practitioner, Keck Hospital of USC, 1510 San Pablo Blvd, Suite 322, Los Angeles, CA 90033 . Roselou Rabara is Heart Failure Nurse Practitioner, Keck Hospital of USC, Los Angeles, California. Irene Peralta is Registered Nurse, Keck Hospital of USC, Los Angeles, California. Rahul N. Doshi is Director of Electrophysiology, University of Southern California Keck School of Medicine, Los Angeles
| | - Rahul N. Doshi
- Mary Eng Huntsinger is Cardiac Electrophysiology Nurse Practitioner, Keck Hospital of USC, 1510 San Pablo Blvd, Suite 322, Los Angeles, CA 90033 . Roselou Rabara is Heart Failure Nurse Practitioner, Keck Hospital of USC, Los Angeles, California. Irene Peralta is Registered Nurse, Keck Hospital of USC, Los Angeles, California. Rahul N. Doshi is Director of Electrophysiology, University of Southern California Keck School of Medicine, Los Angeles
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137
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Abstract
Cardiac resynchronisation therapy (CRT) is an effective intervention for appropriately selected patients with heart failure, but exactly how it works is uncertain. Recent data suggest that much, or perhaps most, of the benefits of CRT are not delivered by re-coordinating left ventricular dyssynchrony. Atrio-ventricular resynchronization, reduction in mitral regurgitation and prevention of bradycardia are other potential mechanisms of benefit that will vary from one patient to the next and over time. Because there is no single therapeutic target, it is unlikely that any single measure will accurately predict benefit. The only clinical characteristic that appears to be a useful predictor of the benefits of CRT is a QRS duration of >140 ms. Many new approaches are being developed to try to improve the effectiveness of and extend the indications for CRT. These include smart pacing algorithms, better pacing-site targeting, new sensors, multipoint pacing, remote device monitoring and leadless endocardial pacing. Whether CRT is effective in patients with atrial fibrillation or whether adding a defibrillator function to CRT improves prognosis awaits further evidence.
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138
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Abstract
PURPOSE OF REVIEW Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in patients with mild-to-severe heart failure. However, up to 40% of CRT recipients are nonresponders. This review addresses important aspects with regard to the identification and management of CRT nonresponders. RECENT FINDINGS Mid-term clinical or echocardiographic nonresponse is associated with worse clinical outcomes during the extended follow-up. A number of predictors are indicative of CRT response, which include patient characteristics, electrical determinants, and imaging techniques from preimplant to postimplant period, and can be grouped as modifiable and nonmodifiable contributors to treatment response. Advanced age, male sex, ischemic cause, end-stage heart failure, inadequate electrical delay, and absence of mechanical dyssynchrony are regarded as unfavorable but nonmodifiable factors, for which considering underutilization of CRT by refining patient selection is reasonable. On the contrary, more efforts should be made to optimize patient management by correcting those modifiable factors, such as suboptimal medical therapy, uncontrolled atrial fibrillation, left ventricular lead dislodgement or inappropriate location, loss of biventricular capture, and lack of device optimization. SUMMARY Proper management and careful selection of CRT recipients will transform a proportion of treatment nonresponders into responders, which is vital to improve patients' outcome.
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139
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Kusiak A, Wiliński J, Wojciechowska W, Jastrzębski M, Sondej T, Kloch-Badełek M, Czarnecka DM. Echocardiographic assessment of right ventricular function in responders and non-responders to cardiac resynchronization therapy. Arch Med Sci 2015; 11:736-42. [PMID: 26322084 PMCID: PMC4548031 DOI: 10.5114/aoms.2015.53292] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 06/29/2013] [Accepted: 08/30/2013] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION The aim of this study was to determine whether baseline right ventricular (RV) function assessed by standard echocardiography may indicate patients who will respond to cardiac resynchronization therapy (CRT). MATERIAL AND METHODS The data of 57 patients (54 men, 95%), aged 66.4 ±8.7 years with heart failure (HF) having a CRT device implanted were collected. All patients had left ventricular ejection fraction (LVEF) ≤ 35% and QRS complex duration ≥ 120 ms. Echocardiographic examination with tissue Doppler imaging techniques and complex RV evaluation were performed at baseline and three months after CRT onset. RESULTS Three months after CRT implantation, patients responding to CRT, defined as a reduction of left ventricle end-systolic volume (LVESV) of at least 10% (n = 34), compared to patients with a reduction of LVESV of less than 10% (n = 23), had at baseline a smaller right atrium diameter (47.85 ±11.33 mm vs. 52.65 ±8.69 mm; p = 0.028), higher TAPSE (14.56 ±2.57 mm vs. 13.04 ±2.93 mm; p = 0.030) and lower grade of tricuspid valve regurgitation (1.82 ±0.97 vs. 2.3 ±0.88; p = 0.033). CONCLUSIONS This study showed that there are differences in baseline right ventricular function between responders and non-responders to CRT. Yet in our study, none of the baseline RV parameters provided any value in identifying patients who would respond to CRT.
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Affiliation(s)
- Aleksander Kusiak
- 1 Department of Cardiology, Interventional Electrocardiology and Anterial Hypertension, the University Hospital, Krakow, Poland
| | - Jerzy Wiliński
- 1 Department of Cardiology, Interventional Electrocardiology and Anterial Hypertension, the University Hospital, Krakow, Poland
| | - Wiktoria Wojciechowska
- 1 Department of Cardiology, Interventional Electrocardiology and Anterial Hypertension, the University Hospital, Krakow, Poland
| | - Marek Jastrzębski
- 1 Department of Cardiology, Interventional Electrocardiology and Anterial Hypertension, the University Hospital, Krakow, Poland
| | - Tomasz Sondej
- 1 Department of Cardiology, Interventional Electrocardiology and Anterial Hypertension, the University Hospital, Krakow, Poland
| | - Małgorzata Kloch-Badełek
- 1 Department of Cardiology, Interventional Electrocardiology and Anterial Hypertension, the University Hospital, Krakow, Poland
| | - Danuta M Czarnecka
- 1 Department of Cardiology, Interventional Electrocardiology and Anterial Hypertension, the University Hospital, Krakow, Poland
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140
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Hartlage GR, Suever JD, Clement-Guinaudeau S, Strickland PT, Ghasemzadeh N, Magrath RP, Parikh A, Lerakis S, Hoskins MH, Leon AR, Lloyd MS, Oshinski JN. Prediction of response to cardiac resynchronization therapy using left ventricular pacing lead position and cardiovascular magnetic resonance derived wall motion patterns: a prospective cohort study. J Cardiovasc Magn Reson 2015; 17:57. [PMID: 26170046 PMCID: PMC4501253 DOI: 10.1186/s12968-015-0158-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 06/22/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Despite marked benefits in many heart failure patients, a considerable proportion of patients treated with cardiac resynchronization therapy (CRT) fail to respond appropriately. Recently, a "U-shaped" (type II) wall motion pattern identified by cardiovascular magnetic resonance (CMR) has been associated with improved CRT response compared to a homogenous (type I) wall motion pattern. There is also evidence that a left ventricular (LV) lead localized to the latest contracting LV site predicts superior response, compared to an LV lead localized remotely from the latest contracting LV site. METHODS We prospectively evaluated patients undergoing CRT with pre-procedural CMR to determine the presence of type I and type II wall motion patterns and pre-procedural echocardiography to determine end systolic volume (ESV). We assessed the final LV lead position on post-procedural fluoroscopic images to determine whether the lead was positioned concordant to or remote from the latest contracting LV site. CRT response was defined as a ≥ 15% reduction in ESV on a 6 month follow-up echocardiogram. RESULTS The study included 33 patients meeting conventional indications for CRT with a mean New York Heart Association class of 2.8 ± 0.4 and mean LV ejection fraction of 28 ± 9%. Overall, 55% of patients were echocardiographic responders by ESV criteria. Patients with both a type II pattern and an LV lead concordant to the latest contracting site (T2CL) had a response rate of 92%, compared to a response rate of 33% for those without T2CL (p = 0.003). T2CL was the only independent predictor of response on multivariate analysis (odds ratio 18, 95% confidence interval 1.6-206; p = 0.018). T2CL resulted in significant incremental improvement in prediction of echocardiographic response (increase in the area under the receiver operator curve from 0.69 to 0.84; p = 0.038). CONCLUSIONS The presence of a type II wall motion pattern on CMR and a concordant LV lead predicts superior CRT response. Improving patient selection by evaluating wall motion pattern and targeting LV lead placement may ultimately improve the response rate to CRT.
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Affiliation(s)
- Gregory R Hartlage
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA.
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
| | - Jonathan D Suever
- Department of Biomedical Engineering, Georgia Institute of Technology/Emory University, Atlanta, GA, USA.
| | | | - Patrick T Strickland
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
| | - Nima Ghasemzadeh
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
| | - R Patrick Magrath
- Department of Biomedical Engineering, Georgia Institute of Technology/Emory University, Atlanta, GA, USA.
| | - Ankit Parikh
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
| | - Stamatios Lerakis
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA.
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
| | - Michael H Hoskins
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
| | - Angel R Leon
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
| | - Michael S Lloyd
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
| | - John N Oshinski
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA.
- Department of Biomedical Engineering, Georgia Institute of Technology/Emory University, Atlanta, GA, USA.
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141
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Lappegård KT, Bjørnstad H, Mollnes TE, Hovland A. Effect of Cardiac Resynchronization Therapy on Inflammation in Congestive Heart Failure: A Review. Scand J Immunol 2015; 82:191-8. [PMID: 26099323 DOI: 10.1111/sji.12328] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 06/16/2015] [Indexed: 11/30/2022]
Abstract
Congestive heart failure is associated with increased levels of several inflammatory mediators, and animal studies have shown that infusion of a number of cytokines can induce heart failure. However, several drugs with proven efficacy in heart failure have failed to affect inflammatory mediators, and anti-inflammatory therapy in heart failure patients has thus far been disappointing. Hence, to what extent heart failure is caused by or responsible for the increased inflammatory burden in the patient is still unclear. Over the past couple of decades, resynchronization therapy with a biventricular pacemaker has emerged as an effective treatment in a subset of heart failure patients, reducing both morbidity and mortality. Such treatment has also been shown to affect the inflammation associated with heart failure. In this study, we review recent data on the association between heart failure and inflammation, and in particular how resynchronization therapy can affect the inflammatory process.
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Affiliation(s)
- K T Lappegård
- Cardiac Care Unit, Division of Internal Medicine, Nordland Hospital, Bodø, Norway.,Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway
| | - H Bjørnstad
- Cardiac Care Unit, Division of Internal Medicine, Nordland Hospital, Bodø, Norway.,Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway
| | - T E Mollnes
- Research Laboratory, Nordland Hospital, Bodø and K.G. Jebsen TREC, University of Tromsø, Tromsø, Norway.,Department of Immunology, Oslo University Hospital and K.G. Jebsen IRC, University of Oslo, Oslo, Norway.,Centre of Molecular Inflammation Research, Norwegian University of Science and Technology, Trondheim, Norway
| | - A Hovland
- Cardiac Care Unit, Division of Internal Medicine, Nordland Hospital, Bodø, Norway.,Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway
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142
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Jackson T, Claridge S, Behar J, Sammut E, Webb J, Carr-White G, Razavi R, Rinaldi CA. Narrow QRS systolic heart failure: is there a target for cardiac resynchronization? Expert Rev Cardiovasc Ther 2015; 13:783-97. [PMID: 26048215 DOI: 10.1586/14779072.2015.1049945] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Cardiac resynchronization therapy has revolutionized the management of systolic heart failure in patients with prolonged QRS during the past 20 years. Initially, the use of this treatment in patients with shorter QRS durations showed promising results, which have since been opposed by larger randomized controlled trials. Despite this, some questions remain, such as, whether correction of mechanical dyssynchrony is the therapeutic target by which biventricular pacing may confer benefit in this group, or are there other mechanisms that need consideration? In addition, novel techniques of cardiac resynchronization therapy delivery such as endocardial and multisite pacing may reduce potential detrimental effects of biventricular pacing, thereby improving the benefit/harm balance of this therapy in some patients.
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Affiliation(s)
- Tom Jackson
- Department of Cardiovascular Imaging, 4th Floor Lambeth Wing, St Thomas' Hospital, London, SE1 7EH, UK
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143
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Improving cardiac resynchronization therapy response with multipoint left ventricular pacing: Twelve-month follow-up study. Heart Rhythm 2015; 12:1250-8. [DOI: 10.1016/j.hrthm.2015.02.008] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Indexed: 11/24/2022]
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144
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Lalani GG, Birgersdotter-Green U. Cardiac resynchronisation therapy in patients with chronic heart failure. Heart 2015; 101:1008-14. [PMID: 25882504 DOI: 10.1136/heartjnl-2014-306835] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 03/18/2015] [Indexed: 11/04/2022] Open
Abstract
Cardiac resynchronisation therapy (CRT) is common treatment for congestive heart failure (HF) with decreased LV function and wide QRS complex. Its foundations are set in the understanding of the pathophysiology of ventricular dyssynchrony. Over the last several decades, CRT has evolved through changes in implantation techniques, device and lead design, imaging modalities and our growing clinical experience. This review article will discuss the vast clinical experience that has led to current guidelines recommendations for CRT in patients with mild-to-severe HF. In addition, the article will also discuss recent evidence of benefits of CRT in patients beyond the guidelines. The article will also address the issue of non-responders, optimisation of CRT, postimplant evaluation and remote monitoring.
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145
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146
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Pappone C, alovi A, Cuko A, McSpadden LC, Ryu K, Jordan CD, Saviano M, Baldi M, Pappone A, Dozza L, Giannelli L, Fragakis N, Vicedomini G, Santinelli V. Multipoint left ventricular pacing provides additional echocardiographic benefit to responders and non-responders to conventional cardiac resynchronization therapy. Eur Heart J Suppl 2015. [DOI: 10.1093/eurheartj/suv005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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147
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High sensitivity C-reactive protein and cardfiac resynchronization therapy in patients with advanced heart failure. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2015; 11:296-302. [PMID: 25593578 PMCID: PMC4294146 DOI: 10.11909/j.issn.1671-5411.2014.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 09/03/2014] [Accepted: 09/25/2014] [Indexed: 11/28/2022]
Abstract
Background The data on the prognostic values of high sensitivity C-reactive protein (hsCRP) levels in patients with advanced symptomatic heart failure (HF) receiving cardiac resynchronization therapy (CRT) are scarce. The aim of present study was to investigate the association of serum hsCRP levels with left ventricle reverse remodeling after six months of CRT as well as long-term outcome. Methods A total of 232 CRT patients were included. The assessment of hsCRP values, clinical status and echocardiographic data were performed at baseline and after six months of CRT. Long-term follow-up included all-cause mortality and hospitalizations for HF. Results During the mean follow-up periods of 31.3 ± 31.5 months, elevated hsCRP (> 3 mg/L) prior to CRT was associated with a significant 2.39-fold increase (P = 0.006) in the risk of death or HF hospitalizations. At 6-month follow-up, patients who responded to CRT showed significant reductions or maintained low in hsCRP levels (–0.5 ± 4.1 mg/L reduction) compared with non-responders (1.7 ± 6.1 mg/L increase, P = 0.018). Compared with patients in whom 6-month hsCRP levels were reduced or remained low, patients in whom 6-month hsCRP levels were increased or maintained high experienced a significantly higher risk of subsequent death or HF hospitalizations (Log-rank P < 0.001). The echocardiographic improvement was also better among patients in whom 6-month hsCRP levels were reduced or remained low compared to those in whom 6-month hsCRP levels were raised or maintained high. Conclusions Our findings demonstrated that measurement of baseline and follow-up hsCRP levels may be useful as prognostic markers for timely potential risk stratification and subsequent appropriate treatment strategies in patients with advanced HF undergoing CRT.
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148
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Schmitz B, De Maria R, Gatsios D, Chrysanthakopoulou T, Landolina M, Gasparini M, Campolo J, Parolini M, Sanzo A, Galimberti P, Bianchi M, Lenders M, Brand E, Parodi O, Lunati M, Brand SM. Identification of Genetic Markers for Treatment Success in Heart Failure Patients. ACTA ACUST UNITED AC 2014; 7:760-70. [DOI: 10.1161/circgenetics.113.000384] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background—
Cardiac resynchronization therapy (CRT) can improve ventricular size, shape, and mass and reduce mitral regurgitation by reverse remodeling of the failing ventricle. About 30% of patients do not respond to this therapy for unknown reasons. In this study, we aimed at the identification and classification of CRT responder by the use of genetic variants and clinical parameters.
Methods and Results—
Of 1421 CRT patients, 207 subjects were consecutively selected, and CRT responder and nonresponder were matched for their baseline parameters before CRT. Treatment success of CRT was defined as a decrease in left ventricular end-systolic volume >15% at follow-up echocardiography compared with left ventricular end-systolic volume at baseline. All other changes classified the patient as CRT nonresponder. A genetic association study was performed, which identified 4 genetic variants to be associated with the CRT responder phenotype at the allelic (
P
<0.035) and genotypic (
P
<0.031) level: rs3766031 (
ATPIB1
), rs5443 (
GNB3
), rs5522 (
NR3C2
), and rs7325635 (
TNFSF11
). Machine learning algorithms were used for the classification of CRT patients into responder and nonresponder status, including combinations of the identified genetic variants and clinical parameters.
Conclusions—
We demonstrated that rule induction algorithms can successfully be applied for the classification of heart failure patients in CRT responder and nonresponder status using clinical and genetic parameters. Our analysis included information on alleles and genotypes of 4 genetic loci, rs3766031 (
ATPIB1
), rs5443 (
GNB3
), rs5522 (
NR3C2
), and rs7325635 (
TNFSF11
), pathophysiologically associated with remodeling of the failing ventricle.
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Affiliation(s)
- Boris Schmitz
- From the Institute of Sports Medicine, Molecular Genetics of Cardiovascular Disease (B.S., S.-M.B.) and Internal Medicine D, Department of Nephrology, Hypertension and Rheumatology (B.S., M. Lenders, E.B.), University Hospital Münster, Münster, Germany; Cardiothoracic and Vascular Department, CNR Institute of Clinical Physiology, Niguarda Ca’ Granda Hospital, Milan, Italy (R.D.M., J.C., M.P., O.P.); University of Ioannina, Department of Biomedical Research, Ioannina University Campus (D.G.); Neuron
| | - Renata De Maria
- From the Institute of Sports Medicine, Molecular Genetics of Cardiovascular Disease (B.S., S.-M.B.) and Internal Medicine D, Department of Nephrology, Hypertension and Rheumatology (B.S., M. Lenders, E.B.), University Hospital Münster, Münster, Germany; Cardiothoracic and Vascular Department, CNR Institute of Clinical Physiology, Niguarda Ca’ Granda Hospital, Milan, Italy (R.D.M., J.C., M.P., O.P.); University of Ioannina, Department of Biomedical Research, Ioannina University Campus (D.G.); Neuron
| | - Dimitris Gatsios
- From the Institute of Sports Medicine, Molecular Genetics of Cardiovascular Disease (B.S., S.-M.B.) and Internal Medicine D, Department of Nephrology, Hypertension and Rheumatology (B.S., M. Lenders, E.B.), University Hospital Münster, Münster, Germany; Cardiothoracic and Vascular Department, CNR Institute of Clinical Physiology, Niguarda Ca’ Granda Hospital, Milan, Italy (R.D.M., J.C., M.P., O.P.); University of Ioannina, Department of Biomedical Research, Ioannina University Campus (D.G.); Neuron
| | - Theodora Chrysanthakopoulou
- From the Institute of Sports Medicine, Molecular Genetics of Cardiovascular Disease (B.S., S.-M.B.) and Internal Medicine D, Department of Nephrology, Hypertension and Rheumatology (B.S., M. Lenders, E.B.), University Hospital Münster, Münster, Germany; Cardiothoracic and Vascular Department, CNR Institute of Clinical Physiology, Niguarda Ca’ Granda Hospital, Milan, Italy (R.D.M., J.C., M.P., O.P.); University of Ioannina, Department of Biomedical Research, Ioannina University Campus (D.G.); Neuron
| | - Maurizio Landolina
- From the Institute of Sports Medicine, Molecular Genetics of Cardiovascular Disease (B.S., S.-M.B.) and Internal Medicine D, Department of Nephrology, Hypertension and Rheumatology (B.S., M. Lenders, E.B.), University Hospital Münster, Münster, Germany; Cardiothoracic and Vascular Department, CNR Institute of Clinical Physiology, Niguarda Ca’ Granda Hospital, Milan, Italy (R.D.M., J.C., M.P., O.P.); University of Ioannina, Department of Biomedical Research, Ioannina University Campus (D.G.); Neuron
| | - Maurizio Gasparini
- From the Institute of Sports Medicine, Molecular Genetics of Cardiovascular Disease (B.S., S.-M.B.) and Internal Medicine D, Department of Nephrology, Hypertension and Rheumatology (B.S., M. Lenders, E.B.), University Hospital Münster, Münster, Germany; Cardiothoracic and Vascular Department, CNR Institute of Clinical Physiology, Niguarda Ca’ Granda Hospital, Milan, Italy (R.D.M., J.C., M.P., O.P.); University of Ioannina, Department of Biomedical Research, Ioannina University Campus (D.G.); Neuron
| | - Jonica Campolo
- From the Institute of Sports Medicine, Molecular Genetics of Cardiovascular Disease (B.S., S.-M.B.) and Internal Medicine D, Department of Nephrology, Hypertension and Rheumatology (B.S., M. Lenders, E.B.), University Hospital Münster, Münster, Germany; Cardiothoracic and Vascular Department, CNR Institute of Clinical Physiology, Niguarda Ca’ Granda Hospital, Milan, Italy (R.D.M., J.C., M.P., O.P.); University of Ioannina, Department of Biomedical Research, Ioannina University Campus (D.G.); Neuron
| | - Marina Parolini
- From the Institute of Sports Medicine, Molecular Genetics of Cardiovascular Disease (B.S., S.-M.B.) and Internal Medicine D, Department of Nephrology, Hypertension and Rheumatology (B.S., M. Lenders, E.B.), University Hospital Münster, Münster, Germany; Cardiothoracic and Vascular Department, CNR Institute of Clinical Physiology, Niguarda Ca’ Granda Hospital, Milan, Italy (R.D.M., J.C., M.P., O.P.); University of Ioannina, Department of Biomedical Research, Ioannina University Campus (D.G.); Neuron
| | - Antonio Sanzo
- From the Institute of Sports Medicine, Molecular Genetics of Cardiovascular Disease (B.S., S.-M.B.) and Internal Medicine D, Department of Nephrology, Hypertension and Rheumatology (B.S., M. Lenders, E.B.), University Hospital Münster, Münster, Germany; Cardiothoracic and Vascular Department, CNR Institute of Clinical Physiology, Niguarda Ca’ Granda Hospital, Milan, Italy (R.D.M., J.C., M.P., O.P.); University of Ioannina, Department of Biomedical Research, Ioannina University Campus (D.G.); Neuron
| | - Paola Galimberti
- From the Institute of Sports Medicine, Molecular Genetics of Cardiovascular Disease (B.S., S.-M.B.) and Internal Medicine D, Department of Nephrology, Hypertension and Rheumatology (B.S., M. Lenders, E.B.), University Hospital Münster, Münster, Germany; Cardiothoracic and Vascular Department, CNR Institute of Clinical Physiology, Niguarda Ca’ Granda Hospital, Milan, Italy (R.D.M., J.C., M.P., O.P.); University of Ioannina, Department of Biomedical Research, Ioannina University Campus (D.G.); Neuron
| | - Michele Bianchi
- From the Institute of Sports Medicine, Molecular Genetics of Cardiovascular Disease (B.S., S.-M.B.) and Internal Medicine D, Department of Nephrology, Hypertension and Rheumatology (B.S., M. Lenders, E.B.), University Hospital Münster, Münster, Germany; Cardiothoracic and Vascular Department, CNR Institute of Clinical Physiology, Niguarda Ca’ Granda Hospital, Milan, Italy (R.D.M., J.C., M.P., O.P.); University of Ioannina, Department of Biomedical Research, Ioannina University Campus (D.G.); Neuron
| | - Malte Lenders
- From the Institute of Sports Medicine, Molecular Genetics of Cardiovascular Disease (B.S., S.-M.B.) and Internal Medicine D, Department of Nephrology, Hypertension and Rheumatology (B.S., M. Lenders, E.B.), University Hospital Münster, Münster, Germany; Cardiothoracic and Vascular Department, CNR Institute of Clinical Physiology, Niguarda Ca’ Granda Hospital, Milan, Italy (R.D.M., J.C., M.P., O.P.); University of Ioannina, Department of Biomedical Research, Ioannina University Campus (D.G.); Neuron
| | - Eva Brand
- From the Institute of Sports Medicine, Molecular Genetics of Cardiovascular Disease (B.S., S.-M.B.) and Internal Medicine D, Department of Nephrology, Hypertension and Rheumatology (B.S., M. Lenders, E.B.), University Hospital Münster, Münster, Germany; Cardiothoracic and Vascular Department, CNR Institute of Clinical Physiology, Niguarda Ca’ Granda Hospital, Milan, Italy (R.D.M., J.C., M.P., O.P.); University of Ioannina, Department of Biomedical Research, Ioannina University Campus (D.G.); Neuron
| | - Oberdan Parodi
- From the Institute of Sports Medicine, Molecular Genetics of Cardiovascular Disease (B.S., S.-M.B.) and Internal Medicine D, Department of Nephrology, Hypertension and Rheumatology (B.S., M. Lenders, E.B.), University Hospital Münster, Münster, Germany; Cardiothoracic and Vascular Department, CNR Institute of Clinical Physiology, Niguarda Ca’ Granda Hospital, Milan, Italy (R.D.M., J.C., M.P., O.P.); University of Ioannina, Department of Biomedical Research, Ioannina University Campus (D.G.); Neuron
| | - Maurizio Lunati
- From the Institute of Sports Medicine, Molecular Genetics of Cardiovascular Disease (B.S., S.-M.B.) and Internal Medicine D, Department of Nephrology, Hypertension and Rheumatology (B.S., M. Lenders, E.B.), University Hospital Münster, Münster, Germany; Cardiothoracic and Vascular Department, CNR Institute of Clinical Physiology, Niguarda Ca’ Granda Hospital, Milan, Italy (R.D.M., J.C., M.P., O.P.); University of Ioannina, Department of Biomedical Research, Ioannina University Campus (D.G.); Neuron
| | - Stefan-Martin Brand
- From the Institute of Sports Medicine, Molecular Genetics of Cardiovascular Disease (B.S., S.-M.B.) and Internal Medicine D, Department of Nephrology, Hypertension and Rheumatology (B.S., M. Lenders, E.B.), University Hospital Münster, Münster, Germany; Cardiothoracic and Vascular Department, CNR Institute of Clinical Physiology, Niguarda Ca’ Granda Hospital, Milan, Italy (R.D.M., J.C., M.P., O.P.); University of Ioannina, Department of Biomedical Research, Ioannina University Campus (D.G.); Neuron
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149
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Naegeli B, Brunner-La Rocca HP, Attenhofer Jost C, Fah-Gunz A, Maurer D, Bertel O, Scharf C. Clinical Long-Term Response to Cardiac Resynchronization Therapy Is Independent of Persisting Echocardiographic Markers of Dyssynchrony. Cardiol Res 2014; 5:163-170. [PMID: 28352448 PMCID: PMC5358264 DOI: 10.14740/cr368w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2014] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The aim of the study was to prove the concept that correction of established parameters of dyssynchrony is a requirement for favorable long-term outcome in patients with cardiac resynchronization therapy (CRT), whereas patients with persisting dyssynchrony should have a less favorable response. METHODS After CRT implantation and optimization of dyssynchrony parameters, we evaluated whether correction or persistence of dyssynchrony predicted long-term outcome. Primary endpoint was a combination of cardiac mortality/heart transplantation and hospitalization due to worsening heart failure, and secondary endpoint was NYHA class. RESULTS One hundred twenty-eight consecutive patients (mean age 68 ± 10 years) undergoing CRT with a mean left ventricular ejection fraction of 27±9% were followed for 27 ± 19 months. All cause mortality was 17.2%, cardiac mortality was 7.8% and 3.1% had to undergo heart transplantation. Rehospitalization due to worsening heart failure was observed in 14.8%. NYHA class before CRT implantation was 2.8 ± 0.8 and improved during follow-up to 2.0 ± 0.8 (P < 0.001). A clinical response was observed in 76% (n = 97) and an echocardiographic response was documented in 66% (n = 85). After individually optimized AV and VV intervals with echocardiography, atrioventricular dyssynchrony was still present in 7.2%, interventricular dyssynchrony in 13.3% and intraventricular dyssynchrony in 16.4%. Despite persistent atrioventricular, interventricular and intraventricular dyssynchrony at long-term follow-up, the combined primary and secondary endpoints did not differ compared to the group without mechanical dyssynchrony (P = ns). QRS duration with biventricular stimulation did not differ between responders vs. nonresponders. CONCLUSION After successful CRT implantation, clinical long-term response is independent of correction of dyssynchrony measured by echocardiographic parameters and QRS width.
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Affiliation(s)
- Barbara Naegeli
- HerzGefassZentrum, Klinik Im Park, Seestrasse 247, CH-8027 Zurich, Switzerland
| | - Hans-Peter Brunner-La Rocca
- Department of Cardiology, Maastricht University Medical Centre, PO Box 5800, NL-6202 AZ Maastricht, The Netherlands
| | | | - Anja Fah-Gunz
- HerzGefassZentrum, Klinik Im Park, Seestrasse 247, CH-8027 Zurich, Switzerland
| | - Dominik Maurer
- HerzGefassZentrum, Klinik Im Park, Seestrasse 247, CH-8027 Zurich, Switzerland
| | - Osmund Bertel
- HerzGefassZentrum, Klinik Im Park, Seestrasse 247, CH-8027 Zurich, Switzerland
| | - Christoph Scharf
- HerzGefassZentrum, Klinik Im Park, Seestrasse 247, CH-8027 Zurich, Switzerland
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150
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Gamble JHP, Betts TR. Multisite left ventricular pacing in cardiac resynchronization therapy. Future Cardiol 2014; 10:469-77. [PMID: 25301310 DOI: 10.2217/fca.14.31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Cardiac resynchronization therapy is an effective treatment for selected patients with heart failure and left bundle branch block dyssynchrony. Unfortunately, about a third of patients, so-called nonresponders, do not display any symptomatic or structural improvements after the treatment. In another 5% of patients, the left ventricular lead cannot be implanted due to technical limitations. Novel quadripolar pacing lead and associated multisite pacing technology has the potential to help improve both of these problems. The technology and applications of these leads are reviewed and the novel technique of multisite pacing from two poles of one quadripolar lead is discussed. This technology may improve response to cardiac resynchronization therapy for some patients.
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Affiliation(s)
- James H P Gamble
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, OX3 9DU, UK
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