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Effect of Continued Cardiac Resynchronization Therapy on Ventricular Arrhythmias After Left Ventricular Assist Device Implantation. Am J Cardiol 2016; 118:556-9. [PMID: 27328958 DOI: 10.1016/j.amjcard.2016.05.050] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/23/2016] [Accepted: 05/23/2016] [Indexed: 11/21/2022]
Abstract
Cardiac resynchronization therapy (CRT) reduces ventricular arrhythmia (VA) burden in some patients with heart failure, but its effect after left ventricular assist device (LVAD) implantation is unknown. We compared VA burden in patients with CRT devices in situ who underwent LVAD implantation and continued CRT (n = 39) to those who had CRT turned off before discharge (n = 26). Implantable cardioverter-defibrillator (ICD) shocks were significantly reduced in patients with continued CRT (1.5 ± 2.7 shocks per patient vs 5.5 ± 9.3 with CRT off, p = 0.014). There was a nonsignificant reduction in cumulative VA episodes per patient with CRT continued at discharge (42 ± 105 VA per patient vs 82 ± 198 with CRT off, p = 0.29). On-treatment analysis by whether CRT was on or off identified a significantly lower burden of VA (17 ± 1 per patient-year CRT on vs 37 ± 1 per patient-year CRT off, p <0.0001) and ICD shocks (1.2 ± 0.3 per patient-year CRT on vs 1.7 ± 0.3 per patient-year CRT off, p = 0.018). In conclusion, continued CRT is associated with significantly reduced ICD shocks and VA burden after LVAD implantation.
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402
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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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403
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Agrawal S, Garg L, Nanda S, Sharma A, Bhatia N, Manda Y, Singh A, Fegley M, Shirani J. The role of implantable cardioverter-defibrillators in patients with continuous flow left ventricular assist devices - A meta-analysis. Int J Cardiol 2016; 222:379-384. [PMID: 27505320 DOI: 10.1016/j.ijcard.2016.07.257] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 07/12/2016] [Accepted: 07/30/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Left ventricular assist devices (LVADs) and implantable cardioverter defibrillators (ICD) are each known to improve mortality in patients with advanced congestive heart failure (CHF). If ICDs contribute to improved survival specifically in recipients of LVADs is currently unknown. AIM To evaluate the impact of presence of ICD on mortality in continuous flow LVAD recipients. METHODS A meta- analysis of available literature was performed. PubMed, Embase and Google Scholar databases were searched for studies that compared mortality in continuous flow LVAD patients with ICDs (new implantation or no de-activation) and without ICDs (including de-activation of existing implant). Pooled analysis using a fixed effects model was used for outcomes of interest. RESULTS We included 3 observational studies for a total of 292 patients (203 (69.5%) with ICD versus 89 (30.5%) without ICD). The presence of an active ICD was not associated with improved survival [OR 0.63, 95% CI 0.33-1.18; p=0.15]. In bridge to transplantation [BT] patients (224 patients, 149 with ICD versus 75 without ICD), an active ICD was not associated with a higher probability of survivzal [OR 1.47, 95% CI 0.78-2.76; p=0.23]. There was no difference in the occurrence of severe right ventricular dysfunction or failure between two groups [OR 0.78, 95% CI 0.42-1.47; p=0.45]. The risk of LVAD related complications were similar [OR 0.68, 95% CI 0.35-1.31; P=0.25]. CONCLUSION This meta-analysis demonstrates that there is no survival benefit with ICD in heart failure patients supported with continuous flow LVAD. There is an urgent need of large-scale randomized trials to specifically address this issue.
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Affiliation(s)
- Sahil Agrawal
- Division of Cardiology, Department of Medicine, St. Luke's University Health Network, Bethlehem, PA 18015, USA.
| | - Lohit Garg
- Department of Medicine, Beaumont Health System, Royal Oak, MI, USA
| | - Sudip Nanda
- Division of Cardiology, Department of Medicine, St. Luke's University Health Network, Bethlehem, PA 18015, USA
| | - Abhishek Sharma
- Division of Cardiology, Department of Medicine, State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA
| | - Nirmanmoh Bhatia
- Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Yugandhar Manda
- Division of Cardiology, Department of Medicine, St. Luke's University Health Network, Bethlehem, PA 18015, USA
| | - Amitoj Singh
- Division of Cardiology, Department of Medicine, St. Luke's University Health Network, Bethlehem, PA 18015, USA
| | - Mark Fegley
- Division of Cardiology, Department of Medicine, St. Luke's University Health Network, Bethlehem, PA 18015, USA
| | - Jamshid Shirani
- Division of Cardiology, Department of Medicine, St. Luke's University Health Network, Bethlehem, PA 18015, USA
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404
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Sabbag A, Goldenberg I, Moss AJ, McNitt S, Glikson M, Biton Y, Jackson L, Polonsky B, Zareba W, Kutyifa V. Predictors and Risk of Ventricular Tachyarrhythmias or Death in Black and White Cardiac Patients. JACC Clin Electrophysiol 2016; 2:448-455. [DOI: 10.1016/j.jacep.2016.03.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 02/25/2016] [Accepted: 03/10/2016] [Indexed: 11/16/2022]
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405
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Karaca O, Gunes HM, Omaygenc MO, Cakal B, Cakal SD, Demir GG, Kizilirmak F, Gokdeniz T, Barutcu I, Boztosun B, Kilicaslan F. Predicting Ventricular Arrhythmias in Cardiac Resynchronization Therapy: The Impact of Persistent Electrical Dyssynchrony. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:969-77. [PMID: 27333978 DOI: 10.1111/pace.12908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 05/03/2016] [Accepted: 06/09/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although response to cardiac resynchronization therapy (CRT) has been conventionally assessed with left ventricular volume reduction, ventricular arrhythmias (ventricular tachycardia/ventricular fibrillation [VT/VF]) are of critical importance associated with unfavorable outcomes even in the "superresponders" to therapy. We evaluated the predictors of VT/VF and the association of residual dyssynchrony during follow-up. METHODS Ninety-five patients receiving CRT were followed-up for 9 ± 3 months. Post-CRT dyssynchrony was defined as a prolonged QRS duration (QRSd) for persistent electrical dyssynchrony (ED), and a Yu index ≥ 33 ms for persistent mechanical dyssynchrony. The first VT/VF episode, including nonsustained VT detected on device interrogation and/or appropriate antitachycardia pacing or shock for VT/VF, were the end points of the study. RESULTS Forty-five patients who reached the study end points had significantly lower mean ΔQRS (baseline QRSd - post-CRT QRSd) values than those without VT/VF (-20.8 ± 28.9 ms vs -6.6 ± 30.7 ms, P = 0.022). Both the baseline and post-CRT QRSds, along with the Yu index values, were not different in two groups. Patients with VT/VF were statistically more likely to have persistent ED (38% vs 9%, P = 0.021). Kaplan-Meier curves showed that a negative ΔQRS was associated with a higher incidence of VT/VF during follow-up (P = 0.016). A multivariate Cox model revealed that QRS prolongation was an independent predictor of VT/VF after CRT (P = 0.029). CONCLUSIONS A negative ΔQRS, also called persistent ED, is associated with VT/VF. Narrowest possible QRSd might be a reliable goal of both implantation and optimization of devices to reduce arrhythmic events after CRT.
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Affiliation(s)
- Oguz Karaca
- Cardiology Department, Medipol University Faculty of Medicine, Istanbul, Turkey.
| | - Haci M Gunes
- Cardiology Department, Medipol University Faculty of Medicine, Istanbul, Turkey
| | | | - Beytullah Cakal
- Cardiology Department, Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Sinem Deniz Cakal
- Cardiology Department, Medipol University Faculty of Medicine, Istanbul, Turkey
| | | | - Filiz Kizilirmak
- Cardiology Department, Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Tayyar Gokdeniz
- Cardiology Department, Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Irfan Barutcu
- Cardiology Department, Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Bilal Boztosun
- Cardiology Department, Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Fethi Kilicaslan
- Cardiac Electrophysiology, Medipol University Faculty of Medicine, Istanbul, Turkey
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406
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016; 37:2129-2200. [PMID: 27206819 DOI: 10.1093/eurheartj/ehw128] [Citation(s) in RCA: 9016] [Impact Index Per Article: 1127.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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407
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Or CK, Tao D, Wang H. The effectiveness of the use of consumer health information technology in patients with heart failure: A meta-analysis and narrative review of randomized controlled trials. J Telemed Telecare 2016; 23:155-166. [PMID: 26759365 DOI: 10.1177/1357633x15625540] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Purpose The purpose of this study was to examine whether the use of consumer health information technologies (CHITs) has an impact on outcomes of patients in the self-management of heart failure (HF). Methods A literature search of six electronic databases was conducted to identify relevant reports of randomized controlled trials (RCTs) for the analysis. Mortality, hospitalization and length of hospital stay were meta-analyzed and other patient outcomes were synthesized using a narrative approach. Results The literature search identified 50 studies, representing 43 RCTs, comparing the use of CHITs with usual care for HF patients. The meta-analysis showed that the use of CHITs reduced the risk of HF-caused mortality (relative risk (RR) = 0.70, 95% confidence interval (CI): 0.54-0.91), p = 0.007), lowered the risk of HF-caused hospitalization (RR = 0.80, 95% CI: 0.66-0.96), p = 0.020), and shortened HF-caused length of hospital stay (mean difference = -0.52, 95% CI: -0.77 to -0.27, p < 0.00), but not all-cause mortality, all-cause hospitalization or all-cause length of hospital stay, compared with usual care. The narrative synthesis indicated that only a small proportion of the trials reported positive effects of CHITs over usual care. Conclusions Evidence from RCTs presents mixed results on the impacts of CHITs for HF management. Further studies are required to assess whether and how CHITs would play a role in enhancing health care and patient outcomes and what specific CHIT features and functions are relevant to different HF treatment goals and self-care objectives.
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Affiliation(s)
- Calvin Kl Or
- 1 Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong, China
| | - Da Tao
- 2 Institute of Human Factors and Ergonomics, College of Mechatronics and Control Engineering, Shenzhen University, China
| | - Hailiang Wang
- 1 Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong, China
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408
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Sustained clinical benefit of cardiac resynchronization therapy in non-LBBB patients with prolonged PR-interval: MADIT-CRT long-term follow-up. Clin Res Cardiol 2016; 105:944-952. [DOI: 10.1007/s00392-016-1003-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 05/30/2016] [Indexed: 10/21/2022]
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409
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Chia N, Fulcher J, Keech A. Beta-blocker, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, nitrate-hydralazine, diuretics, aldosterone antagonist, ivabradine, devices and digoxin (BANDAID(2) ): an evidence-based mnemonic for the treatment of systolic heart failure. Intern Med J 2016; 46:653-62. [PMID: 26109136 DOI: 10.1111/imj.12839] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Heart failure causes significant morbidity and mortality, with recognised underutilisation rates of guideline-based therapies. Our aim was to review current evidence for heart failure treatments and derive a mnemonic summarising best practice, which might assist physicians in patient care. Treatments were identified for review from multinational society guidelines and recent randomised trials, with a primary aim of examining their effects in systolic heart failure patients on mortality, hospitalisation rates and symptoms. Secondary aims were to consider other clinical benefits. MEDLINE and EMBASE were searched using a structured keyword strategy and the retrieved articles were evaluated methodically to produce an optimised reference list for each treatment. We devised the mnemonic BANDAID (2) , standing for beta-blocker, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, nitrate-hydralazine (or potentially neprilysin inhibitor), diuretics, aldosterone antagonist, ivabradine, devices (automatic implantable cardioverter defibrillator, cardiac resynchronisation therapy or both) and digoxin as a representation of treatments with strong evidence for their use in systolic heart failure. Treatment with omega-3 fatty acids, statins or anti-thrombotic therapies has limited benefits in a general heart failure population. Adoption of this mnemonic for current evidence-based treatments for heart failure may help improve prescribing rates and patient outcomes in this debilitating, high mortality condition.
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Affiliation(s)
- N Chia
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - J Fulcher
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - A Keech
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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410
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Japp AG, Gulati A, Cook SA, Cowie MR, Prasad SK. The Diagnosis and Evaluation of Dilated Cardiomyopathy. J Am Coll Cardiol 2016; 67:2996-3010. [DOI: 10.1016/j.jacc.2016.03.590] [Citation(s) in RCA: 237] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 03/21/2016] [Accepted: 03/21/2016] [Indexed: 01/23/2023]
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411
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Menet A, Bardet-Bouchery H, Guyomar Y, Graux P, Delelis F, Castel AL, Heuls S, Cuvelier E, Gevaert C, Ennezat PV, Tribouilloy C, Maréchaux S. Prognostic importance of postoperative QRS widening in patients with heart failure receiving cardiac resynchronization therapy. Heart Rhythm 2016; 13:1636-43. [PMID: 27236025 DOI: 10.1016/j.hrthm.2016.05.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Landmark reports have suggested that patients with QRS widening immediately after cardiac resynchronization therapy (CRT) experienced less frequently reverse left ventricular remodeling during follow-up. OBJECTIVE We sought to investigate the relationship between postoperative QRS widening relative to baseline and mortality in a prospective cohort of heart failure patients receiving CRT. METHODS A 12-lead electrocardiogram was recorded for 237 heart failure patients (New York Heart Association class II to IV, left ventricular ejection fraction ≤35%, and QRS width ≥120 ms) before and immediately after CRT device implantation. The relationships between QRS widening, all-cause and cardiovascular mortality, and echocardiographic response to CRT were studied. RESULTS During a median follow-up of 24 months, 39 patients died. Fifty patients (21%) experienced QRS widening after CRT [QRS(+) group]. During follow-up, all-cause mortality was higher in QRS(+) patients than in QRS(-) patients (36-month survival free from death 81% ± 7% vs 64% ± 16%; log rank, P = .029). After adjustment for important prognostic confounders, QRS(+) patients remained associated with an excess overall mortality (adjusted hazard ratio [HR] 2.67; 95% confidence interval 1.07-6.65; P = .035) and cardiovascular mortality (adjusted hazard ratio 3.63; 95% confidence interval 1.13-11.65; P = .03). QRS(+) patients were less frequent responders to CRT than were QRS(-) patients (20 [47%] vs 136 [83%]; P < .0001). CONCLUSION Postoperative QRS widening relative to baseline after CRT is associated with a considerable increased mortality risk during follow-up. Whether QRS narrowing should be achieved to optimize CRT placement, and thereby increase the rate of CRT responders and improve outcome, deserves further research.
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Affiliation(s)
- Aymeric Menet
- GCS-Groupement des hôpitaux de l'institut Catholique de Lille/Faculté Libre de Médecine, Département de Cardiologie, Université Catholique de Lille, Lille, France; INSERM U 1088, Université de Picardie, Amiens, France
| | - Hélène Bardet-Bouchery
- GCS-Groupement des hôpitaux de l'institut Catholique de Lille/Faculté Libre de Médecine, Département de Cardiologie, Université Catholique de Lille, Lille, France; Centre Hospitalier de la région de Saint Omer, Saint Omer, France
| | - Yves Guyomar
- GCS-Groupement des hôpitaux de l'institut Catholique de Lille/Faculté Libre de Médecine, Département de Cardiologie, Université Catholique de Lille, Lille, France
| | - Pierre Graux
- GCS-Groupement des hôpitaux de l'institut Catholique de Lille/Faculté Libre de Médecine, Département de Cardiologie, Université Catholique de Lille, Lille, France
| | - François Delelis
- GCS-Groupement des hôpitaux de l'institut Catholique de Lille/Faculté Libre de Médecine, Département de Cardiologie, Université Catholique de Lille, Lille, France
| | - Anne-Laure Castel
- GCS-Groupement des hôpitaux de l'institut Catholique de Lille/Faculté Libre de Médecine, Département de Cardiologie, Université Catholique de Lille, Lille, France
| | - Sébastien Heuls
- GCS-Groupement des hôpitaux de l'institut Catholique de Lille/Faculté Libre de Médecine, Département de Cardiologie, Université Catholique de Lille, Lille, France
| | - Estelle Cuvelier
- GCS-Groupement des hôpitaux de l'institut Catholique de Lille/Faculté Libre de Médecine, Département de Cardiologie, Université Catholique de Lille, Lille, France
| | - Cécile Gevaert
- GCS-Groupement des hôpitaux de l'institut Catholique de Lille/Faculté Libre de Médecine, Département de Cardiologie, Université Catholique de Lille, Lille, France
| | | | - Christophe Tribouilloy
- INSERM U 1088, Université de Picardie, Amiens, France; Pôle Cardiovasculaire et Thoracique, Centre Hospitalier Universitaire Amiens, Amiens, France
| | - Sylvestre Maréchaux
- GCS-Groupement des hôpitaux de l'institut Catholique de Lille/Faculté Libre de Médecine, Département de Cardiologie, Université Catholique de Lille, Lille, France; INSERM U 1088, Université de Picardie, Amiens, France.
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412
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Cannon JA, Collier TJ, Shen L, Swedberg K, Krum H, Van Veldhuisen DJ, Vincent J, Pocock SJ, Pitt B, Zannad F, McMurray JJV. Clinical outcomes according to QRS duration and morphology in the Eplerenone in Mild Patients: Hospitalization and SurvIval Study in Heart Failure (EMPHASIS-HF). Eur J Heart Fail 2016; 17:707-16. [PMID: 26139584 DOI: 10.1002/ejhf.303] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 05/02/2015] [Accepted: 05/07/2015] [Indexed: 11/07/2022] Open
Abstract
AIMS We examined the relationship between different degrees of QRS prolongation and different QRS morphologies and clinical outcomes in patients with heart failure, reduced ejection fraction (HF-REF), and mild symptoms in the Eplerenone in Mild Patients Hospitalization and SurvIval Study in Heart Failure trial (EMPHASIS-HF). We also evaluated the effect of eplerenone in these patients according to QRS duration/morphology. METHODS AND RESULTS Patients were categorized as: QRS duration (ms) (i) <120 (n = 1375); (ii) 120-149 (n = 517); and (iii) ≥150 (n = 383), and QRS morphology (i) normal (n = 1252); (ii) left bundle branch block (BBB) (n = 608); and (iii) right BBB/intraventricular conduction defect (IVCD) (n = 415). The outcomes examined were the composite of cardiovascular death or heart failure hospitalization and all-cause mortality. Both abnormal QRS duration and QRS morphology were associated with higher risk, e.g. the rates of the composite outcome were: 10.2, 17.6, and 15.5 per 100 patient-years in the <120, 120-149, and ≥150 ms groups, respectively. Eplerenone reduced the risk of the primary outcome and mortality, compared with placebo, consistently across the QRS duration/morphology subgroups. CONCLUSION We found that even moderate prolongation of QRS duration and right BBB/IVCD were associated with a high risk of adverse outcomes in HF-REF. Eplerenone was similarly effective, irrespective of QRS duration/morphology.
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Affiliation(s)
- Jane A Cannon
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | | | - Li Shen
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | | | | | | | | | | | | | - Faiez Zannad
- Nancy Université, Nancy, France Inserm, Université de Lorraine and CHU de Nancy, Nancy, France
| | - John J V McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
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413
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur J Heart Fail 2016; 18:891-975. [DOI: 10.1002/ejhf.592] [Citation(s) in RCA: 4631] [Impact Index Per Article: 578.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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414
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Atrial fibrillation burden and atrial fibrillation type: Clinical significance and impact on the risk of stroke and decision making for long-term anticoagulation. Vascul Pharmacol 2016; 83:26-35. [PMID: 27196706 DOI: 10.1016/j.vph.2016.03.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 03/04/2016] [Accepted: 03/24/2016] [Indexed: 12/20/2022]
Abstract
Atrial fibrillation (AF) is a common arrhythmia increasing the risk of morbidity and adverse outcomes (stroke, heart failure, death). AF is found in 1-2% of the general population, with increasing prevalence with aging. Its exact epidemiological profile is incomplete and underestimated, because 10-40% of AF patients (particularly the elderly) can be asymptomatic ("clinically silent or subclinical AF"), with occasional electrocardiographic diagnosis. The research interest on silent AF has increased by the evidence that its outcome is no less severe, in terms of risks of stroke and death, than that for symptomatic patients. Data collected from more than 18,000 patients indicate that cardiac implantable electrical devices (CIEDs) are validated tools for detecting silent AF and measuring the time spent in AF, defined as "AF burden." A maximum daily AF burden of ≥5-6min, but particularly ≥1h, is associated with a significant increase in the risk of stroke, and may be clinically relevant to improve current risk stratification based on risk scores and for "personalizing" prescription of oral anticoagulants. An in-depth study of the temporal relationship between AF and ischemic stroke showed that data from CIEDs reveal a complex scenario, by which AF is certainly a risk factor for cardioembolic stroke, with a cause-effect relationship related to atrial thrombi, but can also be a simple "marker of risk," with a noncausal association with stroke. In such cases, stroke is possibly related to atheroemboli from the aorta, the carotid arteries, or other sources.
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415
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Abstract
Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an inherited cardiac arrhythmia disorder that is characterized by emotion- and exercise-induced polymorphic ventricular arrhythmias and may lead to sudden cardiac death (SCD). CPVT plays an important role in SCD in the young and therefore recognition and adequate treatment of the disease are of vital importance. In the past years tremendous improvements have been made in the diagnostic methods and treatment of the disease. In this review, we summarize the clinical characteristics, genetics, and diagnostic and therapeutic strategies of CPVT and describe the most recent advances and some of the current challenges. (Circ J 2016; 80: 1285-1291).
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Affiliation(s)
- Krystien V Lieve
- Heart Centre, Department of Clinical and Experimental Cardiology, Academic Medical Centre
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416
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Ladapo JA, Turakhia MP, Ryan MP, Mollenkopf SA, Reynolds MR. Health Care Utilization and Expenditures Associated With Remote Monitoring in Patients With Implantable Cardiac Devices. Am J Cardiol 2016; 117:1455-62. [PMID: 26996767 DOI: 10.1016/j.amjcard.2016.02.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 02/08/2016] [Accepted: 02/08/2016] [Indexed: 10/22/2022]
Abstract
Several randomized trials and decision analysis models have found that remote monitoring may reduce health care utilization and expenditures in patients with cardiac implantable electronic devices (CIEDs), compared with in-office monitoring. However, little is known about the generalizability of these findings to unselected populations in clinical practice. To compare health care utilization and expenditures associated with remote monitoring and in-office monitoring in patients with CIEDs, we used Truven Health MarketScan Commercial Claims and Medicare Supplemental Databases. We selected patients newly implanted with an implantable cardioverter defibrillators (ICD), cardiac resynchronization therapy defibrillator (CRT-D), or permanent pacemaker (PPM), in 2009, who had continuous health plan enrollment 2 years after implantation. Generalized linear models and propensity score matching were used to adjust for confounders and estimate differences in health care utilization and expenditures in patients with remote or in-office monitoring. We identified 1,127; 427; and 1,295 pairs of patients with a similar propensity for receiving an ICD, CRT-D, or PPM, respectively. Remotely monitored patients with ICDs experienced fewer emergency department visits resulting in discharge (p = 0.050). Remote monitoring was associated with lower health care expenditures in office visits among patients with PPMs (p = 0.025) and CRT-Ds (p = 0.006) and lower total inpatient and outpatient expenditures in patients with ICDs (p <0.0001). In conclusion, remote monitoring of patients with CIEDs may be associated with reductions in health care utilization and expenditures compared with exclusive in-office care.
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417
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Yokoshiki H, Shimizu A, Mitsuhashi T, Furushima H, Sekiguchi Y, Manaka T, Nishii N, Ueyama T, Morita N, Nitta T, Okumura K. Trends and determinant factors in the use of cardiac resynchronization therapy devices in Japan: Analysis of the Japan cardiac device treatment registry database. J Arrhythm 2016; 32:486-490. [PMID: 27920834 PMCID: PMC5129119 DOI: 10.1016/j.joa.2016.04.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 03/27/2016] [Accepted: 04/06/2016] [Indexed: 11/04/2022] Open
Abstract
Background The choice of cardiac resynchronization therapy device, with (CRT-D) or without (CRT-P) a defibrillator, in patients with heart failure largely depends on the physician׳s discretion, because it has not been established which subjects benefit most from a defibrillator. Methods We examined the annual trend of CRT device implantations between 2006 and 2014, and evaluated the factors related to the device selection (CRT-D or CRT-P) for primary prevention of sudden cardiac death in patients with heart failure by analyzing the Japan Cardiac Device Treatment Registry (JCDTR) database from January 2011 and August 2015 (CRT-D, n=2714; CRT-P, n=555). Results The proportion of CRT-D implantations for primary prevention among all the CRT-D recipients was more than 70% during the study period. The number of CRT-D implantations for primary prevention reached a maximum in 2011 and decreased gradually between 2011 and 2014, whereas CRT-P implantations increased year by year until 2011 and remained unchanged in recent years. Multivariate analysis identified age (odds ratio [OR] 0.92, 95% confidence interval [CI] 0.90–0.95, P<0.0001), male sex (OR 1.99, 95% CI 1.28–3.11, P<0.005), reduced left ventricular ejection fraction (LVEF) (OR 0.96, 95% CI 0.94–0.98, P<0.0001), and non-sustained ventricular tachycardia (NSVT) (OR 2.85, 95% CI 1.87–4.35, P<0.0001) as independent factors favoring the choice of CRT-D. Conclusions Younger age, male sex, reduced LVEF, and a history of NSVT were independently associated with the choice of CRT-D for primary prevention of sudden cardiac death in patients with heart failure in Japan.
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Affiliation(s)
- Hisashi Yokoshiki
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan
| | - Akihiko Shimizu
- Faculty of Health Sciences, Yamaguchi Graduate School of Medicine, Japan
| | - Takeshi Mitsuhashi
- Cardiovascular Medicine, Jichi Medical University Saitama Medical Center, Japan
| | | | - Yukio Sekiguchi
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Japan
| | | | - Nobuhiro Nishii
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Takeshi Ueyama
- Division of Cardiology, Department of Medicine and Clinical Sciences, Yamaguchi Graduate School of Medicine, Japan
| | - Norishige Morita
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Japan
| | - Takashi Nitta
- Cardiovascular Surgery, Nippon Medical School, Japan
| | - Ken Okumura
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Japan
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418
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VAN DER HEIJDEN AAFKEC, LEVY WAYNEC, VAN ERVEN LIESELOT, SCHALIJ MARTINJ, BORLEFFS CJANWILLEM. Prognostic Impact of Implementation of QRS Characteristics in the Seattle Heart Failure Model in ICD and CRT-D Recipients. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:565-73. [DOI: 10.1111/pace.12862] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 01/24/2016] [Accepted: 03/14/2016] [Indexed: 11/28/2022]
Affiliation(s)
| | - WAYNE C. LEVY
- Department of Cardiology; University of Washington; Seattle Washington
| | - LIESELOT VAN ERVEN
- Department of Cardiology; Leiden University Medical Center; Leiden The Netherlands
| | - MARTIN J. SCHALIJ
- Department of Cardiology; Leiden University Medical Center; Leiden The Netherlands
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419
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Sun WP, Li CL, Guo JC, Zhang LX, Liu R, Zhang HB, Zhang L. Long-term efficacy of implantable cardiac resynchronization therapy plus defibrillator for primary prevention of sudden cardiac death in patients with mild heart failure: an updated meta-analysis. Heart Fail Rev 2016; 21:447-53. [PMID: 27043219 DOI: 10.1007/s10741-016-9550-y] [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] [Indexed: 11/28/2022]
Abstract
Previous studies of implantable cardiac resynchronization therapy plus defibrillator (CRT-D) therapy used for primary prevention of sudden cardiac death have suggested that CRT-D therapy is less effective in patients with mild heart failure and a wide QRS complex. However, the long-term benefits are variable. We performed a meta-analysis of randomized trials identified in systematic searches of MEDLINE, EMBASE, and the Cochrane Database. Three studies (3858 patients) with a mean follow-up of 66 months were included. Overall, CRT-D therapy was associated with significantly lower all-cause mortality than was implantable cardioverter defibrillator (ICD) therapy (OR, 0.78; 95 % CI, 0.63-0.96; P = 0.02; I (2) = 19 %). However, the risk of cardiac mortality was comparable between two groups (OR, 0.74; 95 % CI, 0.53-1.01; P = 0.06). CRT-D treatment was associated with a significantly lower risk of hospitalization for heart failure (OR, 0.67; 95 % CI, 0.50-0.89; P = 0.005; I (2) = 55 %). The composite outcome of all-cause mortality and hospitalization for heart failure was also markedly lower with CRT-D therapy than with ICD treatment alone (OR, 0.67; 95 % CI, 0.57-0.77; P < 0.0001; I (2) = 0 %). CRT-D therapy decreased the long-term risk of mortality and heart failure events in patients with mild heart failure with a wide QRS complex. However, long-term risk of cardiac mortality was similar between two groups. More randomized studies are needed to confirm these findings, especially in patients with NYHA class I heart failure or patients without LBBB.
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Affiliation(s)
- Wei-Ping Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.,Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Chun-Lei Li
- Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Jin-Cheng Guo
- Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Li-Xin Zhang
- Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Ran Liu
- Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Hai-Bin Zhang
- Beijing Luhe Hospital, Capital Medical University, Beijing, China.
| | - Ling Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China. .,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
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420
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Remote monitoring of cardiac implantable electronic devices (CIED). Trends Cardiovasc Med 2016; 26:568-77. [PMID: 27134007 DOI: 10.1016/j.tcm.2016.03.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/07/2016] [Accepted: 03/24/2016] [Indexed: 11/20/2022]
Abstract
With increasing indications and access to cardiac implantable electronic devices (CIEDs) worldwide, the number of patients needing CIED follow-up continues to rise. In parallel, the technology available for managing these devices has advanced considerably. In this setting, remote monitoring (RM) has emerged as a complement to routine in-office care. Rigorous studies, randomized and otherwise, have demonstrated advantages to patient with CIED management systems, which incorporates RM resulting in authoritative guidelines from relevant professional societies recommending RM for all eligible patients. In addition to clinical benefits, CIED management programs that include RM have been shown to be cost effective and associated with high patient satisfaction. Finally, RM programs hold promise for the future of CIED research in light of the massive data collected through RM databases converging with unprecedented computational capability. This review outlines the available data associated with clinical outcomes in patients managed with RM with an emphasis on randomized trials; the impact of RM on patient satisfaction, cost-effectiveness, and healthcare utilization; and possible future directions for the use of RM in clinical practice and research.
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421
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Ebrille E, DeSimone CV, Vaidya VR, Chahal AA, Nkomo VT, Asirvatham SJ. Ventricular pacing - Electromechanical consequences and valvular function. Indian Pacing Electrophysiol J 2016; 16:19-30. [PMID: 27485561 PMCID: PMC4936653 DOI: 10.1016/j.ipej.2016.02.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Although great strides have been made in the areas of ventricular pacing, it is still appreciated that dyssynchrony can be malignant, and that appropriately placed pacing leads may ameliorate mechanical dyssynchrony. However, the unknowns at present include: 1. The mechanisms by which ventricular pacing itself can induce dyssynchrony; 2. Whether or not various pacing locations can decrease the deleterious effects caused by ventricular pacing; 3. The impact of novel methods of pacing, such as atrioventricular septal, lead-less, and far-field surface stimulation; 4. The utility of ECG and echocardiography in predicting response to therapy and/or development of dyssynchrony in the setting of cardiac resynchronization therapy (CRT) lead placement; 5. The impact of ventricular pacing-induced dyssynchrony on valvular function, and how lead position correlates to potential improvement. This review examines the existing literature to put these issues into context, to provide a basis for understanding how electrical, mechanical, and functional aspects of the heart can be distorted with ventricular pacing. We highlight the central role of the mitral valve and its function as it relates to pacing strategies, especially in the setting of CRT. We also provide future directions for improved pacing modalities via alternative pacing sites and speculate over mechanisms on how lead position may affect the critical function of the mitral valve and thus overall efficacy of CRT.
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Affiliation(s)
- Elisa Ebrille
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA; Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | | | - Vaibhav R Vaidya
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Anwar A Chahal
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA; Clinical and Translational Science, Mayo Graduate School, Rochester, MN, USA
| | - Vuyisile T Nkomo
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Samuel J Asirvatham
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA; Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.
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423
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Biton Y, Baman JR, Polonsky B. Roles and indications for use of implantable defibrillator and resynchronization therapy in the prevention of sudden cardiac death in heart failure. Heart Fail Rev 2016; 21:433-46. [DOI: 10.1007/s10741-016-9542-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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424
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Cuba Gyllensten I, Bonomi AG, Goode KM, Reiter H, Habetha J, Amft O, Cleland JG. Early Indication of Decompensated Heart Failure in Patients on Home-Telemonitoring: A Comparison of Prediction Algorithms Based on Daily Weight and Noninvasive Transthoracic Bio-impedance. JMIR Med Inform 2016; 4:e3. [PMID: 26892844 PMCID: PMC4777885 DOI: 10.2196/medinform.4842] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 09/09/2015] [Accepted: 10/07/2015] [Indexed: 12/25/2022] Open
Abstract
Background Heart Failure (HF) is a common reason for hospitalization. Admissions might be prevented by early detection of and intervention for decompensation. Conventionally, changes in weight, a possible measure of fluid accumulation, have been used to detect deterioration. Transthoracic impedance may be a more sensitive and accurate measure of fluid accumulation. Objective In this study, we review previously proposed predictive algorithms using body weight and noninvasive transthoracic bio-impedance (NITTI) to predict HF decompensations. Methods We monitored 91 patients with chronic HF for an average of 10 months using a weight scale and a wearable bio-impedance vest. Three algorithms were tested using either simple rule-of-thumb differences (RoT), moving averages (MACD), or cumulative sums (CUSUM). Results Algorithms using NITTI in the 2 weeks preceding decompensation predicted events (P<.001); however, using weight alone did not. Cross-validation showed that NITTI improved sensitivity of all algorithms tested and that trend algorithms provided the best performance for either measurement (Weight-MACD: 33%, NITTI-CUSUM: 60%) in contrast to the simpler rules-of-thumb (Weight-RoT: 20%, NITTI-RoT: 33%) as proposed in HF guidelines. Conclusions NITTI measurements decrease before decompensations, and combined with trend algorithms, improve the detection of HF decompensation over current guideline rules; however, many alerts are not associated with clinically overt decompensation.
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425
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Abstract
Since the first implant in 1980, implantable cardioverter defibrillator (ICD) technology has progressed rapidly. Modern ICD's have hundreds of programmable options with the general goal of preventing inappropriate shocks and providing shocks for truly life threatening symptomatic ventricular arrhythmias. New studies on ICD programming have shown the benefits of prolonged detection intervals in reaching this goal. Anti-tachycardia pacing (ATP) therapy has become an important adjunct to defibrillator shocks. Remote monitoring technologies have surfaced which have been shown to identify arrhythmias and problems with the device in an expedient fashion. The subcutaneous ICD offers the advantage of avoiding intravascular leads and their inherent risks. Lastly, the current understanding of the effects of MRI in ICD patients has advanced creating new opportunities to provide MRI safely to such patients.
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Affiliation(s)
- John Rickard
- a Department of Cardiovascular Medicine , Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Bruce L Wilkoff
- a Department of Cardiovascular Medicine , Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic Foundation , Cleveland , OH , USA
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426
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Pavlů L, Hutyra M, Táborský M. Changing Views: Safety and Efficacy of Implantable Cardioverter- Defibrillator Therapy in Athletes. Cent Eur J Public Health 2016; 23 Suppl:S74-7. [PMID: 26849548 DOI: 10.21101/cejph.a4228] [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] [Received: 12/15/2014] [Accepted: 06/24/2015] [Indexed: 11/15/2022]
Abstract
The implantable cardioverter-defibrillator (ICD) is highly effective in reducing sudden death from ventricular tachyarrhythmia among high-risk cardiac patients. Conventional advice given to patients with ICD is to avoid physical activity more strenuous than playing golf or bowling. This recommendation is given due to a theoretical risk of arrhythmia precipitation, and thus increased risk of death due to failure to defibrillate, injury resulting from loss of control caused by arrhythmia-related syncope or shock, and also due to sport related direct damage to the ICD system. Recent prospective data from an international registry involving 372 athletes with ICDs in situ and actively participating in sports has been published. This indicates that, although physical activity resulted in an increased number of shocks compared to rest, there was no significant difference between intensive physical activity and any other activity (10% vs. 8%, p=0.34) in frequency of shocks. Furthermore, over a median follow-up period of 31 months (21-46 months), in the period of sports activity and 2 hour rest directly after there were no occurrences of death, resuscitated arrest or arrhythmia, or shock-related injury. This data is likely to start a shift in every-day clinical decision-making leading to revision of the high level of precautions imposed on the rapidly enlarging ICD recipient population.
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Affiliation(s)
- Luděk Pavlů
- 1st Department of Internal Medicine - Cardiology, University Hospital, Olomouc, Czech Republic
| | - Martin Hutyra
- 1st Department of Internal Medicine - Cardiology, University Hospital, Olomouc, Czech Republic
| | - Miloš Táborský
- 1st Department of Internal Medicine - Cardiology, University Hospital, Olomouc, Czech Republic
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427
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Menet A, Guyomar Y, Ennezat PV, Graux P, Castel AL, Delelis F, Heuls S, Cuvelier E, Gevaert C, Le Goffic C, Tribouilloy C, Maréchaux S. Prognostic value of left ventricular reverse remodeling and performance improvement after cardiac resynchronization therapy: A prospective study. Int J Cardiol 2016; 204:6-11. [DOI: 10.1016/j.ijcard.2015.11.091] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 11/13/2015] [Accepted: 11/16/2015] [Indexed: 01/26/2023]
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428
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Biton Y, Kutyifa V, Cygankiewicz I, Goldenberg I, Klein H, McNitt S, Polonsky B, Ruwald AC, Ruwald MH, Moss AJ, Zareba W. Relation of QRS Duration to Clinical Benefit of Cardiac Resynchronization Therapy in Mild Heart Failure Patients Without Left Bundle Branch Block. Circ Heart Fail 2016; 9:e002667. [DOI: 10.1161/circheartfailure.115.002667] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Yitschak Biton
- From the Heart Research Follow-up Program, Division of Cardiology, Department of Medicine at the University of Rochester Medical Center, NY (Y.B., V.K., I.C., I.G., H.K., S.M., B.P., A.C.R., M.H.R., A.J.M., W.Z.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (A.C.R., M.H.R.); and Heart Institute, Sheba Medical Center, Ramat Gan, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (Y.B., I.G.)
| | - Valentina Kutyifa
- From the Heart Research Follow-up Program, Division of Cardiology, Department of Medicine at the University of Rochester Medical Center, NY (Y.B., V.K., I.C., I.G., H.K., S.M., B.P., A.C.R., M.H.R., A.J.M., W.Z.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (A.C.R., M.H.R.); and Heart Institute, Sheba Medical Center, Ramat Gan, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (Y.B., I.G.)
| | - Iwona Cygankiewicz
- From the Heart Research Follow-up Program, Division of Cardiology, Department of Medicine at the University of Rochester Medical Center, NY (Y.B., V.K., I.C., I.G., H.K., S.M., B.P., A.C.R., M.H.R., A.J.M., W.Z.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (A.C.R., M.H.R.); and Heart Institute, Sheba Medical Center, Ramat Gan, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (Y.B., I.G.)
| | - Ilan Goldenberg
- From the Heart Research Follow-up Program, Division of Cardiology, Department of Medicine at the University of Rochester Medical Center, NY (Y.B., V.K., I.C., I.G., H.K., S.M., B.P., A.C.R., M.H.R., A.J.M., W.Z.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (A.C.R., M.H.R.); and Heart Institute, Sheba Medical Center, Ramat Gan, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (Y.B., I.G.)
| | - Helmut Klein
- From the Heart Research Follow-up Program, Division of Cardiology, Department of Medicine at the University of Rochester Medical Center, NY (Y.B., V.K., I.C., I.G., H.K., S.M., B.P., A.C.R., M.H.R., A.J.M., W.Z.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (A.C.R., M.H.R.); and Heart Institute, Sheba Medical Center, Ramat Gan, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (Y.B., I.G.)
| | - Scott McNitt
- From the Heart Research Follow-up Program, Division of Cardiology, Department of Medicine at the University of Rochester Medical Center, NY (Y.B., V.K., I.C., I.G., H.K., S.M., B.P., A.C.R., M.H.R., A.J.M., W.Z.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (A.C.R., M.H.R.); and Heart Institute, Sheba Medical Center, Ramat Gan, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (Y.B., I.G.)
| | - Bronislava Polonsky
- From the Heart Research Follow-up Program, Division of Cardiology, Department of Medicine at the University of Rochester Medical Center, NY (Y.B., V.K., I.C., I.G., H.K., S.M., B.P., A.C.R., M.H.R., A.J.M., W.Z.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (A.C.R., M.H.R.); and Heart Institute, Sheba Medical Center, Ramat Gan, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (Y.B., I.G.)
| | - Anne Christine Ruwald
- From the Heart Research Follow-up Program, Division of Cardiology, Department of Medicine at the University of Rochester Medical Center, NY (Y.B., V.K., I.C., I.G., H.K., S.M., B.P., A.C.R., M.H.R., A.J.M., W.Z.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (A.C.R., M.H.R.); and Heart Institute, Sheba Medical Center, Ramat Gan, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (Y.B., I.G.)
| | - Martin H. Ruwald
- From the Heart Research Follow-up Program, Division of Cardiology, Department of Medicine at the University of Rochester Medical Center, NY (Y.B., V.K., I.C., I.G., H.K., S.M., B.P., A.C.R., M.H.R., A.J.M., W.Z.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (A.C.R., M.H.R.); and Heart Institute, Sheba Medical Center, Ramat Gan, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (Y.B., I.G.)
| | - Arthur J. Moss
- From the Heart Research Follow-up Program, Division of Cardiology, Department of Medicine at the University of Rochester Medical Center, NY (Y.B., V.K., I.C., I.G., H.K., S.M., B.P., A.C.R., M.H.R., A.J.M., W.Z.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (A.C.R., M.H.R.); and Heart Institute, Sheba Medical Center, Ramat Gan, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (Y.B., I.G.)
| | - Wojciech Zareba
- From the Heart Research Follow-up Program, Division of Cardiology, Department of Medicine at the University of Rochester Medical Center, NY (Y.B., V.K., I.C., I.G., H.K., S.M., B.P., A.C.R., M.H.R., A.J.M., W.Z.); Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (A.C.R., M.H.R.); and Heart Institute, Sheba Medical Center, Ramat Gan, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (Y.B., I.G.)
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429
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von Haehling S. Adding insult to injury: heart failure and incident cancer. Eur J Heart Fail 2016; 18:267-8. [DOI: 10.1002/ejhf.491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 01/05/2016] [Accepted: 01/06/2016] [Indexed: 01/23/2023] Open
Affiliation(s)
- Stephan von Haehling
- Institute of Innovative Clinical Trials, Department of Cardiology and Pneumology; University of Göttingen Medical School; Göttingen Germany
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430
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Rogers PA, Morin DP. Editorial commentary: MADIT–CRT and his many sons. Trends Cardiovasc Med 2016; 26:147-9. [DOI: 10.1016/j.tcm.2015.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Accepted: 05/27/2015] [Indexed: 10/23/2022]
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431
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Klersy C, Boriani G, De Silvestri A, Mairesse GH, Braunschweig F, Scotti V, Balduini A, Cowie MR, Leyva F. Effect of telemonitoring of cardiac implantable electronic devices on healthcare utilization: a meta-analysis of randomized controlled trials in patients with heart failure. Eur J Heart Fail 2016; 18:195-204. [DOI: 10.1002/ejhf.470] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 10/18/2015] [Accepted: 11/05/2015] [Indexed: 11/08/2022] Open
Affiliation(s)
- Catherine Klersy
- Service of Biometry & Statistics; IRCCS Fondazione Policlinico S Matteo; Pavia Italy
| | - Giuseppe Boriani
- Cardiology Department; University of Modena and Reggio Emilia, Policlinico di Modena; Modena Italy
| | - Annalisa De Silvestri
- Service of Biometry & Statistics; IRCCS Fondazione Policlinico S Matteo; Pavia Italy
| | | | | | - Valeria Scotti
- Centre for Scientific Documentation; IRCCS Fondazione Policlinico S Matteo; Pavia Italy
| | - Anna Balduini
- Centre for Scientific Documentation; IRCCS Fondazione Policlinico S Matteo; Pavia Italy
| | - Martin R. Cowie
- Centre for Scientific Documentation; IRCCS Fondazione Policlinico S Matteo; Pavia Italy
| | - Francisco Leyva
- Aston Medical Research Institute, Aston Medical School; Aston University; Birmingham UK
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Liu M, Fang F, Luo XX, Shlomo BH, Burkhoff D, Chan JYS, Chan CP, Cheung L, Rousso B, Gutterman D, Yu CM. Improvement of long-term survival by cardiac contractility modulation in heart failure patients: A case-control study. Int J Cardiol 2016; 206:122-6. [PMID: 26788686 DOI: 10.1016/j.ijcard.2016.01.071] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 12/23/2015] [Accepted: 01/01/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Cardiac contractility modulation (CCM) has been shown to be effective in improving symptoms and cardiac function in heart failure (HF). However, there is limited data on the role of CCM on long-term survival, which was explored in the present study. METHODOLOGY Forty-one consecutive HF patients with left ventricular ejection fraction (EF) <40% received CCM and were followed for approximately 6 years. They were compared with another 41 HF patients who were enrolled into the HF registry in the same period, and had similar age, gender, EF and etiology of HF. The primary end-point was all cause-mortality. This was stratified by EF. Secondary end-points included HF hospitalization, cardiovascular death, and the composite outcome of death or heart failure hospitalization. RESULTS The CCM and control groups were well balanced for demographic data, medications and baseline left ventricular EF (27 ± 6 vs 27 ± 7%, p=NS). The mean follow-up duration was 75 ± 19 months in the CCM group and 69 ± 17 months in the control group. All-cause mortality was lower in the CCM group than the control group (39% vs. 71%, respectively; Log-rank χ(2)=11.23, p=0.001). Of note, the improvement of all-cause mortality is more dramatic in patients with EF ≥ 25-40% (36% vs. 80%, Log-rank χ(2)=15.8, p<0.001) than those with EF<25% (50% vs. 56%, p=NS), CCM vs. control respectively. Similar results were shown for the benefit of CCM in the secondary endpoints of cardiovascular death, and the composite outcome of death or heart failure hospitalization. The occurrence of HF hospitalization showed no significant difference between CCM and control groups in the whole cohort (41% vs. 49%, p=NS), but was significantly lower with CCM in subjects with EF ≥ 25-40% at baseline (36% vs. 64%, Log-rank χ(2)=7.79, p=0.005). CONCLUSION CCM resulted in significant improvement of long-term survival, in particular in those with EF ≥ 25-40%. A reduction in heart failure hospitalizations was also seen in this group of patients with less severely reduced EF.
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Affiliation(s)
- Ming Liu
- Division of Cardiology and HEART Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong; Institute of Vascular Medicine, The Chinese University of Hong Kong, Hong Kong; LCW Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Fang Fang
- Division of Cardiology and HEART Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong; Institute of Vascular Medicine, The Chinese University of Hong Kong, Hong Kong; LCW Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Xiu Xia Luo
- Division of Cardiology and HEART Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong; Institute of Vascular Medicine, The Chinese University of Hong Kong, Hong Kong; LCW Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Ben-Haim Shlomo
- Division of Cardiology and HEART Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong; Institute of Vascular Medicine, The Chinese University of Hong Kong, Hong Kong; LCW Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Daniel Burkhoff
- Division of Cardiology and HEART Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong; Institute of Vascular Medicine, The Chinese University of Hong Kong, Hong Kong; LCW Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Joseph Y S Chan
- Division of Cardiology and HEART Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong; Institute of Vascular Medicine, The Chinese University of Hong Kong, Hong Kong; LCW Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Chin-Pang Chan
- Division of Cardiology and HEART Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong; Institute of Vascular Medicine, The Chinese University of Hong Kong, Hong Kong; LCW Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Lili Cheung
- Division of Cardiology and HEART Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong; Institute of Vascular Medicine, The Chinese University of Hong Kong, Hong Kong; LCW Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Benny Rousso
- Division of Cardiology and HEART Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong; Institute of Vascular Medicine, The Chinese University of Hong Kong, Hong Kong; LCW Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong
| | - David Gutterman
- Division of Cardiology and HEART Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong; Institute of Vascular Medicine, The Chinese University of Hong Kong, Hong Kong; LCW Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Cheuk-Man Yu
- Division of Cardiology and HEART Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong; Institute of Vascular Medicine, The Chinese University of Hong Kong, Hong Kong; LCW Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong.
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433
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Relative Wall Thickness and the Risk for Ventricular Tachyarrhythmias in Patients With Left Ventricular Dysfunction. J Am Coll Cardiol 2016; 67:303-12. [DOI: 10.1016/j.jacc.2015.10.076] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 10/09/2015] [Accepted: 10/13/2015] [Indexed: 01/10/2023]
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434
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Daubert JC, Martins R, Leclercq C. Why We Have to Use Cardiac Resynchronization Therapy-Pacemaker More. Card Electrophysiol Clin 2015; 7:709-720. [PMID: 26596813 DOI: 10.1016/j.ccep.2015.08.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Both cardiac resynchronization therapy with a pacemaker (CRT-P) and with a biventricular implantable cardioverter-defibrillator (CRT-D) are electrical treatment modalities validated for the management of chronic heart failure. There is no strong scientific evidence that a CRT-D must be offered to all candidates. Common sense should limit the prescription of these costly and complicated devices. The choice of CRT-P is currently acceptable. A direction to explore could be to downgrade from CRT-D to CRT-P at the time of battery depletion in patients with large reverse remodeling and no ventricular tachycardia and ventricular fibrillation detected.
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435
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Nauffal V, Tanawuttiwat T, Zhang Y, Rickard J, Marine JE, Butcher B, Norgard S, Dickfeld T, Ellenbogen KA, Guallar E, Tomaselli GF, Cheng A. Predictors of mortality, LVAD implant, or heart transplant in primary prevention cardiac resynchronization therapy recipients: The HF-CRT score. Heart Rhythm 2015; 12:2387-94. [PMID: 26190316 PMCID: PMC4656051 DOI: 10.1016/j.hrthm.2015.07.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) reduces morbidity and mortality among individuals with dyssynchronous systolic heart failure (HF). However, patient outcomes vary, with some at higher risk than others for HF progression and death. OBJECTIVE To develop a risk prediction score incorporating variables associated with mortality, left ventricular assist device (LVAD) implant, or heart transplant in recipients of a primary prevention cardiac resynchronization therapy-defibrillator (CRT-D). METHODS We followed 305 CRT-D patients from the Prospective Observational Study of Implantable Cardioverter-Defibrillators for the composite outcome of all-cause mortality, LVAD implant, or heart transplant soon after device implantation. Serum biomarkers and electrocardiographic and clinical variables were collected at implant. Multivariable analysis using the Cox proportional hazards model with stepwise selection method was used to fit the final model. RESULTS Among 305 patients, 53 experienced the composite endpoint. In multivariable analysis, 5 independent predictors ("HF-CRT") were identified: high-sensitivity C-reactive protein >9.42 ng/L (HR = 2.5 [1.4, 4.5]), New York Heart Association functional class III/IV (HR = 2.3 [1.2, 4.5]), creatinine >1.2 mg/dL (HR = 2.7 [1.4, 5.1]), red blood cell count <4.3 × 10(6)/μL (HR = 2.4 [1.3, 4.7]), and cardiac troponin T >28 ng/L (HR = 2.7 [1.4, 5.2]). One point was attributed to each predictor and 3 score categories were identified. Patients with scores 0-1, 2-3, and 4-5 had a 3-year cumulative event-free survival of 96.8%, 79.7%, and 35.2%, respectively (log-rank, P < .001). CONCLUSION A simple score combining clinical and readily available biomarker data can risk-stratify CRT patients for HF progression and death. These findings may help identify patients who are in need of closer monitoring or early application of more aggressive circulatory support.
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Affiliation(s)
- Victor Nauffal
- Department of Medicine, Johns Hopkins Medical Institutes, Baltimore, Maryland
| | | | - Yiyi Zhang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - John Rickard
- Department of Medicine, Johns Hopkins Medical Institutes, Baltimore, Maryland
| | - Joseph E Marine
- Department of Medicine, Johns Hopkins Medical Institutes, Baltimore, Maryland
| | - Barbara Butcher
- Department of Medicine, Johns Hopkins Medical Institutes, Baltimore, Maryland
| | - Sanaz Norgard
- Department of Medicine, Johns Hopkins Medical Institutes, Baltimore, Maryland
| | - Timm Dickfeld
- Department of Medicine, University of Maryland, Baltimore, Maryland
| | | | - Eliseo Guallar
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Gordon F Tomaselli
- Department of Medicine, Johns Hopkins Medical Institutes, Baltimore, Maryland
| | - Alan Cheng
- Department of Medicine, Johns Hopkins Medical Institutes, Baltimore, Maryland.
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436
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Gorcsan J, Tayal B. Newer Echocardiographic Techniques in Cardiac Resynchronization Therapy. Card Electrophysiol Clin 2015; 7:609-618. [PMID: 26596806 DOI: 10.1016/j.ccep.2015.08.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Echocardiographic imaging plays a major role in patient selection for cardiac resynchronization therapy (CRT). One-third of patients do not respond; there is interest in advanced echocardiographic imaging to improve response. Current guidelines favor CRT for patients with electrocardiographic (ECG) QRS width of 150 milliseconds or greater and left bundle branch block. ECG criteria are imperfect; there is interest in advanced echocardiographic imaging to improve patient selection. This discussion focuses on newer echocardiographic methods to improve patient selection, improve delivery, and identify patients at risk for poor outcomes and serious ventricular arrhythmias.
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Affiliation(s)
- John Gorcsan
- Heart and Vascular Institute, Division of Cardiology, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Bhupendar Tayal
- Heart and Vascular Institute, Division of Cardiology, University of Pittsburgh, Pittsburgh, PA, USA
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437
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Gianni C, Di Biase L, Mohanty S, Gökoğlan Y, Güneş MF, Al-Ahmad A, Burkhardt JD, Natale A. How to Improve Cardiac Resynchronization Therapy Benefit in Atrial Fibrillation Patients: Pulmonary Vein Isolation (and Beyond). Card Electrophysiol Clin 2015; 7:755-64. [PMID: 26596817 DOI: 10.1016/j.ccep.2015.08.007] [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: 01/10/2023]
Abstract
Although cardiac resynchronization therapy (CRT) is an important treatment of symptomatic heart failure patients in sinus rhythm with low left ventricular ejection fraction and ventricular dyssynchrony, its role is not well defined in patients with atrial fibrillation (AF). CRT is not as effective in patients with AF because of inadequate biventricular capture and loss of atrioventricular synchrony. Both can be addressed with catheter ablation of AF. It is still unclear if these therapies offer additive benefits in patients with ventricular dyssynchrony. This article discusses the role and techniques of catheter ablation of AF in patients with heart failure, and its application in CRT recipients.
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Affiliation(s)
- Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 700, Austin, TX 78705, USA; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 700, Austin, TX 78705, USA; Arrhythmia Services, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Biomedical Engineering, University of Texas, Austin, TX, USA; Department of Cardiology, University of Foggia, Foggia, Italy
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 700, Austin, TX 78705, USA
| | - Yalçın Gökoğlan
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 700, Austin, TX 78705, USA
| | - Mahmut Fatih Güneş
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 700, Austin, TX 78705, USA
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 700, Austin, TX 78705, USA
| | - J David Burkhardt
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 700, Austin, TX 78705, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 700, Austin, TX 78705, USA; MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA; Division of Cardiology, Stanford University, Stanford, CA, USA; Electrophysiology and Arrhythmia Services, California Pacific Medical Center, San Francisco, CA, USA; Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, CA, USA; Dell Medical School, University of Texas, Austin, TX, USA.
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438
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Piette JD, List J, Rana GK, Townsend W, Striplin D, Heisler M. Mobile Health Devices as Tools for Worldwide Cardiovascular Risk Reduction and Disease Management. Circulation 2015; 132:2012-27. [PMID: 26596977 PMCID: PMC5234768 DOI: 10.1161/circulationaha.114.008723] [Citation(s) in RCA: 145] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We examined evidence on whether mobile health (mHealth) tools, including interactive voice response calls, short message service, or text messaging, and smartphones, can improve lifestyle behaviors and management related to cardiovascular diseases throughout the world. We conducted a state-of-the-art review and literature synthesis of peer-reviewed and gray literature published since 2004. The review prioritized randomized trials and studies focused on cardiovascular diseases and risk factors, but included other reports when they represented the best available evidence. The search emphasized reports on the potential benefits of mHealth interventions implemented in low- and middle-income countries. Interactive voice response and short message service interventions can improve cardiovascular preventive care in developed countries by addressing risk factors including weight, smoking, and physical activity. Interactive voice response and short message service-based interventions for cardiovascular disease management also have shown benefits with respect to hypertension management, hospital readmissions, and diabetic glycemic control. Multimodal interventions including Web-based communication with clinicians and mHealth-enabled clinical monitoring with feedback also have shown benefits. The evidence regarding the potential benefits of interventions using smartphones and social media is still developing. Studies of mHealth interventions have been conducted in >30 low- and middle-income countries, and evidence to date suggests that programs are feasible and may improve medication adherence and disease outcomes. Emerging evidence suggests that mHealth interventions may improve cardiovascular-related lifestyle behaviors and disease management. Next-generation mHealth programs developed worldwide should be based on evidence-based behavioral theories and incorporate advances in artificial intelligence for adapting systems automatically to patients' unique and changing needs.
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Affiliation(s)
- John D Piette
- From Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI (J.D.P., D.S., M.H.); Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI (J.D.P., D.S., M.H.); Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI (J.D.P., M.H.); Robert Wood Johnson Clinical Scholars Program, University of Michigan, Ann Arbor, MI (J.L., M.H.): and Taubman Health Sciences Library, University of Michigan, Ann Arbor, MI (G.K.R., W.T.).
| | - Justin List
- From Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI (J.D.P., D.S., M.H.); Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI (J.D.P., D.S., M.H.); Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI (J.D.P., M.H.); Robert Wood Johnson Clinical Scholars Program, University of Michigan, Ann Arbor, MI (J.L., M.H.): and Taubman Health Sciences Library, University of Michigan, Ann Arbor, MI (G.K.R., W.T.)
| | - Gurpreet K Rana
- From Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI (J.D.P., D.S., M.H.); Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI (J.D.P., D.S., M.H.); Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI (J.D.P., M.H.); Robert Wood Johnson Clinical Scholars Program, University of Michigan, Ann Arbor, MI (J.L., M.H.): and Taubman Health Sciences Library, University of Michigan, Ann Arbor, MI (G.K.R., W.T.)
| | - Whitney Townsend
- From Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI (J.D.P., D.S., M.H.); Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI (J.D.P., D.S., M.H.); Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI (J.D.P., M.H.); Robert Wood Johnson Clinical Scholars Program, University of Michigan, Ann Arbor, MI (J.L., M.H.): and Taubman Health Sciences Library, University of Michigan, Ann Arbor, MI (G.K.R., W.T.)
| | - Dana Striplin
- From Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI (J.D.P., D.S., M.H.); Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI (J.D.P., D.S., M.H.); Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI (J.D.P., M.H.); Robert Wood Johnson Clinical Scholars Program, University of Michigan, Ann Arbor, MI (J.L., M.H.): and Taubman Health Sciences Library, University of Michigan, Ann Arbor, MI (G.K.R., W.T.)
| | - Michele Heisler
- From Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI (J.D.P., D.S., M.H.); Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI (J.D.P., D.S., M.H.); Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI (J.D.P., M.H.); Robert Wood Johnson Clinical Scholars Program, University of Michigan, Ann Arbor, MI (J.L., M.H.): and Taubman Health Sciences Library, University of Michigan, Ann Arbor, MI (G.K.R., W.T.)
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Thomas S, Moss AJ, Zareba W, McNitt S, Barsheshet A, Klein H, Goldenberg I, Huang DT, Biton Y, Kutyifa V. Cardiac Resynchronization in Different Age Groups: A MADIT-CRT Long-Term Follow-Up Substudy. J Card Fail 2015; 22:143-9. [PMID: 26433087 DOI: 10.1016/j.cardfail.2015.09.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 09/03/2015] [Accepted: 09/22/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cardiac resynchronization with defibrillators (CRT-D) reduces heart failure and mortality compared with defibrillators alone. Whether this applies to all ages is unclear. METHODS AND RESULTS We assessed the association of age on heart failure and death as a post hoc analysis of the MADIT-CRT follow-up study, in which 1,281 patients with class I/II heart failure (HF) were randomized to CRT-D or implantable cardioverter-defibrillators alone. Different age groups (<60, 60-74, and ≥75 years) were evaluated over 7 years for mortality and HF events. Among the 3 age groups, there were 399, 651, and 231 patients, respectively. We compared events with the use of a multivariate regression model. CRT-D compared with defibrillators alone significantly reduced the composite of HF or death across all age groups: <60 years: relative risk reduction (RRR) = 36%; 60-74 years: RRR = 61%; ≥75 years: RRR = 56%. CRT-D significantly reduced HF in all age groups: <60 years: RRR = 49%; 60-74 years: RRR = 62%; ≥75 years: RRR = 74%. CRT-D was associated with significant mortality reduction only in the 60-74 year age group: RRR = 59%. CONCLUSIONS CRT-D reduced HF events and the composite of mortality or HF events during long-term follow-up in all age groups. CRT-D reduced mortality only in the 60-74 year age group.
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Affiliation(s)
- Sabu Thomas
- Heart Research Follow-Up Group, University of Rochester School of Medicine, Rochester, New York.
| | - Arthur J Moss
- Heart Research Follow-Up Group, University of Rochester School of Medicine, Rochester, New York
| | - Wojciech Zareba
- Heart Research Follow-Up Group, University of Rochester School of Medicine, Rochester, New York
| | - Scott McNitt
- Heart Research Follow-Up Group, University of Rochester School of Medicine, Rochester, New York
| | - Alon Barsheshet
- Heart Research Follow-Up Group, University of Rochester School of Medicine, Rochester, New York; Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Helmut Klein
- Heart Research Follow-Up Group, University of Rochester School of Medicine, Rochester, New York
| | - Ilan Goldenberg
- Heart Research Follow-Up Group, University of Rochester School of Medicine, Rochester, New York; Sheba Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - David T Huang
- Heart Research Follow-Up Group, University of Rochester School of Medicine, Rochester, New York
| | - Yitschak Biton
- Heart Research Follow-Up Group, University of Rochester School of Medicine, Rochester, New York
| | - Valentina Kutyifa
- Heart Research Follow-Up Group, University of Rochester School of Medicine, Rochester, New York
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Ricci RP, Botto GL, Bénézet JM, Nielsen JC, Roy LD, Piot O, Quesada A, Quaglione R, Vaccari D, Mangoni L, Grammatico A, Kozák M. Association between ventricular pacing and persistent atrial fibrillation in patients indicated to elective pacemaker replacement: Results of the Prefer for Elective Replacement MVP (PreFER MVP) randomized study. Heart Rhythm 2015; 12:2239-46. [DOI: 10.1016/j.hrthm.2015.06.041] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Indexed: 10/23/2022]
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441
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Inglis SC, Clark RA, Dierckx R, Prieto-Merino D, Cleland JGF. Structured telephone support or non-invasive telemonitoring for patients with heart failure. Cochrane Database Syst Rev 2015; 2015:CD007228. [PMID: 26517969 PMCID: PMC8482064 DOI: 10.1002/14651858.cd007228.pub3] [Citation(s) in RCA: 177] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Specialised disease management programmes for heart failure aim to improve care, clinical outcomes and/or reduce healthcare utilisation. Since the last version of this review in 2010, several new trials of structured telephone support and non-invasive home telemonitoring have been published which have raised questions about their effectiveness. OBJECTIVES To review randomised controlled trials (RCTs) of structured telephone support or non-invasive home telemonitoring compared to standard practice for people with heart failure, in order to quantify the effects of these interventions over and above usual care. SEARCH METHODS We updated the searches of the Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE), Health Technology AsseFssment Database (HTA) on the Cochrane Library; MEDLINE (OVID), EMBASE (OVID), CINAHL (EBSCO), Science Citation Index Expanded (SCI-EXPANDED), Conference Proceedings Citation Index- Science (CPCI-S) on Web of Science (Thomson Reuters), AMED, Proquest Theses and Dissertations, IEEE Xplore and TROVE in January 2015. We handsearched bibliographies of relevant studies and systematic reviews and abstract conference proceedings. We applied no language limits. SELECTION CRITERIA We included only peer-reviewed, published RCTs comparing structured telephone support or non-invasive home telemonitoring to usual care of people with chronic heart failure. The intervention or usual care could not include protocol-driven home visits or more intensive than usual (typically four to six weeks) clinic follow-up. DATA COLLECTION AND ANALYSIS We present data as risk ratios (RRs) with 95% confidence intervals (CIs). Primary outcomes included all-cause mortality, all-cause and heart failure-related hospitalisations, which we analysed using a fixed-effect model. Other outcomes included length of stay, health-related quality of life, heart failure knowledge and self care, acceptability and cost; we described and tabulated these. We performed meta-regression to assess homogeneity (the null hypothesis) in each subgroup analysis and to see if the effect of the intervention varied according to some quantitative variable (such as year of publication or median age). MAIN RESULTS We include 41 studies of either structured telephone support or non-invasive home telemonitoring for people with heart failure, of which 17 were new and 24 had been included in the previous Cochrane review. In the current review, 25 studies evaluated structured telephone support (eight new studies, plus one study previously included but classified as telemonitoring; total of 9332 participants), 18 evaluated telemonitoring (nine new studies; total of 3860 participants). Two of the included studies trialled both structured telephone support and telemonitoring compared to usual care, therefore 43 comparisons are evident.Non-invasive telemonitoring reduced all-cause mortality (RR 0.80, 95% CI 0.68 to 0.94; participants = 3740; studies = 17; I² = 24%, GRADE: moderate-quality evidence) and heart failure-related hospitalisations (RR 0.71, 95% CI 0.60 to 0.83; participants = 2148; studies = 8; I² = 20%, GRADE: moderate-quality evidence). Structured telephone support reduced all-cause mortality (RR 0.87, 95% CI 0.77 to 0.98; participants = 9222; studies = 22; I² = 0%, GRADE: moderate-quality evidence) and heart failure-related hospitalisations (RR 0.85, 95% CI 0.77 to 0.93; participants = 7030; studies = 16; I² = 27%, GRADE: moderate-quality evidence).Neither structured telephone support nor telemonitoring demonstrated effectiveness in reducing the risk of all-cause hospitalisations (structured telephone support: RR 0.95, 95% CI 0.90 to 1.00; participants = 7216; studies = 16; I² = 47%, GRADE: very low-quality evidence; non-invasive telemonitoring: RR 0.95, 95% CI 0.89 to 1.01; participants = 3332; studies = 13; I² = 71%, GRADE: very low-quality evidence).Seven structured telephone support studies reported length of stay, with one reporting a significant reduction in length of stay in hospital. Nine telemonitoring studies reported length of stay outcome, with one study reporting a significant reduction in the length of stay with the intervention. One telemonitoring study reported a large difference in the total number of hospitalisations for more than three days, but this was not an analysis of length of stay per hospitalisation. Nine of 11 structured telephone support studies and five of 11 telemonitoring studies reported significant improvements in health-related quality of life. Nine structured telephone support studies and six telemonitoring studies reported costs of the intervention or cost effectiveness. Three structured telephone support studies and one telemonitoring study reported a decrease in costs and two telemonitoring studies reported increases in cost, due both to the cost of the intervention and to increased medical management. Adherence was rated between 55.1% and 98.5% for those structured telephone support and telemonitoring studies which reported this outcome. Participant acceptance of the intervention was reported in the range of 76% to 97% for studies which evaluated this outcome. Seven of nine studies that measured these outcomes reported significant improvements in heart failure knowledge and self-care behaviours. AUTHORS' CONCLUSIONS For people with heart failure, structured telephone support and non-invasive home telemonitoring reduce the risk of all-cause mortality and heart failure-related hospitalisations; these interventions also demonstrated improvements in health-related quality of life and heart failure knowledge and self-care behaviours. Studies also demonstrated participant satisfaction with the majority of the interventions which assessed this outcome.
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Affiliation(s)
- Sally C Inglis
- Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, Sydney, Australia
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442
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Novel Therapeutic Strategies for Reducing Right Heart Failure Associated Mortality in Fibrotic Lung Diseases. BIOMED RESEARCH INTERNATIONAL 2015; 2015:929170. [PMID: 26583148 PMCID: PMC4637079 DOI: 10.1155/2015/929170] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 08/26/2015] [Indexed: 11/21/2022]
Abstract
Fibrotic lung diseases carry a significant mortality burden worldwide. A large proportion of these deaths are due to right heart failure and pulmonary hypertension. Underlying contributory factors which appear to play a role in the mechanism of progression of right heart dysfunction include chronic hypoxia, defective calcium handling, hyperaldosteronism, pulmonary vascular alterations, cyclic strain of pressure and volume changes, elevation of circulating TGF-β, and elevated systemic NO levels. Specific therapies targeting pulmonary hypertension include calcium channel blockers, endothelin (ET-1) receptor antagonists, prostacyclin analogs, phosphodiesterase type 5 (PDE5) inhibitors, and rho-kinase (ROCK) inhibitors. Newer antifibrotic and anti-inflammatory agents may exert beneficial effects on heart failure in idiopathic pulmonary fibrosis. Furthermore, right ventricle-targeted therapies, aimed at mitigating the effects of functional right ventricular failure, include β-adrenoceptor (β-AR) blockers, angiotensin-converting enzyme (ACE) inhibitors, antioxidants, modulators of metabolism, and 5-hydroxytryptamine-2B (5-HT2B) receptor antagonists. Newer nonpharmacologic modalities for right ventricular support are increasingly being implemented. Early, effective, and individualized therapy may prevent overt right heart failure in fibrotic lung disease leading to improved outcomes and quality of life.
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443
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Abstract
Recent technological advances in the management of patients with cardiovascular implantable electronic devices (CIEDs) have expanded clinicians’ ability to remotely monitor patients with CIEDs. Remote monitoring, in addition to periodic in-person device evaluation, provides many advantages to patients and clinicians. Aside from the therapeutic and diagnostic benefits of pacemakers, implantable cardioverter-defibrillators, cardiac resynchronization therapy devices, and implantable loop recorders, improvement in clinical outcomes, clinical efficiencies, and patient experience can be realized with the adoption of remote CIED monitoring. These advantages create significant value to both patients and CIED follow-up centers.
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Affiliation(s)
- Robin A. Leahy
- Robin A. Leahy is Director of Electrophysiology Services, Sanger Heart & Vascular Institute–Carolinas HealthCare System, 1001 Blythe Blvd, Ste 300, Charlotte, NC 28203 (robin. ). Elizabeth E. Davenport is Nurse Manager, Cardiac Rhythm Device Clinics, Sanger Heart & Vascular Institute–Carolinas HealthCare System, Charlotte, North Carolina
| | - Elizabeth E. Davenport
- Robin A. Leahy is Director of Electrophysiology Services, Sanger Heart & Vascular Institute–Carolinas HealthCare System, 1001 Blythe Blvd, Ste 300, Charlotte, NC 28203 (robin. ). Elizabeth E. Davenport is Nurse Manager, Cardiac Rhythm Device Clinics, Sanger Heart & Vascular Institute–Carolinas HealthCare System, Charlotte, North Carolina
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444
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Abstract
Nonresponse to cardiac resynchronization therapy (CRT) is still a major issue in therapy expansion. The description of fast, simple, cost-effective methods to optimize CRT could help in adapting pacing intervals to individual patients. A better understanding of the importance of appropriate patient selection, left ventricular lead placement, and device programming, together with a multidisciplinary approach and an optimal follow-up of the patients, may reduce the percentage of nonresponders.
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445
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Remote monitoring of implantable devices: Should we continue to ignore it? Int J Cardiol 2015; 202:368-77. [PMID: 26432486 DOI: 10.1016/j.ijcard.2015.09.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 08/31/2015] [Accepted: 09/19/2015] [Indexed: 11/23/2022]
Abstract
The number of patients with implantable cardioverter defibrillators (ICDs) is increasing. In addition to improve survival, ICD can collect data related to device function and physiological parameters. Remote monitoring (RM) of these data allows early detection of technical or clinical problems and a prompt intervention (reprogramming device or therapy adjustment) before the patient require hospitalization. RM is not a substitute for emergency service and its consultation is now limited during working hours. Thus, a consent form is required to inform patients about benefits and limitations. The available studies indicate that remote monitoring is more effective than traditional calendar face to face based encounters. RM is safe, highly reliable, cost efficient, allows quick reply to failures, and reduces the number of scheduled visits and the incidence of inappropriate shocks with a positive impact on survival. It follows that RM has the credentials to be the standard of care for ICD management; however, unfortunately, there is a delay in physician acceptance and implementation. The recent observations from randomized IN-TIME study that showed a clear survival benefit with RM in heart failure patients have encouraged us to review both the negative and positive aspects of RM collected in a little more than a decade.
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446
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Tayal B, Gorcsan J, Delgado-Montero A, Marek JJ, Haugaa KH, Ryo K, Goda A, Olsen NT, Saba S, Risum N, Sogaard P. Mechanical Dyssynchrony by Tissue Doppler Cross-Correlation is Associated with Risk for Complex Ventricular Arrhythmias after Cardiac Resynchronization Therapy. J Am Soc Echocardiogr 2015; 28:1474-81. [PMID: 26342653 DOI: 10.1016/j.echo.2015.07.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Tissue Doppler cross-correlation analysis has been shown to be associated with long-term survival after cardiac resynchronization defibrillator therapy (CRT-D). Its association with ventricular arrhythmia (VA) is unknown. METHODS From two centers 151 CRT-D patients (New York Heart Association functional classes II-IV, ejection fraction ≤ 35%, and QRS duration ≥ 120 msec) were prospectively included. Tissue Doppler cross-correlation analysis of myocardial acceleration curves from the basal segments in the apical views both at baseline and 6 months after CRT-D implantation was performed. Patients were divided into four subgroups on the basis of dyssynchrony at baseline and follow-up after CRT-D. Outcome events were predefined as appropriate antitachycardia pacing, shock, or death over 2 years. RESULTS Mechanical dyssynchrony was present in 97 patients (64%) at baseline. At follow-up, 42 of these 97 patients (43%) had persistent dyssynchrony. Furthermore, among 54 patients with no dyssynchrony at baseline, 15 (28%) had onset of new dyssynchrony after CRT-D. In comparison with the group with reduced dyssynchrony, patients with persistent dyssynchrony after CRT-D were associated with a substantially increased risk for VA (hazard ratio [HR], 4.4; 95% CI, 1.2-16.3; P = .03) and VA or death (HR, 4.0; 95% CI, 1.7-9.6; P = .002) after adjusting for other covariates. Similarly, patients with new dyssynchrony had increased risk for VA (HR, 10.6; 95% CI, 2.8-40.4; P = .001) and VA or death (HR, 5.0; 95% CI, 1.8-13.5; P = .002). CONCLUSIONS Persistent and new mechanical dyssynchrony after CRT-D was associated with subsequent complex VA. Dyssynchrony after CRT-D is a marker of poor prognosis.
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Affiliation(s)
- Bhupendar Tayal
- Division of Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
| | - John Gorcsan
- Division of Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Josef J Marek
- Division of Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kristina H Haugaa
- Division of Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Keiko Ryo
- Division of Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Akiko Goda
- Division of Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Samir Saba
- Division of Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Niels Risum
- Department of Cardiology, Hvidovre University Hospital, Copenhagen, Denmark
| | - Peter Sogaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
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447
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Estes NAM. Cardiac Resynchronization Therapy for Mild Heart Failure: Compelling Evidence of Long-Term Benefits. JACC. HEART FAILURE 2015; 3:701-702. [PMID: 26277766 DOI: 10.1016/j.jchf.2015.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 06/23/2015] [Indexed: 06/04/2023]
Affiliation(s)
- N A Mark Estes
- Tufts University School of Medicine, New England Cardiac Arrhythmia Center, Tufts Medical Center, Boston, Massachusetts.
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448
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Linde C. Cardiac resynchronization revisited: what is the next step? Eur J Heart Fail 2015; 17:881-3. [DOI: 10.1002/ejhf.336] [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: 07/05/2015] [Revised: 07/06/2015] [Accepted: 07/08/2015] [Indexed: 11/10/2022] Open
Affiliation(s)
- Cecilia Linde
- Karolinska University Hospital and Karolinska Institutet; Stockholm Sweden
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449
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Biton Y, Moss AJ, Kutyifa V, Mathias A, Sherazi S, Zareba W, McNitt S, Polonsky B, Barsheshet A, Brown MW, Goldenberg I. Inverse Relationship of Blood Pressure to Long-Term Outcomes and Benefit of Cardiac Resynchronization Therapy in Patients With Mild Heart Failure. Circ Heart Fail 2015; 8:921-6. [DOI: 10.1161/circheartfailure.115.002208] [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: 03/20/2015] [Accepted: 07/06/2015] [Indexed: 11/16/2022]
Abstract
Background—
Previous studies have shown that low blood pressure is associated with increased mortality and heart failure (HF) in patients with left ventricular dysfunction. Cardiac resynchronization therapy (CRT) was shown to increase systolic blood pressure (SBP). Therefore, we hypothesized that treatment with CRT would provide incremental benefit in patients with lower SBP values.
Methods and Results—
The independent contribution of SBP to outcome was analyzed in 1267 patients with left bundle brunch block enrolled in Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy (MADIT-CRT). SBP was assessed as continuous measures and further categorized into approximate quintiles. The risk of long-term HF or death and CRT with defibrillator versus implantable cardioverter defibrillator benefit was assessed in multivariate Cox proportional hazards regression models. Multivariate analysis showed that in the implantable cardioverter defibrillator arm, each 10-mm Hg decrement of SBP was independently associated with a significant 21% (
P
<0.001) increased risk for HF or death, and patients with lower quintile SBP (<110 mm Hg) experienced a corresponding >2-fold risk-increase. CRT with defibrillator provided the greatest HF or mortality risk reduction in patients with SBP<110 mm Hg hazard ratio of 0.34,
P
<0.001, when compared with hazard ratio of 0.52,
P
<0.001, in those with 110>SBP≥136 mm Hg and hazard ratio of 0.94,
P
=0.808, with SBP>136 mm Hg (
P
for trend=0.001).
Conclusions—
In patients with mild HF, prolonged QRS, and left bundle brunch block, low SBP is related to higher risk of mortality or HF with implantable cardioverter defibrillator therapy alone. Treatment with CRT is associated with incremental clinical benefits in patients with lower baseline SBP values.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00180271.
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Affiliation(s)
- Yitschak Biton
- From the Heart Research Follow-Up Program, Division of Cardiology, Department of Medicine, University of Rochester Medical Center, NY
| | - Arthur J. Moss
- From the Heart Research Follow-Up Program, Division of Cardiology, Department of Medicine, University of Rochester Medical Center, NY
| | - Valentina Kutyifa
- From the Heart Research Follow-Up Program, Division of Cardiology, Department of Medicine, University of Rochester Medical Center, NY
| | - Andrew Mathias
- From the Heart Research Follow-Up Program, Division of Cardiology, Department of Medicine, University of Rochester Medical Center, NY
| | - Saadia Sherazi
- From the Heart Research Follow-Up Program, Division of Cardiology, Department of Medicine, University of Rochester Medical Center, NY
| | - Wojciech Zareba
- From the Heart Research Follow-Up Program, Division of Cardiology, Department of Medicine, University of Rochester Medical Center, NY
| | - Scott McNitt
- From the Heart Research Follow-Up Program, Division of Cardiology, Department of Medicine, University of Rochester Medical Center, NY
| | - Bronislava Polonsky
- From the Heart Research Follow-Up Program, Division of Cardiology, Department of Medicine, University of Rochester Medical Center, NY
| | - Alon Barsheshet
- From the Heart Research Follow-Up Program, Division of Cardiology, Department of Medicine, University of Rochester Medical Center, NY
| | - Mary W. Brown
- From the Heart Research Follow-Up Program, Division of Cardiology, Department of Medicine, University of Rochester Medical Center, NY
| | - Ilan Goldenberg
- From the Heart Research Follow-Up Program, Division of Cardiology, Department of Medicine, University of Rochester Medical Center, NY
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450
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Priori SG, Blomström-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, Elliott PM, Fitzsimons D, Hatala R, Hindricks G, Kirchhof P, Kjeldsen K, Kuck KH, Hernandez-Madrid A, Nikolaou N, Norekvål TM, Spaulding C, Van Veldhuisen DJ. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC)Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Europace 2015; 17:1601-87. [PMID: 26318695 DOI: 10.1093/europace/euv319] [Citation(s) in RCA: 217] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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