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Beltrami M, Galluzzo A, Brocci RT, Paoletti Perini A, Pieragnoli P, Garofalo M, Halasz G, Milli M, Barilli M, Palazzuoli A. The role of fibrosis, inflammation, and congestion biomarkers for outcome prediction in candidates to cardiac resynchronization therapy: is "response" the right answer? Front Cardiovasc Med 2023; 10:1180960. [PMID: 37378403 PMCID: PMC10291081 DOI: 10.3389/fcvm.2023.1180960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
Background Cardiac resynchronization therapy (CRT) is an established treatment in selected patients suffering from heart failure with reduced ejection fraction (HFrEF). It has been proposed that myocardial fibrosis and inflammation could influence CRT "response" and outcome. Our study investigated the long-term prognostic significance of cardiac biomarkers in HFrEF patients with an indication for CRT. Methods Consecutive patients referred for CRT implantation were retrospectively evaluated. The soluble suppression of tumorigenicity 2 (sST2), galectin-3 (Gal-3), N-terminal portion of the B-type natriuretic peptide (NT-proBNP), and estimated glomerular filtration rate (eGFR) were measured at baseline and after 1 year of follow-up. Multivariate analyses were performed to evaluate their correlation with the primary composite outcome of cardiovascular mortality and heart failure hospitalizations at a mean follow-up of 9 ± 2 years. Results Among the 86 patients enrolled, 44% experienced the primary outcome. In this group, the mean baseline values of NT-proBNP, Gal-3, and sST2 were significantly higher compared with the patients without cardiovascular events. At the multivariate analyses, baseline Gal-3 [cut-off: 16.6 ng/ml, AUC: 0.91, p < 0.001, HR 8.33 (1.88-33.33), p = 0.005] and sST2 [cut-off: 35.6 ng/ml AUC: 0.91, p < 0.001, HR 333 (250-1,000), p = 0.003] significantly correlated with the composite outcome in the prediction models with high likelihood. Among the parameters evaluated at 1-year follow-up, sST2, eGFR, and the variation from baseline to 1-year of Gal-3 levels showed a strong association with the primary outcome [HR 1.15 (1.08-1.22), p < 0.001; HR: 0.84 (0.74-0.91), p = 0.04; HR: 1.26 (1.10-1.43), p ≤ 0.001, respectively]. Conversely, the echocardiographic definition of CRT response did not correlate with any outcome. Conclusion In HFrEF patients with CRT, sST2, Gal-3, and renal function were associated with the combined endpoint of cardiovascular death and HF hospitalizations at long-term follow-up, while the echocardiographic CRT response did not seem to influence the outcome of the patients.
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Affiliation(s)
- Matteo Beltrami
- Cardiology Unit, San Giovanni di Dio Hospital, Azienda USL Toscana Centro, Florence, Italy
| | | | | | - Alessandro Paoletti Perini
- Department of Internal Medicine, Cardiology and Electrophysiology Unit, Azienda USL Toscana Centro, Florence, Italy
| | - Paolo Pieragnoli
- Arrhythmia and Electrophysiology Unit, Careggi University Hospital, Florence, Italy
| | - Manuel Garofalo
- Department of Clinical and Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Geza Halasz
- Department of Cardiosciences, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy
| | - Massimo Milli
- Cardiology Unit, San Giovanni di Dio Hospital, Azienda USL Toscana Centro, Florence, Italy
| | - Maria Barilli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Le Scotte Hospital, Siena, Italy
| | - Alberto Palazzuoli
- Cardiovascular Diseases Unit, Cardio Thoracic and Vascular Department, Le Scotte Hospital, University of Siena, Siena, Italy
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Li Y, Liu X, Xu Y, Li W, Tang S, Zhou X, Sun J, Zhang Q, Han Y, Chen Y. The Prognostic Value of Left Ventricular Mechanical Dyssynchrony Derived from Cardiac MRI in Patients with Idiopathic Dilated Cardiomyopathy. Radiol Cardiothorac Imaging 2021; 3:e200536. [PMID: 34498001 DOI: 10.1148/ryct.2021200536] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 05/12/2021] [Accepted: 06/08/2021] [Indexed: 02/05/2023]
Abstract
Purpose To investigate the prognostic value of mechanical dyssynchrony evaluated by deformable registration algorithm (DRA) analysis of cardiac MRI (CMR) in patients with idiopathic dilated cardiomyopathy (DCM). Materials and Methods This secondary analysis of a prospective study (clinical trial no. ChiCTR1800017058) enrolled 409 patients (mean age, 48 years ± 14:300 men) with idiopathic DCM who underwent CMR between June 2012 and September 2018. Mechanical dyssynchrony was measured as standard deviation of time-to-peak (sdTTP) and uniformity ratio estimate (URE) indexes by DRA strain analysis. The primary endpoint included all-cause mortality and heart transplantation. The secondary endpoint included primary endpoint, aborted sudden cardiac death, and heart failure readmission. Cox regression analyses and Kaplan-Meier survival analysis were performed to identify the association between variables and outcomes. Results During a median follow-up of 25.1 months, 57 and 132 patients reached primary and secondary endpoints, respectively. Most URE indexes were significantly lower in patients reaching primary endpoint. In multivariable analysis, circumferential URE (CURE) at apical level was independently associated with primary endpoints (hazard ratio, 0.307 [95% CI: 0.106, 0.883]; P = .03) and secondary endpoints (hazard ratio, 0.452 [95% CI: 0.209, 0.979]; P = .04), whereas most sdTTP measures were not. Furthermore, among patients with left ventricular ejection fraction of less than 35% or presence of late gadolinium enhancement, those with CURE at apical level of less than 0.917 had a significantly higher rate of adverse outcomes. Conclusion URE indexes were more predictive of prognostic outcomes compared with sdTTP measurements; the CURE at apical level was an independent predictor of adverse cardiac events in patients with DCM.Keywords: Heart, Outcomes Analysis, MR-ImagingClinical trial registration no. ChiCTR1800017058 Supplemental material is available for this article. See also commentary by Rajiah and François in this issue.© RSNA, 2021.
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Affiliation(s)
- Yangjie Li
- Departments of Cardiology (Y.L., Y.X., W.L., S.T., Q.Z., Y.C.) and Radiology (X.L., J.S.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China; Siemens Healthcare, Shanghai, China (X.Z.); and Cardiovascular Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Xiumin Liu
- Departments of Cardiology (Y.L., Y.X., W.L., S.T., Q.Z., Y.C.) and Radiology (X.L., J.S.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China; Siemens Healthcare, Shanghai, China (X.Z.); and Cardiovascular Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Yuanwei Xu
- Departments of Cardiology (Y.L., Y.X., W.L., S.T., Q.Z., Y.C.) and Radiology (X.L., J.S.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China; Siemens Healthcare, Shanghai, China (X.Z.); and Cardiovascular Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Weihao Li
- Departments of Cardiology (Y.L., Y.X., W.L., S.T., Q.Z., Y.C.) and Radiology (X.L., J.S.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China; Siemens Healthcare, Shanghai, China (X.Z.); and Cardiovascular Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Siqi Tang
- Departments of Cardiology (Y.L., Y.X., W.L., S.T., Q.Z., Y.C.) and Radiology (X.L., J.S.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China; Siemens Healthcare, Shanghai, China (X.Z.); and Cardiovascular Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Xiaoyue Zhou
- Departments of Cardiology (Y.L., Y.X., W.L., S.T., Q.Z., Y.C.) and Radiology (X.L., J.S.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China; Siemens Healthcare, Shanghai, China (X.Z.); and Cardiovascular Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Jiayu Sun
- Departments of Cardiology (Y.L., Y.X., W.L., S.T., Q.Z., Y.C.) and Radiology (X.L., J.S.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China; Siemens Healthcare, Shanghai, China (X.Z.); and Cardiovascular Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Qing Zhang
- Departments of Cardiology (Y.L., Y.X., W.L., S.T., Q.Z., Y.C.) and Radiology (X.L., J.S.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China; Siemens Healthcare, Shanghai, China (X.Z.); and Cardiovascular Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Yuchi Han
- Departments of Cardiology (Y.L., Y.X., W.L., S.T., Q.Z., Y.C.) and Radiology (X.L., J.S.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China; Siemens Healthcare, Shanghai, China (X.Z.); and Cardiovascular Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Yucheng Chen
- Departments of Cardiology (Y.L., Y.X., W.L., S.T., Q.Z., Y.C.) and Radiology (X.L., J.S.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China; Siemens Healthcare, Shanghai, China (X.Z.); and Cardiovascular Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pa (Y.H.)
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3
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Ruwald AC, Aktas MK, Ruwald MH, Kutyifa V, McNitt S, Jons C, Mittal S, Steinberg JS, Daubert JP, Moss AJ, Zareba W. Postimplantation ventricular ectopic burden and clinical outcomes in cardiac resynchronization therapy-defibrillator patients: a MADIT-CRT substudy. Ann Noninvasive Electrocardiol 2017; 23:e12491. [PMID: 28940909 DOI: 10.1111/anec.12491] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 07/27/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Frequent ventricular ectopy on preimplantation Holter has been associated with attenuated benefit from cardiac resynchronization therapy (CRT). However, it is unclear whether ectopic burden measured post-CRT implantation can be utilized to evaluate long-term prognosis. We aimed to describe the association between post-CRT implantation ectopic burden and subsequent risk of clinical outcomes. METHODS At the 12-month follow-up visit, 24-hour Holter recordings were performed in 698 CRT-D patients from the MADIT-CRT study. The mean number of ventricular premature complexes (VPCs/hour) was calculated. High ectopic burden was defined as >10 VPCs/hour and low burden as ≤10 VPCs/hour. Multivariate Cox proportional hazards models were utilized to assess the association between 12-month ectopic burden and the risk of the end points of heart failure (HF) or death and ventricular tachyarrhythmias (VT/VF). RESULTS At 12 months, 282 (40%) patients presented with low ectopic burden and 416 (60%) patients presented with high ectopic burden. The 3-year risk of HF/death and VT/VF was lower in patients with a low burden (7% and 8%) and significantly higher (25% and 24%) in patients with high burden. In multivariate analyses, patients with a high ectopic burden had approximately threefold increased risk of both HF/death (HR=2.76 [1.62-4.70], p < .001) and VT/VF (HR=2.79 [1.69-4.58], p < .001). CONCLUSION In CRT-D patients with mild heart failure, high ectopic burden at 12-month follow-up was associated with a high 3-year risk of HF/death and VT/VF and threefold increased risk as compared to patients with low burden. Ectopic burden at 12 months may be a valuable approach for evaluating long-term prognosis.
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Affiliation(s)
- Anne-Christine Ruwald
- Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, NY, USA.,Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark
| | - Mehmet K Aktas
- Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, NY, USA
| | - Martin H Ruwald
- Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, NY, USA.,Department of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Valentina Kutyifa
- Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, NY, USA
| | - Scott McNitt
- Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, NY, USA
| | - Christian Jons
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Suneet Mittal
- Arrhythmia Institute, Valley Health System New York, New York, Ridgewood, NJ, USA
| | - Jonathan S Steinberg
- Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, NY, USA.,Arrhythmia Institute, Valley Health System New York, New York, Ridgewood, NJ, USA
| | - James P Daubert
- Cardiology Division, Department of Medicine and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Arthur J Moss
- Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, NY, USA
| | - Wojciech Zareba
- Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, NY, USA
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Széplaki G, Boros AM, Szilágyi S, Osztheimer I, Jenei Z, Kosztin A, Nagy KV, Karády J, Molnár L, Tahin T, Zima E, Gellér L, Prohászka Z, Merkely B. Complement C3a predicts outcome in cardiac resynchronization therapy of heart failure. Inflamm Res 2016; 65:933-940. [DOI: 10.1007/s00011-016-0976-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/23/2016] [Accepted: 07/19/2016] [Indexed: 12/19/2022] Open
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5
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Bencardino G, Di Monaco A, Russo E, Colizzi C, Perna F, Pelargonio G, Narducci ML, Gabrielli FA, Lanza GA, Rebuzzi AG, Crea F. Outcome of Patients Treated by Cardiac Resynchronization Therapy Using a Quadripolar Left Ventricular Lead. Circ J 2016; 80:613-8. [DOI: 10.1253/circj.cj-15-0932] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Antonio Di Monaco
- Department of Cardiovascular Medicine, Catholic University of the Sacred Heart
| | - Eleonora Russo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS
| | - Cristian Colizzi
- Department of Cardiovascular Medicine, Catholic University of the Sacred Heart
| | - Francesco Perna
- Department of Cardiovascular Medicine, Catholic University of the Sacred Heart
| | - Gemma Pelargonio
- Department of Cardiovascular Medicine, Catholic University of the Sacred Heart
| | | | | | | | | | - Filippo Crea
- Department of Cardiovascular Medicine, Catholic University of the Sacred Heart
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6
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Role of Right Ventricular Global Longitudinal Strain in Predicting Early and Long-Term Mortality in Cardiac Resynchronization Therapy Patients. PLoS One 2015; 10:e0143907. [PMID: 26700308 PMCID: PMC4689553 DOI: 10.1371/journal.pone.0143907] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 11/11/2015] [Indexed: 11/30/2022] Open
Abstract
Background Right ventricular (RV) dysfunction has been associated with poor prognosis in chronic heart failure (HF). However, less data is available about the role of RV dysfunction in patients with cardiac resynchronization therapy (CRT). We aimed to investigate if RV dysfunction would predict outcome in CRT. Design We enrolled prospectively ninety-three consecutive HF patients in this single center observational study. All patients underwent clinical evaluation and echocardiography before CRT and 6 months after implantation. We assessed RV geometry and function by using speckle tracking imaging and calculated strain parameters. We performed multivariable Cox regression models to test mortality at 6 months and at 24 months. Results RV dysfunction, characterized by decreased RVGLS (RV global longitudinal strain) [10.2 (7.0–12.8) vs. 19.5 (15.0–23.9) %, p<0.0001] and RVFWS (RV free wall strain) [15.6 (10.0–19.3) vs. 17.4 (10.5–22.2) %, p = 0.04], improved 6 months after CRT implantation. Increasing baseline RVGLS and RVFWS predicted survival independent of other parameters at 6 months [hazard ratio (HR) = 0.37 (0.15–0.90), p = 0.02 and HR = 0.42 (0.19–0.89), p = 0.02; per 1 standard deviation increase, respectively]. RVGLS proved to be a significant independent predictor of mortality at 24 months [HR = 0.53 (0.32–0.86), p = 0.01], and RVFWS showed a strong tendency [HR = 0.64 (0.40–1.00), p = 0.05]. The 24-month survival was significantly impaired in patients with RVGLS below 10.04% before CRT implantation [area under the curve = 0.72 (0.60–0.84), p = 0.002, log-rank p = 0.0008; HR = 5.23 (1.76–15.48), p = 0.003]. Conclusions Our findings indicate that baseline RV dysfunction is associated with poor short-term and long-term prognosis after CRT implantation.
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Abstract
PURPOSE OF REVIEW Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in patients with mild-to-severe heart failure. However, up to 40% of CRT recipients are nonresponders. This review addresses important aspects with regard to the identification and management of CRT nonresponders. RECENT FINDINGS Mid-term clinical or echocardiographic nonresponse is associated with worse clinical outcomes during the extended follow-up. A number of predictors are indicative of CRT response, which include patient characteristics, electrical determinants, and imaging techniques from preimplant to postimplant period, and can be grouped as modifiable and nonmodifiable contributors to treatment response. Advanced age, male sex, ischemic cause, end-stage heart failure, inadequate electrical delay, and absence of mechanical dyssynchrony are regarded as unfavorable but nonmodifiable factors, for which considering underutilization of CRT by refining patient selection is reasonable. On the contrary, more efforts should be made to optimize patient management by correcting those modifiable factors, such as suboptimal medical therapy, uncontrolled atrial fibrillation, left ventricular lead dislodgement or inappropriate location, loss of biventricular capture, and lack of device optimization. SUMMARY Proper management and careful selection of CRT recipients will transform a proportion of treatment nonresponders into responders, which is vital to improve patients' outcome.
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8
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Cai Q, Ahmad M. Left Ventricular Dyssynchrony by Three-Dimensional Echocardiography: Current Understanding and Potential Future Clinical Applications. Echocardiography 2015; 32:1299-306. [PMID: 25923952 DOI: 10.1111/echo.12965] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Left ventricular mechanical dyssynchrony is an important prognostic factor for patients with symptomatic systolic heart failure and has emerged as a therapeutic target for cardiac resynchronization therapy (CRT). However, approximately one-third of patients fail to improve after CRT based on current guideline recommendations and electrocardiographic criteria. Two-dimensional echocardiography and tissue Doppler-based techniques have shown variable results in assessment of left ventricular (LV) dyssynchrony and have limited value in clinical practice. Three-dimensional echocardiography (3DE) is an appealing novel imaging modality that has been recently used in quantitative evaluation of global and regional LV function. There is accumulating evidence that 3DE measurement of LV systolic dyssynchrony index may potentially play a role in predicting the short- and long-term response to CRT and further improve patient selection for CRT. New developments in 3DE speckle tracking technique and strain analysis may further improve the accuracy of LV mechanical dyssynchrony assessment in this population. In addition, recent studies suggest that mechanical dyssynchrony is present in patients with LV hypertrophy and diastolic heart failure. Three-dimensional echocardiographic assessment of dyssynchrony may aid in diagnosis and in predicting long-term outcome in these patients. We will summarize current understanding of 3DE techniques and parameters in assessment of LV mechanical dyssynchrony in the population of patients with systolic heart failure, LV hypertrophy, and diastolic heart failure. A number of the novel 3DE techniques described in this review are early in their stage of development, and they will continue to evolve and need further testing in large multicenter studies.
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Affiliation(s)
- Qiangjun Cai
- Division of Cardiology, University of Texas Medical Branch, Galveston, Texas
| | - Masood Ahmad
- Division of Cardiology, University of Texas Medical Branch, Galveston, Texas
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9
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Grupper A, Killu AM, Friedman PA, Abu Sham'a R, Buber J, Kuperstein R, Rozen G, Asirvatham SJ, Espinosa RE, Luria D, Webster TL, Brooke KL, Hodge DO, Wiste HJ, Cha YM, Glikson M. Effects of tricuspid valve regurgitation on outcome in patients with cardiac resynchronization therapy. Am J Cardiol 2015; 115:783-9. [PMID: 25638518 DOI: 10.1016/j.amjcard.2014.12.046] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 12/13/2014] [Accepted: 12/13/2014] [Indexed: 11/29/2022]
Abstract
Cardiac resynchronization therapy (CRT) has a symptomatic and survival benefit for patients with heart failure (HF), but the percentage of nonresponders remains relatively high. The aims of this study were to assess the clinical significance of baseline tricuspid regurgitation (TR) or worsening TR after implantation of a CRT device on the response to therapy. This is a multicenter retrospective analysis of prospectively collected databases that includes 689 consecutive patients who underwent implantation of CRT. The patients were divided into groups according to baseline TR grade and according to worsening TR within 15 months after device implantation. Outcome was assessed by clinical and echocardiographic response within 15 months and by estimated survival for a median interquartile range follow-up time of 3.3 years (1.6, 4.6). TR worsening after CRT implantation was documented in 104 patients (15%). These patients had worse clinical and echocardiographic response to CRT, but worsening of TR was not a significant predictor of mortality (p = 0.17). According to baseline echocardiogram, 620 patients (90%) had some degree of TR before CRT implant. Baseline TR was an independent predictor of worse survival (p <0.001), although these patients had significantly better clinical and echocardiographic response compared with patients without TR. In conclusion, worsening of TR after CRT implantation is a predictor of worse clinical and echocardiographic response but was not significantly associated with increased mortality. Baseline TR is associated with reduced survival despite better clinical and echocardiographic response after CRT implantation.
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Affiliation(s)
- Avishay Grupper
- Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel.
| | - Ammar M Killu
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Paul A Friedman
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Raed Abu Sham'a
- Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Jonathan Buber
- Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Rafael Kuperstein
- Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Guy Rozen
- Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
| | | | - Raul E Espinosa
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - David Luria
- Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Tracy L Webster
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Kelly L Brooke
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - David O Hodge
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Heather J Wiste
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Yong-Mei Cha
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Michael Glikson
- Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
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Lalonde M, Wells RG, Birnie D, Ruddy TD, Wassenaar R. Development and optimization of SPECT gated blood pool cluster analysis for the prediction of CRT outcome. Med Phys 2014; 41:072506. [DOI: 10.1118/1.4883881] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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11
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Madhavan M, Friedman PA. Leadless endocardial left ventricular resynchronization: is it ready for prime time? Europace 2014; 16:623-5. [DOI: 10.1093/europace/euu075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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12
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Ukena C, Cremers B, Ewen S, Böhm M, Mahfoud F. Response and non-response to renal denervation: who is the ideal candidate? EUROINTERVENTION 2014; 9 Suppl R:R54-7. [PMID: 23732156 DOI: 10.4244/eijv9sra10] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Catheter-based renal denervation (RDN) leads to a considerable decrease of blood pressure in the vast majority of patients with resistant hypertension. However, only minor or no blood pressure change is achieved in some patients. This non-reponse is defined as a reduction of office systolic blood pressure of less than 10 mmHg following RDN. The rates of non-response vary between 8-37%. Here several causes are discussed such as inappropriate patient selection, an ineffective procedure, the subordinate contribution of sympathetic activation for the maintenance of hypertension, and patient conditions such as non-adherence to drug therapy. Based on current evidence, an ideal candidate for RDN has high baseline blood pressure, which is known to be the best predictor for blood pressure reduction after RDN. In order to ensure treatment success further criteria have to be fulfilled, such as exclusion of secondary hypertension and optimised medical therapy.
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Affiliation(s)
- Christian Ukena
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany.
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13
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Lalonde M, Birnie D, Ruddy TD, deKemp RA, Beanlands RSB, Wassenaar R, Wells RG. SPECT gated blood pool phase analysis of lateral wall motion for prediction of CRT response. Int J Cardiovasc Imaging 2014; 30:559-69. [DOI: 10.1007/s10554-013-0360-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 12/31/2013] [Indexed: 10/25/2022]
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14
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Lionetti V, Romano SL, Bianchi G, Bernini F, Dushpanova A, Mascia G, Nesti M, Di Gregorio F, Barbetta A, Padeletti L. Impact of acute changes of left ventricular contractility on the transvalvular impedance: validation study by pressure-volume loop analysis in healthy pigs. PLoS One 2013; 8:e80591. [PMID: 24260431 PMCID: PMC3834044 DOI: 10.1371/journal.pone.0080591] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 10/06/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The real-time and continuous assessment of left ventricular (LV) myocardial contractility through an implanted device is a clinically relevant goal. Transvalvular impedance (TVI) is an impedentiometric signal detected in the right cardiac chambers that changes during stroke volume fluctuations in patients. However, the relationship between TVI signals and LV contractility has not been proven. We investigated whether TVI signals predict changes of LV inotropic state during clinically relevant loading and inotropic conditions in swine normal heart. METHODS The assessment of RVTVI signals was performed in anesthetized adult healthy anesthetized pigs (n = 6) instrumented for measurement of aortic and LV pressure, dP/dtmax and LV volumes. Myocardial contractility was assessed with the slope (Ees) of the LV end systolic pressure-volume relationship. Effective arterial elastance (Ea) and stroke work (SW) were determined from the LV pressure-volume loops. Pigs were studied at rest (baseline), after transient mechanical preload reduction and afterload increase, after 10-min of low dose dobutamine infusion (LDDS, 10 ug/kg/min, i.v), and esmolol administration (ESMO, bolus of 500 µg and continuous infusion of 100 µg·kg-1·min-1). RESULTS We detected a significant relationship between ESTVI and dP/dtmax during LDDS and ESMO administration. In addition, the fluctuations of ESTVI were significantly related to changes of the Ees during afterload increase, LDDS and ESMO infusion. CONCLUSIONS ESTVI signal detected in right cardiac chamber is significantly affected by acute changes in cardiac mechanical activity and is able to predict acute changes of LV inotropic state in normal heart.
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Affiliation(s)
- Vincenzo Lionetti
- Laboratory of Medical Science, Institute of Life Sciences, Scuola Superiore Sant’Anna, Pisa, Italy
- Fondazione CNR/Regione Toscana “G. Monasterio”, Pisa, Italy
- * E-mail:
| | - Simone Lorenzo Romano
- Laboratory of Medical Science, Institute of Life Sciences, Scuola Superiore Sant’Anna, Pisa, Italy
| | - Giacomo Bianchi
- Laboratory of Medical Science, Institute of Life Sciences, Scuola Superiore Sant’Anna, Pisa, Italy
- Fondazione CNR/Regione Toscana “G. Monasterio”, Pisa, Italy
| | - Fabio Bernini
- Laboratory of Medical Science, Institute of Life Sciences, Scuola Superiore Sant’Anna, Pisa, Italy
| | - Anar Dushpanova
- Laboratory of Medical Science, Institute of Life Sciences, Scuola Superiore Sant’Anna, Pisa, Italy
| | - Giuseppe Mascia
- Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy
| | - Martina Nesti
- Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy
| | | | | | - Luigi Padeletti
- Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy
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Paoletti Perini A, Bartolini S, Pieragnoli P, Ricciardi G, Perrotta L, Valleggi A, Vergaro G, Michelotti F, Boggian G, Sassone B, Mascioli G, Emdin M, Padeletti L. CHADS2 and CHA2DS2-VASc scores to predict morbidity and mortality in heart failure patients candidates to cardiac resynchronization therapy. Europace 2013; 16:71-80. [DOI: 10.1093/europace/eut190] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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16
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D'Andrea A, Mele D, Nistri S, Riegler L, Galderisi M, Agricola E, Losi MA, Ballo P, Mondillo S, Badano LP. The prognostic impact of dynamic ventricular dyssynchrony in patients with idiopathic dilated cardiomyopathy and narrow QRS. Eur Heart J Cardiovasc Imaging 2013; 14:183-189. [DOI: 10.1093/ehjci/jes154] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
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18
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Wang H, Shuraih M, Ahmad M. Real Time Three-Dimensional Echocardiography in Assessment of Left Ventricular Dyssynchrony and Cardiac Resynchronization Therapy. Echocardiography 2012; 29:192-9. [DOI: 10.1111/j.1540-8175.2011.01622.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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19
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Fazio S, Carlomagno G. The importance of tricuspid regurgitation and right ventricular overload in ICD/CRT recipients: beside the left, beyond the left. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 34:1181-4. [PMID: 21819432 DOI: 10.1111/j.1540-8159.2011.03189.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Device therapy for advanced heart failure has become increasingly employed in the last 10 years. Several retrospective studies have postulated a harmful effect of implantable cardioverter-defibrillator (ICD) lead placement on tricuspid valve function and right heart hemodynamics, in particular among patients with preexisting pulmonary vascular overload and both left and right ventricular remodeling/dysfunction. This functional hypothesis is also supported by long-term clinical follow-up analyses of ICD and cardiac resynchronization therapy recipients. In this viewpoint, we propose that the possibility of worsening tricuspid regurgitation and consequent hemodynamic deterioration following device implantation should be considered in future studies, as well as in the preimplant evaluation of individual candidates among other clinical factors.
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Affiliation(s)
- Serafino Fazio
- Department of Clinical Medicine, Cardiovascular and Immunological Sciences Federico II University, Naples, Italy.
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