Prognostic Usefulness of Systolic Blood Pressure One-Year Following Cardiac Resynchronization Therapy (from MADIT-CRT)

Optimizing Patient Selection for Cardiac Resynchronization Therapy With or Without Defibrillator in a Multicenter Study of Japanese Patients - Assessment of the MADIT-ICD Benefit Score

BACKGROUND

Although the MADIT-ICD benefit score (MBS) helps select suitable implantable cardioverter defibrillator (ICD) candidates, optimal indicators for cardiac resynchronization therapy (CRT) remain uncertain. Evaluating the applicability of the MBS in Japanese CRT patients is imperative.

METHODS AND RESULTS

This multicenter study assessed the cumulative incidence of ventricular tachycardia/fibrillation (VT/VF) and non-arrhythmic mortality (AM) in CRT patients grouped according to potential benefit (lowest, highest, and intermediate). Among 400 primary prevention patients (mean age 65 years, 76% male), VT/VF occurred in 4 (7%), 68 (24%), and 14 (23%) patients in the lowest-, intermediate-, and highest-benefit groups, respectively (P=0.027), over a median follow-up of 34 months. Non-arrhythmic death was observed in 15 (25%), 91 (33%), and 9 (15%) patients in the lowest-, intermediate-, and highest-benefit groups, respectively (P=0.025). Multivariate analysis identified VT/VF score ≥7 (hazard ratio [HR] 2.14; 95% confidence interval [CI] 1.09-4.19; P=0.027) as a significant VT/VF predictor. The presence of left bundle branch block (HR 0.51; 95% CI 0.29-0.92; P=0.025) was associated with a reduced risk of VT/VF events. Non-AM score ≥3 (HR 1.70; 95% CI 1.01-2.88; P=0.047), systolic blood pressure <100 mmHg (HR 1.84; 95% CI 1.25-2.70; P=0.002), and estimated glomerular filtration rate <30 mL/min/1.73 m2(HR 1.98; 95% CI 1.23-3.20; P=0.005) were significant predictors of non-arrhythmic death.

CONCLUSIONS

The MBS can identify suitable candidates for CRT-D among Japanese individuals.

The efficacy and safety outcomes of cardiac resynchronization therapy in patients with heart failure in Thailand: Phramongkutklao experience

BACKGROUND

Cardiac resynchronization therapy (CRT) is one of the crucial treatments in patients with symptomatic heart failure reduced ejection fraction. This study aimed to report the efficacy and safety of CRT implantation in treating patients with heart failure. The responders and related outcomes were also analyzed.

METHODS

Medical records of all patients with CRT implantation, because of heart failure treatment indication, in Phramongkutklao Hospital between 2008 and 2019 were reviewed. Free from death and heart failure hospitalization were analyzed as composited efficacy outcomes with survival analysis. Follow-up echocardiography was used to define a responder. The safety outcomes were reported using descriptive data. Cox-proportional hazard model analysis was used for the responder as a predictor of outcomes.

RESULTS

A total of 152 patients underwent CRT implantation because of heart failure. 77.63% were male, the mean age of 65.9 ± 13.19 years, 59.85% were diagnosed with ischemic cardiomyopathy, mean LVEF of 22.69 ± 7.51%, and QRS duration of 147 ± 21 ms. Mean Follow-up was 41 months. The composited efficacy outcomes were 91.7%, 54.8%, and 35.4% at 1, 5, and 10 years, respectively. CRT-related complications were found in 12 patients (7.89%). 71.30% of patients who were responders had lower death or heart failure hospitalization when compared to non-responders (HR: 0.43, 95% CI: 0.24-0.78).

CONCLUSION

The efficacy and safety in CRT treating patients in our center were consistent with the previous randomized and observational studies. The responder rate remained the same as in previous trials but was a strong predictor for better outcomes.