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Ruddy TD, Davies RA, Kiess MC. Development and evolution of nuclear cardiology and cardiac PET in Canada. J Med Imaging Radiat Sci 2024; 55:S3-S9. [PMID: 38637261 DOI: 10.1016/j.jmir.2024.03.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/20/2024]
Abstract
Gated radionuclide angiography and myocardial perfusion imaging were developed in the United States and Europe in the 1970's and soon adopted in Canadian centers. Much of the early development of nuclear cardiology in Canada was in Toronto, Ontario and was quickly followed by new programs across the country. Clinical research in Canada contributed to the further development of nuclear cardiology and cardiac PET. The Canadian Nuclear Cardiology Society (CNCS) was formed in 1995 and became the Canadian Society of Cardiovascular Nuclear and CT Imaging (CNCT) in 2014. The CNCS had a major role in education and advocacy for cardiovascular nuclear medicine testing. The CNCS established the Dr Robert Burns Lecture and CNCT named the Canadian Society of Cardiovascular Nuclear and CT Imaging Annual Achievement Award for Dr Michael Freeman in memoriam of these two outstanding Canadian leaders in nuclear cardiology. The future of nuclear cardiology in Canada is exciting with the expanding use of SPECT imaging to include Tc-99m-pyrophosphate for diagnosis of transthyretin cardiac amyloidosis and the ongoing introduction of cardiac PET imaging.
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Affiliation(s)
- Terrence D Ruddy
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
| | - Ross A Davies
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Marla C Kiess
- Division of Cardiology, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada
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Lazăr-Höcher AI, Cozma D, Cirin L, Cozgarea A, Faur-Grigori AA, Catană R, Tudose DG, Târtea G, Crișan S, Gaiță D, Luca CT, Văcărescu C. A Comparative Analysis of Apical Rocking and Septal Flash: Two Views of the Same Systole? J Clin Med 2024; 13:3109. [PMID: 38892820 PMCID: PMC11172686 DOI: 10.3390/jcm13113109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/11/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024] Open
Abstract
Heart failure (HF) is a complex medical condition characterized by both electrical and mechanical dyssynchrony. Both dyssynchrony mechanisms are intricately linked together, but the current guidelines for cardiac resynchronization therapy (CRT) rely only on the electrical dyssynchrony criteria, such as the QRS complex duration. This possible inconsistency may result in undertreating eligible individuals who could benefit from CRT due to their mechanical dyssynchrony, even if they fail to fulfill the electrical criteria. The main objective of this literature review is to provide a comprehensive analysis of the practical value of echocardiography for the assessment of left ventricular (LV) dyssynchrony using parameters such as septal flash and apical rocking, which have proven their relevance in patient selection for CRT. The secondary objectives aim to offer an overview of the relationship between septal flash and apical rocking, to emphasize the primary drawbacks and benefits of using echocardiography for evaluation of septal flash and apical rocking, and to offer insights into potential clinical applications and future research directions in this area. Conclusion: there is an opportunity to render resynchronization therapy more effective for every individual; septal flash and apical rocking could be a very useful and straightforward echocardiography resource.
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Affiliation(s)
- Alexandra-Iulia Lazăr-Höcher
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.-I.L.-H.); (L.C.); (A.C.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania; (A.-A.F.-G.); (S.C.); (D.G.); (C.-T.L.); (C.V.)
| | - Dragoș Cozma
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania; (A.-A.F.-G.); (S.C.); (D.G.); (C.-T.L.); (C.V.)
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania;
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Liviu Cirin
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.-I.L.-H.); (L.C.); (A.C.)
| | - Andreea Cozgarea
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.-I.L.-H.); (L.C.); (A.C.)
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania
| | - Adelina-Andreea Faur-Grigori
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania; (A.-A.F.-G.); (S.C.); (D.G.); (C.-T.L.); (C.V.)
| | - Rafael Catană
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania;
| | - Dănuț George Tudose
- Institute of Cardiovascular Diseases C.C. Iliescu, Fundeni Clinical Institute, 258 Fundeni Street, 022328 Bucharest, Romania;
| | - Georgică Târtea
- Department of Physiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Simina Crișan
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania; (A.-A.F.-G.); (S.C.); (D.G.); (C.-T.L.); (C.V.)
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania;
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Dan Gaiță
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania; (A.-A.F.-G.); (S.C.); (D.G.); (C.-T.L.); (C.V.)
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania;
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Constantin-Tudor Luca
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania; (A.-A.F.-G.); (S.C.); (D.G.); (C.-T.L.); (C.V.)
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania;
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Cristina Văcărescu
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania; (A.-A.F.-G.); (S.C.); (D.G.); (C.-T.L.); (C.V.)
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania;
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
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Iddagoda Hewage Don SP, Kuruppu KCN, Dunuwille A, Wijewardena A, Gunawardena R. Clinical characteristics and outcome of cardiac resynchronization therapy for heart failure in National Hospital of Sri Lanka from year 2005 to 2020 - a retrospective observational study. BMC Cardiovasc Disord 2024; 24:69. [PMID: 38262994 PMCID: PMC10804476 DOI: 10.1186/s12872-024-03719-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/06/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) has been a well-established treatment modality for moderate to severe left ventricular systolic dysfunction with left ventricular desynchrony. This is the pioneering study that analyses the cohort who underwent CRT implantation at the National Hospital of Sri Lanka (NHSL) in Colombo from 2005 to 2020. OBJECTIVES This study was carried out to describe socio-demographic factors, improvements in clinical outcome (symptoms, electrocardiographic, and echocardiographic features), and post-CRT complications in the study population, as well as to determine the efficacy of CRT in heart failure. METHOD A retrospective observational study was conducted on all the living patients who had undergone CRT implantation from 2005 to 2020. The data was gathered from all the consented patients who visited the device programming clinic using a physician-administered questionnaire and clinical records. Data was analyzed using SPSS 25, and significant statistics were assessed with the McNemer test, the Student T test, and the Chi-Squared test. RESULTS The study included 50 patients with a mean age of 52.82+/- 11.66 years and female predominance (56%, n = 28). Idiopathic dilated cardiomyopathy (50%, n = 25) was the leading etiological factor, followed by ischemic cardiomyopathy (28%, n = 14). Clinical symptoms have improved significantly with CRT implantation (p < 0.001). A significant improvement was found in NYHA functional class (p < 0.001, 95% CI = 0.072 to 0.284), QRS width (p < 0.001, 95% CI = 0.229 to 0.534), ejection fraction (p < 0.001, 95% CI = - 16.437 to - 8.504), and LV EDD (p < 0.001, 95% CI = 2.89 to 9.24). Post-CRT complications included lead malfunction (6%, n = 3) and chronic (14%, n = 7), bleeding or hematoma (2%, n = 1), pocket erosion or infection (6%, n = 3), and infective endocarditis (2%, n = 1). CONCLUSION According to the study, CRT significantly improves both clinical and functional outcomes in patients with moderate to severe heart failure.
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Affiliation(s)
| | | | - Asunga Dunuwille
- Cardiac Electrophysiology Unit, Institute of Cardiology, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Asanka Wijewardena
- Cardiac Electrophysiology Unit, Institute of Cardiology, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Rohan Gunawardena
- Cardiac Electrophysiology Unit, Institute of Cardiology, National Hospital of Sri Lanka, Colombo, Sri Lanka
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Hafkamp FJ, Tio RA, Otterspoor LC, de Greef T, van Steenbergen GJ, van de Ven ART, Smits G, Post H, van Veghel D. Optimal effectiveness of heart failure management - an umbrella review of meta-analyses examining the effectiveness of interventions to reduce (re)hospitalizations in heart failure. Heart Fail Rev 2022; 27:1683-1748. [PMID: 35239106 PMCID: PMC8892116 DOI: 10.1007/s10741-021-10212-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 12/11/2022]
Abstract
Heart failure (HF) is a major health concern, which accounts for 1-2% of all hospital admissions. Nevertheless, there remains a knowledge gap concerning which interventions contribute to effective prevention of HF (re)hospitalization. Therefore, this umbrella review aims to systematically review meta-analyses that examined the effectiveness of interventions in reducing HF-related (re)hospitalization in HFrEF patients. An electronic literature search was performed in PubMed, Web of Science, PsycInfo, Cochrane Reviews, CINAHL, and Medline to identify eligible studies published in the English language in the past 10 years. Primarily, to synthesize the meta-analyzed data, a best-evidence synthesis was used in which meta-analyses were classified based on level of validity. Secondarily, all unique RCTS were extracted from the meta-analyses and examined. A total of 44 meta-analyses were included which encompassed 186 unique RCTs. Strong or moderate evidence suggested that catheter ablation, cardiac resynchronization therapy, cardiac rehabilitation, telemonitoring, and RAAS inhibitors could reduce (re)hospitalization. Additionally, limited evidence suggested that multidisciplinary clinic or self-management promotion programs, beta-blockers, statins, and mitral valve therapy could reduce HF hospitalization. No, or conflicting evidence was found for the effects of cell therapy or anticoagulation. This umbrella review highlights different levels of evidence regarding the effectiveness of several interventions in reducing HF-related (re)hospitalization in HFrEF patients. It could guide future guideline development in optimizing care pathways for heart failure patients.
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Affiliation(s)
| | - Rene A. Tio
- Netherlands Heart Network, Veldhoven, The Netherlands
- Catharina Hospital, Eindhoven, The Netherlands
| | - Luuk C. Otterspoor
- Netherlands Heart Network, Veldhoven, The Netherlands
- Catharina Hospital, Eindhoven, The Netherlands
| | - Tineke de Greef
- Netherlands Heart Network, Veldhoven, The Netherlands
- Catharina Hospital, Eindhoven, The Netherlands
| | | | - Arjen R. T. van de Ven
- Netherlands Heart Network, Veldhoven, The Netherlands
- St. Anna Hospital, Geldrop, The Netherlands
| | - Geert Smits
- Netherlands Heart Network, Veldhoven, The Netherlands
- Primary care group Pozob, Veldhoven, The Netherlands
| | - Hans Post
- Netherlands Heart Network, Veldhoven, The Netherlands
- Catharina Hospital, Eindhoven, The Netherlands
| | - Dennis van Veghel
- Netherlands Heart Network, Veldhoven, The Netherlands
- Catharina Hospital, Eindhoven, The Netherlands
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Goanță EV, Luca CT, Vacarescu C, Crișan S, Petrescu L, Vatasescu R, Lazăr MA, Gurgu A, Turi VR, Cozma D. Nonischemic Super-Responders in Fusion CRT Pacing with Normal Atrioventricular Conduction. Diagnostics (Basel) 2022; 12:diagnostics12092032. [PMID: 36140434 PMCID: PMC9497644 DOI: 10.3390/diagnostics12092032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/29/2022] [Accepted: 08/19/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Fusion CRT pacing (FCRT) is noninferior to biventricular pacing, according to the current data. The aim of this study is to assess the response to FCRT and to identify predictors of super-responders (SRs) in a nonischemic population with normal AV conduction. Methods: LV-only CRT patients (pts) with a right atrium/left ventricle pacing system implanted in two CRT centers in Romania were included. Device interrogation, exercise tests, echocardiography, and individualized drug optimization were performed every 6 months during close follow-up. SRs pts were defined as those with left ventricular end-systolic volume (LVESV) improvement ≥30% and stable ejection fraction (LVEF) ≥45%. Results: A total of 25 out of 83 pts (31%) were SRs, with nonischemic LBBB low EF cardiomyopathy (50 male, 62 ± 9 y.o.) initially included. Mean follow-up was 5 years ± 27 months. Patients were divided in two groups: SRs and non-SRs (52 responders/6 hypo-responders). Two predictors were found in the SRs group: a higher baseline LVEF (SRs 29 ± 5% vs. non-SRs 26 ± 5%, p = 0.02) and a lower pulmonary arterial systolic pressure (SRs 38 ± 11 mm Hg vs. non-SRs 50 ± 15 mmHg, p = 0.003). Baseline severe mitral regurgitation was found in 11% of SRs vs. 64% in the non-SRs group. Conclusions: SRs in the selected NICM-FCRT group are significative high. Higher baseline LVEF and mild pulmonary arterial hypertension were independently associated with super-response.
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Affiliation(s)
- Emilia-Violeta Goanță
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Constantin-Tudor Luca
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Cristina Vacarescu
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Correspondence: (C.V.); (S.C.)
| | - Simina Crișan
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Correspondence: (C.V.); (S.C.)
| | - Lucian Petrescu
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania
| | - Radu Vatasescu
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila”, 014451 Bucharest, Romania
- Clinical Emergency Hospital, 014451 Bucharest, Romania
| | - Mihai-Andrei Lazăr
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Andra Gurgu
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Vladiana-Romina Turi
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Dragos Cozma
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
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Legris V, Thibault B, Dupuis J, White M, Asgar AW, Fortier A, Pitre C, Bouabdallaoui N, Henri C, O'Meara E, Ducharme A. Right ventricular function and its coupling to pulmonary circulation predicts exercise tolerance in systolic heart failure. ESC Heart Fail 2021; 9:450-464. [PMID: 34953062 PMCID: PMC8788036 DOI: 10.1002/ehf2.13726] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 10/31/2021] [Accepted: 11/11/2021] [Indexed: 12/05/2022] Open
Abstract
Aims Right ventricular (RV) dysfunction, pulmonary hypertension, and exercise intolerance have prognostic values, but their interrelation is not fully understood. We investigated how RV function alone and its coupling with pulmonary circulation (RV‐PA) predict cardio‐respiratory fitness in patients with heart failure and reduced ejection fraction (HFrEF). Methods and results The Evaluation of Resynchronization Therapy for Heart Failure (EARTH) study included 205 HFrEF patients with narrow (n = 85) and prolonged (n = 120) QRS duration undergoing implantable cardioverter defibrillator implantation. All patients underwent a comprehensive evaluation with exercise tolerance tests and echocardiography. We investigated the correlations at baseline between RV parameters {size, function [tricuspid annular plane systolic excursion (TAPSE), RV fractional area change (RV‐FAC), and RV myocardial performance index (RV‐MPI)], pulmonary artery systolic pressure (PASP), and tricuspid regurgitation}; left ventricular ejection fraction (LVEF), left ventricular end‐diastolic volume index (LVEDVi), and left atrial volume index (LAVi); and cardiopulmonary exercise test (CPET) [peak VO2, minute ventilation/carbon dioxide production (VE/VCO2), 6 min walk distance (6MWD), and submaximal exercise duration (SED)]. We also studied the relationship between RV‐PA coupling (TAPSE/PASP ratio) and echocardiographic parameters in patients with both data available. Univariate and multivariate linear regression models were used. Patients enrolled in EARTH (overall population) were mostly male (73.2%), mean age 61.0 ± 9.8 years, New York Heart Association class II–III (87.8%), mean LVEF of 26.6 ± 7.7%, and reduced peak VO2 (15.1 ± 4.6 mL/kg/min). Of these, 100 had both TAPSE and PASP available (TAPSE/PASP population): they exhibited higher BNP, wider QRS duration, larger LVEDVi, with more having tricuspid regurgitation compared with the 105 patients for whom these values were not available (all P < 0.05). RV‐FAC (β = 7.5), LAVi (β = −0.1), and sex (female, β = −1.9) predicted peak VO2 in the overall population (all P = 0.01). When available, TAPSE/PASP ratio was the only echocardiographic parameter associated with peak VO2 (β = 6.8; P < 0.01), a threshold ≤0.45 predicting a peak VO2 ≤ 14 mL/kg/min (0.39 for VO2 ≤ 12). RV‐MPI was the only echocardiographic parameter associated with ventilatory inefficiency (VE/VCO2) and 6MWD (β = 21.9 and β = −69.3, respectively, both P ≤ 0.01) in the overall population. In presence of TAPSE/PASP, it became an important predictor for those two CPET (β = −18.0 and β = 72.4, respectively, both P < 0.01), together with RV‐MPI (β = 18.5, P < 0.01) for VE/VCO2. Tricuspid regurgitation predicted SED (β = −3.2, P = 0.03). Conclusions Right ventricular function assessed by echocardiography (RV‐MPI and RV‐FAC) is closely associated with exercise tolerance in patients with HFrEF. When the TAPSE/PASP ratio is available, this marker of RV‐PA coupling becomes the stronger echocardiographic predictor of exercise capacity in this population, highlighting its potential role as a screening tool to identify patients with reduced exercise capacity and potentially triage them to formal peak VO2 and/or evaluation for advanced HF therapies.
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Affiliation(s)
- Valéry Legris
- Department of Medicine, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
| | - Bernard Thibault
- Department of Medicine, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
| | - Jocelyn Dupuis
- Department of Medicine, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
| | - Michel White
- Department of Medicine, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
| | - Anita W Asgar
- Department of Medicine, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
| | - Annik Fortier
- Montreal Health Institute Coordinating Center (MHICC), Montreal, Quebec, Canada
| | - Céline Pitre
- Department of Medicine, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
| | - Nadia Bouabdallaoui
- Department of Medicine, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
| | - Christine Henri
- Department of Medicine, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
| | - Eileen O'Meara
- Department of Medicine, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
| | - Anique Ducharme
- Department of Medicine, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
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Comparison of Echocardiographic and Electrocardiographic Mapping for Cardiac Resynchronisation Therapy Optimisation. Cardiol Res Pract 2019; 2019:4351693. [PMID: 30918721 PMCID: PMC6409049 DOI: 10.1155/2019/4351693] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 11/06/2018] [Accepted: 11/14/2018] [Indexed: 11/17/2022] Open
Abstract
Study hypothesis We sought to investigate the association between echocardiographic optimisation and ventricular activation time in cardiac resynchronisation therapy (CRT) patients, obtained through the use of electrocardiographic mapping (ECM). We hypothesised that echocardiographic optimisation of the pacing delay between the atrial and ventricular leads-atrioventricular delay (AVD)-and the delay between ventricular leads-interventricular pacing interval (VVD)-would correlate with reductions in ventricular activation time. Background Optimisation of AVD and VVD may improve CRT patient outcome. Optimal delays are currently set based on echocardiographic indices; however, acute studies have found that reductions in bulk ventricular activation time correlate with improvements in acute haemodynamic performance. Materials and methods Twenty-one patients with established CRT criteria were recruited. After implantation, patients underwent echo-guided optimisation of the AVD and VVD. During this procedure, the participants also underwent noninvasive ECM. ECM maps were constructed for each AVD and VVD. ECM maps were analysed offline. Total ventricular activation time (TVaT) and a ventricular activation time index (VaT10-90) were calculated to identify the optimal AVD and VVD timings that gave the minimal TVaT and VaT10-90 values. We correlated cardiac output with these electrical timings. Results Echocardiographic programming optimisation was not associated with the greatest reductions in biventricular activation time (VaT10-90 and TVaT). Instead, bulk activation times were reduced by a further 20% when optimised with ECM. A significant inverse correlation was identified between reductions in bulk ventricular activation time and improvements in LVOT VTI (p < 0.001), suggesting that improved ventricular haemodynamics are a sequelae of more rapid ventricular activation. Conclusions EAM-guided programming optimisation may achieve superior fusion of activation wave fronts leading to improvements in CRT response.
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Skaf S, Thibault B, Khairy P, O'Meara E, Fortier A, Vakulenko HV, Pitre C, White M, Ducharme A. Impact of Left Ventricular vs Biventricular Pacing on Reverse Remodelling: Insights From the Evaluation of Resynchronization Therapy for Heart Failure (EARTH) Trial. Can J Cardiol 2017; 33:1274-1282. [DOI: 10.1016/j.cjca.2017.07.478] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 07/17/2017] [Accepted: 07/19/2017] [Indexed: 10/19/2022] Open
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Ali-Hassan-Al-Saegh S, Mirhosseini SJ, Karimi-Bondarabadi AA, Sahidzadeh A, Mahdavi P, Tahernejad M, Heydari S, Weymann A, Zeriouh M, Sabashnikov A, Popov AF. Cardiac resynchronization therapy in patients with mild heart failure is a reversal therapy. Indian Heart J 2017; 69:112-118. [PMID: 28228294 PMCID: PMC5319120 DOI: 10.1016/j.ihj.2016.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 05/26/2016] [Accepted: 08/08/2016] [Indexed: 01/14/2023] Open
Abstract
This systematic review with meta-analysis sought to determine the efficacy, safety of implantation of cardiac resynchronization therapy (CRT) in mild heart failure (HF). Medline, Embase, Elsevier, and Sciences online database as well as Google scholar literature were used for selecting appropriate studies with randomized controlled design. The literature search of all major databases retrieved 2035 studies. After screening, a total of 10 trials were identified that reported outcomes of interest. Pooled analysis was performed on left ventricular (LV) ejection fraction (P < 0.001), LV end-diastolic volume (P < 0.001), LV end-systolic volume (P < 0.001), LV end-diastolic diameter (P < 0.001), LV end-systolic diameter (P < 0.001), incidence of progression of heart failure (P < 0.001), mortality (P = 0.06), infection (P = 0.1), and pneumothorax (P = 0.08). Overall, implantation of CRT in patients with asymptomatic and mild HF resulted in improved cardiac function, decreased progression of HF, trend to decrease of mortality in short to long-term follow-up.
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Affiliation(s)
| | | | | | - Azadeh Sahidzadeh
- Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Parisa Mahdavi
- Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mahbube Tahernejad
- Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Safieyehsadat Heydari
- Department of Research and Technology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Alexander Weymann
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom
| | - Mohamed Zeriouh
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom
| | - Anton Sabashnikov
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom
| | - Aron-Frederik Popov
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom
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10
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Gopi A, Sundar G, Yelagudri S, Lalukota K, Sridevi C, Narasimhan C. Atrial synchronous left ventricular only pacing with VDD pacemaker system - a cost effective alternative to conventional cardiac resynchronization therapy. Indian Heart J 2014; 66:612-6. [PMID: 25634394 PMCID: PMC4311010 DOI: 10.1016/j.ihj.2014.10.398] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 10/09/2014] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Atrial synchronous left ventricular (LV) only pacing using two leads and VDD pacemaker could be a cost effective alternative to conventional cardiac resynchronization therapy (CRT). METHODS We implanted right atrial (RA) and LV leads with VDD pulse generator (LV only pacing) in five carefully screened heart failure patients who could not afford conventional CRT. All had NYHA class III/IV symptoms despite maximal guideline directed medical therapy. The sensed atrioventricular delay was programmed to pre-excite the LV and achieve fusion beat. Response to treatment was assessed at 6 months. RESULTS Four patients were males. The mean age was 58 ± 12 years. At follow up, there was improvement in electrocardiographic, and echocardiographic parameters: Mean QRS duration decreased from 174 ± 17 msec to 128 ± 10.9 msec (p = 0.009), LV end-diastolic diameter decreased from 73.2 ± 12 mm to 65.8 ± 9.6 mm (p = 0.026), LV end-systolic diameter decreased from 65 ± 12 mm to 54 ± 10 mm (p = 0.020). There was a trend towards reduction of LV end-systolic and end-diastolic volumes. LV ejection fraction improved from 25 ± 6% to 34 ± 6% (p = 0.013) and left atrial dimension reduced from 44 ± 4 mm to 39 ± 5 mm (p = 0.045). All patients improved clinically. CONCLUSION RA-LV pacing using VDD pacemaker is a safe and effective technique of CRT. This may be a cost effective alternative to conventional CRT for patients in developing countries.
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Affiliation(s)
- Arun Gopi
- CARE Hospital, Road No. 1, Banjara Hills, Hyderabad 34, India
| | - Gomathi Sundar
- CARE Hospital, Road No. 1, Banjara Hills, Hyderabad 34, India
| | | | | | - C Sridevi
- CARE Hospital, Road No. 1, Banjara Hills, Hyderabad 34, India
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11
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Diastolic asynchrony and myocardial dysfunction in patients with univentricular heart after Fontan operation. J Echocardiogr 2013; 11:130-7. [DOI: 10.1007/s12574-013-0191-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 08/03/2013] [Accepted: 08/14/2013] [Indexed: 10/26/2022]
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12
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Thibault B, Harel F, Ducharme A, White M, Ellenbogen KA, Frasure-Smith N, Roy D, Philippon F, Dorian P, Talajic M, Dubuc M, Guerra PG, Macle L, Rivard L, Andrade J, Khairy P. Cardiac Resynchronization Therapy in Patients With Heart Failure and a QRS Complex <120 Milliseconds. Circulation 2013; 127:873-81. [PMID: 23388213 DOI: 10.1161/circulationaha.112.001239] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background—
Although the benefits of cardiac resynchronization therapy are well established in selected patients with heart failure and a prolonged QRS duration, salutary effects in patients with narrow QRS complexes remain to be demonstrated.
Methods and Results—
The Evaluation of Resynchronization Therapy for Heart Failure (LESSER-EARTH) trial is a randomized, double-blind, 12-center study that was designed to compare the effects of active and inactive cardiac resynchronization therapy in patients with severe left ventricular dysfunction and a QRS duration <120 milliseconds. The trial was interrupted prematurely by the Data Safety and Monitoring Board because of futility and safety concerns after 85 patients were randomized. Changes in exercise duration after 12 months were no different in patients with and without active cardiac resynchronization therapy (−0.7 minutes [95% confidence interval (CI), −2.9 to 1.5] versus 0.8 minutes [95% CI, −1.2 to 2.9];
P
=0.31]. Similarly, no significant differences were observed in left ventricular end-systolic volumes (−6.4 mL [95% CI, −18.8 to 5.9] versus 3.1 mL [95% CI, −9.2 to 15.5];
P
=0.28) and ejection fraction (3.3% [95% CI, 0.7–6.0] versus 2.1% [95% CI, −0.5 to 4.8];
P
=0.52). Moreover, cardiac resynchronization therapy was associated with a significant reduction in the 6-minute walk distance (−11.3 m [95% CI, −31.7 to 9.7] versus 25.3 m [95% CI, 6.1–44.5];
P
=0.01), an increase in QRS duration (40.2 milliseconds [95% CI, 34.2–46.2] versus 3.4 milliseconds [95% CI, 0.6–6.2];
P
<0.0001), and a nonsignificant trend toward an increase in heart failure–related hospitalizations (15 hospitalizations in 5 patients versus 4 hospitalizations in 4 patients).
Conclusions—
In patients with a left ventricular ejection fraction ≤35%, symptoms of heart failure, and a QRS duration <120 milliseconds, cardiac resynchronization therapy did not improve clinical outcomes or left ventricular remodeling and was associated with potential harm.
Clinical Trial Registration
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00900549.
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Affiliation(s)
- Bernard Thibault
- From the Montreal Heart Institute, Université de Montréal, Montreal, QB, Canada (B.T., F.H., A.D., M.W., N.F.-S., D.R., M.T., M.D., P.G.G., L.M., L.R., J.A., P.K.); Medical College of Virginia, Richmond (K.A.E.); Institut Universitaire de Cardiologie et Pneumologie, Université Laval, Quebec City, QC, Canada (F.P.); and St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada (P.D.)
| | - François Harel
- From the Montreal Heart Institute, Université de Montréal, Montreal, QB, Canada (B.T., F.H., A.D., M.W., N.F.-S., D.R., M.T., M.D., P.G.G., L.M., L.R., J.A., P.K.); Medical College of Virginia, Richmond (K.A.E.); Institut Universitaire de Cardiologie et Pneumologie, Université Laval, Quebec City, QC, Canada (F.P.); and St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada (P.D.)
| | - Anique Ducharme
- From the Montreal Heart Institute, Université de Montréal, Montreal, QB, Canada (B.T., F.H., A.D., M.W., N.F.-S., D.R., M.T., M.D., P.G.G., L.M., L.R., J.A., P.K.); Medical College of Virginia, Richmond (K.A.E.); Institut Universitaire de Cardiologie et Pneumologie, Université Laval, Quebec City, QC, Canada (F.P.); and St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada (P.D.)
| | - Michel White
- From the Montreal Heart Institute, Université de Montréal, Montreal, QB, Canada (B.T., F.H., A.D., M.W., N.F.-S., D.R., M.T., M.D., P.G.G., L.M., L.R., J.A., P.K.); Medical College of Virginia, Richmond (K.A.E.); Institut Universitaire de Cardiologie et Pneumologie, Université Laval, Quebec City, QC, Canada (F.P.); and St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada (P.D.)
| | - Kenneth A. Ellenbogen
- From the Montreal Heart Institute, Université de Montréal, Montreal, QB, Canada (B.T., F.H., A.D., M.W., N.F.-S., D.R., M.T., M.D., P.G.G., L.M., L.R., J.A., P.K.); Medical College of Virginia, Richmond (K.A.E.); Institut Universitaire de Cardiologie et Pneumologie, Université Laval, Quebec City, QC, Canada (F.P.); and St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada (P.D.)
| | - Nancy Frasure-Smith
- From the Montreal Heart Institute, Université de Montréal, Montreal, QB, Canada (B.T., F.H., A.D., M.W., N.F.-S., D.R., M.T., M.D., P.G.G., L.M., L.R., J.A., P.K.); Medical College of Virginia, Richmond (K.A.E.); Institut Universitaire de Cardiologie et Pneumologie, Université Laval, Quebec City, QC, Canada (F.P.); and St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada (P.D.)
| | - Denis Roy
- From the Montreal Heart Institute, Université de Montréal, Montreal, QB, Canada (B.T., F.H., A.D., M.W., N.F.-S., D.R., M.T., M.D., P.G.G., L.M., L.R., J.A., P.K.); Medical College of Virginia, Richmond (K.A.E.); Institut Universitaire de Cardiologie et Pneumologie, Université Laval, Quebec City, QC, Canada (F.P.); and St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada (P.D.)
| | - François Philippon
- From the Montreal Heart Institute, Université de Montréal, Montreal, QB, Canada (B.T., F.H., A.D., M.W., N.F.-S., D.R., M.T., M.D., P.G.G., L.M., L.R., J.A., P.K.); Medical College of Virginia, Richmond (K.A.E.); Institut Universitaire de Cardiologie et Pneumologie, Université Laval, Quebec City, QC, Canada (F.P.); and St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada (P.D.)
| | - Paul Dorian
- From the Montreal Heart Institute, Université de Montréal, Montreal, QB, Canada (B.T., F.H., A.D., M.W., N.F.-S., D.R., M.T., M.D., P.G.G., L.M., L.R., J.A., P.K.); Medical College of Virginia, Richmond (K.A.E.); Institut Universitaire de Cardiologie et Pneumologie, Université Laval, Quebec City, QC, Canada (F.P.); and St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada (P.D.)
| | - Mario Talajic
- From the Montreal Heart Institute, Université de Montréal, Montreal, QB, Canada (B.T., F.H., A.D., M.W., N.F.-S., D.R., M.T., M.D., P.G.G., L.M., L.R., J.A., P.K.); Medical College of Virginia, Richmond (K.A.E.); Institut Universitaire de Cardiologie et Pneumologie, Université Laval, Quebec City, QC, Canada (F.P.); and St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada (P.D.)
| | - Marc Dubuc
- From the Montreal Heart Institute, Université de Montréal, Montreal, QB, Canada (B.T., F.H., A.D., M.W., N.F.-S., D.R., M.T., M.D., P.G.G., L.M., L.R., J.A., P.K.); Medical College of Virginia, Richmond (K.A.E.); Institut Universitaire de Cardiologie et Pneumologie, Université Laval, Quebec City, QC, Canada (F.P.); and St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada (P.D.)
| | - Peter G. Guerra
- From the Montreal Heart Institute, Université de Montréal, Montreal, QB, Canada (B.T., F.H., A.D., M.W., N.F.-S., D.R., M.T., M.D., P.G.G., L.M., L.R., J.A., P.K.); Medical College of Virginia, Richmond (K.A.E.); Institut Universitaire de Cardiologie et Pneumologie, Université Laval, Quebec City, QC, Canada (F.P.); and St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada (P.D.)
| | - Laurent Macle
- From the Montreal Heart Institute, Université de Montréal, Montreal, QB, Canada (B.T., F.H., A.D., M.W., N.F.-S., D.R., M.T., M.D., P.G.G., L.M., L.R., J.A., P.K.); Medical College of Virginia, Richmond (K.A.E.); Institut Universitaire de Cardiologie et Pneumologie, Université Laval, Quebec City, QC, Canada (F.P.); and St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada (P.D.)
| | - Léna Rivard
- From the Montreal Heart Institute, Université de Montréal, Montreal, QB, Canada (B.T., F.H., A.D., M.W., N.F.-S., D.R., M.T., M.D., P.G.G., L.M., L.R., J.A., P.K.); Medical College of Virginia, Richmond (K.A.E.); Institut Universitaire de Cardiologie et Pneumologie, Université Laval, Quebec City, QC, Canada (F.P.); and St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada (P.D.)
| | - Jason Andrade
- From the Montreal Heart Institute, Université de Montréal, Montreal, QB, Canada (B.T., F.H., A.D., M.W., N.F.-S., D.R., M.T., M.D., P.G.G., L.M., L.R., J.A., P.K.); Medical College of Virginia, Richmond (K.A.E.); Institut Universitaire de Cardiologie et Pneumologie, Université Laval, Quebec City, QC, Canada (F.P.); and St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada (P.D.)
| | - Paul Khairy
- From the Montreal Heart Institute, Université de Montréal, Montreal, QB, Canada (B.T., F.H., A.D., M.W., N.F.-S., D.R., M.T., M.D., P.G.G., L.M., L.R., J.A., P.K.); Medical College of Virginia, Richmond (K.A.E.); Institut Universitaire de Cardiologie et Pneumologie, Université Laval, Quebec City, QC, Canada (F.P.); and St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada (P.D.)
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13
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Boriani G, Gardini B, Diemberger I, Reggiani MLB, Biffi M, Martignani C, Ziacchi M, Valzania C, Gasparini M, Padeletti L, Branzi A. Meta‐analysis of randomized controlled trials evaluating left ventricular vs. biventricular pacing in heart failure: effect on all‐cause mortality and hospitalizations. Eur J Heart Fail 2012; 14:652-660. [DOI: 10.1093/eurjhf/hfs040] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Affiliation(s)
| | | | | | | | - Mauro Biffi
- Institute of Cardiology University of Bologna Bologna Italy
| | | | - Matteo Ziacchi
- Institute of Cardiology University of Bologna Bologna Italy
| | | | - Maurizio Gasparini
- Electrophysiology and Pacing Unit, Cardiology Department IRCCS Istituto Clinico Humanitas Rozzano Milano Italy
| | - Luigi Padeletti
- Department of Heart and Vessels University of Florence Florence Italy
| | - Angelo Branzi
- Institute of Cardiology University of Bologna Bologna Italy
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14
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Cardiac resynchronization therapy in patients with mild heart failure: a systematic review and meta-analysis of randomized controlled trials. Cardiovasc Drugs Ther 2011; 25:331-40. [PMID: 21750900 PMCID: PMC3151402 DOI: 10.1007/s10557-011-6313-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Objective This review aims at updating the results of cardiac resynchronization therapy (CRT) in mild heart failure patients, and investigating whether CRT can prevent or reverse heart failure progression in an earlier stage. Methods Randomized controlled trials of CRT in patients with New York Heart Association (NYHA) Class I or II heart failure were identified. The effects of CRT on worsening heart failure hospitalization, all-cause mortality, and overall adverse events were meta-analyzed, and the effects of CRT on left ventricular (LV) were systematically reviewed and meta-analyzed. Results Eight studies were identified with a total of 4,302 patients. CRT was associated with a substantial improvement in LV end-systolic volume (WMD −39, 95%CI −41.56 to −36.45). CRT also had a marked effect in reducing new hospitalizations for worsening heart failure by 31% (RR 0.69, 95%CI 0.60 to 0.79). In addition, CRT significantly decreased all-cause mortality by 21% (RR 0.79, 95%CI 0.67 to 0.93). However, complications in patients with CRT increased by 74% (RR 1.74, 95%CI 1.44 to 2.11). Conclusions This meta-analysis suggests that CRT could improve the prognosis in patients with mild heart failure and ventricular dyssynchrony, but these improvements are accompanied by more adverse events. Since most patients in the included trials had received ICD therapy, our analysis suggests that CRT could offer an additional benefit.
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