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Saffi H, Winsløw U, Sakthivel T, Højgaard EV, Linde J, Philbert B, Vinther M, Jøns C, Bundgaard H, Risum N. Global constructive work is associated with ventricular arrhythmias after cardiac resynchronization therapy. Eur Heart J Cardiovasc Imaging 2023; 25:29-36. [PMID: 37490039 DOI: 10.1093/ehjci/jead180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 06/26/2023] [Accepted: 07/14/2023] [Indexed: 07/26/2023] Open
Abstract
AIMS Non-invasive left ventricular (LV) pressure-strain loops provide a novel method for quantifying myocardial work by incorporating LV pressure in measurements of myocardial deformation. Early studies suggest that myocardial work parameters such as global constructive work (GCW) could be useful and reliable in arrhythmia prediction, particularly in patients undergoing cardiac resynchronization therapy (CRT). The aim of this study was to evaluate whether the magnitude of GCW was associated with the occurrence of ventricular arrhythmias in patients after CRT. METHODS AND RESULTS Patients on guideline-recommended treatment with a CRT defibrillator (CRT-D) were evaluated by 2D speckle-tracking echocardiography including measurements of GCW at least 6 months after implantation. The primary outcome was a composite of appropriate defibrillator therapy and sustained ventricular arrhythmia under the monitor zone. A total of 162 patients [mean age 66 years (±10), 122 males (75%)] were included. Sixteen (10%) patients experienced the primary outcome during a median follow-up of 18 months (interquartile range: 12-25) after the performance of index echocardiography. Patients with a below-median GCW (<1473 mmHg%) had a hazard ratio (HR) for the outcome of 8.14 [95% confidence interval (CI): 1.83-36.08], P = 0.006 compared with patients above the median in a univariate model and remained an independent predictor after multivariate adjustment for the estimated glomerular filtration rate and QRS duration [HR 4.75 (95% CI: 1.01-22.28), P < 0.05]. CONCLUSION In patients treated with CRT-D, a GCW below median level was associated with a five-fold increase in the risk of ventricular arrhythmias.
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Affiliation(s)
- Hillah Saffi
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Ulrik Winsløw
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Tharsika Sakthivel
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Emma Vinther Højgaard
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jesper Linde
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Berit Philbert
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Michael Vinther
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Christian Jøns
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Niels Risum
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
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2
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Yuyun MF, Erqou SA, Peralta AO, Hoffmeister PS, Yarmohammadi H, Echouffo Tcheugui JB, Martin DT, Joseph J, Singh JP. Risk of ventricular arrhythmia in cardiac resynchronization therapy responders and super-responders: a systematic review and meta-analysis. Europace 2021; 23:1262-1274. [PMID: 33496319 DOI: 10.1093/europace/euaa414] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/18/2020] [Indexed: 12/22/2022] Open
Abstract
AIMS Response to cardiac resynchronization therapy (CRT) is associated with improved survival, and reduction in heart failure hospitalization, and ventricular arrhythmia (VA) risk. However, the impact of CRT super-response [CRT-SR, increase in left ventricular ejection fraction (LVEF) to ≥ 50%] on VA remains unclear. METHODS AND RESULTS We undertook a meta-analysis aimed at determining the impact of CRT response and CRT-SR on risk of VA and all-cause mortality. Systematic search of PubMed, EMBASE, and Cochrane databases, identifying all relevant English articles published until 31 December 2019. A total of 34 studies (7605 patients for VA and 5874 patients for all-cause mortality) were retained for the meta-analysis. The pooled cumulative incidence of appropriate implantable cardioverter-defibrillator therapy for VA was significantly lower at 13.0% (4.5% per annum) in CRT-responders, vs. 29.0% (annualized rate of 10.0%) in CRT non-responders, relative risk (RR) 0.47 [95% confidence interval (CI) 0.39-0.56, P < 0.0001]; all-cause mortality 3.5% vs. 9.1% per annum, RR of 0.38 (95% CI 0.30-0.49, P < 0.0001). The pooled incidence of VA was significantly lower in CRT-SR compared with CRT non-super-responders (non-responders + responders) at 0.9% vs. 3.8% per annum, respectively, RR 0.22 (95% CI 0.12-0.40, P < 0.0001); as well as all-cause mortality at 2.0% vs. 4.3%, respectively, RR 0.47 (95% CI 0.33-0.66, P < 0.0001). CONCLUSIONS Cardiac resynchronization therapy super-responders have low absolute risk of VA and all-cause mortality. However, there remains a non-trivial residual absolute risk of these adverse outcomes in CRT responders. These findings suggest that among CRT responders, there may be a continued clinical benefit of defibrillators.
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Affiliation(s)
- Matthew F Yuyun
- Cardiology and Vascular Medicine Service, VA Boston Healthcare System, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Sebhat A Erqou
- Department of Medicine, Brown University, Providence, RI, USA.,Division of Cardiology, Providence VA Medical Center, Providence, RI, USA
| | - Adelqui O Peralta
- Cardiology and Vascular Medicine Service, VA Boston Healthcare System, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Peter S Hoffmeister
- Cardiology and Vascular Medicine Service, VA Boston Healthcare System, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Hirad Yarmohammadi
- Division of Cardiology, Department of Medicine, Columbia University, New York, NY, USA
| | | | - David T Martin
- Cardiology and Vascular Medicine Service, VA Boston Healthcare System, Boston, MA, USA.,Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jacob Joseph
- Cardiology and Vascular Medicine Service, VA Boston Healthcare System, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jagmeet P Singh
- Cardiology and Vascular Medicine Service, VA Boston Healthcare System, Boston, MA, USA.,Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA, USA
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3
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Bazoukis G, Saplaouras A, Letsas KP, Yeung C, Xydonas S, Karamichalakis N, Thomopoulos C, Manolatos D, Papathanakos G, Vlachos K, Tse G, Korantzopoulos P, Efremidis M, Sideris A, Naka KK. The association of hematological indices with the response to cardiac resynchronization therapy: a single-center study. Hippokratia 2019; 23:118-125. [PMID: 32581497 PMCID: PMC7307505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) is an established therapeutic option for patients with heart failure (HF) and left ventricular ejection fraction (LVEF) ≤35 % who meet specific criteria according to current guidelines. However, up to 40 % of patients have no response to CRT. Our study aimed to investigate the association between different hematological and biochemical indices and response to CRT. METHODS Patients with HF due to ischemic or dilated cardiomyopathy referred to our hospital for CRT implantation from January 2013 to November 2017 were included in the study. Response to CRT was defined as an increase in LVEF ≥10 % or a decrease in left ventricular end-systolic volume (LVESV) ≥15 % at six months of follow-up. RESULTS A total of 48 patients (mean age: 66.2 ± 9.5 years, 81.3 % males) were included in the study. Of these HF patients, 29 (60.4 %) had ischemic cardiomyopathy, and 19 (39.6 %) had dilated cardiomyopathy. At six months of follow-up, 37 patients (77.1 %) had responded to CRT. Ten patients (20.8 %) had ventricular tachycardia (VT), 24 (50 %) patients were hospitalized, and two patients (4.2 %) died during the follow-up period. Multivariate analysis demonstrated that age (p =0.03) and creatinine levels (p =0.02) were independent predictors of the response to CRT. No significant associations between hematological markers (white blood cells, neutrophils, lymphocytes, platelets, neutrophil to lymphocyte ratio, red blood cells distribution width) and CRT response were observed. CONCLUSIONS A smaller increase in LVEF and a smaller decrease in LVESV were predictive for VT occurrence and hospitalizations in patients receiving CRT. No significant association between hematological markers and response to CRT was found. HIPPOKRATIA 2019, 23(3): 118-125.
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Affiliation(s)
- G Bazoukis
- Second Department of Cardiology, General Hospital of Athens "Evangelismos", Athens, Greece
| | - A Saplaouras
- Second Department of Cardiology, General Hospital of Athens "Evangelismos", Athens, Greece
| | - K P Letsas
- Second Department of Cardiology, General Hospital of Athens "Evangelismos", Athens, Greece
| | - C Yeung
- Department of Cardiology, Queen's University, Kingston, Ontario K7L 2V7, Canada
| | - S Xydonas
- Second Department of Cardiology, General Hospital of Athens "Evangelismos", Athens, Greece
| | - N Karamichalakis
- Second Department of Cardiology, General Hospital of Athens "Evangelismos", Athens, Greece
| | - C Thomopoulos
- Department of Cardiology, Helena Venizelou Hospital, Athens, Greece
| | - D Manolatos
- Second Department of Cardiology, General Hospital of Athens "Evangelismos", Athens, Greece
| | - G Papathanakos
- Intensive Care Unit, University Hospital of Ioannina, Ioannina, Greece
| | - K Vlachos
- Second Department of Cardiology, General Hospital of Athens "Evangelismos", Athens, Greece
| | - G Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - P Korantzopoulos
- First Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece
| | - M Efremidis
- Second Department of Cardiology, General Hospital of Athens "Evangelismos", Athens, Greece
| | - A Sideris
- Second Department of Cardiology, General Hospital of Athens "Evangelismos", Athens, Greece
| | - K K Naka
- Second Department of Cardiology; Michaelidion Cardiac Center, University of Ioannina, Ioannina, Greece
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Deif B, Ballantyne B, Almehmadi F, Mikhail M, McIntyre WF, Manlucu J, Yee R, Sapp JL, Roberts JD, Healey JS, Leong-Sit P, Tang AS. Cardiac resynchronization is pro-arrhythmic in the absence of reverse ventricular remodelling: a systematic review and meta-analysis. Cardiovasc Res 2018; 114:1435-1444. [PMID: 30010807 DOI: 10.1093/cvr/cvy182] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 09/27/2018] [Indexed: 11/14/2022] Open
Abstract
Aims Cardiac resynchronization therapy (CRT) has been shown to reduce mortality and heart failure (HF) hospitalization but its effects on the rate of ventricular arrhythmias (VAs) appears to be neutral. We hypothesize that CRT with LV epicardial stimulation is inherently pro-arrhythmic and increases VA rates in the absence of reverse ventricular remodelling while conferring an anti-arrhythmic effect in mechanical responders. Methods and results In this systematic review and meta-analysis, we considered retrospective cohort, prospective cohort, and randomized controlled trials comparing VA rates between cardiac resynchronization therapy-defibrillator (CRT-D) non-responders, CRT-D responders and those with implantable cardioverter-defibrillator (ICD) only. Studies were eligible if they defined CRT-D responders using a discrete left ventricular volumetric value as assessed by any imaging modality. Studies were identified through searching electronic databases from their inception to July 2017. We identified 2579 citations, of which 23 full-text articles were eligible for final analysis. Our results demonstrated that CRT-D responders were less likely to experience VA than CRT-D non-responders, relative risk (RR) 0.49 [95% confidence interval (CI) 0.41-0.58, P < 0.01] and also less than patients with ICD only: RR 0.59 (95% CI 0.50-0.69, P < 0.01). However, CRT-D mechanical non-responders had a greater likelihood of VA compared with ICD only, RR 0.76 (95% CI 0.63-0.92, P = 0.004). Conclusion CRT-D non-responders experienced more VA than CRT-D responders and also more than those with ICD only, suggesting that CRT with LV epicardial stimulation may be inherently pro-arrhythmic in the absence of reverse remodelling.
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Affiliation(s)
- Bishoy Deif
- Division of Cardiology, Department of Medicine, Western University, 339 Windermere Road, London, Ontario, Canada
| | - Brennan Ballantyne
- Division of Cardiology, Department of Medicine, Western University, 339 Windermere Road, London, Ontario, Canada
| | - Fahad Almehmadi
- Division of Cardiology, Department of Medicine, Western University, 339 Windermere Road, London, Ontario, Canada
| | - Michael Mikhail
- School of Biomedical Sciences, Department of Graduate Studies, Rowan University, Stratford, New Jersey, USA
| | - William F McIntyre
- Population Health Research Institute & Division of Cardiology, Department of Medicine McMaster University, Hamilton, Canada
| | - Jaimie Manlucu
- Division of Cardiology, Department of Medicine, Western University, 339 Windermere Road, London, Ontario, Canada
| | - Raymond Yee
- Division of Cardiology, Department of Medicine, Western University, 339 Windermere Road, London, Ontario, Canada
| | - John L Sapp
- Department of Medicine, QEII Health Sciences Centre, Dalhousie University, Halifax, Canada
| | - Jason D Roberts
- Division of Cardiology, Department of Medicine, Western University, 339 Windermere Road, London, Ontario, Canada
| | - Jeff S Healey
- Population Health Research Institute & Division of Cardiology, Department of Medicine McMaster University, Hamilton, Canada
| | - Peter Leong-Sit
- Division of Cardiology, Department of Medicine, Western University, 339 Windermere Road, London, Ontario, Canada
| | - Anthony S Tang
- Division of Cardiology, Department of Medicine, Western University, 339 Windermere Road, London, Ontario, Canada
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5
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Galve E, Oristrell G, Acosta G, Ribera‐Solé A, Moya‐Mitjans À, Ferreira‐González I, Pérez‐Rodon J, García‐Dorado D. Cardiac resynchronization therapy is associated with a reduction in ICD therapies as it improves ventricular function. Clin Cardiol 2018; 41:803-808. [PMID: 29604094 PMCID: PMC6490060 DOI: 10.1002/clc.22958] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/23/2018] [Accepted: 03/29/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Repeated implantable cardioverter-defibrillator (ICD) therapies cause myocardial damage and, thus, an increased risk of arrhythmias and mortality. HYPOTHESIS Cardiac resynchronization therapy-defibrillator (CRT-D) reduces the number of appropriate therapies in patients with left ventricular dysfunction (left ventricular ejection fraction [LVEF] <50%). METHODS The retrospective study involved 175 consecutive patients (mean age, 64.6 ±10.4 years; 86.9% males) with reduced LVEF of 27.9% ±7.6% treated with an ICD (56.6%) or CRT-D (43.4%), according to standard indications, between January 2009 and July 2014. Devices were placed for either primary (54.3%) or secondary prevention (45.7%). Mean follow-up was 2.5 ±1.5 years. Predictors of first appropriate therapy were assessed using Cox regression analysis. RESULTS Forty-four (25.1%) patients received ≥1 appropriate therapy. Although patients treated with CRT-D had lower LVEF and poorer New York Heart Association class, CRT-D patients with LVEF improvement >35% at the end of follow-up had a significantly lower risk of receiving a first appropriate therapy relative to those with an ICD (adjusted hazard ratio: 0.24, 95% confidence interval: 0.07-0.83, P = 0.025), independently of ischemic cardiomyopathy, baseline LVEF, and secondary prevention. There were no differences in mortality between the ICD and the CRT-D groups. CONCLUSIONS Although patients receiving CRT-D had a worse clinical profile, they received fewer device therapies in comparison with those receiving an ICD. This reduction is associated with a significant improvement in LVEF.
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Affiliation(s)
- Enrique Galve
- Department of CardiologyVall d'Hebron University HospitalBarcelonaSpain
- Vall d'Hebron Research Institute (VHIR)BarcelonaSpain
| | - Gerard Oristrell
- Department of CardiologyVall d'Hebron University HospitalBarcelonaSpain
- Vall d'Hebron Research Institute (VHIR)BarcelonaSpain
| | - Gabriel Acosta
- Department of CardiologyVall d'Hebron University HospitalBarcelonaSpain
| | - Aida Ribera‐Solé
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)BarcelonaSpain
| | | | - Ignacio Ferreira‐González
- Department of CardiologyVall d'Hebron University HospitalBarcelonaSpain
- Vall d'Hebron Research Institute (VHIR)BarcelonaSpain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)BarcelonaSpain
| | - Jordi Pérez‐Rodon
- Department of CardiologyVall d'Hebron University HospitalBarcelonaSpain
- Vall d'Hebron Research Institute (VHIR)BarcelonaSpain
| | - David García‐Dorado
- Department of CardiologyVall d'Hebron University HospitalBarcelonaSpain
- Vall d'Hebron Research Institute (VHIR)BarcelonaSpain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)BarcelonaSpain
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Jørgensen ME, Andersson C, Vasan RS, Køber L, Abdulla J. Characteristics and prognosis of heart failure with improved compared with persistently reduced ejection fraction: A systematic review and meta-analyses. Eur J Prev Cardiol 2018; 25:366-376. [PMID: 29313369 DOI: 10.1177/2047487317750437] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Aims We assessed the clinical characteristics and prognosis of chronic heart failure patients with improved ejection fraction (HFIEF) compared with persistently reduced ejection fraction (HFpREF) after evidence-based therapy. Methods and results We performed a meta-analysis including 24 eligible observational studies comparing 2663 HFIEF (≥5% left ventricular ejection fraction (LVEF) improvement) versus 8355 HFpREF patients who received recommended drug therapy, cardiac resynchronization therapy and/or intracardiac defibrillator. LVEF was assessed at baseline and reassessed after 19 ± 19 months. The primary endpoints were all-cause mortality and appropriate shocks. The mean duration of follow-up was 39 ± 12 months. Among HFIEF patients, LVEF improved 16.3 percentage points (95% confidence interval 15.9-16.6, p < 0.0001). Compared with HFpREF patients, HFIEF patients had a comparable mean age (60.9 years vs. 62.4 years, p = 0.11), were more often women (33% vs. 25%), had a higher prevalence of non-ischaemic heart failure (58% vs. 53%), less diabetes (27% vs. 28%), higher systolic blood pressure (127.5 ± 9 vs. 122 ± 12 mmHg) and lower left ventricle end-diastolic diameter (64.1 ± 3.7 vs. 67.4 ± 4.9 mmHg), all p-values < 0.05. Absolute risk of all-cause mortality was lower in HFIEF (5.8%) compared with HFpREF (17.5%) with a risk ratio of 0.34 (95% confidence interval 0.28-0.41), p < 0.001. Risk of appropriate shocks was significantly lower in HFIEF versus HFpREF (risk ratio 0.58 (95% confidence interval 0.46-0.74), p < 0.001). Conclusion In heart failure patients, we identified several baseline characteristics in favour of an improved LVEF, in response to evidence based therapy. Patients with improved LVEF had significantly lower risks of mortality and appropriate shocks compared with patients with persistently reduced LVEF.
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Affiliation(s)
- Mads E Jørgensen
- 1 Division of Cardiology, Department of Medicine, Glostrup University Hospital, Copenhagen, Denmark.,2 The Cardiovascular Research Centre, Herlev-Gentofte University Hospital, Copenhagen, Denmark
| | - Charlotte Andersson
- 1 Division of Cardiology, Department of Medicine, Glostrup University Hospital, Copenhagen, Denmark.,2 The Cardiovascular Research Centre, Herlev-Gentofte University Hospital, Copenhagen, Denmark
| | - Ramachandran S Vasan
- 3 Sections of Preventive Medicine and Epidemiology, and Departments of Cardiology and Epidemiology, Boston University Schools of Medicine and Public Health, Boston, USA
| | - Lars Køber
- 4 Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark
| | - Jawdat Abdulla
- 1 Division of Cardiology, Department of Medicine, Glostrup University Hospital, Copenhagen, Denmark
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7
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Cheng CM, Su CS, Chou P, Liao YC, Wang CY, Zhang JR, Hsieh YC, Wu TJ, Chen YW, Weng CJ, Chang KH, Zhou W, Hung GU, Huang JL, Nakajima K. Prediction of Both Electrical and Mechanical Reverse Remodeling on Acute Electrocardiogram Changes After Cardiac Resynchronization Therapy. Circ J 2017; 81:1322-1328. [PMID: 28442644 DOI: 10.1253/circj.cj-16-1181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The development of both electrical reverse remodeling and mechanical reverse remodeling (ERR+MRR) after cardiac resynchronization therapy (CRT) implantation could reduce the incidence of lethal arrhythmia, hence the prediction of ERR+MRR is clinically important.Methods and Results:Eighty-three patients (54 male; 67±12 years old) with CRT >6 months were enrolled. ERR was defined as baseline intrinsic QRS duration (iQRSd) shortening ≥10 ms in lead II on ECG after CRT, and MRR as improvement in LVEF ≥25% on echocardiography after CRT. Acute ECG changes were measured by comparing the pre-implant and immediate post-implant ECG. Ventricular arrhythmia episodes, including ventricular tachycardia and ventricular fibrillation, detected by the implanted device were recorded. Patients were classified as ERR only (n=12), MRR only (n=23), ERR+MRR (n=26), or non-responder (ERR- & MRR-, n=22). On multivariate regression analysis, difference between baseline intrinsic QRS and paced QRS duration (∆QRSd) >35 ms was a significant predictor of ERR+MRR (sensitivity, 68%; specificity, 64%; AUC, 0.7; P=0.003), and paced QTc >443 ms was a negative predictor of ERR+MRR (sensitivity, 78%; specificity, 60%; AUC, 0.7; P=0.002). On Cox proportional hazard modeling, ERR+MRR may reduce risk of ventricular arrhythma around 70% compared with non-responder (HR, 0.29; 95% CI: 0.13-0.65). CONCLUSIONS Acute ECG changes after CRT were useful predictors of ERR+MRR. ERR+MRR was also a protective factor for ventricular arrhythmia.
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Affiliation(s)
- Chien-Ming Cheng
- Division of Cardiology, Department of Medicine, Feng Yuan Hospital, Department of Health of the Executive Yuan.,Institute of Public Health and Community Medicine Research Center, National Yang-Ming University
| | - Chieh-Shou Su
- Institute of Clinical Medicine and Cardiovascular Research Institute, Department of Medicine, School of Medicine, National Yang-Ming University.,Cardiovascular Center, Taichung Veterans General Hospital
| | - Pesus Chou
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University
| | - Ying-Chieh Liao
- Institute of Clinical Medicine and Cardiovascular Research Institute, Department of Medicine, School of Medicine, National Yang-Ming University.,Cardiovascular Center, Taichung Veterans General Hospital
| | - Chi-Yen Wang
- Cardiovascular Center, Taichung Veterans General Hospital
| | - Jian-Rong Zhang
- Department of Cardiology, Tungs' Taichung MetroHarbor Hospital
| | - Yu-Cheng Hsieh
- Institute of Clinical Medicine and Cardiovascular Research Institute, Department of Medicine, School of Medicine, National Yang-Ming University.,Cardiovascular Center, Taichung Veterans General Hospital
| | - Tsu-Juey Wu
- Institute of Clinical Medicine and Cardiovascular Research Institute, Department of Medicine, School of Medicine, National Yang-Ming University.,Cardiovascular Center, Taichung Veterans General Hospital
| | - Yu-Wei Chen
- Cardiovascular Center, Taichung Veterans General Hospital
| | - Chi-Jen Weng
- Cardiovascular Center, Taichung Veterans General Hospital
| | - Keng-Hao Chang
- Cardiovascular Center, Taichung Veterans General Hospital
| | - Weihua Zhou
- School of Computing, University of Southern Mississippi
| | - Guang-Uei Hung
- Department of Nuclear Medicine, Chang Bing Show Chwan Memorial Hospital
| | - Jin-Long Huang
- Institute of Clinical Medicine and Cardiovascular Research Institute, Department of Medicine, School of Medicine, National Yang-Ming University.,Cardiovascular Center, Taichung Veterans General Hospital
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8
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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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9
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Saini A, Kannabhiran M, Reddy P, Gopinathannair R, Olshansky B, Dominic P. Cardiac Resynchronization Therapy May Be Antiarrhythmic Particularly in Responders. JACC Clin Electrophysiol 2016; 2:307-316. [DOI: 10.1016/j.jacep.2015.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 10/22/2015] [Indexed: 02/09/2023]
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10
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Chatterjee NA, Roka A, Lubitz SA, Gold MR, Daubert C, Linde C, Steffel J, Singh JP, Mela T. Reduced appropriate implantable cardioverter-defibrillator therapy after cardiac resynchronization therapy-induced left ventricular function recovery: a meta-analysis and systematic review. Eur Heart J 2015; 36:2780-9. [PMID: 26264552 DOI: 10.1093/eurheartj/ehv373] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 07/15/2015] [Indexed: 01/25/2023] Open
Abstract
AIMS For patients undergoing cardiac resynchronization therapy (CRT) with implantable cardioverter-defibrillator (ICD; CRT-D), the effect of an improvement in left ventricular ejection fraction (LVEF) on appropriate ICD therapy may have significant implications regarding management at the time of ICD generator replacement. METHODS AND RESULTS We conducted a meta-analysis to determine the effect of LVEF recovery following CRT on the incidence of appropriate ICD therapy. A search of multiple electronic databases identified 709 reports, of which 6 retrospective cohort studies were included (n = 1740). In patients with post-CRT LVEF ≥35% (study n = 4), the pooled estimated rate of ICD therapy (5.5/100 person-years) was significantly lower than patients with post-CRT LVEF <35% [incidence rate difference (IRD): -6.5/100 person-years, 95% confidence interval (95% CI): -8.8 to -4.2, P < 0.001]. Similarly, patients with post-CRT LVEF ≥45% (study n = 4) demonstrated lower estimated rates of ICD therapy (2.3/100 person-years) compared with patients without such recovery (IRD: -5.8/100 person-years, 95% CI: -7.6 to -4.0, P < 0.001). Restricting analysis to studies discounting ICD therapies during LVEF recovery (study n = 3), patients with LVEF recovery (≥35 or ≥45%) had significantly lower rates of ICD therapy compared with patients without such recovery (P for both <0.001). Patients with primary prevention indication for ICD, regardless of LVEF recovery definition, had very low rates of ICD therapy (0.4 to 0.8/100-person years). CONCLUSION Recovery of LVEF post-CRT is associated with significantly reduced appropriate ICD therapy. Patients with improvement of LVEF ≥45% and those with primary prevention indication for ICD appear to be at lowest risk.
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Affiliation(s)
- Neal A Chatterjee
- Department of Medicine and the Cardiac Arrhythmia Service, GRB 109, Massachusetts General Hospital Heart Center, 55 Fruit Street, Boston, MA 02411, USA
| | - Attila Roka
- Department of Medicine and the Cardiac Arrhythmia Service, GRB 109, Massachusetts General Hospital Heart Center, 55 Fruit Street, Boston, MA 02411, USA
| | - Steven A Lubitz
- Department of Medicine and the Cardiac Arrhythmia Service, GRB 109, Massachusetts General Hospital Heart Center, 55 Fruit Street, Boston, MA 02411, USA
| | - Michael R Gold
- Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - Claude Daubert
- Cardiology Division, Rennes University Hospital, Rennes, France
| | - Cecilia Linde
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Jan Steffel
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Jagmeet P Singh
- Department of Medicine and the Cardiac Arrhythmia Service, GRB 109, Massachusetts General Hospital Heart Center, 55 Fruit Street, Boston, MA 02411, USA
| | - Theofanie Mela
- Department of Medicine and the Cardiac Arrhythmia Service, GRB 109, Massachusetts General Hospital Heart Center, 55 Fruit Street, Boston, MA 02411, USA
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Bortnik M, Degiovanni A, Dell’Era G, Cavallino C, Occhetta E, Marino P. Prevalence of ventricular arrhythmias in patients with cardiac resynchronization therapy without back-up ICD. J Cardiovasc Med (Hagerstown) 2014; 15:301-6. [DOI: 10.2459/jcm.0b013e3283638148] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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