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Strisciuglio T, Stabile G, Pecora D, Arena G, Caico SI, Marini M, Pepi P, D’Onofrio A, De Simone A, Ricciardi G, Badolati S, Spotti A, Casu G, Solimene F, La Greca C, Ammirati G, Pergola V, Addeo L, Malacrida M, Bertaglia E, Rapacciuolo A. Does the Age Affect the Outcomes of Cardiac Resynchronization Therapy in Elderly Patients? J Clin Med 2021; 10:jcm10071451. [PMID: 33916276 PMCID: PMC8036418 DOI: 10.3390/jcm10071451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/23/2021] [Accepted: 03/29/2021] [Indexed: 11/25/2022] Open
Abstract
Background: More and more heart failure (HF) patients aged ≥ 75 years undergo cardiac resynchronization therapy (CRT) device implantation, however the data regarding the outcomes and their predictors are scant. We investigated the mid- to long-term outcomes and their predictors in CRT patients aged ≥ 75 years. Methods: Patients in the Cardiac Resynchronization Therapy Modular (CRT MORE) Registry were divided into three age-groups: <65 (group A), 65–74 (group B) and ≥75 years (group C). Mortality, hospitalization, and composite event rate were evaluated at 1 year and during long-term follow-up. Results: Patients (n = 934) were distributed as follows: group A 242; group B 347; group C 345. On 12-month follow-up examination, 63% of patients ≥ 75 years displayed a positive clinical response. Mortality was significantly higher in patients ≥ 75 years than in the other two groups, although the rate of hospitalizations for HF worsening was similar to that of patients aged 65–74 (7 vs. 9.5%, respectively; p = 0.15). Independent predictors of death and of negative clinical response were age >80 years, chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD). Over long-term follow-up (1020 days (IQR 680-1362)) mortality was higher in patients ≥ 75 years than in the other two groups. Hospitalization and composite event rates were similar in patients ≥ 75 years and those aged 65–74 (9 vs. 11.8%; p = 0.26, and 26.7 vs. 20.5%; p = 0.06). Conclusion: Positive clinical response and hospitalization rates do not differ between CRT recipients ≥ 75 years and those aged 65–74. However, age > 80 years, COPD and CKD are predictors of worse outcomes.
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Affiliation(s)
- Teresa Strisciuglio
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80138 Naples, Italy; (T.S.); (G.A.); (V.P.); (L.A.)
| | | | - Domenico Pecora
- Fondazione Poliambulanza, 25124 Brescia, Italy; (D.P.); (C.L.G.)
| | - Giuseppe Arena
- Department of Cardiology, Apuane Hospital, 54100 Massa, Italy;
| | - Salvatore Ivan Caico
- Department of Cardiology, ASST Valle Olona, Gallarate Hospital, 21013 Gallarate, Italy;
| | | | | | | | | | - Giuseppe Ricciardi
- Heart and Vessels Department, University of Florence, 50121 Firenze, Italy;
| | | | | | - Gavino Casu
- Department of Cardiology, Ospedale San Francesco, 08100 Nuoro, Italy;
| | | | - Carmelo La Greca
- Fondazione Poliambulanza, 25124 Brescia, Italy; (D.P.); (C.L.G.)
| | - Giuseppe Ammirati
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80138 Naples, Italy; (T.S.); (G.A.); (V.P.); (L.A.)
| | - Valerio Pergola
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80138 Naples, Italy; (T.S.); (G.A.); (V.P.); (L.A.)
| | - Lucio Addeo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80138 Naples, Italy; (T.S.); (G.A.); (V.P.); (L.A.)
| | | | - Emanuele Bertaglia
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, 35122 Padova, Italy;
| | - Antonio Rapacciuolo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80138 Naples, Italy; (T.S.); (G.A.); (V.P.); (L.A.)
- Correspondence: ; Tel.: +39-081-746-2235
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Bertaglia E, Arena G, Pecora D, Reggiani A, D'Onofrio A, Palmisano P, De Simone A, Caico SI, Marini M, Maglia G, Ferraro A, Solimene F, Cecchetto A, Malacrida M, Botto GL, Lunati M, Stabile G. The VALID-CRT risk score reliably predicts response and outcome of cardiac resynchronization therapy in a real-world population. Clin Cardiol 2019; 42:919-924. [PMID: 31301152 PMCID: PMC6788573 DOI: 10.1002/clc.23229] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/24/2019] [Accepted: 06/28/2019] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES The aim of the study was to confirm the value of the VALID-cardiac resynchronization therapy (CRT) risk score in predicting outcome and to assess its association with clinical response (CR) in an unselected real-world CRT population. METHODS AND RESULTS The present analysis comprised all consecutive CRT patients (pts) enrolled in the CRT-MORE registry from 2011 to 2013. Pts were stratified into five groups (quintiles 1-5) according to the VALID-CRT risk predictor index applied to the CRT-MORE population. In the analysis of clinical outcome, adverse events comprised death from any cause and non-fatal heart failure (HF) events requiring hospitalization. CR at 12-month follow-up was also assessed. We enrolled 905 pts. During a median follow-up of 1005 [627-1361] days, 134 patients died, and 79 had at least one HF hospitalization. At 12 months, 69% of pts displayed an improvement in their CR. The mean VALID-CRT risk score derived from the CRT-MOdular Registry (MORE) population was 0.317, ranging from -0.419 in Q1 to 2.59 in Q5. The risk-stratification algorithm was able to predict total mortality after CRT (survival ranging from 93%-Q1 to 77%-Q5; hazards ratio [HR] = 1.42, 95% confidence interval [CI]: 1.25-1.61, P < .0001), and HF hospitalization (ranging from 95% to 90%; HR = 1.24, 95% CI: 1.06-1.45, P = .009). CR was significantly lower in pts with a high-to-very high risk profile (Q4-5) than in pts with a low-to-intermediate risk profile (Q1-2-3) (55% vs 79%, P < .0001). CONCLUSION The VALID-CRT risk-stratification algorithm reliably predicts outcome and CRT response after CRT in an unselected, real-world population.
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Affiliation(s)
- Emanuele Bertaglia
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padua, Italy
| | | | | | | | | | - Pietro Palmisano
- Cardiology Unit, 'Card. G. Panico' Hospital, Tricase (LE), Italy
| | | | | | | | | | | | | | | | | | - Giovanni L Botto
- U.O. Electrophysiology, ASST Rhodense, Rho-Garbagnate Milanese (MI), Italy
| | - Maurizio Lunati
- Cardiotoracovascular Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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Bertaglia E, Reggiani A, Palmisano P, D'Onofrio A, De Simone A, Caico SI, Pecora D, Arena G, Marini M, Ricciardi G, Badolati S, Spotti A, Solimene F, Ferraro A, Migliore F, Botto GL, Malacrida M, Stabile G. The stricter criteria for Class I CRT indication suggested by the 2016 ESC Guidelines reliably exclude patients with a worse prognosis in comparison with the 2013 ESC indication criteria. Int J Cardiol 2018; 273:162-167. [PMID: 30217421 DOI: 10.1016/j.ijcard.2018.09.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 09/01/2018] [Accepted: 09/07/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND The European Society of Cardiology (ESC) Guidelines published in 2016 modified indications for cardiac resynchronization therapy (CRT) in comparison with the 2013 ESC Guidelines. The aim of this analysis was to evaluate the impact of the stricter criteria suggested by the 2016 ESC Guidelines on patient outcome in a real-world population. METHODS We collected data on 930 consecutive patients with complete outcome information who had undergone CRT implantation from 2011 to 2013 from the CRT-MORE registry. Patients were classified according to 2013 (Reference) and 2016 (Current) ESC Guidelines. The primary end-point of the study was death from any cause and heart failure hospitalization. RESULTS According to the Reference Guidelines, 650 (69.9%) patients met Class I indications, 190 (20.4%) Class IIa, 39 (4.2%) Class IIb and 51 (5.5%) Class III. According to the Current Guidelines, 563 (60.5%) patients met Class I indications, 145 (15.6%) Class IIa, 108 (11.6%) Class IIb and 114 (12.3%) Class III. On comparing the Reference and Current Guidelines, the 538 patients who confirmed their Class I indication had a better outcome in terms of freedom from the combined end-point of heart failure (HF) hospitalization or death from any cause (hazard ratio (HR) of 0.64; 95% CI 0.42 to 0.99; p = 0.0436) when compared to the 112 patients who lost their class I indication (84 moved to class IIb and 28 moved to class III). CONCLUSIONS The stricter criteria for Class I CRT indication suggested by the 2016 ESC Guidelines excluded about 20% of patients with a worse prognosis. CLINICAL TRIAL REGISTRATION CRT MORE: Cardiac Resynchronization Therapy Modular Registry URL: http://clinicaltrials.gov/Identifier:NCT01573091.
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Affiliation(s)
- Emanuele Bertaglia
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy.
| | | | - Pietro Palmisano
- Cardiology Unit, "Card. G. Panico" Hospital, Tricase (LE), Italy
| | | | | | | | | | | | | | | | | | | | | | | | - Federico Migliore
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy
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Adherence to 2016 European Society of Cardiology guidelines predicts outcome in a large real-world population of heart failure patients requiring cardiac resynchronization therapy. Heart Rhythm 2018; 15:1675-1682. [PMID: 29665405 DOI: 10.1016/j.hrthm.2018.04.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Professional guidelines are based on the best available evidence. However, patients treated in clinical practice may differ from those included in reference trials. OBJECTIVE The aim of this study was to evaluate the effects of cardiac resynchronization therapy (CRT) in a large population of patients implanted with a CRT device stratified in accordance with the 2016 European heart failure (HF) guidelines. METHODS We collected data on 930 consecutive patients from the Cardiac Resynchronization Therapy MOdular REgistry. The primary end point was a composite of death and HF hospitalization. RESULTS Five hundred sixty-three (60.5%) patients met class I indications, 145 (15.6%) class IIa, 108 (11.6%) class IIb, and 114 (12.3%) class III. After a median follow-up of 1001 days, 120 (14.7%) patients who had an indication to CRT had died and 71 (8.7%) had been hospitalized for HF. The time to the end point was longer in patients with a class I indication (hazard ratio 0.55; 95% confidence interval 0.39-0.76; P = .0001). After 12 months, left ventricular (LV) end-systolic volume had decreased by ≥15% in 61.5% (320/520) of patients whereas in 57.5% (389/676) of patients the absolute LV ejection fraction improvement was ≥5%. Adherence to class I was also associated with an absolute LV ejection fraction increase of >5% (P = .0142) and an LV end-systolic volume decrease of ≥15% (P = .0055). CONCLUSION In our population, ∼60% of patients underwent implantation according to the 2016 European HF guidelines class I indication. Adherence to class I was associated with a lower death and HF hospitalization rates and better LV reverse remodeling.
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Incidence, predictors, and impact on outcome of increased left ventricular latency in patients undergoing cardiac resynchronization therapy. J Interv Card Electrophysiol 2018; 51:245-252. [DOI: 10.1007/s10840-018-0321-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 01/26/2018] [Indexed: 10/17/2022]
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Bertaglia E, Migliore F, Baritussio A, De Simone A, Reggiani A, Pecora D, D'Onofrio A, Rapacciuolo A, Savarese G, Pierantozzi A, Marenna B, Ruffa F, Campari M, Malacrida M, Stabile G. Stricter criteria for left bundle branch block diagnosis do not improve response to CRT. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:850-856. [PMID: 28543265 DOI: 10.1111/pace.13104] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 04/20/2017] [Accepted: 04/28/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) has proved to be effective in patients with heart failure and left bundle branch block (LBBB). Recently, new electrocardiography criteria have been proposed for the diagnosis of LBBB. These criteria are stricter than the current American Heart Association (AHA) criteria. We assessed the rate of echocardiographic response to CRT in patients with traditional LBBB versus patients who met the new criteria (strict LBBB). METHODS Consecutive patients undergoing CRT were enrolled in the CRT MORE registry. Patients with no-LBBB QRS morphology according to AHA criteria, atrial fibrillation, right bundle branch block, and right ventricular pacing were excluded. Strict LBBB was defined as: QRS ≥ 140 ms for men and ≥130 ms for women, QS or rS in V1-V2, mid-QRS notching or slurring in ≥2 contiguous leads. Patients showing a relative decrease of ≥15% in left ventricular end-systolic volume (LVESV) at 12 months were defined as responders. RESULTS Among 335 patients with LBBB, 131 (39%) had strict LBBB. Patients with and without strict LBBB showed comparable baseline characteristics, except for QRS duration (166 ± 20 ms vs 152 ± 25 ms, P < 0.001). On 12-month evaluation, 205 patients (61%) were responders; 85 of 131 (65%) had strict LBBB and 120 of 204 (59%) had traditional LBBB (P = 0.267). On multivariate analysis, a history of atrial fibrillation, larger LVESV, and the presence of mid-QRS notching in ≥1 lead (odds ratio 2.099; 95% confidence interval 1.061-4.152, P = 0.033) were independently associated with echocardiographic response. CONCLUSION Stricter definition of LBBB did not improve response to CRT in comparison to the current AHA definition.
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Affiliation(s)
- Emanuele Bertaglia
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy
| | - Federico Migliore
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy
| | - Anna Baritussio
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy
| | | | | | | | | | - Antonio Rapacciuolo
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
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Carità P, Corrado E, Pontone G, Curnis A, Bontempi L, Novo G, Guglielmo M, Ciaramitaro G, Assennato P, Novo S, Coppola G. Non-responders to cardiac resynchronization therapy: Insights from multimodality imaging and electrocardiography. A brief review. Int J Cardiol 2016; 225:402-407. [PMID: 27776243 DOI: 10.1016/j.ijcard.2016.09.037] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 09/07/2016] [Accepted: 09/15/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) is a successful strategy for heart failure (HF) patients. The pre-requisite for the response is the evidence of electrical dyssynchrony on the surface electrocardiogram usually as left bundle branch block (LBBB). Non-response to CRT is a significant problem in clinical practice. Patient selection, inadequate delivery and sub-optimal left ventricle lead position may be important causes. OBJECTIVES In an effort to improve CRT response multimodality imaging (especially echocardiography, computed tomography and cardiac magnetic resonance) could play a decisive role and extensive literature has been published on the matter. However, we are so far from routinary use in clinical practice. Electrocardiography (with respect to left ventricle capture and QRS narrowing) may represent a simple and low cost approach for early prediction of potential non-responder, with immediate practical implications. CONCLUSION This brief review covers the current recommendations for CRT in HF patients with particular attention to the potential benefits of multimodality imaging and electrocardiography in improving response rate.
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Affiliation(s)
- Patrizia Carità
- Department of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy.
| | - Egle Corrado
- Department of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy
| | | | - Antonio Curnis
- Chair and Unit of Cardiology University of Brescia, Spedali Civili Hospital, Italy
| | - Luca Bontempi
- Chair and Unit of Cardiology University of Brescia, Spedali Civili Hospital, Italy
| | - Giuseppina Novo
- Department of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy
| | | | | | - Pasquale Assennato
- Department of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy
| | - Salvatore Novo
- Department of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy
| | - Giuseppe Coppola
- Department of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy
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Rapacciuolo A, Maffè S, Palmisano P, Ferraro A, Cecchetto A, D'Onofrio A, Solimene F, Musatti P, Paffoni P, Esposito F, Parravicini U, Agresta A, Botto GL, Malacrida M, Stabile G. Prognostic Role of Right Ventricular Function in Patients With Heart Failure Undergoing Cardiac Resynchronization Therapy. Clin Cardiol 2016; 39:640-645. [PMID: 27468173 DOI: 10.1002/clc.22574] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/01/2016] [Accepted: 06/15/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Because 20% to 40% of patients undergoing cardiac resynchronization therapy (CRT) do not respond to it, identification of potential factors predicting response is a relevant research topic. HYPOTHESIS There is a possible association between right ventricular function and response to CRT. METHODS We analyzed 227 patients from the Cardiac Resynchronization Therapy Modular Registry (CRT-MORE) who received CRT according to current guidelines from March to December 2013. Response to therapy was defined as a decrease of ≥15% in left ventricular end-systolic volume (LVESV) at 6 months. RESULTS The tricuspid annular plane systolic excursion (TAPSE) value that best predicted improvement in LVESV (sensitivity 68%, specificity 54%) was 17 mm. Stratifying patients according to TAPSE, LVESV decreased ≥15% in 78% of patients with TAPSE >17 mm (vs 59% in patients with TAPSE ≤17 mm; P = 0.006). At multivariate analysis, TAPSE >17 mm was independently associated with LVESV improvement (odds ratio: 1.97, 95% confidence interval: 1.03-3.80, P < 0.05), together with ischemic etiology (odds ratio: 0.39, 95% confidence interval: 0.20-0.75, P < 0.01). These results were confirmed for New York Heart Association class III to IV patients (79% echocardiographic response rate in patients with TAPSE >17 mm vs 55% in patients with TAPSE <17 mm; P = 0.012). CONCLUSIONS Baseline signs of right ventricular dysfunction suggest possible remodeling after CRT. A TAPSE value of 17 mm was identified as a good cutoff for predicting a better response to CRT in patients with both mildly symptomatic and severe heart failure.
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Affiliation(s)
- Antonio Rapacciuolo
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Stefano Maffè
- Division of Cardiology, SS Trinità Hospital, Borgomanero, Italy
| | | | - Anna Ferraro
- Division of Cardiology, Rivoli Hospital, Rivoli, Italy
| | - Antonella Cecchetto
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Antonio D'Onofrio
- Department of Cardiology, Monaldi Hospital, AORN Ospedali dei Colli, Naples, Italy
| | - Francesco Solimene
- Casa di Cura Montevergine, Electrophysiology Department, Mercogliano, Italy
| | - Paola Musatti
- Fondazione Poliambulanza, Cardiology Department, Brescia, Italy
| | - Paola Paffoni
- Division of Cardiology, SS Trinità Hospital, Borgomanero, Italy
| | - Francesca Esposito
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | | | - Alessia Agresta
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Giovanni Luca Botto
- Hospital Sant'Anna, Electrophysiology and Cardiac Stimulation Department San Fermo della Battaglia, Italy
| | | | - Giuseppe Stabile
- Clinica Mediterranea, Laboratory of Electrophysiology, Naples, Italy
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Migliore F, Baritussio A, Stabile G, Reggiani A, D’Onofrio A, Palmisano P, Caico SI, De Simone A, Marini M, Pecora D, Padeletti L, Botto GL, Malacrida M, Bertaglia E. Prevalence of true left bundle branch block in current practice of cardiac resynchronization therapy implantation. J Cardiovasc Med (Hagerstown) 2016; 17:462-8. [DOI: 10.2459/jcm.0000000000000297] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Magnitude of QRS duration reduction after biventricular pacing identifies responders to cardiac resynchronization therapy. Int J Cardiol 2016; 221:450-5. [PMID: 27414720 DOI: 10.1016/j.ijcard.2016.06.203] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 05/12/2016] [Accepted: 06/25/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Several studies have investigated the association between native QRS duration (QRSd) or QRS narrowing and response to biventricular pacing. However, their results have been conflicting. The aim of our study was to determine the association between the relative change in QRS narrowing index (QI) and clinical outcome and prognosis in patients who undergo cardiac resynchronization therapy (CRT) implantation. METHODS AND RESULTS We included 311 patients in whom a CRT device was implanted in accordance with current guidelines for CRT. On implantation, the native QRS, the QRSd and the QI during CRT were measured. After 6months, 220 (71%) patients showed a 10% reduction in LVESV. The median [25th-75th] QI was 14.3% [7.2-21.4] and was significantly related to reverse remodeling (r=+0.22; 95%CI: 0.11-0.32, p=0.0001). The cut-off value of QI that best predicted LV reverse remodeling after 6months of CRT was 12.5% (sensitivity=63.6%, specificity=57.1%, area under the curve=0.633, p=0.0002). The time to the event death or cardiovascular hospitalization was significantly longer among patients with QI>12.5% (log-rank test, p=0.0155), with a hazard ratio (HR) of 0.3 [95%CI: 0.11-0.78]. In the multivariate regression model adjusted for baseline parameters, a 10% increment in QI (HR=0.61[0.44-0.83], p=0.002) remained significantly associated with CRT response. CONCLUSIONS Patients with a larger decrease in QRSd after CRT initiation showed greater echocardiographic reverse remodeling and better outcome from death or cardiovascular hospitalization. QI is an easy-to-measure variable that could be used to predict CRT response at the time of pacing site selection or pacing configuration programming.
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Electrical remodeling after cardiac resynchronization therapy and its relationship with the anatomical remodeling. Int J Cardiol 2016; 211:86-7. [DOI: 10.1016/j.ijcard.2016.02.138] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 02/28/2016] [Indexed: 11/18/2022]
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Stabile G, D’Onofrio A, Pepi P, Simone AD, Santamaria M, Caico SI, Rapacciuolo A, Padeletti L, Pecora D, Giovannini T, Arena G, Spotti A, Iuliano A, Bertaglia E, Malacrida M, Botto GL. Interlead anatomic and electrical distance predict outcome in CRT patients. Heart Rhythm 2015; 12:2221-9. [DOI: 10.1016/j.hrthm.2015.05.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Indexed: 12/15/2022]
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Stabile G, Iuliano A, La Rocca V, Solimene F, Fazio R, De Simone A. Geometrical and electrical predictors of cardiac resynchronization therapy response. Expert Rev Cardiovasc Ther 2014; 12:873-84. [PMID: 24849323 DOI: 10.1586/14779072.2014.921117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Giuseppe Stabile
- Laboratorio di Elettrofisiologia, Clinica Mediterranea, Via Orazio 2, 80122, Napoli, Italy
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Geometrical characteristics of interventricular electrical delay. Int J Cardiol 2014; 172:e271-2. [DOI: 10.1016/j.ijcard.2013.12.206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 12/28/2013] [Indexed: 11/19/2022]
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