1
|
van der Lingen ALCJ, Verstraelen TE, van Erven L, Meeder JG, Theuns DA, Vernooy K, Wilde AAM, Maass AH, Allaart CP. Assessment of ICD eligibility in non-ischaemic cardiomyopathy patients: a position statement by the Task Force of the Dutch Society of Cardiology. Neth Heart J 2024; 32:190-197. [PMID: 38634993 DOI: 10.1007/s12471-024-01859-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 04/19/2024] Open
Abstract
International guidelines recommend implantation of an implantable cardioverter-defibrillator (ICD) in non-ischaemic cardiomyopathy (NICM) patients with a left ventricular ejection fraction (LVEF) below 35% despite optimal medical therapy and a life expectancy of more than 1 year with good functional status. We propose refinement of these recommendations in patients with NICM, with careful consideration of additional risk parameters for both arrhythmic and non-arrhythmic death. These additional parameters include late gadolinium enhancement on cardiac magnetic resonance imaging and genetic testing for high-risk genetic variants to further assess arrhythmic risk, and age, comorbidities and sex for assessment of non-arrhythmic mortality risk. Moreover, several risk modifiers should be taken into account, such as concomitant arrhythmias that may affect LVEF (atrial fibrillation, premature ventricular beats) and resynchronisation therapy. Even though currently no valid cut-off values have been established, the proposed approach provides a more careful consideration of risks that may result in withholding ICD implantation in patients with low arrhythmic risk and substantial non-arrhythmic mortality risk.
Collapse
Affiliation(s)
- Anne-Lotte C J van der Lingen
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Tom E Verstraelen
- Department of Cardiology, Heart Centre, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Lieselot van Erven
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Joan G Meeder
- Department of Cardiology, VieCuri Medical Centre Noord-Limburg, Venlo, The Netherlands
| | - Dominic A Theuns
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Arthur A M Wilde
- Department of Cardiology, Heart Centre, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Alexander H Maass
- Department of Cardiology, University Medical Centre Groningen, Heart Centre, University of Groningen, Groningen, The Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| |
Collapse
|
2
|
Nishimura T, Goya M, Takigawa M, Negishi M, Ikenouchi T, Yamamoto T, Kawamura I, Goto K, Shigeta T, Takamiya T, Tao S, Yonetsu T, Miyazaki S, Sasano T. Transcoronary mapping with an over-the-wire multielectrode catheter in scar-related ventricular tachycardia patients. Europace 2023; 26:euad365. [PMID: 38096246 PMCID: PMC10763523 DOI: 10.1093/europace/euad365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/05/2023] [Indexed: 01/04/2024] Open
Abstract
AIMS The usefulness of coronary venous system mapping has been reported for assessing intramural and epicardial substrates in patients with scar-related ventricular tachycardia (VT). However, there has been little data on mapping from coronary arteries. We investigated the safety and utility of mapping from coronary arteries with a novel over-the-wire multielectrode catheter in scar-related VT patients. METHODS AND RESULTS Ten consecutive scar-related VT patients with non-ischaemic cardiomyopathy who underwent mapping from a coronary artery were analysed. Six patients underwent simultaneous coronary venous mapping. High-density maps were created by combining the left ventricular endocardium and coronary vessels. Substrate maps were created during the baseline rhythm with 2438 points (IQR 2136-3490 points), including 329 (IQR 59-508 points) in coronary arteries. Abnormal bipolar electrograms were successfully recorded within coronary arteries close to the endocardial substrate in seven patients. During VT, isthmus components were recorded within the coronary vessels in three patients with no discernible isthmus components on endocardial mapping. The ablation terminated the VT from an endocardial site opposite the earliest site in the coronary arteries in five patients. CONCLUSION The transcoronary mapping with an over-the-wire multielectrode catheter can safely record abnormal bipolar electrograms within coronary arteries. Additional mapping data from the coronary vessels have the potential to assess three-dimensional ventricular substrates and circuit structures in scar-related VT patients.
Collapse
Affiliation(s)
- Takuro Nishimura
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-Ku, Tokyo 113-8510, Japan
| | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-Ku, Tokyo 113-8510, Japan
| | - Masateru Takigawa
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-Ku, Tokyo 113-8510, Japan
| | - Miho Negishi
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-Ku, Tokyo 113-8510, Japan
| | - Takashi Ikenouchi
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-Ku, Tokyo 113-8510, Japan
| | - Tasuku Yamamoto
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-Ku, Tokyo 113-8510, Japan
| | - Iwanari Kawamura
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-Ku, Tokyo 113-8510, Japan
| | - Kentaro Goto
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-Ku, Tokyo 113-8510, Japan
| | - Takatoshi Shigeta
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-Ku, Tokyo 113-8510, Japan
| | - Tomomasa Takamiya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-Ku, Tokyo 113-8510, Japan
| | - Susumu Tao
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-Ku, Tokyo 113-8510, Japan
| | - Taishi Yonetsu
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-Ku, Tokyo 113-8510, Japan
| | - Shinsuke Miyazaki
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-Ku, Tokyo 113-8510, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-Ku, Tokyo 113-8510, Japan
| |
Collapse
|
3
|
Hammersley DJ, Jones RE, Owen R, Mach L, Lota AS, Khalique Z, De Marvao A, Androulakis E, Hatipoglu S, Gulati A, Reddy RK, Yoon WY, Talukder S, Shah R, Baruah R, Guha K, Pantazis A, Baksi AJ, Gregson J, Cleland JG, Tayal U, Pennell DJ, Ware JS, Halliday BP, Prasad SK. Phenotype, outcomes and natural history of early-stage non-ischaemic cardiomyopathy. Eur J Heart Fail 2023; 25:2050-2059. [PMID: 37728026 PMCID: PMC10946699 DOI: 10.1002/ejhf.3037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/03/2023] [Accepted: 09/15/2023] [Indexed: 09/21/2023] Open
Abstract
AIMS To characterize the phenotype, clinical outcomes and rate of disease progression in patients with early-stage non-ischaemic cardiomyopathy (early-NICM). METHODS AND RESULTS We conducted a prospective observational cohort study of patients with early-NICM assessed by late gadolinium enhancement cardiovascular magnetic resonance (CMR). Cases were classified into the following subgroups: isolated left ventricular dilatation (early-NICM H-/D+), non-dilated left ventricular cardiomyopathy (early-NICM H+/D-), or early dilated cardiomyopathy (early-NICM H+/D+). Clinical follow-up for major adverse cardiovascular events (MACE) included non-fatal life-threatening arrhythmia, unplanned cardiovascular hospitalization or cardiovascular death. A subset of patients (n = 119) underwent a second CMR to assess changes in cardiac structure and function. Of 254 patients with early-NICM (median age 46 years [interquartile range 36-58], 94 [37%] women, median left ventricular ejection fraction [LVEF] 55% [52-59]), myocardial fibrosis was present in 65 (26%). There was no difference in the prevalence of fibrosis between subgroups (p = 0.90), however fibrosis mass was lowest in early-NICM H-/D+, higher in early-NICM H+/D- and highest in early-NICM H+/D+ (p = 0.03). Over a median follow-up of 7.9 (5.5-10.0) years, 28 patients (11%) experienced MACE. Non-sustained ventricular tachycardia (hazard ratio [HR] 5.1, 95% confidence interval [CI] 2.36-11.00, p < 0.001), myocardial fibrosis (HR 3.77, 95% CI 1.73-8.20, p < 0.001) and diabetes mellitus (HR 5.12, 95% CI 1.73-15.18, p = 0.003) were associated with MACE in a multivariable model. Only 8% of patients progressed from early-NICM to dilated cardiomyopathy with LVEF <50% over a median of 16 (11-34) months. CONCLUSION Early-NICM is not benign. Fibrosis develops early in the phenotypic course. In-depth characterization enhances risk stratification and might aid clinical management.
Collapse
Affiliation(s)
- Daniel J. Hammersley
- National Heart and Lung InstituteImperial College LondonLondonUK
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Richard E. Jones
- National Heart and Lung InstituteImperial College LondonLondonUK
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
- Anglia Ruskin Medical School, UKCambridgeUK
- Essex Cardiothoracic CentreBasildonUK
| | - Ruth Owen
- London School of Hygiene and Tropical MedicineLondonUK
| | - Lukas Mach
- National Heart and Lung InstituteImperial College LondonLondonUK
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Amrit S. Lota
- National Heart and Lung InstituteImperial College LondonLondonUK
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Zohya Khalique
- National Heart and Lung InstituteImperial College LondonLondonUK
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Antonio De Marvao
- Department of Women and Children's HealthKing's College LondonLondonUK
- British Heart Foundation Centre of Research Excellence, School of Cardiovascular Medicine and SciencesKing's College LondonLondonUK
| | - Emmanuel Androulakis
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Suzan Hatipoglu
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | | | - Rohin K. Reddy
- National Heart and Lung InstituteImperial College LondonLondonUK
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Won Young Yoon
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Suprateeka Talukder
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Riya Shah
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Resham Baruah
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | | | - Antonis Pantazis
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - A. John Baksi
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - John Gregson
- London School of Hygiene and Tropical MedicineLondonUK
| | - John G.F. Cleland
- British Heart Foundation Centre of Research Excellence, School of Cardiovascular and Metabolic HealthUniversity of GlasgowGlasgowUK
| | - Upasana Tayal
- National Heart and Lung InstituteImperial College LondonLondonUK
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Dudley J. Pennell
- National Heart and Lung InstituteImperial College LondonLondonUK
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - James S. Ware
- National Heart and Lung InstituteImperial College LondonLondonUK
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
- MRC London Institute of Medical SciencesImperial College LondonLondonUK
| | - Brian P. Halliday
- National Heart and Lung InstituteImperial College LondonLondonUK
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Sanjay K. Prasad
- National Heart and Lung InstituteImperial College LondonLondonUK
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| |
Collapse
|
4
|
Desroche LM, Mandry D, Ducrocq G, Durand-Zaleski I, Alfaiate T, Millischer D, Milleron O, Huttin O, Valla M, Belle L, Lavie-Badie Y, Farah B, Diakov C, Logeart D, Safar B, Burdet C, Jondeau G. Multicentre medicoeconomic evaluation of cardiac magnetic resonance imaging for predicting coronary artery disease in left ventricular dysfunction: The CAMAREC study design. Arch Cardiovasc Dis 2023; 116:366-372. [PMID: 37573160 DOI: 10.1016/j.acvd.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/08/2023] [Accepted: 06/08/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND Cardiac magnetic resonance imaging may provide a non-invasive alternative to coronary angiography for differentiating between ischaemic and non-ischaemic cardiomyopathy in cases of unexplained reduced left ventricular ejection fraction. AIM The CAMAREC study aims to evaluate the diagnostic accuracy of cardiac magnetic resonance imaging in predicting significant coronary artery disease in patients with reduced left ventricular ejection fraction, using coronary angiography as the gold standard for comparison. METHODS CAMAREC is a prospective cohort study of 406 patients in 10 centres with newly diagnosed, unexplained left ventricular ejection fraction ≤ 45%. Cardiac magnetic resonance imaging and coronary angiography will be conducted within a 2-week interval, starting with cardiac magnetic resonance imaging; independent committees will review the results blindly. Primary outcome is sensitivity of detecting ischaemic scar on cardiac magnetic resonance imaging for predicting significant coronary artery disease on coronary angiography according to Felker's criteria. Secondary outcomes include specificity and positive and negative predictive values (with 95% confidence intervals) of cardiac magnetic resonance imaging for predicting significant coronary artery disease in patients with reduced left ventricular ejection fraction, kappa concordance coefficient between cardiac magnetic resonance imaging and coronary angiography for diagnosing the affected myocardial territory, and the impact of cardiac magnetic resonance imaging on revascularization decisions. Two ancillary studies will evaluate the incremental cost-effectiveness of using cardiac magnetic resonance imaging first versus coronary angiography first, and the sensitivity of pre- and postcontrast T1-mapping for predicting significant coronary artery disease in patients with reduced left ventricular ejection fraction. CONCLUSION Our study protocol is designed to rigorously evaluate cardiac magnetic resonance imaging as a non-invasive alternative to coronary angiography in patients with unexplained reduced left ventricular ejection fraction. The results will have significant implications for patient management, and may support growing evidence for the clinical utility of cardiac magnetic resonance imaging.
Collapse
Affiliation(s)
- Louis-Marie Desroche
- Cardiology Department, CHU de la Réunion, allée des Topazes, 97490 Saint-Denis, France.
| | - Damien Mandry
- Cardiology Department, CHU Nancy-Brabois, 54500 Vandœuvre-lès-Nancy, France
| | - Gregory Ducrocq
- Cardiology Department, hôpital Bichat, AP-HP, 75018 Paris, France
| | | | - Toni Alfaiate
- Département d'épidémiologie, biostatistique et recherche clinique, hôpital Bichat, AP-HP, 75018 Paris, France
| | - Damien Millischer
- Cardiology Department, GHI de Montfermeil, 93370 Montfermeil, France
| | - Olivier Milleron
- Cardiology Department, hôpital Bichat, AP-HP, 75018 Paris, France
| | - Olivier Huttin
- Cardiology Department, CHU Nancy-Brabois, 54500 Vandœuvre-lès-Nancy, France
| | - Mathieu Valla
- Cardiology Department, CHR de Metz, 57085 Metz, France
| | - Loic Belle
- Cardiology Department, CH Annecy, 74370 Epagny Metz-Tessy, France
| | | | - Bruno Farah
- Cardiology Department, clinique Pasteur, 31076 Toulouse, France
| | - Christelle Diakov
- Cardiology Department, institut mutualiste Montsouris, 75014 Paris, France
| | - Damien Logeart
- Cardiology Department, Lariboisière Hospital, AP-HP, 75010 Paris, France
| | - Benjamin Safar
- Cardiology Department, GHI de Montfermeil, 93370 Montfermeil, France
| | - Charles Burdet
- Département d'épidémiologie, biostatistique et recherche clinique, hôpital Bichat, AP-HP, 75018 Paris, France; Université Paris-Cité and université Sorbonne-Paris-Nord, Inserm, IAME, 75870 Paris, France
| | - Guillaume Jondeau
- Cardiology Department, hôpital Bichat, AP-HP, 75018 Paris, France; Service de cardiologie, université Paris-Cité, Inserm U1148 LVTS, 75018 Paris, France
| |
Collapse
|
5
|
Dziewięcka E, Winiarczyk M, Wiśniowska-Śmiałek S, Karabinowska-Małocha A, Robak J, Kaciczak M, Baranowski F, Rubiś P. Comparison of Clinical Course and Outcomes between Dilated and Hypokinetic Non-Dilated Cardiomyopathy. Cardiology 2023; 148:395-401. [PMID: 37311443 DOI: 10.1159/000531534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 05/31/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND By definition, dilated cardiomyopathy (DCM) is characterized by enlargement of the left ventricular (LV) cavity, and systolic dysfunction. However, in 2016 ESC introduced a new clinical entity - hypokinetic non-dilated cardiomyopathy (HNDC). HNDC is defined as LV systolic dysfunction without LV dilatation. However, the diagnosis of HNDC has so far rarely been made by a cardiologist, and it is unknown whether "classic" DCM differs from HNDC in terms of clinical course and outcomes. OBJECTIVES Comparison of heart failure profiles and outcomes between patients with "classic" dilated (DCM) and HNDCs. METHOD We retrospectively analysed 785 DCM patients, defined as impaired left ventricle (LV) systolic function (ejection fraction [LVEF] <45%) in the absence of coronary artery disease, valve disease, congenital heart disease, and severe arterial hypertension. "Classic" DCM was diagnosed when LV dilatation was present (LV end-diastolic diameter >52 mm/58 mm in women/men); otherwise, HNDC was diagnosed. After 47 ± 31 months, the all-cause mortality and composite endpoint (all-cause mortality, heart transplant - HTX, left ventricle assist device implantation - LVAD) were assessed. RESULTS There were 617 (79%) patients with LV dilatation. Patients with "classic" DCM differed from HNDC in terms of clinically relevant parameters [hypertension (47% vs. 64%, p = 0.008), ventricular tachyarrhythmias (29% vs. 15%, p = 0.007), NYHA class (2.5 ± 0.9 vs. 2.2 ± 0.8, p = 0.003)], had lower cholesterol (LDL: 2.9 ± 1.0 vs. 3.2 ± 1.1 mmol/L, p = 0.049), and higher N-terminal pro-brain natriuretic peptide (3,351 ± 5,415 vs. 2,563 ± 8584 pg/mL, p = 0.0001) and required higher diuretics dosages (57.8 ± 89.5 vs. 33.7 ± 48.7 mg/day, p ≤ 0.0001). All of their chambers were larger (LVEDd: 68.3 ± 4.5 vs. 52.7 ± 3.5 mm, p < 0.0001) and they had lower LVEF (25.2 ± 9.4 vs. 36.6 ± 11.7%, p < 0.0001). During the follow-up, there were 145 (18%) composite endpoints ("classic" DCM vs. HNDC: 122 [20%] vs. 26 [18%], p = 0.22): deaths (97 [16%] vs. 24 [14%], p = 0.67), HTX (17 [4%] vs. 4 [4%], p = 0.97) and LVAD (19 [5%] vs. 0 [0%], p = 0.03). Both groups did not differ in terms of all-cause mortality (p = 0.70), cardiovascular (CV) mortality (p = 0.37) and composite endpoint (p = 0.26). CONCLUSIONS LV dilatation was absent in more than one-fifth of DCM patients. HNDC patients had less severe heart failure symptoms, less advanced cardiac remodelling, and required lower diuretics dosages. On the other hand, "classic" DCM and HNDC patients did not differ in terms of all-cause mortality, CV mortality, and composite endpoint.
Collapse
Affiliation(s)
- Ewa Dziewięcka
- Department of Cardiac and Vascular Diseases, Jagiellonian University Collegium Medicum, John Paul II Hospital, Krakow, Poland
| | - Mateusz Winiarczyk
- Department of Cardiac and Vascular Diseases, Jagiellonian University Collegium Medicum, John Paul II Hospital, Krakow, Poland
| | - Sylwia Wiśniowska-Śmiałek
- Department of Cardiac and Vascular Diseases, Jagiellonian University Collegium Medicum, John Paul II Hospital, Krakow, Poland
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Collegium Medicum, John Paul II Hospital, Krakow, Poland
| | - Aleksandra Karabinowska-Małocha
- Department of Cardiac and Vascular Diseases, Jagiellonian University Collegium Medicum, John Paul II Hospital, Krakow, Poland
| | - Jan Robak
- Students' Scientific Group at Department of Cardiac and Vascular Diseases, Jagiellonian University Collegium Medicum, John Paul II Hospital, Krakow, Poland
| | - Monika Kaciczak
- Students' Scientific Group at Department of Cardiac and Vascular Diseases, Jagiellonian University Collegium Medicum, John Paul II Hospital, Krakow, Poland
| | - Filip Baranowski
- Students' Scientific Group at Department of Cardiac and Vascular Diseases, Jagiellonian University Collegium Medicum, John Paul II Hospital, Krakow, Poland
| | - Paweł Rubiś
- Department of Cardiac and Vascular Diseases, Jagiellonian University Collegium Medicum, John Paul II Hospital, Krakow, Poland
| |
Collapse
|
6
|
Di Marco A, Brown P, Mateus G, Faga V, Nucifora G, Claver E, Viedma J, Galvan F, Bradley J, Dallaglio PD, de Frutos F, Miller CA, Comín-Colet J, Anguera I, Schmitt M. Late gadolinium enhancement and the risk of ventricular arrhythmias and sudden death in NYHA class I patients with non-ischaemic cardiomyopathy. Eur J Heart Fail 2023; 25:740-750. [PMID: 36781200 DOI: 10.1002/ejhf.2793] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/15/2023] Open
Abstract
AIM To compare the risk of ventricular arrhythmias (VA) and sudden death (SD) between New York Heart Association (NYHA) class I and NYHA class II-III patients with non-ischaemic cardiomyopathy (NICM). METHODS AND RESULTS Observational retrospective cohort study including patients with NICM who underwent cardiac magnetic resonance at two hospitals. The primary endpoint included appropriate implantable cardioverter defibrillator (ICD) therapies, sustained ventricular tachycardia, resuscitated cardiac arrest and SD. The secondary endpoint included heart failure (HF) hospitalizations, heart transplant, left ventricular assist device implant or HF death. Overall, 698 patients were included, 33% in NYHA class I. During a median follow-up of 31 months, the primary endpoint occurred in 57 patients (8%), with no differences between NYHA class I and NYHA class II-III cases (7% vs. 9%, p = 0.62). Late gadolinium enhancement (LGE) was the only independent predictor of the primary outcome both in NYHA class I and NYHA class II-III patients. LGE+ NYHA class I patients had a similar cumulative incidence of the primary endpoint as compared to LGE+ NYHA class II-III (p = 0.92) and a significantly higher risk as compared to LGE- NYHA class II-III cases (p < 0.001). The risk of the secondary endpoint was significantly higher in patients in NYHA class II-III as compared to those in NYHA class I (hazard ratio 3.2, p = 0.001). CONCLUSIONS Patients with NICM in NYHA class I are not necessarily at low risk of VA and SD. Actually, LGE+ NYHA class I patients have a high risk. NYHA class I patients with high-risk factors, such as LGE, could benefit from primary prevention ICD at least as much as those in NYHA class II-III with the same risk factors.
Collapse
MESH Headings
- Humans
- Contrast Media
- Gadolinium
- Retrospective Studies
- Heart Failure/therapy
- Arrhythmias, Cardiac/epidemiology
- Arrhythmias, Cardiac/etiology
- Arrhythmias, Cardiac/therapy
- Myocardial Ischemia/diagnostic imaging
- Myocardial Ischemia/epidemiology
- Myocardial Ischemia/complications
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Risk Factors
- Defibrillators, Implantable/adverse effects
- Cardiomyopathies
Collapse
Affiliation(s)
- Andrea Di Marco
- Department of Cardiology, Hospital Universitari de Bellvitge, Barcelona, Spain
- Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Pamela Brown
- Department of Cardiology, North West Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Gemma Mateus
- Department of Cardiology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Valentina Faga
- Department of Cardiology, Hospital Universitari de Bellvitge, Barcelona, Spain
- Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - Gaetano Nucifora
- Department of Cardiology, North West Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Eduard Claver
- Department of Cardiology, Hospital Universitari de Bellvitge, Barcelona, Spain
- Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - Jisela Viedma
- Department of Cardiology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Francisco Galvan
- Department of Cardiology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Joshua Bradley
- Department of Cardiology, North West Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Paolo D Dallaglio
- Department of Cardiology, Hospital Universitari de Bellvitge, Barcelona, Spain
- Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - Fernando de Frutos
- Department of Cardiology, Hospital Universitari de Bellvitge, Barcelona, Spain
- Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - Christopher A Miller
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology & Regenerative Medicine, School of Biology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Josep Comín-Colet
- Department of Cardiology, Hospital Universitari de Bellvitge, Barcelona, Spain
- Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Ignasi Anguera
- Department of Cardiology, Hospital Universitari de Bellvitge, Barcelona, Spain
- Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - Matthias Schmitt
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Department of Cardiology, North West Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK
| |
Collapse
|
7
|
Theuns DA, Verstraelen TE, van der Lingen ACJ, Delnoy PP, Allaart CP, van Erven L, Maass AH, Vernooy K, Wilde AAM, Boersma E, Meeder JG. Implantable defibrillator therapy and mortality in patients with non-ischaemic dilated cardiomyopathy : An updated meta-analysis and effect on Dutch clinical practice by the Task Force of the Dutch Society of Cardiology. Neth Heart J 2023; 31:89-99. [PMID: 36066840 PMCID: PMC9950314 DOI: 10.1007/s12471-022-01718-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 10/14/2022] Open
Abstract
BACKGROUND Primary prophylactic implantable cardioverter-defibrillators (ICDs) in patients with non-ischaemic cardiomyopathy (NICMP) remains controversial. This study sought to assess the benefit of ICD therapy with or without cardiac resynchronisation therapy (CRT) in patients with NICMP. In addition, data were compared with real-world clinical data to perform a risk/benefit analysis. METHODS Relevant randomised clinical trials (RCTs) published in meta-analyses since DANISH, and in PubMed, EMBASE and Cochrane databases from 2016 to 2020 were identified. The benefit of ICD therapy stratified by CRT use was assessed using random effects meta-analysis techniques. RESULTS Six RCTs were included in the meta-analysis. Among patients without CRT, ICD use was associated with a 24% reduction in mortality (hazard ratio [HR]: 0.76; 95% confidence interval [CI]: 0.62-0.93; P = 0.008). In contrast, among patients with CRT, a CRT-defibrillator was not associated with reduced mortality (HR: 0.74, 95% CI 0.47-1.16; P = 0.19). For ICD therapy without CRT, absolute risk reduction at 3‑years follow-up was 3.7% yielding a number needed to treat of 27. CONCLUSION ICD use significantly improved survival among patients with NICMP who are not eligible for CRT. Considering CRT, the addition of defibrillator therapy was not significantly associated with mortality benefit compared with CRT pacemaker.
Collapse
Affiliation(s)
- D. A. Theuns
- grid.5645.2000000040459992XDepartment of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - T. E. Verstraelen
- grid.5650.60000000404654431Amsterdam UMC, AMC, Amsterdam, The Netherlands
| | - A. C. J. van der Lingen
- grid.12380.380000 0004 1754 9227Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - P. P. Delnoy
- grid.452600.50000 0001 0547 5927Isala klinieken, Zwolle, The Netherlands
| | - C. P. Allaart
- grid.12380.380000 0004 1754 9227Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - L. van Erven
- grid.10419.3d0000000089452978LUMC, Leiden, The Netherlands
| | - A. H. Maass
- grid.4494.d0000 0000 9558 4598UMCG, Groningen, The Netherlands
| | - K. Vernooy
- grid.412966.e0000 0004 0480 1382Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands ,grid.5012.60000 0001 0481 6099Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - A. A. M. Wilde
- grid.5650.60000000404654431Amsterdam UMC, AMC, Amsterdam, The Netherlands
| | - E. Boersma
- grid.5645.2000000040459992XDepartment of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - J. G. Meeder
- grid.416856.80000 0004 0477 5022VieCuri, Venlo, The Netherlands
| |
Collapse
|
8
|
Kanagaratnam A, Virk SA, Pham T, Anderson RD, Turnbull S, Campbell T, Bennett R, Thomas SP, Lee G, Kumar S. Catheter Ablation for Ventricular Tachycardia in Ischaemic Versus Non-Ischaemic Cardiomyopathy: A Systematic Review and Meta-Analysis. Heart Lung Circ 2022; 31:1064-1074. [PMID: 35643798 DOI: 10.1016/j.hlc.2022.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 02/28/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND There are differences in substrate and ablation approaches for ventricular tachycardia (VT) in ischaemic (ICM) and non-ischaemic cardiomyopathy (NICM). OBJECTIVE To perform a systematic review and meta-analysis comparing clinical and procedural characteristics/outcomes of VT ablation in ICM versus NICM. METHODS Electronic databases were searched for comparative studies reporting outcomes of VT ablation in patients with ICM and NICM. Primary outcomes were acute procedural success, VT recurrence and long-term mortality. Meta-analyses were performed using random-effects modelling. RESULTS Thirty-one (31) studies (7,473 patients; 4,418 ICM and 3,055 NICM) were included. Patients with ICM were significantly older (67.0 vs 55.3 yrs), more commonly male (89% vs 79%), had lower left ventricular ejection fraction (29% vs 38%) were less likely to undergo epicardial access (11% vs 36%) and were more likely to require haemodynamic support during ablation (relative risk [RR] 1.30; 95% CI 1.01-1.69). Acute procedural success (i.e. non-inducibility of VT) was higher in the ICM cohort (RR 1.10, 95% CI 1.05-1.15). Recurrence of VT at follow-up was significantly lower in the ICM cohort (RR 0.77; 95% CI 0.70-0.84). Peri-procedural mortality, incidence of procedural complications and long-term mortality were not significantly different between the cohorts. CONCLUSIONS NICM and ICM patients undergoing VT ablation are fundamentally different in their clinical characteristics, ablation approaches, acute procedural outcomes and likelihood of VA recurrence. VT ablation in NICM has a lower likelihood of procedural success with increased risk of VA recurrence, consistent with known challenging arrhythmia substrate.
Collapse
Affiliation(s)
| | - Sohaib A Virk
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
| | - Timmy Pham
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia
| | - Robert D Anderson
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal Melbourne Hospital, Melbourne, Vic, Australia; Faculty of Medicine, Dentistry, and Health Science, University of Melbourne, Melbourne, Vic, Australia
| | - Samual Turnbull
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia
| | - Timothy Campbell
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia
| | - Richard Bennett
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia
| | - Stuart P Thomas
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia
| | - Geoffrey Lee
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Vic, Australia; Faculty of Medicine, Dentistry, and Health Science, University of Melbourne, Melbourne, Vic, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia.
| |
Collapse
|
9
|
Muehlberg F, Blaszczyk E, Will K, Wilczek S, Brederlau J, Schulz-Menger J. Characterization of critically ill patients with septic shock and sepsis-associated cardiomyopathy using cardiovascular MRI. ESC Heart Fail 2022; 9:2147-2156. [PMID: 35587684 PMCID: PMC9288744 DOI: 10.1002/ehf2.13938] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 03/18/2022] [Accepted: 04/04/2022] [Indexed: 11/16/2022] Open
Abstract
Aims Sepsis‐induced cardiomyopathy is a major complication of septic shock and contributes to its high mortality. This pilot study investigated myocardial tissue differentiation in critically ill, sedated, and ventilated patients with septic shock using cardiovascular magnetic resonance (MR). Methods and results Fifteen patients with septic shock were prospectively recruited from the intensive care unit. Individuals received a cardiac MR scan (1.5 T) within 48 h after initial catecholamine peak and a transthoracic echocardiography at 48 and 96 h after cardiac MR. Left ventricular ejection fraction was assessed using both imaging modalities. During cardiac MR imaging, balanced steady‐state free precession imaging was performed for evaluation of cardiac anatomy and function in long‐axis and short‐axis views. Native T1 maps (modified Look–Locker inversion recovery 5 s(3 s)3 s), T2 maps, and extracellular volume maps were acquired in mid‐ventricular short axis and assessed for average plane values. Patients were given 0.2 mmol/kg of gadoteridol for extracellular volume quantification and late gadolinium enhancement imaging. Critical care physicians monitored sedated and ventilated patients during the scan with continuous invasive monitoring and realized breathholds through manual ventilation breaks. Laboratory analysis included high‐sensitive troponine T and N terminal pro brain natriuretic peptide levels. Twelve individuals with complete datasets were available for analysis (age 59.5 ± 16.9 years; 6 female). Nine patients had impaired systolic function with left ventricular ejection fraction (LVEF) < 50% (39.8 ± 5.7%), and three individuals had preserved LVEF (66.9 ± 6.7%). Global longitudinal strain was impaired in both subgroups (LVEF impaired: 11.0 ± 1.8%; LVEF preserved: 16.0 ± 5.8%; P = 0.1). All patients with initially preserved LVEF died during hospital stay; in‐hospital mortality with initially impaired LVEF was 11%. Upon echocardiographic follow‐up, LVEF improved in all previously impaired patients at 48 (52.3 ± 9.0%, P = 0.06) and 96 h (54.9 ± 7.0%, P = 0.02). Patients with impaired systolic function had increased T2 times as compared with patients with preserved LVEF (60.8 ± 5.6 ms vs. 52.2 ± 2.8 ms; P = 0.02). Left ventricular GLS was decreased in all study individuals with impaired LVEF (11.0 ± 1.8%) and less impaired with preserved LVEF (16.0 ± 5.8%; P = 0.01). T1 mapping showed increased T1 times in patients with LVEF impairment as compared with patients with preserved LVEF (1093.9 ± 86.6 ms vs. 987.7 ± 69.3 ms; P = 0.03). Extracellular volume values were elevated in patients with LVEF impairment (27.9 ± 2.1%) as compared with patients with preserved LVEF (22.7 ± 1.9%; P < 0.01). Conclusions Septic cardiomyopathy with impaired LVEF reflects inflammatory cardiomyopathy. Takotsubo‐like contractility patterns occur in some cases. Cardiac MR is safely feasible in critically ill, sedated, and ventilated patients using extensive monitoring and experienced staff. Trial Registration: retrospectively registered (ISRCTN85297773)
Collapse
Affiliation(s)
- Fabian Muehlberg
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center - a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine; and HELIOS Hospital Berlin Buch, Department of Cardiology and Nephrology, DZHK (German Center for Cardiovascular Research) partner site, Berlin, Germany
| | - Edyta Blaszczyk
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center - a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine; and HELIOS Hospital Berlin Buch, Department of Cardiology and Nephrology, DZHK (German Center for Cardiovascular Research) partner site, Berlin, Germany
| | - Kerstin Will
- Department for Critical Care Medicine, HELIOS Hospital Berlin-Buch, Berlin, Germany
| | - Stefan Wilczek
- Department for Critical Care Medicine, HELIOS Hospital Berlin-Buch, Berlin, Germany
| | - Joerg Brederlau
- Department for Critical Care Medicine, HELIOS Hospital Berlin-Buch, Berlin, Germany
| | - Jeanette Schulz-Menger
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center - a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine; and HELIOS Hospital Berlin Buch, Department of Cardiology and Nephrology, DZHK (German Center for Cardiovascular Research) partner site, Berlin, Germany
| |
Collapse
|
10
|
Manca P, Stolfo D, Merlo M, Gregorio C, Cannatà A, Ramani F, Nuzzi V, Lund LH, Savarese G, Sinagra G. Transient versus persistent improved ejection fraction in non-ischaemic dilated cardiomyopathy. Eur J Heart Fail 2022; 24:1171-1179. [PMID: 35460146 DOI: 10.1002/ejhf.2512] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 03/28/2022] [Accepted: 04/10/2022] [Indexed: 12/22/2022] Open
Abstract
AIMS The recent definition of heart failure with improved ejection fraction outlined the importance of the longitudinal assessment of left ventricular ejection fraction (LVEF). However, long-term progression and outcomes of this subgroup are poorly explored. We sought to assess the LVEF trajectories and their correlations with outcome in non-ischaemic dilated cardiomyopathy (NICM) with improved ejection fraction (impEF). METHODS AND RESULTS Consecutive NICM patients with baseline LVEF ≤40% enrolled in the Trieste Heart Muscle Disease Registry with ≥1 LVEF assessment after baseline were included. ImpEF was defined as a baseline LVEF ≤40%, and second evaluation showing both a ≥10% point increase from baseline LVEF and LVEF >40%. Transient impEF was defined by the documentation of recurrent LVEF ≤40% during follow-up. The primary endpoint was a composite of all-cause death, heart transplantation and left ventricular assist device (D/HT/LVAD). Among 800 patients, 460 (57%) had impEF (median time to improvement 13 months). Transient impEF was observed in 189 patients (41% of the overall impEF group) and was associated with higher risk of D/HT/LVAD compared with persistent impEF at multivariable analysis (hazard ratio 2.54; 95% confidence interval 1.60-4.04). The association of declining LVEF with the risk of D/HT/LVAD was non-linear, with a steep increase up to 8% points reduction, then remaining stable. CONCLUSIONS In NICM, a 57% rate of impEF was observed. However, recurrent decline in LVEF was observed in ≈40% of impEF patients and it was associated with an increased risk of D/HT/LVAD.
Collapse
Affiliation(s)
- Paolo Manca
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Trieste, Italy
| | - Davide Stolfo
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Trieste, Italy
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Marco Merlo
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Trieste, Italy
| | - Caterina Gregorio
- Biostatistics Unit, Department of Medical Sciences, University of Trieste, Trieste, Italy
- MOX - Department of Mathematics, Politecnico di Milano, Milan, Italy
| | - Antonio Cannatà
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Trieste, Italy
- Department of Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, London, UK
| | - Federica Ramani
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Trieste, Italy
| | - Vincenzo Nuzzi
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Trieste, Italy
| | - Lars H Lund
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Trieste, Italy
| |
Collapse
|
11
|
Hnat T, Veselka J, Honek J. Left ventricular reverse remodelling and its predictors in non-ischaemic cardiomyopathy. ESC Heart Fail 2022; 9:2070-2083. [PMID: 35437948 PMCID: PMC9288763 DOI: 10.1002/ehf2.13939] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 02/16/2022] [Accepted: 04/04/2022] [Indexed: 11/21/2022] Open
Abstract
Adverse remodelling following an initial insult is the hallmark of heart failure (HF) development and progression. It is manifested as changes in size, shape, and function of the myocardium. While cardiac remodelling may be compensatory in the short term, further neurohumoral activation and haemodynamic overload drive this deleterious process that is associated with impaired prognosis. However, in some patients, the changes may be reversed. Left ventricular reverse remodelling (LVRR) is characterized as a decrease in chamber volume and normalization of shape associated with improvement in both systolic and diastolic function. LVRR might occur spontaneously or more often in response to therapeutic interventions that either remove the initial stressor or alleviate some of the mechanisms that contribute to further deterioration of the failing heart. Although the process of LVRR in patients with new‐onset HF may take up to 2 years after initiating treatment, there is a significant portion of patients who do not improve despite optimal therapy, which has serious clinical implications when considering treatment escalation towards more aggressive options. On the contrary, in patients that achieve delayed improvement in cardiac function and architecture, waiting might avoid untimely implantable cardioverter‐defibrillator implantation. Therefore, prognostication of successful LVRR based on clinical, imaging, and biomarker predictors is of utmost importance. LVRR has a positive impact on prognosis. However, reverse remodelled hearts continue to have abnormal features. In fact, most of the molecular, cellular, interstitial, and genome expression abnormalities remain and a susceptibility to dysfunction redevelopment under biomechanical stress persists in most patients. Hence, a distinction should be made between reverse remodelling and true myocardial recovery. In this comprehensive review, current evidence on LVRR, its predictors, and implications on prognostication, with a specific focus on HF patients with non‐ischaemic cardiomyopathy, as well as on novel drugs, is presented.
Collapse
Affiliation(s)
- Tomas Hnat
- Department of Cardiology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, V Úvalu 84/1, Prague, 15006, Czech Republic
| | - Josef Veselka
- Department of Cardiology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, V Úvalu 84/1, Prague, 15006, Czech Republic
| | - Jakub Honek
- Department of Cardiology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, V Úvalu 84/1, Prague, 15006, Czech Republic
| |
Collapse
|
12
|
Deckers JW, Arshi B, van den Berge JC, Constantinescu AA. Preventive implantable cardioverter defibrillator therapy in contemporary clinical practice: need for more stringent selection criteria. ESC Heart Fail 2021; 8:3656-3662. [PMID: 34337903 PMCID: PMC8497353 DOI: 10.1002/ehf2.13506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 12/03/2022] Open
Abstract
While the efficacy of the intracardiac defibrillators (ICDs) for primary prevention is not disputed, the relevant studies were carried out a long time ago. Most pertinent trials, including MADIT‐II, SCD‐Heft, and DEFINITE, recruited patients more than 20 years ago. Since then, improved therapeutic modalities including, in addition to cardiac resynchronization therapy, mineralocorticoid receptor antagonists, angiotensin receptor‐neprilysin inhibitors, and, most recently, inhibitors of sodium‐glucose cotransporter 2, have lowered present‐day rates of mortality and of sudden cardiac death. Thus, nowadays, ICD therapy may be less effective than previously reported, and not as beneficial as many people currently believe. However, criteria for ICD implantation remain very inclusive. The patient must (only) be symptomatic and have ejection fraction (EF) ≤ 35%. The choice of EF 35% is notable because the average EF in all large trials was much lower, and clinical benefit was mainly limited to EF ≤ 30%. This EF cut‐off value defines a substantial portion of potential ICD recipients. It seems therefore reasonable to limit ICD eligibility criteria in the EF range 30–35% to patients at highest risk only. We discuss and present some rational criteria to assist the clinician in improving risk stratification for preventive ICD implantation.
Collapse
Affiliation(s)
- Jaap W Deckers
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, Dr. Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands.,Department of Epidemiology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Banafsheh Arshi
- Department of Epidemiology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan C van den Berge
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, Dr. Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands
| | - Alina A Constantinescu
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, Dr. Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands
| |
Collapse
|
13
|
Seong SW, Jin G, Kim M, Ahn KT, Yang JH, Gwon HC, Ko YG, Yu CW, Chun WJ, Jang WJ, Kim HJ, Bae JW, Kwon SU, Lee HJ, Lee WS, Park SD, Cho SS, Ahn JH, Song PS, Jeong JO. Comparison of in-hospital outcomes of patients with vs. without ischaemic cardiomyopathy undergoing veno-arterial-extracorporeal membrane oxygenation. ESC Heart Fail 2021; 8:3308-3315. [PMID: 34145983 PMCID: PMC8318412 DOI: 10.1002/ehf2.13481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 05/31/2021] [Accepted: 06/06/2021] [Indexed: 12/29/2022] Open
Abstract
Aims This study aimed to investigate differences in baseline and treatment characteristics, and in‐hospital mortality according to the aetiologies of cardiogenic shock in patients undergoing veno‐arterial‐extracorporeal membrane oxygenation (VA‐ECMO). Methods and results The RESCUE registry is a multicentre, observational cohort that includes 1247 patients with cardiogenic shock from 12 centres. A total of 496 patients requiring VA‐ECMO were finally selected, and the study population was stratified by cardiogenic shock aetiology [ischaemic cardiomyopathy (ICM, n = 342) and non‐ICM (NICM, n = 154)]. The primary outcome of interest was in‐hospital mortality. Sensitivity analyses including propensity‐score matching adjustments were performed. Mean age of the entire population was 61.8 ± 14.2, and 30.8% were women. There were significant differences in baseline characteristics; notable differences included the older age of patients with ICM (65.1 ± 13.7 vs. 58.2 ± 13.8, P < 0.001), preponderance of males [258 (75.4%) vs. 85 (55.2%), P < 0.001], and higher prevalence of diabetes mellitus [140 (40.9%) vs. 39 (25.3%), P = 0.001] compared with patients in the NICM aetiology group. Patients with ischaemic cardiogenic shock were more likely to have longer shock duration before VA‐ECMO implantation (518.7 ± 941.4 min vs. 292.4 ± 707.8 min, P = 0.003) and were less likely to undergo distal limb perfusion than those with NICM [108 (31.6%) vs. 79 (51.3%), P < 0.001]. In‐hospital mortality in the overall cohort was 52.2%; patients with ICM had a higher unadjusted risk of in‐hospital mortality [203 (59.4%) vs. 56 (36.4%); unadjusted hazard ratio, 2.295; 95% confidence interval, 1.698–3.100; P < 0.001]. There were no significant differences in the primary outcome between the two aetiologies following propensity‐score matching multiple adjustments (adjusted hazard ratio, 1.265; 95% confidence interval, 0.840–1.906; P = 0.260). Conclusions Results of the current study indicated among patients with cardiogenic shock undergoing VA‐ECMO, ischaemic aetiology does not seem to impact in‐hospital mortality. These findings underline that early initiation and appropriate treatment strategies of VA‐ECMO for patients with ICM shock are required.
Collapse
Affiliation(s)
- Seok-Woo Seong
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Guiyue Jin
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Mijoo Kim
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Kye Taek Ahn
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young-Guk Ko
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Cheol Woong Yu
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Woo Jung Chun
- Department of Cardiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Woo Jin Jang
- Department of Cardiology, Ewha Woman's University Seoul Hospital, Ehwa Woman's University School of Medicine, Seoul, Republic of Korea
| | - Hyun-Joong Kim
- Division of Cardiology, Department of Medicine, Konkuk University Medical Center, Seoul, South Korea
| | - Jang-Whan Bae
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Sung Uk Kwon
- Division of Cardiology, Department of Internal Medicine, Ilsan Paik Hospital, University of Inje College of Medicine, Seoul, Republic of Korea
| | - Hyun-Jong Lee
- Division of Cardiology, Department of Medicine, Sejong General Hospital, Bucheon, Republic of Korea
| | - Wang Soo Lee
- Division of Cardiology, Department of Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Sang-Don Park
- Division of Cardiology, Department of Medicine, Inha University Hospital, Incheon, Republic of Korea
| | - Sung Soo Cho
- Division of Cardiovascular Medicine, Department of Internal Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Joong Hyun Ahn
- Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Pil Sang Song
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Jin-Ok Jeong
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| |
Collapse
|
14
|
Ding WY, Pearman CM, Bonnett L, Adlan A, Chin SH, Denham N, Modi S, Todd D, Hall MCS, Mahida S. Complication rates following ventricular tachycardia ablation in ischaemic and non-ischaemic cardiomyopathies: a systematic review. J Interv Card Electrophysiol 2021; 63:59-67. [PMID: 33512605 PMCID: PMC8755671 DOI: 10.1007/s10840-021-00948-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/17/2021] [Indexed: 11/25/2022]
Abstract
Background Catheter ablation of ventricular tachycardia (VT) is associated with potential major complications, including mortality. The risk of acute complications in patients with ischaemic cardiomyopathy (ICM) and non-ischaemic cardiomyopathy (NICM) has not been systematically evaluated. Methods PubMed was searched for studies of catheter ablation of VT published between September 2009 and September 2019. Pre-specified primary outcomes were (1) rate of major acute complications, including death, and (2) mortality rate. Results A total of 7395 references were evaluated for relevance. From this, 50 studies with a total of 3833 patients undergoing 4319 VT ablation procedures fulfilled the inclusion criteria (mean age 59 years; male 82%; 2363 [62%] ICM; 1470 [38%] NICM). The overall major complication rate in ICM cohorts was 9.4% (95% CI, 8.1–10.7) and NICM cohorts was 7.1% (95% CI, 6.0–8.3). Reported complication rates were highly variable between studies (ICM I2 = 90%; NICM I2 = 89%). Vascular complications (ICM 2.5% [95% CI, 1.9–3.1]; NICM 1.2% [95% CI, 0.7–1.7]) and cerebrovascular events (ICM 0.5% [95% CI, 0.2–0.7]; NICM, 0.1% [95% CI, 0–0.2]) were significantly higher in ICM cohorts. Acute mortality rates in the ICM and NICM cohorts were low (ICM 0.9% [95% CI, 0.5–1.3]; NICM 0.6% [95% CI, 0.3–1.0]) with the majority of overall deaths (ICM 75%; NICM 80%) due to either recurrent VT or cardiogenic shock. Conclusion Overall acute complication rates of VT ablation are comparable between ICM and NICM patients. However, the pattern and predictors of complications vary depending on the underlying cardiomyopathy. Supplementary Information The online version contains supplementary material available at 10.1007/s10840-021-00948-6.
Collapse
Affiliation(s)
- Wern Yew Ding
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, UK.
- Liverpool Centre for Cardiovascular Science, Liverpool, UK.
| | - Charles M Pearman
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, UK
- Unit of Cardiac Physiology, Institute of Cardiovascular Sciences, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
| | - Laura Bonnett
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Ahmed Adlan
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Shui Hao Chin
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Nathan Denham
- Unit of Cardiac Physiology, Institute of Cardiovascular Sciences, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
| | - Simon Modi
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Derick Todd
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Mark C S Hall
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Saagar Mahida
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, Liverpool, UK
| |
Collapse
|
15
|
Nucifora G, Selvanayagam JB. Cardiac Magnetic Resonance Late Gadolinium Enhancement Imaging in Arrhythmic Risk Stratification. Heart Lung Circ 2020; 29:1268-1269. [PMID: 32718901 DOI: 10.1016/j.hlc.2020.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Gaetano Nucifora
- Flinders University of South Australia, Adelaide, SA, Australia; Manchester University NHS Foundation Trust, Manchester, UK
| | - Joseph B Selvanayagam
- Flinders University of South Australia, Adelaide, SA, Australia; Flinders Medical Centre, Adelaide, SA, Australia; South Australian Health and Medical Research Institute, Adelaide, SA, Australia.
| |
Collapse
|
16
|
Kahr PC, Trenson S, Schindler M, Kuster J, Kaufmann P, Tonko J, Hofer D, Inderbitzin DT, Breitenstein A, Saguner AM, Flammer AJ, Ruschitzka F, Steffel J, Winnik S. Differential effect of cardiac resynchronization therapy in patients with diabetes mellitus: a long-term retrospective cohort study. ESC Heart Fail 2020; 7:2773-2783. [PMID: 32652900 PMCID: PMC7524059 DOI: 10.1002/ehf2.12876] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 05/04/2020] [Accepted: 06/16/2020] [Indexed: 01/08/2023] Open
Abstract
AIMS Cardiac resynchronization therapy (CRT) has become an important therapy in patients with heart failure with reduced left ventricular ejection fraction (LVEF). The effect of diabetes on long-term outcome in these patients is controversial. We assessed the effect of diabetes on long-term outcome in CRT patients and investigated the role of diabetes in ischaemic and non-ischaemic cardiomyopathy. METHODS AND RESULTS All patients undergoing CRT implantation at our institution between November 2000 and January 2015 were enrolled. The study endpoints were (i) a composite of ventricular assist device (VAD) implantation, heart transplantation, or all-cause mortality; and (ii) reverse remodelling (improvement of LVEF ≥ 10% or reduction of left ventricular end-systolic volume ≥ 15%). Median follow-up of the 418 patients (age 64.6 ± 11.6 years, 22.5% female, 25.1% diabetes) was 4.8 years [inter-quartile range: 2.8;7.4]. Diabetic patients had an increased risk to reach the composite endpoint [adjusted hazard ratio (aHR) 1.48 [95% CI 1.12-2.16], P = 0.041]. Other factors associated with an increased risk to reach the composite endpoint were a lower body mass index or baseline LVEF (aHR 0.95 [0.91; 0.98] and 0.97 [0.95; 0.99], P < 0.01 each), and a higher New York Heart Association functional class or creatinine level (aHR 2.14 [1.38; 3.30] and 1.04 [1.01; 1.05], P < 0.05 each). Early response to CRT, defined as LVEF improvement ≥ 10%, was associated with a lower risk to reach the composite endpoint (aHR 0.60 [0.40; 0.89], P = 0.011). Reverse remodelling did not differ between diabetic and non-diabetic patients with respect to LVEF improvement ≥ 10% (aHR 0.60 [0.32; 1.14], P = 0.118). However, diabetes was associated with decreased reverse remodelling with respect to a reduction of left ventricular end-systolic volume ≥ 15% (aHR 0.45 [0.21; 0.97], P = 0.043). In patients with ischaemic cardiomyopathy, survival rates were not significantly different between diabetic and non-diabetic patients (HR 1.28 [0.83-1.97], P = 0.101), whereas in patients with non-ischaemic cardiomyopathy, diabetic patients had a higher risk of reaching the composite endpoint (HR 1.65 [1.06-2.58], P = 0.027). The latter effect was dependent on other risk factors (aHR 1.47 [0.83-2.61], P = 0.451). The risk of insulin-dependent patients was not significantly higher than in patients under oral antidiabetic drugs (HR 1.55 [95% CI 0.92-2.61], P = 0.102). CONCLUSIONS Long-term follow-up revealed diabetes mellitus as independent risk factor for all-cause mortality, heart transplantation, or VAD in heart failure patients undergoing CRT. The detrimental effect of diabetes appeared to weigh heavier in patients with non-ischaemic compared with ischaemic cardiomyopathy.
Collapse
Affiliation(s)
- Peter C Kahr
- Department of Cardiology, University Heart Center Zurich, Raemistr. 100, Zurich, 8091, Switzerland
| | - Sander Trenson
- Department of Cardiology, University Heart Center Zurich, Raemistr. 100, Zurich, 8091, Switzerland.,Cardiovascular Sciences, University Hospital Leuven, Leuven, Belgium
| | - Matthias Schindler
- Department of Cardiology, University Heart Center Zurich, Raemistr. 100, Zurich, 8091, Switzerland
| | - Joël Kuster
- Department of Cardiology, University Heart Center Zurich, Raemistr. 100, Zurich, 8091, Switzerland
| | - Philippe Kaufmann
- Department of Cardiology, University Heart Center Zurich, Raemistr. 100, Zurich, 8091, Switzerland.,Department of Medicine, GZO Zurich Regional Health Center, Wetzikon, Switzerland
| | - Johanna Tonko
- Department of Cardiology, University Heart Center Zurich, Raemistr. 100, Zurich, 8091, Switzerland
| | - Daniel Hofer
- Department of Cardiology, University Heart Center Zurich, Raemistr. 100, Zurich, 8091, Switzerland
| | - Devdas T Inderbitzin
- Department of Cardiovascular Surgery, University Heart Center Zurich, Zurich, Switzerland
| | - Alexander Breitenstein
- Department of Cardiology, University Heart Center Zurich, Raemistr. 100, Zurich, 8091, Switzerland
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center Zurich, Raemistr. 100, Zurich, 8091, Switzerland
| | - Andreas J Flammer
- Department of Cardiology, University Heart Center Zurich, Raemistr. 100, Zurich, 8091, Switzerland
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center Zurich, Raemistr. 100, Zurich, 8091, Switzerland
| | - Jan Steffel
- Department of Cardiology, University Heart Center Zurich, Raemistr. 100, Zurich, 8091, Switzerland
| | - Stephan Winnik
- Department of Cardiology, University Heart Center Zurich, Raemistr. 100, Zurich, 8091, Switzerland
| |
Collapse
|
17
|
Vachalcova M, Valočik G, Kurečko M, Grapsa J, Taha VA, Michalek P, Jankajová M, Sabol F, Kubikova L, Orban M, Uher T, Böhm A. The three-dimensional speckle tracking echocardiography in distinguishing between ischaemic and non-ischaemic aetiology of heart failure. ESC Heart Fail 2020; 7:2297-2304. [PMID: 32558395 PMCID: PMC7524069 DOI: 10.1002/ehf2.12766] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 04/10/2020] [Accepted: 05/07/2020] [Indexed: 11/23/2022] Open
Abstract
Aims The aim of this pilot study was to compare selected three‐dimensional speckle tracking echocardiography (3D STE) parameters in patients with ischaemic and non‐ischaemic aetiology of heart failure (HF) and to identify indices that can differentiate the two pathologies. Methods and results Forty patients with left ventricular ejection fraction (LVEF) ≤ 40% were included to the study: 20 patients (age 63 ± 9.0 years, LVEF 29.0 ± 11.3%) with ischaemic cardiomyopathy and 20 patients (age 64.0 ± 11.0 years, LVEF 27.3 ± 7.5%) with non‐ischaemic cardiomyopathy. All patients underwent two‐dimensional (2D) and three‐dimensional (3D) transthoracic echocardiography. Standard echocardiographic parameters, global longitudinal strain, and rotational parameters of left ventricle (LV) were assessed using 3D speckle tracking (3D STE). There were no differences in standard and STE parameters between the two groups. Among rotational parameters, the LV apical rotation (4.9 ± 3.5° vs. 2.3 ± 2.4°, P = 0.0022) was significantly higher in patients with ischaemic HF. Among all echocardiographic parameters, a cut‐off value of 3.28° (area under the curve 0.78; 95% confidence interval, 0.62 to 0.93) was able to distinguish the ischaemic and non‐ischaemic aetiology of HF with a sensitivity of 80% and specificity of 75%. Conclusions This is the first study that compares 3D STE parameters between patients with ischaemic and non‐ischaemic cardiomyopathy. It was proved that the apical rotation was significantly higher in patients with ischaemic cardiomyopathy. Our findings suggest that 3D STE might be useful in non‐invasive differentiation between ischaemic and non‐ischaemic aetiology of HF.
Collapse
Affiliation(s)
- Marianna Vachalcova
- East Slovak Institute of Cardiovascular Diseases, Kosice, Slovakia.,Faculty of Medicine, Pavol Jozef Šafárik University, Kosice, Slovakia
| | - Gabriel Valočik
- East Slovak Institute of Cardiovascular Diseases, Kosice, Slovakia.,Faculty of Medicine, Pavol Jozef Šafárik University, Kosice, Slovakia
| | - Marián Kurečko
- East Slovak Institute of Cardiovascular Diseases, Kosice, Slovakia.,Faculty of Medicine, Pavol Jozef Šafárik University, Kosice, Slovakia
| | - Julia Grapsa
- Cardiology Department, Guys and St Thomas NHS Hospitals, London, UK
| | | | - Peter Michalek
- University Hospital of St. Cyril and Methodius, Bratislava, Slovakia.,Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Monika Jankajová
- East Slovak Institute of Cardiovascular Diseases, Kosice, Slovakia.,Faculty of Medicine, Pavol Jozef Šafárik University, Kosice, Slovakia
| | - František Sabol
- East Slovak Institute of Cardiovascular Diseases, Kosice, Slovakia.,Faculty of Medicine, Pavol Jozef Šafárik University, Kosice, Slovakia
| | - Lucia Kubikova
- East Slovak Institute of Cardiovascular Diseases, Kosice, Slovakia.,Faculty of Medicine, Pavol Jozef Šafárik University, Kosice, Slovakia
| | - Marek Orban
- Faculty of Medicine, Comenius University, Bratislava, Slovakia.,National Institute of Cardiovascular Diseases, Bratislava, Slovakia
| | - Tomas Uher
- Academy-Research Organization, Bratislava, Slovakia.,Internal Department, Malacky Hospital, Malacky, Slovakia
| | - Allan Böhm
- National Institute of Cardiovascular Diseases, Bratislava, Slovakia.,Faculty of Medicine, Slovak Medical University, Bratislava, Slovakia.,Academy-Research Organization, Bratislava, Slovakia
| |
Collapse
|
18
|
Campbell CM, Cassol C, Cataland SR, Kahwash R. Atypical haemolytic uraemic syndrome: a case report of a rare cause of reversible cardiomyopathy. Eur Heart J Case Rep 2020; 4:1-6. [PMID: 32352052 DOI: 10.1093/ehjcr/ytaa050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 10/10/2019] [Accepted: 02/12/2020] [Indexed: 12/29/2022]
Abstract
Background Atypical haemolytic uraemic syndrome (aHUS) is a life-threatening, genetic disease of complement-mediated thrombotic microangiopathy that typically presents as anaemia, thrombocytopenia, and renal failure. Cardiomyopathy is seen in up to 10% of aHUS cases, but the aetiology is not well-understood. Case summary A 63-year-old man recently was diagnosed with a thrombotic microangiopathy most consistent with aHUS by renal biopsy after presentation with acute renal failure requiring haemodialysis. He was started on therapy with complement inhibitor, eculizumab. Six weeks after diagnosis, he presented with progressive dyspnoea on exertion and chest pain. An echocardiogram demonstrated an acute drop in left ventricular ejection fraction to 20-25% with global hypokinesis. Left heart catheterization showed moderate, non-obstructive coronary artery disease. Cardiac magnetic resonance imaging demonstrated diffuse myocardial oedema. Endomyocardial biopsy revealed an arteriole with obliterative changes and a few possible fragmented red blood cells suggestive of thrombotic microangiopathy. There was no biopsy evidence of immune complex deposition or myocarditis. He was treated for heart failure and was maintained on eculizumab. On repeat echocardiogram 3 months later, the patient had complete recovery of his ejection fraction (60-65%). Discussion In this report, we describe complete recovery of aHUS-associated heart failure with eculizumab therapy and demonstrate for the first time that the aetiology of aHUS-associated heart failure is likely an acute thrombotic microangiopathy involving small intramyocardial arterioles, as demonstrated by cardiac biopsy.
Collapse
Affiliation(s)
- Courtney M Campbell
- Division of Cardiovascular Medicine, Department of Internal Medicine, Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, 473 W 12th Ave, Suite 200, Columbus, OH 43210, USA
| | - Clarissa Cassol
- Department of Pathology, The Ohio State University Wexner Medical Center, 129 Hamilton Hall, 1645 Neil Ave, Columbus, OH 43210, USA
| | - Spero R Cataland
- Division of Hematology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, B302 Starling Loving Hall, 320 West 10th Ave, Columbus, OH 43210, USA
| | - Rami Kahwash
- Division of Cardiovascular Medicine, Department of Internal Medicine, Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, 473 W 12th Ave, Suite 200, Columbus, OH 43210, USA
| |
Collapse
|
19
|
Gutman SJ, Costello BT, Papapostolou S, Iles L, Ja J, Hare JL, Ellims A, Marwick TH, Taylor AJ. Impact of sex, socio-economic status, and remoteness on therapy and survival in heart failure. ESC Heart Fail 2019; 6:944-952. [PMID: 31618531 PMCID: PMC6816230 DOI: 10.1002/ehf2.12481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/26/2019] [Accepted: 05/30/2019] [Indexed: 01/28/2023] Open
Abstract
Aims This study aims to determine if traditional markers of disadvantage [female sex, low socio‐economic status (SES), and remoteness] are associated with lower prescription of evidence‐based therapy and higher mortality among patients with moderate–severe heart failure with reduced ejection fraction. Methods and results We recruited 452 consecutive class II–III heart failure with reduced ejection fraction patients. Baseline clinical data were recorded prospectively. The primary outcome was the association of female sex on overall survival. Secondary outcomes included association between evidence‐based therapy delivery and sex and association of SES and remoteness on heart failure therapy and survival. The Australian Bureau of Statistics generated all indices. Median follow‐up was 37.9 months. One hundred and nine patients (24.3%) were women. There was no difference in overall survival based on sex (hazard ratio = 1.19, 95% confidence interval: 0.74–1.92, 0.48). There was no difference in prescription of beta‐blockers [χ2(1) = 0.91, 0.66], angiotensin‐converting enzyme inhibitors [χ2(1) = 0.001, 0.97], nor aldosterone antagonists [χ2(1) = 2.71, 0.10]. There was no difference in rates of primary prevention implantable cardioverter‐defibrillator implantation in men compared with women [χ2(1) = 0.35, 0.56]. Neither higher SES nor inner city residence conferred an overall survival benefit. Conclusions In this Australian cohort of heart failure patients, delivery of care and likelihood of death are comparable between the sexes, SES groups, and rural vs. city residents.
Collapse
Affiliation(s)
- Sarah J Gutman
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Ben T Costello
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Stavroula Papapostolou
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Leah Iles
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Johnson Ja
- The Alfred Hospital, Melbourne, Victoria, Australia
| | - James L Hare
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Andris Ellims
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Thomas H Marwick
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Andrew J Taylor
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
20
|
Korosoglou G, Giusca S, Hofmann NP, Patel AR, Lapinskas T, Pieske B, Steen H, Katus HA, Kelle S. Strain-encoded magnetic resonance: a method for the assessment of myocardial deformation. ESC Heart Fail 2019; 6:584-602. [PMID: 31021534 PMCID: PMC6676282 DOI: 10.1002/ehf2.12442] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 03/28/2019] [Indexed: 12/26/2022] Open
Abstract
This study aims to assess the usefulness of strain‐encoded magnetic resonance (SENC) for the quantification of myocardial deformation (‘strain’) in healthy volunteers and for the diagnostic workup of patients with different cardiovascular pathologies. SENC was initially described in the year 2001. Since then, the SENC sequence has undergone several technical developments, aiming at the detection of strain during single‐heartbeat acquisitions (fast‐SENC). Experimental and clinical studies that used SENC and fast‐SENC or compared SENC with conventional cine or tagged magnetic resonance in phantoms, animals, healthy volunteers, or patients were systematically searched for in PubMed. Using ‘strain‐encoded magnetic resonance and SENC’ as keywords, three phantom and three animal studies were identified, along with 27 further clinical studies, involving 185 healthy subjects and 904 patients. SENC (i) enabled reproducible assessment of myocardial deformation in vitro, in animals and in healthy volunteers, (ii) showed high reproducibility and substantially lower time spent compared with conventional tagging, (iii) exhibited incremental value to standard cine imaging for the detection of inducible ischaemia and for the risk stratification of patients with ischaemic heart disease, and (iv) enabled the diagnostic classification of patients with transplant vasculopathy, cardiomyopathies, pulmonary hypertension, and diabetic heart disease. SENC has the potential to detect a wide range of myocardial diseases early, accurately, and without the need of contrast agent injection, possibly enabling the initiation of specific cardiac therapies during earlier disease stages. Its one‐heartbeat acquisition mode during free breathing results in shorter cardiovascular magnetic resonance protocols, making its implementation in the clinical realm promising.
Collapse
Affiliation(s)
- Grigorios Korosoglou
- Departments of Cardiology, Vascular Medicine and Pneumology, GRN Hospital Weinheim, Weinheim, Germany
| | - Sorin Giusca
- Departments of Cardiology, Vascular Medicine and Pneumology, GRN Hospital Weinheim, Weinheim, Germany
| | - Nina P Hofmann
- Departments of Cardiology, Vascular Medicine and Pneumology, GRN Hospital Weinheim, Weinheim, Germany
| | - Amit R Patel
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Tomas Lapinskas
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Burkert Pieske
- Department of Internal Medicine, Cardiology German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, Berlin, Germany
| | - Henning Steen
- Department of Cardiology, Marien Hospital Hamburg, Hamburg, Germany
| | - Hugo A Katus
- Departments of Cardiology, Angiology and Pneumology, Heidelberg University, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Sebastian Kelle
- Department of Internal Medicine, Cardiology German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, Berlin, Germany
| |
Collapse
|
21
|
Lee TC, Qian M, Mu L, Di Tullio MR, Graham S, Mann DL, Nakanishi K, Teerlink JR, Lip GYH, Freudenberger RS, Sacco RL, Mohr JP, Labovitz AJ, Ponikowski P, Lok DJ, Estol C, Anker SD, Pullicino PM, Buchsbaum R, Levin B, Thompson JLP, Homma S, Ye S. Association between mortality and implantable cardioverter-defibrillators by aetiology of heart failure: a propensity-matched analysis of the WARCEF trial. ESC Heart Fail 2019; 6:297-307. [PMID: 30816013 PMCID: PMC6437435 DOI: 10.1002/ehf2.12407] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 12/12/2018] [Indexed: 12/28/2022] Open
Abstract
Aims There is debate on whether the beneficial effect of implantable cardioverter‐defibrillators (ICDs) is attenuated in patients with non‐ischaemic cardiomyopathy (NICM). We assess whether any ICD benefit differs between patients with NICM and those with ischaemic cardiomyopathy (ICM), using data from the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) trial. Methods and results We performed a post hoc analysis using WARCEF (N = 2293; ICM, n = 991 vs. NICM, n = 1302), where participants received optimal medical treatment. We developed stratified propensity scores for having an ICD at baseline using 41 demographic and clinical variables and created 1:2 propensity‐matched cohorts separately for ICM patients with ICD (N = 223 with ICD; N = 446 matched) and NICM patients (N = 195 with ICD; N = 390 matched). We constructed a Cox proportional hazards model to assess the effect of ICD status on mortality for patients with ICM and those with NICM and tested the interaction between ICD status and aetiology of heart failure. During mean follow‐up of 3.5 ± 1.8 years, 527 patients died. The presence of ICD was associated with a lower risk of all‐cause death among those with ICM (hazard ratio: 0.640; 95% confidence interval: 0.448 to 0.915; P = 0.015) but not among those with NICM (hazard ratio: 0.984; 95% confidence interval: 0.641 to 1.509; P = 0.941). There was weak evidence of interaction between ICD status and the aetiology of heart failure (P = 0.131). Conclusions The presence of ICD is associated with a survival benefit in patients with ICM but not in those with NICM.
Collapse
Affiliation(s)
- Tetz C Lee
- Columbia University Irving Medical Center, New York, NY, USA
| | - Min Qian
- Columbia University Irving Medical Center, New York, NY, USA
| | - Lan Mu
- Columbia University Irving Medical Center, New York, NY, USA
| | | | - Susan Graham
- The State University of New York at Buffalo, Buffalo, NY, USA
| | - Douglas L Mann
- Washington University School of Medicine, St. Louis, MO, USA
| | - Koki Nakanishi
- Columbia University Irving Medical Center, New York, NY, USA
| | - John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | | | | | - Jay P Mohr
- Columbia University Irving Medical Center, New York, NY, USA
| | | | | | - Dirk J Lok
- Deventer Hospital, Deventer, The Netherlands
| | - Conrado Estol
- Neurological Center for Treatment and Rehabilitation, Buenos Aires, Argentina
| | - Stefan D Anker
- Division of Cardiology and Metabolism, Department of Cardiology; and Berlin-Brandenburg Center for Regenerative Therapies; Deutsches Zentrum für Herz-Kreislauf-Forschung partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Cardiology and Pneumology, University Medicine Göttingen, Göttingen, Germany
| | | | | | - Bruce Levin
- Columbia University Irving Medical Center, New York, NY, USA
| | | | - Shunichi Homma
- Columbia University Irving Medical Center, New York, NY, USA
| | - Siqin Ye
- Columbia University Irving Medical Center, New York, NY, USA
| | | |
Collapse
|
22
|
Bizino MB, Tao Q, Amersfoort J, Siebelink HMJ, van den Bogaard PJ, van der Geest RJ, Lamb HJ. High spatial resolution free-breathing 3D late gadolinium enhancement cardiac magnetic resonance imaging in ischaemic and non-ischaemic cardiomyopathy: quantitative assessment of scar mass and image quality. Eur Radiol 2018; 28:4027-4035. [PMID: 29626239 PMCID: PMC6096581 DOI: 10.1007/s00330-018-5361-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 01/13/2018] [Accepted: 01/30/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare breath-hold (BH) with navigated free-breathing (FB) 3D late gadolinium enhancement cardiac MRI (LGE-CMR) MATERIALS AND METHODS: Fifty-one patients were retrospectively included (34 ischaemic cardiomyopathy, 14 non-ischaemic cardiomyopathy, three discarded). BH and FB 3D phase sensitive inversion recovery sequences were performed at 3T. FB datasets were reformatted into normal resolution (FB-NR, 1.46x1.46x10mm) and high resolution (FB-HR, isotropic 0.91-mm voxels). Scar mass, scar edge sharpness (SES), SNR and CNR were compared using paired-samples t-test, Pearson correlation and Bland-Altman analysis. RESULTS Scar mass was similar in BH and FB-NR (mean ± SD: 15.5±18.0 g vs. 15.5±16.9 g, p=0.997), with good correlation (r=0.953), and no bias (mean difference ± SD: 0.00±5.47 g). FB-NR significantly overestimated scar mass compared with FB-HR (15.5±16.9 g vs 14.4±15.6 g; p=0.007). FB-NR and FB-HR correlated well (r=0.988), but Bland-Altman demonstrated systematic bias (1.15±2.84 g). SES was similar in BH and FB-NR (p=0.947), but significantly higher in FB-HR than FB-NR (p<0.01). SNR and CNR were lower in BH than FB-NR (p<0.01), and lower in FB-HR than FB-NR (p<0.01). CONCLUSION Navigated free-breathing 3D LGE-CMR allows reliable scar mass quantification comparable to breath-hold. During free-breathing, spatial resolution can be increased resulting in improved sharpness and reduced scar mass. KEY POINTS • Navigated free-breathing 3D late gadolinium enhancement is reliable for myocardial scar quantification. • High-resolution 3D late gadolinium enhancement increases scar sharpness • Ischaemic and non-ischaemic cardiomyopathy patients can be imaged using free-breathing LGE CMR.
Collapse
Affiliation(s)
- Maurice B Bizino
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Qian Tao
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Jacob Amersfoort
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Hans-Marc J Siebelink
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Pieter J van den Bogaard
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Rob J van der Geest
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| |
Collapse
|
23
|
Barakat AF, Saad M, Elgendy AY, Mentias A, Abuzaid A, Mahmoud AN, Elgendy IY. Primary prevention implantable cardioverter defibrillator in patients with non-ischaemic cardiomyopathy: a meta-analysis of randomised controlled trials. BMJ Open 2017. [PMID: 28637742 PMCID: PMC5726098 DOI: 10.1136/bmjopen-2017-016352] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES The objective of this meta-analysis of randomised controlled trials (RCTs) is to evaluate the role of primary prevention implantable cardioverter defibrillator (ICD) in patients with non-ischaemic cardiomyopathy (NICM). SETTING A meta-analysis of RCTs performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. DATA SOURCES The PubMed, MEDLINE, Embase and Cochrane Central Register of Controlled Trials databases were searched for relevant articles. PARTICIPANTS A total of 5 RCTs with 2573 patients with NICM were included. INTERVENTION Primary prevention ICD, compared with medical therapy alone. PRIMARY AND SECONDARY OUTCOME MEASURES All-cause mortality (primary outcome) and sudden cardiac death (SCD, secondary outcome). DATA ANALYSIS Summary estimate HR were constructed using the random-effect DerSimonian and Laird's model. Multiple study-level subgroup analyses were performed, and interaction was tested using random-effect analysis. RESULTS Compared with medical therapy alone, ICD placement was associated with lower risk of all-cause mortality (HR 0.79; 95% CI 0.64 to 0.93; p<0.001; I2=0%) at a mean follow-up of 4.2 years. The risk of SCD was also lower with ICD placement (RR 0.47; 95% CI 0.30 to 0.73; p=0.001; I2=0%) compared with control. On subgroup analyses, there was a suggestion of possible effect modification by age, in which benefit was observed in age group <60 years (HR 0.64; 95% CI 0.47 to 0.89), but not with age ≥60 years (HR 0.82; 95% CI 0.65 to 1.03) (Pinteraction=0.058), but not with other study-level variables. CONCLUSIONS Compared with medical therapy alone, primary prevention ICD therapy in patients with NICM is associated with a significant reduction in all-cause mortality, especially in younger patients. Future dedicated studies are needed to investigate the role of primary prevention ICD in the elderly population. PROSPEROREGISTRATIONNUMBER PROSPERO CRD42016052010.
Collapse
Affiliation(s)
- Amr F Barakat
- Department of Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Marwan Saad
- Department of Medicine, Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Akram Y Elgendy
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Amgad Mentias
- Department of Medicine, Division of Cardiovascular Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Ahmed Abuzaid
- Department of Medicine, Division of Cardiovascular Medicine, Sidney Kimmel Medical College at Thomas Jefferson University/Christiana Care Health System, Newark, Delaware, USA
| | - Ahmed N Mahmoud
- Department of Medicine, Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
| | - Islam Y Elgendy
- Department of Medicine, Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
| |
Collapse
|
24
|
Pandian J, Kaur D, Yalagudri S, Devidutta S, Sundar G, Chennapragada S, Narasimhan C. Safety and efficacy of epicardial approach to catheter ablation of ventricular tachycardia - An institutional experience. Indian Heart J 2017; 69:170-175. [PMID: 28460764 PMCID: PMC5414949 DOI: 10.1016/j.ihj.2016.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 10/05/2016] [Accepted: 10/24/2016] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND AND AIM Epicardial approach to VT ablation increases the success rate of ablation but is not without complications. We studied the safety and efficacy of epicardial VT ablations performed at our institute. METHODS All patients who underwent epicardial VT ablation at our institute were studied retrospectively. The outcome of VT ablation was among three groups: ischaemic cardiomyopathy (ICM), non-ischaemic cardiomyopathy (NICM) and granulomatous myocarditis (GM). Safety outcomes assessed included all complications considered to be due to pericardial access or epicardial mapping/ablation. RESULTS A total of 54 patients (total 119 VTs, mean 2.2 (0.9)) were taken up for ablation procedure through epicardial access. Mean age: 47 (10) years, males: 83%. All patients had drug resistant recurrent VTs. The epicardial procedure was abandoned in three patients due to access issues; percutaneous sub-xiphoid access was employed in 48 and surgical approach in four patients. Complete success was achieved in 59% and partial success in 76%. The outcomes were poor in ICM patients as compared to those with GM and NICM. Overall success rates for all clinical VTs were 89% in GM, 90% in NICM and 67% in ICM. Success rates for epicardial VT ablation were 94%, 85% and 78% respectively for GM, NICM and ICM. Procedure related complications occurred in six patients. CONCLUSION Epicardial ablation for VT offers good immediate outcomes with acceptable safety profile.
Collapse
Affiliation(s)
| | - Daljeet Kaur
- CARE Hospital, Road No.1, Banjara Hills, Hyderabad 500 034, India
| | - Sachin Yalagudri
- CARE Hospital, Road No.1, Banjara Hills, Hyderabad 500 034, India
| | - Soumen Devidutta
- CARE Hospital, Road No.1, Banjara Hills, Hyderabad 500 034, India
| | - Gomathi Sundar
- CARE Hospital, Road No.1, Banjara Hills, Hyderabad 500 034, India
| | | | | |
Collapse
|
25
|
Perkiomaki JS, Ruwald AC, Kutyifa V, Ruwald MH, Mcnitt S, Polonsky B, Goldstein RE, Haigney MC, Krone RJ, Zareba W, Moss AJ. Risk factors and the effect of cardiac resynchronization therapy on cardiac and non-cardiac mortality in MADIT-CRT. Europace 2015; 17:1816-22. [PMID: 26071234 DOI: 10.1093/europace/euv201] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 05/11/2015] [Indexed: 11/14/2022] Open
Abstract
AIMS To understand modes of death and factors associated with the risk for cardiac and non-cardiac deaths in patients with cardiac resynchronization therapy with implantable cardioverter-defibrillator (CRT-D) vs. implantable cardioverter-defibrillator (ICD) therapy, which may help clarify the action and limitations of cardiac resynchronization therapy (CRT) in relieving myocardial dysfunction. METHODS AND RESULTS In Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT), during 4 years of follow-up, 169 (9.3%) of 1820 patients died of known causes, 108 (63.9%) deemed cardiac, and 61 (36.1%) non-cardiac. In multivariate analysis, increased baseline creatinine was significantly associated with both cardiac and non-cardiac deaths [hazard ratio (HR) 2.97, P < 0.001; HR 1.80, P = 0.035, respectively], as was diabetes (HR 1.79, P = 0.006; HR 1.73, P = 0.038, respectively), and the worst New York Heart Association Class > II more than 3 months prior to enrolment (HR 1.90, P = 0.012; HR 2.46, P = 0.010, respectively). Baseline left atrial volume index was significantly associated only with cardiac mortality (HR 1.28 per 5 unit increase, P < 0.001). Ischaemic cardiomyopathy was associated only with non-cardiac death (HR 3.54, P = 0.001). CRT-D vs. an ICD-only was associated with a reduced risk for cardiac death in patients with left bundle branch block (LBBB) (HR 0.56, P = 0.029) but was associated with an increased risk for non-cardiac death in non-LBBB patients (HR 3.48, P = 0.048). CONCLUSIONS In MADIT-CRT, two-thirds of the deaths were cardiac and one-third non-cardiac. Many of the same risk factors were associated with both cardiac and non-cardiac mortalities. CRT-D was associated with a reduced risk for cardiac death in LBBB but an increased risk for non-cardiac death in non-LBBB. CLINICAL TRIAL REGISTRATION Information for the MADIT-CRT main study http://www.clinicaltrials.gov, NCT00180271.
Collapse
Affiliation(s)
- Juha S Perkiomaki
- Cardiology Unit, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000 (Kajaanintie 50), FIN-90014 Oulu, Finland
| | - Anne-Christine Ruwald
- Cardiology Unit, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA Department of Cardiology, Gentofte Hospital, Hellerup, Denmark
| | - Valentina Kutyifa
- Cardiology Unit, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Martin H Ruwald
- Cardiology Unit, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA Department of Cardiology, Gentofte Hospital, Hellerup, Denmark
| | - Scott Mcnitt
- Cardiology Unit, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Bronislava Polonsky
- Cardiology Unit, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Robert E Goldstein
- Cardiology Division, Uniformed Services University of Health Sciences, Bethesda, MD, USA
| | - Mark C Haigney
- Cardiology Division, Uniformed Services University of Health Sciences, Bethesda, MD, USA
| | - Ronald J Krone
- Division of Cardiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Wojciech Zareba
- Cardiology Unit, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Arthur J Moss
- Cardiology Unit, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | | |
Collapse
|
26
|
George RS, Birks EJ, Cheetham A, Webb C, Smolenski RT, Khaghani A, Yacoub MH, Kelion A. The effect of long-term left ventricular assist device support on myocardial sympathetic activity in patients with non-ischaemic dilated cardiomyopathy. Eur J Heart Fail 2013; 15:1035-43. [PMID: 23610136 DOI: 10.1093/eurjhf/hft059] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS Dilated cardiomyopathy (DCM) patients have abundant levels of norepinephrine secondary to failure of the norepinephrine transporter uptake mechanism. Little is known about the effects of an LV assist device (LVAD) on cardiac sympathetic innervations and norepinephrine transporter dysfunction. This study examines the effects of continuous-flow HeartMate II LVAD on cardiac sympathetic innervations using [(123)I]metaiodobenzylguanidine ([(123)I]MIBG) nuclear imaging. METHODS AND RESULTS After injecting 431 ± 21 MBq of [(123)I]MIBG, planar scintigraphy was performed at 15 min and 4 h in 14 consecutive non-diabetic non-ischaemic DCM patients. Scans were executed early post-LVAD implantation (T1) and prior to either device explantation for myocardial recovery or transplant listing (T2). [(123)I]MIBG measured parameters included early and delayed heart-mediastinum (H/M) ratios and washout rate (W/O). Catecholamine levels were measured using liquid chromatography-mass spectrometry. Following 208.4 ± 85.5 days of LVAD support, both early and delayed H/M ratios increased by 42.1% (P < 0.001) and 54.7% (P < 0.001), respectively. The W/O rate decreased by 46% (P = 0.003). Plasma norepinephrine, epinephrine, and dopamine decreased significantly in correlation with [(123)I]MIBG parameters. Ten patients had recovered and had their device explanted as they had demonstrated a higher percentage change in delayed H/M ratio, W/O rate, and norepinephrine levels. Linear regression analysis revealed a strong correlation between percentage changes in both norepinephrine and epinephrine and myocardial recovery. CONCLUSION Combination therapy with LVAD and drug resulted in enhancement of [(123)I]MIBG uptake in DCM patients.
Collapse
|