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Fonderico C, Pergola V, Faccenda D, Salucci A, Comparone G, Marrese A, Ammirati G, Cocchiara L, Varriale A, Esposito G, Rapacciuolo A, Strisciuglio T. Impact of sacubitril/valsartan and gliflozins on cardiac resynchronization therapy response in ischemic and non-ischemic heart failure patients. Int J Cardiol 2023; 393:131391. [PMID: 37748521 DOI: 10.1016/j.ijcard.2023.131391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 09/27/2023]
Abstract
AIMS Angiotensin receptor-neprilysin inhibitor (ARNi) and sodium-glucose co-transporter 2 inhibitor (SGLT2i) improve outcomes in heart failure with reduced ejection fraction (HFrEF) patients, however their effects in cardiac resynchronization therapy (CRT) recipients have been scarcely explored. This study investigated whether ARNi and SGLT2i 1) improve the rate of clinical and echocardiographic CRT response and 2) have different impact based on the ischemic or non-ischemic etiology. METHODS HFrEF patients referred for CRT implant were grouped in no treatment (group 1), only ARNi (group 2) and both ARNi and SGLT2i (group 3). Clinical and echocardiographic response were evaluated at 12 months. RESULTS A total of 178 patients were enrolled. At one-year follow-up, 74.4% patients in group 2 (p = 0.031) and 88.9% in group 3 (p = 0.014) were classified as clinical responders vs 54.5% in the no treatments group. In multivariable analysis, ARNi/SGLT2i use was an independent predictor of CRT response (OR 3.72; CI 95%, 1.40-10.98; p = 0.011), confirmed in both groups 2 and 3. At 12 months, the median Δ LVEF increase was 6% and 8.5% in groups 2 and 3 respectively, vs 4.5% in group 1 (p = 0.042 and p = 0.029) with significantly more echocardiographic responders in groups 2 and 3 (76% and 78% vs 50%, p = 0.003 and p = 0.036). Significantly more ischemic HFrEF patients than non-ischemic were considered clinical and echocardiographic responders in the treatment groups. CONCLUSIONS ARNi alone or in combination with SGLT2i in CRT patients improves the clinical and echocardiographic response at 12 months. Ischemic patients seem to benefit more from these treatments.
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Affiliation(s)
- Celeste Fonderico
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Valerio Pergola
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Daniele Faccenda
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Alfonsomaria Salucci
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Gianluigi Comparone
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Aldo Marrese
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Giuseppe Ammirati
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Luigi Cocchiara
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Alfonso Varriale
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Giovanni Esposito
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Antonio Rapacciuolo
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy..
| | - Teresa Strisciuglio
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
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Ho LT, Juang JMJ, Chen YH, Chen YS, Hsu RB, Huang CC, Lee CM, Chien KL. Predictors of Left Ventricular Ejection Fraction Improvement in Patients with Early-Stage Heart Failure with Reduced Ejection Fraction. ACTA CARDIOLOGICA SINICA 2023; 39:854-861. [PMID: 38022429 PMCID: PMC10646602 DOI: 10.6515/acs.202311_39(6).20230412b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/12/2023] [Indexed: 12/01/2023]
Abstract
Objectives To identify the predictors of left ventricular ejection fraction (LVEF) recovery in patients with heart failure with reduced ejection fraction (HFrEF) and compare the mortality rate between patients with HFrEF and heart failure with improved ejection fraction (HFimpEF). Methods Patients in a post-acute care program from 2018 to 2021 were enrolled. A series of echocardiograms were arranged during follow-up. Mortality, cardiovascular death and sudden cardiac death events were recorded. A total of 259 patients were enrolled and followed for at least 1 year; 158 (61%) patients fulfilled the criteria of HFimpEF, 87 (33.6%) were defined as having persistent HFrEF, and 14 (5.4%) were defined as having heart failure with mildly reduced ejection fraction. The patients with HFimpEF and persistent HFrEF were included for analysis. Results The mean follow-up duration was 1090 ± 414 days, and the median time to LVEF recovery was 159 days (IQR 112-289 days). Multivariate logistic regression analysis showed that beta-blocker prescription was the only independent predictor of HFimpEF [odds ratio (OR) 2.11, 95% confidence interval (CI) 1.10-4.08, p = 0.03]. Diagnosis of ischemic cardiomyopathy (ICM) and QRS duration ≥ 110 ms were negative predictors of HFimpEF (OR 0.49, 95% CI 0.27-0.88, p = 0.02, and OR 0.4, 95% CI 0.21-0.77, p = 0.005, respectively). The patients with HfimpEF had a significantly better prognosis with lower mortality (hazard ratio 0.2, 95% CI 0.08-0.50, log-rank p < 0.001) than the patients with persistent HFrEF. Conclusions Beta-blocker prescription was an independent predictor of HFimpEF, while the diagnosis of ICM and QRS duration ≥ 110 ms were negative predictors of HFimpEF. Patients with HfimpEF had a significantly lower mortality rate compared to those with persistent HFrEF.
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Affiliation(s)
- Li-Ting Ho
- Division of Cardiology, Department of Internal Medicine
- Cardiovascular Center, National Taiwan University College of Medicine and Hospital
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University
| | - Jyh-Ming Jimmy Juang
- Division of Cardiology, Department of Internal Medicine
- Cardiovascular Center, National Taiwan University College of Medicine and Hospital
| | - Ying-Hsien Chen
- Division of Cardiology, Department of Internal Medicine
- Cardiovascular Center, National Taiwan University College of Medicine and Hospital
| | - Yih-Sharng Chen
- Cardiovascular Center, National Taiwan University College of Medicine and Hospital
- Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University College of Medicine and Hospital
| | - Ron-Bin Hsu
- Cardiovascular Center, National Taiwan University College of Medicine and Hospital
- Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University College of Medicine and Hospital
| | - Ching-Chang Huang
- Division of Cardiology, Department of Internal Medicine
- Cardiovascular Center, National Taiwan University College of Medicine and Hospital
| | - Chii-Ming Lee
- Division of Cardiology, Department of Internal Medicine
- Cardiovascular Center, National Taiwan University College of Medicine and Hospital
| | - Kuo-Liong Chien
- Division of Cardiology, Department of Internal Medicine
- Cardiovascular Center, National Taiwan University College of Medicine and Hospital
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University
- Population Health Research Center, National Taiwan University, Taipei, Taiwan
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Leyva F, Zegard A, Patel P, Stegemann B, Marshall H, Ludman P, Walton J, de Bono J, Boriani G, Qiu T. Timing of cardiac resynchronization therapy implantation. Europace 2023; 25:euad059. [PMID: 36944529 PMCID: PMC10227865 DOI: 10.1093/europace/euad059] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/14/2023] [Indexed: 03/23/2023] Open
Abstract
AIMS The optimum timing of cardiac resynchronization therapy (CRT) implantation is unknown. We explored long-term outcomes after CRT in relation to the time interval from a first heart failure hospitalization (HFH) to device implantation. METHODS AND RESULTS A database covering the population of England (56.3 million in 2019) was used to quantify clinical outcomes after CRT implantation in relation to first HFHs. From 2010 to 2019, 64 968 patients [age: 71.4 ± 11.7 years; 48 606 (74.8%) male] underwent CRT implantation, 57% in the absence of a previous HFH, 12.9% during the first HFH, and 30.1% after ≥1 HFH. Over 4.54 (2.80-6.71) years [median (interquartile range); 272 989 person-years], the time in years from the first HFH to CRT implantation was associated with a higher risk of total mortality [hazard ratio (HR); 95% confidence intervals (95% CI)] (1.15; 95% CI 1.14-1.16, HFH (HR: 1.26; 95% CI 1.24-1.28), and the combined endpoint of total mortality or HFH (HR: 1.19; 95% CI 1.27-1.20) than CRT in patients with no previous HFHs, after co-variate adjustment. Total mortality (HR: 1.67), HFH (HR: 2.63), and total mortality or HFH (HR: 1.92) (all P < 0.001) were highest in patients undergoing CRT ≥2 years after the first HFH. CONCLUSION In this study of a healthcare system covering an entire nation, delays from a first HFH to CRT implantation were associated with progressively worse long-term clinical outcomes. The best clinical outcomes were observed in patients with no previous HFH and in those undergoing CRT implantation during the first HFH. CONDENSED ABSTRACT The optimum timing of CRT implantation is unknown. In this study of 64 968 consecutive patients, delays from a first heart failure hospitalization (HFH) to CRT implantation were associated with progressively worse long-term clinical outcomes. Each year from a first HFH to CRT implantation was associated with a 21% higher risk of total mortality and a 34% higher risk of HFH. The best outcomes after CRT were observed in patients with no previous HFHs and in those undergoing implantation during their first HFH.
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Affiliation(s)
- Francisco Leyva
- Aston Medical Research Institute, Aston University, Aston Triangle, Birmingham B4 7ET, UK
| | - Abbasin Zegard
- Aston Medical Research Institute, Aston University, Aston Triangle, Birmingham B4 7ET, UK
- Department of Cardiology, University Hospitals Birmingham, Queen Elizabeth, Mindelsohn Way, Birmingham B15 2GW, UK
| | - Peysh Patel
- Department of Cardiology, University Hospitals Birmingham, Queen Elizabeth, Mindelsohn Way, Birmingham B15 2GW, UK
| | - Berthold Stegemann
- Aston Medical Research Institute, Aston University, Aston Triangle, Birmingham B4 7ET, UK
- Department of Cardiology, University Hospitals Birmingham, Queen Elizabeth, Mindelsohn Way, Birmingham B15 2GW, UK
| | - Howard Marshall
- Department of Cardiology, University Hospitals Birmingham, Queen Elizabeth, Mindelsohn Way, Birmingham B15 2GW, UK
| | - Peter Ludman
- Department of Cardiology, University Hospitals Birmingham, Queen Elizabeth, Mindelsohn Way, Birmingham B15 2GW, UK
| | - Jamie Walton
- Department of Cardiology, University Hospitals Birmingham, Queen Elizabeth, Mindelsohn Way, Birmingham B15 2GW, UK
| | - Joseph de Bono
- Department of Cardiology, University Hospitals Birmingham, Queen Elizabeth, Mindelsohn Way, Birmingham B15 2GW, UK
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via Università, 4, 41121, Modena, Italy
| | - Tian Qiu
- Department of Cardiology, University Hospitals Birmingham, Queen Elizabeth, Mindelsohn Way, Birmingham B15 2GW, UK
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Chen Z, Zhou X, Ma X, Chen K. Recruitment of the cardiac conduction system for optimal resynchronization therapy in failing heart. Front Physiol 2022; 13:1045740. [PMID: 36589433 PMCID: PMC9798297 DOI: 10.3389/fphys.2022.1045740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
Heart failure (HF) is a leading health burden around the world. Although pharmacological development has dramatically advanced medication therapy in the field, hemodynamic disorders or mechanical desynchrony deteriorated by intra or interventricular conduction abnormalities remains a critical target beyond the scope of pharmacotherapy. In the past 2 decades, nonpharmacologic treatment for heart failure, such as cardiac resynchronization therapy (CRT) via biventricular pacing (BVP), has been playing an important role in improving the prognosis of heart failure. However, the response rate of BVP-CRT is variable, leaving one-third of patients not benefiting from the therapy as expected. Considering the non-physiological activation pattern of BVP-CRT, more efforts have been made to optimize resynchronization. The most extensively investigated approach is by stimulating the native conduction system, e.g., His-Purkinje conduction system pacing (CSP), including His bundle pacing (HBP) and left bundle branch area pacing (LBBAP). These emerging CRT approaches provide an alternative to traditional BVP-CRT, with multiple proof-of-concept studies indicating the safety and efficacy of its utilization in dyssynchronous heart failure. In this review, we summarize the mechanisms of dyssynchronous HF mediated by conduction disturbance, the rationale and acute effect of CSP for CRT, the recent advancement in clinical research, and possible future directions of CSP.
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Affiliation(s)
- Zhongli Chen
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | - Xuan Ma
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Keping Chen
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,*Correspondence: Keping Chen,
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