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Neves Pereira MT, Tinoco M, Castro M, Pinheiro L, Cardoso F, Calvo L, Ribeiro S, Monteiro V, Sanfins V, Lourenço A. Assessing cardiac resynchronization therapy response in heart failure patients: a comparative analysis of efficacy and outcomes between transvenous and epicardial leads. Monaldi Arch Chest Dis 2024. [PMID: 38332712 DOI: 10.4081/monaldi.2024.2845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/23/2024] [Indexed: 02/10/2024] Open
Abstract
Cardiac resynchronization therapy (CRT) is an effective treatment for selected heart failure (HF) patients. Although transvenous implantation is the standard method, it is not feasible in some patients, so the epicardial lead emerges as an alternative. We aim to compare CRT response, procedure-related complications, and the occurrence of clinical outcomes between patients with transvenous and epicardial leads. In a single-center retrospective study, we enrolled consecutive HF patients submitted to CRT implantation with a defibrillator between 2013 and 2022. Clinical response was defined as an improvement of at least one of the New York Heart Association classes with no occurrence of cardiovascular death or HF hospitalization in the first year of follow-up. Echocardiographic response was attained with an increase in left ventricular ejection fraction 10% or a reduction of left ventricular end-diastolic volume >15% at 6-12 months after CRT implantation. Major adverse cardiovascular events (MACE) (cardiovascular mortality and HF hospitalization) and all-cause mortality were evaluated. From a total of 149 patients, 38% (n=57) received an epicardial lead. Clinical (63% versus 60%, p=0.679) and echocardiographic (63% versus 60%, p=0.679) responses were similar between the transvenous and epicardial groups. Patients in the transvenous group had a shorter hospital stay (2 versus 7 days, p<0.001). Procedure-related complications were comparable between groups (24% versus 28%, p=0.572), but left ventricular lead-related complications were more frequent in the transvenous group (14% versus 2%). During a median follow-up of 4.7 years, the rate of MACE was 30% (n=44), with no differences in both groups (p=0.591), neither regarding HF hospitalization (p=0.917) nor cardiovascular mortality (p=0.060). Nevertheless, the epicardial group had a higher rate of all-cause mortality (35% versus 20%, p=0.005), the majority occurring during long-term follow-up (>12 months), with no deaths in the postoperative period. Considering the comparable rates of CRT response, procedure-related complications, and MACE between groups, we conclude that epicardial lead is a feasible alternative for CRT when transvenous lead implantation is not possible. The occurrence of a higher number of all-cause deaths in epicardial patients in the long-term follow-up was mainly due to infectious complications (unrelated to the lead) and the progression of oncological/chronic diseases.
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Affiliation(s)
| | | | | | | | | | - Lucy Calvo
- Senhora da Oliveira Hospital, Guimarães.
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2
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Bishawi M, Hattler B, Almassi GH, Quin JA, Grover FL, Collins JF, Ebrahimi R, Wolbrom DH, Shroyer AL. Health-related quality of life impacts upon 5-year survival after coronary artery bypass surgery. J Card Surg 2022; 37:4899-4905. [PMID: 36423254 DOI: 10.1111/jocs.17165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 10/27/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Poor preoperative health-related quality of life (HRQoL) has been associated with reduced short-term survival after coronary artery bypass graft (CABG) surgery; however, its impact on long-term mortality is unknown. This study's objective was to determine if baseline HRQoL status predicts 5-year post-CABG mortality. METHODS This prespecified, randomized on/off bypass follow-up study (ROOBY-FS) subanalysis compared baseline patient characteristics and HRQoL scores, obtained from the Seattle Angina Questionnaire (SAQ) and Veterans RAND Short Form-36 (VR-36), between 5-year post-CABG survivors and nonsurvivors. Standardized subscores were calculated for each questionnaire. Multivariable logistic regression assessed whether HRQoL survey subcomponents independently predicted 5-year mortality (p ≤ .05). RESULTS Of the 2203 ROOBY-FS enrollees, 2104 (95.5%) completed baseline surveys. Significant differences between 5-year post-CABG deaths (n = 286) and survivors (n = 1818) included age, history of chronic obstructive pulmonary disease, stroke, peripheral vascular disease, renal dysfunction, diabetes, lower left ventricular ejection fraction, atrial fibrillation, depression, non-White race/ethnicity, lower education status, and off-pump CABG. Adjusting for these factors, baseline VR-36 physical component summary score (p = .01), VR-36 mental component summary score (p < .001), and SAQ physical limitation score (p = .003) were all associated with 5-year all-cause mortality. CONCLUSIONS Pre-CABG HRQoL scores may provide clinically relevant prognostic information beyond traditional risk models and prove useful for patient-provider shared decision-making and enhancing pre-CABG informed consent.
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Affiliation(s)
- Muath Bishawi
- Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Brack Hattler
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, USA.,Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - G Hossein Almassi
- Department of Surgery, Clement J. Zablocki Veterans Affairs (VA) Medical Center, Milwaukee, Wisconsin, USA.,Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jacquelyn A Quin
- Department of Surgery, Division of Cardiac Surgery, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Frederick L Grover
- Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Joseph F Collins
- Cooperative Studies Program Coordinating Center, Veterans Affairs Medical Center, Perry Point, Maryland, USA
| | - Ramin Ebrahimi
- Department of Cardiology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA.,Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Daniel H Wolbrom
- Northport Veterans Affairs Medical Center, Research and Development Office, Northport, New York, USA
| | - A Laurie Shroyer
- Northport Veterans Affairs Medical Center, Research and Development Office, Northport, New York, USA
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3
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Berg SK, Rasmussen TB, Mols RE, Thorup CB, Borregaard B, Christensen AV, Cromhout PF, Ekholm O, Juel K, Thrysoee L. Both mental and physical health predicts one year mortality and readmissions in patients with implantable cardioverter defibrillators: findings from the national DenHeart study. Eur J Cardiovasc Nurs 2018; 18:96-105. [DOI: 10.1177/1474515118794598] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | | | | | - Charlotte Brun Thorup
- Department of Cardiology and Department of Cardiothoracic Surgery, Aalborg University Hospital, Denmark
| | - Britt Borregaard
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Denmark
| | | | | | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Knud Juel
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Lars Thrysoee
- Department of Cardiology, Odense University Hospital, Denmark
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4
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Spartalis M, Tzatzaki E, Spartalis E, Damaskos C, Athanasiou A, Livanis E, Voudris V. The Role of Echocardiography in the Optimization of Cardiac Resynchronization Therapy: Current Evidence and Future Perspectives. Open Cardiovasc Med J 2017; 11:133-145. [PMID: 29387277 PMCID: PMC5748829 DOI: 10.2174/1874192401711010133] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 11/28/2017] [Accepted: 11/28/2017] [Indexed: 01/24/2023] Open
Abstract
Background: Cardiac resynchronization therapy (CRT) has become a mainstay in the management of heart failure. Up to one-third of patients who received resynchronization devices do not experience the full benefits of CRT. The clinical factors influencing the likelihood to respond to the therapy are wide QRS complex, left bundle branch block, female gender, non-ischaemic cardiomyopathy (highest responders), male gender, ischaemic cardiomyopathy (moderate responders) and narrow QRS complex, non-left bundle branch block (lowest, non-responders). Objective: This review provides a conceptual description of the role of echocardiography in the optimization of CRT. Method: A literature survey was performed using PubMed database search to gather information regarding CRT and echocardiography. Results: A total of 70 studies met selection criteria for inclusion in the review. Echocardiography helps in the initial selection of the patients with dyssynchrony, which will benefit the most from optimal biventricular pacing and provides a guide to left ventricular (LV) lead placement during implantation. Different echocardiographic parameters have shown promise and can offer the possibility of patient selection, response prediction, lead placement optimization strategies and optimization of device configurations. Conclusion: LV ejection fraction along with specific electrocardiographic criteria remains the cornerstone of CRT patient selection. Echocardiography is a non-invasive, cost-effective, highly reproducible method with certain limitations and accuracy that is affected by measurement errors. Echocardiography can assist with the identification of the appropriate electromechanical substrate of CRT response and LV lead placement. The targeted approach can improve the haemodynamic response, as also the patient-specific parameters estimation.
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Affiliation(s)
- Michael Spartalis
- Division of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Eleni Tzatzaki
- Division of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Eleftherios Spartalis
- Laboratory of Experimental Surgery and Surgical Research, University of Athens, Medical School, Athens, Greece
| | - Christos Damaskos
- Laboratory of Experimental Surgery and Surgical Research, University of Athens, Medical School, Athens, Greece
| | | | - Efthimios Livanis
- Division of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Vassilis Voudris
- Division of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
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5
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Lum HD, Carey EP, Fairclough D, Plomondon ME, Hutt E, Rumsfeld JS, Bekelman DB. Burdensome Physical and Depressive Symptoms Predict Heart Failure-Specific Health Status Over One Year. J Pain Symptom Manage 2016; 51:963-70. [PMID: 26921492 PMCID: PMC5711728 DOI: 10.1016/j.jpainsymman.2015.12.328] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 12/06/2015] [Accepted: 12/24/2015] [Indexed: 11/29/2022]
Abstract
CONTEXT Heart failure (HF)-specific health status (symptom burden, functional status, and health-related quality of life) is an important patient-reported outcome that is associated with palliative care needs, hospitalizations, and death. OBJECTIVES To identify potentially modifiable patient-reported factors that predict HF-specific health status over one year. METHODS This was a prospective cohort study using data from the Patient-Centered Disease Management trial. Participants were identified using population-based sampling of all patients with an HF diagnosis at four VA Medical Centers. Patients were enrolled with reduced HF-specific health status (i.e., significant HF symptoms, limited functional status, and poor quality of life, defined by a Kansas City Cardiomyopathy Questionnaire [KCCQ] score <60). Patient-reported factors at baseline were chest pain, other noncardiac pain, dry mouth, numbness/tingling, constipation, nausea, cough, dizziness, depressive symptoms (Patient Health Questionnaire-9), and spiritual well-being (validated, single-item measure). Patients reported HF-specific health status (KCCQ) at 3, 6, and 12 months. RESULTS Of 384 U.S. veterans, 42% screened positive for depression and 76% described burdensome physical symptoms at baseline. In bivariate analyses, all patient-reported factors were correlated with KCCQ score over one year. Multivariable mixed-effect modeling showed that baseline chest pain, numbness/tingling, depressive symptoms, and higher comorbidity count predicted HF-specific health status over the following year. CONCLUSION Burdensome physical and depressive symptoms independently predicted subsequent HF-specific health status in patients with symptomatic HF. Whether addressing these aspects of the patient experience can improve health status and well-being in symptomatic HF should be studied further.
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Affiliation(s)
- Hillary D Lum
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA; Department of Veterans Affairs, Eastern Colorado Health Care System, Research (151), Denver, Colorado, USA.
| | - Evan P Carey
- Department of Veterans Affairs, Eastern Colorado Health Care System, Research (151), Denver, Colorado, USA
| | - Diane Fairclough
- University of Colorado School of Public Health, Aurora, Colorado, USA
| | | | - Evelyn Hutt
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA; Department of Veterans Affairs, Eastern Colorado Health Care System, Research (151), Denver, Colorado, USA
| | - John S Rumsfeld
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA; Cardiology (111B), Denver, Colorado, USA
| | - David B Bekelman
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA; Department of Veterans Affairs, Eastern Colorado Health Care System, Research (151), Denver, Colorado, USA
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6
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Wieslander B, Loring Z, Zareba W, McNitt S, Wagner GS, Daubert JP, Strauss DG. Scar burden assessed by Selvester QRS score predicts prognosis, not CRT clinical benefit in preventing heart failure event and death: A MADIT-CRT sub-study. J Electrocardiol 2016; 49:603-9. [PMID: 27212144 DOI: 10.1016/j.jelectrocard.2016.04.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Indexed: 11/18/2022]
Affiliation(s)
- Björn Wieslander
- Department of Clinical Physiology, Karolinska Institutet, Stockholm, Sweden
| | - Zak Loring
- Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD.
| | - Wojciech Zareba
- Cardiology Unit of the Department of Medicine, University of Rochester Medical Center, Rochester, NY
| | - Scott McNitt
- The Heart Research Follow-Up Program, University of Rochester Medical Center, Rochester, NY
| | | | - James P Daubert
- Electrophysiology Section/Cardiology Division, and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - David G Strauss
- Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD
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7
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Abstract
Echocardiography is used in cardiac resynchronisation therapy (CRT) to assess cardiac function, and in particular left ventricular (LV) volumetric status, and prediction of response. Despite its widespread applicability, LV volumes determined by echocardiography have inherent measurement errors, interobserver and intraobserver variability, and discrepancies with the gold standard magnetic resonance imaging. Echocardiographic predictors of CRT response are based on mechanical dyssynchrony. However, parameters are mainly tested in single-centre studies or lack feasibility. Speckle tracking echocardiography can guide LV lead placement, improving volumetric response and clinical outcome by guiding lead positioning towards the latest contracting segment. Results on optimisation of CRT device settings using echocardiographic indices have so far been rather disappointing, as results suffer from noise. Defining response by echocardiography seems valid, although re-assessment after 6 months is advisable, as patients can show both continuous improvement as well as deterioration after the initial response. Three-dimensional echocardiography is interesting for future implications, as it can determine volume, dyssynchrony and viability in a single recording, although image quality needs to be adequate. Deformation patterns from the septum and the derived parameters are promising, although validation in a multicentre trial is required. We conclude that echocardiography has a pivotal role in CRT, although clinicians should know its shortcomings.
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8
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Versteeg H, Denollet J, Meine M, Pedersen SS. Patient-reported health status prior to cardiac resynchronisation therapy identifies patients at risk for poor survival and prolonged hospital stays. Neth Heart J 2015; 24:18-24. [PMID: 26645709 PMCID: PMC4692829 DOI: 10.1007/s12471-015-0775-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Patient-reported factors have largely been neglected in search of predictors of response to cardiac resynchronisation therapy (CRT). The current study aimed to examine the independent value of pre-implantation patient-reported health status in predicting four-year survival and cardiac-related hospitalisation of CRT patients. Methods Consecutive patients (N = 139) indicated to receive a first-time CRT-defibrillator at the University Medical Center Utrecht were asked to complete a set of questionnaires prior to implantation. The Kansas City Cardiomyopathy Questionnaire (KCCQ) was used to assess heart failure-specific health status. Data on patients’ demographic, clinical and psychological characteristics at baseline, and on cardiac-related hospitalisations and all-cause deaths during a median follow-up of 3.9 years were obtained from purpose-designed questionnaires and patients’ medical records. Results Results of multivariable Cox regression analyses showed that poor patient-reported health status (KCCQ score < 50) prior to implantation was associated with a 2.5-fold increased risk of cardiac hospitalisation or all-cause death, independent of sociodemographic, clinical and psychological risk factors (adjusted hazard ratio 2.46, 95 % confidence interval (CI) 1.30–4.65). Poor health status was not significantly associated with the absolute number of cardiac-related hospital admissions, but with the total number of days spent in hospital during follow-up (adjusted incidence rate ratio 3.20, 95 % CI 1.88–5.44). Conclusions Patient-reported health status assessed prior to CRT identifies patients at risk for poor survival and prolonged hospital stays, independent of traditional risk factors. These results emphasise the importance of incorporating health status measures in cardiovascular research and patient management. Heart failure patients reporting poor health status should be identified and offered appropriate additional treatment programs.
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Affiliation(s)
- H Versteeg
- Department of Cardiology, University Medical Center, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.
- CoRPS-Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands.
| | - J Denollet
- CoRPS-Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands
| | - M Meine
- Department of Cardiology, University Medical Center, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands
| | - S S Pedersen
- CoRPS-Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
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9
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Mastenbroek MH, Pedersen SS, Meine M, Versteeg H. Distinct trajectories of disease-specific health status in heart failure patients undergoing cardiac resynchronization therapy. Qual Life Res 2015; 25:1451-60. [PMID: 26563250 PMCID: PMC4870284 DOI: 10.1007/s11136-015-1176-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2015] [Indexed: 11/18/2022]
Abstract
Purpose It is well known that a significant proportion of heart failure patients (10–44 %) do not show improvement in symptoms or functioning from cardiac resynchronization therapy (CRT), yet no study has examined patient-reported health status trajectories after implantation. Methods A cohort of 139 patients with a CRT-defibrillator (70 % men; age 65.7 ± 10.1 years) completed the Kansas City Cardiomyopathy Questionnaire (KCCQ) prior to implantation (baseline) and at 2, 6, and 12–14 months post-implantation. Latent class analyses were used to identify trajectories and associates of disease-specific health status over time. Results All health status trajectories showed an initial small to large improvement from baseline to 2-month follow-up, whereafter most trajectories displayed a stable pattern between short- and long-term follow-up. Low educational level, NYHA class III/IV, smoking, no use of beta-blockers, use of psychotropic medication, anxiety, depression, and type D personality were found to be associated with poorer health status in unadjusted analyses. Interestingly, subgroups of patients (12–20 %) who experienced poor health status at baseline improved to stable good health status levels after implantation. Conclusions Levels of disease-specific health status vary considerably across subgroups of CRT-D patients. Classification into poorer disease-specific health status trajectories was particularly associated with patients’ psychological profile and NYHA classification. The timely identification of CRT-D patients who present with poor disease-specific health status (i.e., KCCQ score < 50) and a distressed psychological profile (i.e., anxiety, depression, and/or type D personality) is paramount, as they may benefit from cardiac rehabilitation in combination with psychological intervention.
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Affiliation(s)
- Mirjam H Mastenbroek
- Department of Cardiology, University Medical Center, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.,CoRPS - Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands
| | - Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark.,Department of Cardiology, Odense University Hospital, Odense, Denmark.,Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Mathias Meine
- Department of Cardiology, University Medical Center, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands
| | - Henneke Versteeg
- Department of Cardiology, University Medical Center, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands. .,CoRPS - Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands.
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10
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Mastenbroek MH, Van't Sant J, Versteeg H, Cramer MJ, Doevendans PA, Pedersen SS, Meine M. Relationship Between Reverse Remodeling and Cardiopulmonary Exercise Capacity in Heart Failure Patients Undergoing Cardiac Resynchronization Therapy. J Card Fail 2015; 22:385-94. [PMID: 26363091 DOI: 10.1016/j.cardfail.2015.08.342] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 06/30/2015] [Accepted: 08/14/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Studies on the relationship between left ventricular reverse remodeling and cardiopulmonary exercise capacity in heart failure patients undergoing cardiac resynchronization therapy (CRT) are scarce and inconclusive. METHODS AND RESULTS Eighty-four patients with a 1st-time CRT-defibrillator (mean age 65 ± 11; 73% male) underwent echocardiography and cardiopulmonary exercise testing (CPX) before implantation (baseline) and 6 months after implantation. At baseline, patients also completed a set of questionnaires measuring mental and physical health. The association between echocardiographic response (left ventricular end-systolic volume decrease ≥15%) and a comprehensive set of CPX results was examined. Echocardiographic responders (54%) demonstrated higher peak oxygen consumption and better exercise performance than nonresponders at baseline and at 6-month follow-up. Furthermore, only echocardiographic responders showed improvements in ventilatory efficiency during follow-up. Multivariable repeated measures analyses revealed that, besides reverse remodeling, New York Heart Association functional class II and good patient-reported health status before implantation were the most important correlates of higher average oxygen consumption during exercise, and that nonischemic etiology and smaller pre-implantation QRS width were associated with better ventilatory efficiency over time. CONCLUSIONS During the first 6 months of CRT there was a significant positive association between reverse remodeling and cardiopulmonary exercise capacity.
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Affiliation(s)
- Mirjam H Mastenbroek
- Department of Cardiology, University Medical Center, Utrecht, The Netherlands; Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands.
| | - Jetske Van't Sant
- Department of Cardiology, University Medical Center, Utrecht, The Netherlands
| | - Henneke Versteeg
- Department of Cardiology, University Medical Center, Utrecht, The Netherlands; Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands
| | - Maarten J Cramer
- Department of Cardiology, University Medical Center, Utrecht, The Netherlands
| | - Pieter A Doevendans
- Department of Cardiology, University Medical Center, Utrecht, The Netherlands
| | - Susanne S Pedersen
- Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands; Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Odense University Hospital, Odense, Denmark; Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Mathias Meine
- Department of Cardiology, University Medical Center, Utrecht, The Netherlands
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11
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van ’t Sant J, Fiolet ATL, ter Horst IAH, Cramer MJ, Mastenbroek MH, van Everdingen WM, Mast TP, Doevendans PA, Versteeg H, Meine M. Volumetric Response beyond Six Months of Cardiac Resynchronization Therapy and Clinical Outcome. PLoS One 2015; 10:e0124323. [PMID: 25933068 PMCID: PMC4416763 DOI: 10.1371/journal.pone.0124323] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 03/02/2015] [Indexed: 01/14/2023] Open
Abstract
Aims Response to cardiac resynchronization therapy (CRT) is often assessed six months after implantation. Our objective was to assess the number of patients changing from responder to non-responder between six and 14 months, so-called late non-responders, and compare them to patients who were responder both at six and 14 months, so-called stable responders. Furthermore, we assessed predictive values of six and 14-month response concerning clinical outcome. Methods 105 patients eligible for CRT were enrolled. Clinical, laboratory, ECG, and echocardiographic parameters and patient-reported health status (Kansas City Cardiomyopathy Questionnaire [KCCQ]) were assessed before, and six and 14 months after implantation. Response was defined as ≥15% LVESV decrease as compared to baseline. Major adverse cardiac events (MACE) were registered until 24 months after implantation. Predictive values of six and 14-month response for MACE were examined. Results In total, 75 (71%) patients were six-month responders of which 12 (16%) patients became late non-responder. At baseline, late non-responders more often had ischemic cardiomyopathy and atrial fibrillation, higher BNP and less dyssynchrony compared to stable responders. At six months, late non-responders showed significantly less LVESV decrease, and higher creatinine levels. Mean KCCQ scores of late non-responders were lower than those of stable responders at every time point, with the difference being significant at 14 months. The 14 months response was a better predictor of MACE than six months response. Conclusions The assessment of treatment outcomes after six months of CRT could be premature and response rates beyond might better correlate to long-term clinical outcome.
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Affiliation(s)
- Jetske van ’t Sant
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
- * E-mail:
| | - Aernoud T. L. Fiolet
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Iris A. H. ter Horst
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maarten J. Cramer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mirjam H. Mastenbroek
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Medical and Clinical Psychology, CoRPS—Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands
| | | | - Thomas P. Mast
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pieter A. Doevendans
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Henneke Versteeg
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Medical and Clinical Psychology, CoRPS—Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands
| | - Mathias Meine
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
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12
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Mastenbroek MH, Denollet J, Versteeg H, van den Broek KC, Theuns DA, Meine M, Zijlstra WP, Pedersen SS. Trajectories of patient-reported health status in patients with an implantable cardioverter defibrillator. Am J Cardiol 2015; 115:771-7. [PMID: 25623734 DOI: 10.1016/j.amjcard.2014.12.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 12/23/2014] [Accepted: 12/23/2014] [Indexed: 10/24/2022]
Abstract
To date, no study has assessed the course of patient-reported health status in patients with an implantable cardioverter defibrillator (ICD). Studying health status trajectories and their baseline determinants would permit the identification of patients at risk for poor health outcomes after ICD implantation. A combined cohort of 1,222 patients with an ICD (79% men; age = 61.4 [11.2] years) completed the 12-Item Short-Form Health Survey at baseline and 2 to 3 months and 12 to 14 months after implantation. Latent class analyses were used to identify trajectories and predictors of health status over time. Most health status trajectories showed a stable pattern after short-term follow-up, with differences between trajectories being mainly related to differences in absolute levels of health status. Seven trajectories were identified for physical health status. Being unemployed, symptomatic heart failure, ICD shock, psychotropic medication, negative affectivity, and type D personality were identified as independent determinants of poorer physical health status. For mental health status, 6 trajectories were identified. Younger age, low educational level, symptomatic heart failure, renal failure, no use of ACE inhibitors, psychotropic medication, negative affectivity, and type D personality were identified as independent determinants of poorer mental health status. In conclusion, the population with an ICD seems to be heterogeneous in terms of patient-reported physical and mental health status. Patients with an ICD who present with poor health status and a distressed personality profile should be timely identified and monitored as they may benefit from cardiac rehabilitation in combination with behavioral intervention.
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LENARCZYK RADOSŁAW, JĘDRZEJCZYK-PATEJ EWA, MAZUREK MICHAŁ, SZULIK MARIOLA, KOWALSKI OSKAR, PRUSZKOWSKA PATRYCJA, SOKAL ADAM, ŚREDNIAWA BEATA, BOIDOL JOANNA, KOWALCZYK JACEK, PODOLECKI TOMASZ, MENCEL GRZEGORZ, KALARUS ZBIGNIEW. Quality of Life in Cardiac Resynchronization Recipients: Association with Response and Impact on Outcome. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 38:8-17. [DOI: 10.1111/pace.12523] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Revised: 08/08/2014] [Accepted: 08/10/2014] [Indexed: 11/30/2022]
Affiliation(s)
- RADOSŁAW LENARCZYK
- From the Department of Cardiology; Congenital Heart Disease and Electrotherapy; Silesian Medical University; Silesian Centre for Heart Diseases; Zabrze Poland
| | - EWA JĘDRZEJCZYK-PATEJ
- From the Department of Cardiology; Congenital Heart Disease and Electrotherapy; Silesian Medical University; Silesian Centre for Heart Diseases; Zabrze Poland
| | - MICHAŁ MAZUREK
- From the Department of Cardiology; Congenital Heart Disease and Electrotherapy; Silesian Medical University; Silesian Centre for Heart Diseases; Zabrze Poland
| | - MARIOLA SZULIK
- From the Department of Cardiology; Congenital Heart Disease and Electrotherapy; Silesian Medical University; Silesian Centre for Heart Diseases; Zabrze Poland
| | - OSKAR KOWALSKI
- From the Department of Cardiology; Congenital Heart Disease and Electrotherapy; Silesian Medical University; Silesian Centre for Heart Diseases; Zabrze Poland
| | - PATRYCJA PRUSZKOWSKA
- From the Department of Cardiology; Congenital Heart Disease and Electrotherapy; Silesian Medical University; Silesian Centre for Heart Diseases; Zabrze Poland
| | - ADAM SOKAL
- From the Department of Cardiology; Congenital Heart Disease and Electrotherapy; Silesian Medical University; Silesian Centre for Heart Diseases; Zabrze Poland
| | - BEATA ŚREDNIAWA
- From the Department of Cardiology; Congenital Heart Disease and Electrotherapy; Silesian Medical University; Silesian Centre for Heart Diseases; Zabrze Poland
| | - JOANNA BOIDOL
- From the Department of Cardiology; Congenital Heart Disease and Electrotherapy; Silesian Medical University; Silesian Centre for Heart Diseases; Zabrze Poland
| | - JACEK KOWALCZYK
- From the Department of Cardiology; Congenital Heart Disease and Electrotherapy; Silesian Medical University; Silesian Centre for Heart Diseases; Zabrze Poland
| | - TOMASZ PODOLECKI
- From the Department of Cardiology; Congenital Heart Disease and Electrotherapy; Silesian Medical University; Silesian Centre for Heart Diseases; Zabrze Poland
| | - GRZEGORZ MENCEL
- From the Department of Cardiology; Congenital Heart Disease and Electrotherapy; Silesian Medical University; Silesian Centre for Heart Diseases; Zabrze Poland
| | - ZBIGNIEW KALARUS
- From the Department of Cardiology; Congenital Heart Disease and Electrotherapy; Silesian Medical University; Silesian Centre for Heart Diseases; Zabrze Poland
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Gierula J, Witte KKA. Response to (resynchronization) therapy in chronic heart failure: time for a different approach. Eur J Heart Fail 2014; 16:117-8. [DOI: 10.1002/ejhf.53] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 12/11/2013] [Indexed: 11/10/2022] Open
Affiliation(s)
- John Gierula
- Division of Cardiovascular and Diabetes Research; Leeds Institute of Genetics, Health and Therapeutics Multidisciplinary Cardiovascular Research Centre, University of Leeds; UK
| | - Klaus K. A. Witte
- Division of Cardiovascular and Diabetes Research; Leeds Institute of Genetics, Health and Therapeutics Multidisciplinary Cardiovascular Research Centre, University of Leeds; UK
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