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Pola K, Roijer A, Borgquist R, Ostenfeld E, Carlsson M, Bakos Z, Arheden H, Arvidsson PM. Hemodynamic forces from 4D flow magnetic resonance imaging predict left ventricular remodeling following cardiac resynchronization therapy. J Cardiovasc Magn Reson 2023; 25:45. [PMID: 37620886 PMCID: PMC10463519 DOI: 10.1186/s12968-023-00955-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 07/10/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Patients with heart failure and left bundle branch block (LBBB) may receive cardiac resynchronization therapy (CRT), but current selection criteria are imprecise, and many patients have limited treatment response. Hemodynamic forces (HDF) have been suggested as a marker for CRT response. The aim of this study was therefore to investigate left ventricular (LV) HDF as a predictive marker for LV remodeling after CRT. METHODS Patients with heart failure, EF < 35% and LBBB (n = 22) underwent CMR with 4D flow prior to CRT. LV HDF were computed in three directions using the Navier-Stokes equations, reported in median N [interquartile range], and the ratio of transverse/longitudinal HDF was calculated for systole and diastole. Transthoracic echocardiography was performed before and 6 months after CRT. Patients with end-systolic volume reduction ≥ 15% were defined as responders. RESULTS Non-responders had smaller HDF than responders in the inferior-anterior direction in systole (0.06 [0.03] vs. 0.07 [0.03], p = 0.04), and in the apex-base direction in diastole (0.09 [0.02] vs. 0.1 [0.05], p = 0.047). Non-responders had larger diastolic HDF ratio compared to responders (0.89 vs. 0.67, p = 0.004). ROC analysis of diastolic HDF ratio for identifying CRT non-responders had AUC of 0.88 (p = 0.005) with sensitivity 57% and specificity 100% for ratio > 0.87. Intragroup comparison found higher HDF ratio in systole compared to diastole for responders (p = 0.003), but not for non-responders (p = 0.8). CONCLUSION Hemodynamic force ratio is a potential marker for identifying patients with heart failure and LBBB who are unlikely to benefit from CRT. Larger-scale studies are required before implementation of HDF analysis into clinical practice.
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Affiliation(s)
- Karin Pola
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Anders Roijer
- Heart Failure and Valvular Heart Disease Section, Skåne University Hospital, Lund, Sweden
| | - Rasmus Borgquist
- Cardiology Division, Arrhythmia Section, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Ellen Ostenfeld
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Marcus Carlsson
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Zoltan Bakos
- Cardiology Division, Arrhythmia Section, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Håkan Arheden
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Per M Arvidsson
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden.
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Ziacchi M, Spadotto A, Ghio S, Pellegrino M, Potena L, Masarone D, Merlo M, Stolfo D, Caracciolo MM, Inserra C, Ammirati F, Ciccarelli M, Colivicchi F, Bianchi S, Patti G, Oliva F, Arcidiacono G, Rordorf R, Pini D, Pacileo G, D'Onofrio A, Forleo GB, Mariani M, Adamo F, Alonzo A, Ruzzolini M, Ghiglieno C, Cipriani M, Firetto G, Aspromonte N, Clemenza F, Maria De Ferrari G, Senni M, Grazia Bongiorni M, Tondo C, Grimaldi M, Giallauria F, Rametta F, Marchese P, Biffi M, Sinagra G. Bridging the gap in the symptomatic heart failure patient journey: insights from the Italian scenario. Expert Rev Med Devices 2023; 20:951-961. [PMID: 37712650 DOI: 10.1080/17434440.2023.2258786] [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: 06/05/2023] [Revised: 07/19/2023] [Accepted: 08/05/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND The prognosis for heart failure (HF) patients remains poor, with a high mortality rate, and a marked reduction in quality of life (QOL) and functional status. This study aims to explore the ongoing needs of HF management and the epidemiology of patients followed by Italian HF clinics, with a specific focus on cardiac contractility modulation (CCM). RESEARCH DESIGN AND METHODS Data from patients admitted to 14 HF outpatients clinics over 4 weeks were collected and compared to the results of a survey open to physicians involved in HF management operating in Italian centers. RESULTS One hundred and five physicians took part in the survey. Despite 94% of patients receive a regular follow-up every 3-6 months, available therapies are considered insufficient in 30% of cases. Physicians reported a lack of treatment options for 23% of symptomatic patients with reduced ejection fraction (EF) and for 66% of those without reduced EF. Approximately 3% of HF population (two patients per month per HF clinic) meets the criteria for immediate CCM treatment, which is considered a useful option by 15% of survey respondents. CONCLUSIONS Despite this relatively small percentage, considering total HF population, CCM could potentially benefit numerous HF patients, particularly the elderly, by reducing hospitalizations, improving functional capacity and QOL.
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Affiliation(s)
- Matteo Ziacchi
- Cardiology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Alberto Spadotto
- Cardiology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Stefano Ghio
- Division of Cardiology, Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marta Pellegrino
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Luciano Potena
- Cardiology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Daniele Masarone
- Heart Failure Unit, AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Marco Merlo
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste, Trieste, Italy
| | - Davide Stolfo
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste, Trieste, Italy
| | | | - Corinna Inserra
- Department of Cardiovascular Disease, Unit of Cardiology, Ospedale Civile di Legnano, Legnano, Italy
| | - Fabrizio Ammirati
- Cardiology Division, Presidio Ospedaliero GB Grassi Ostia Lido, Rome, Italy
| | - Michele Ciccarelli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | | | - Stefano Bianchi
- UOC Cardiologia, Ospedale Fatebenefratelli Isola Tiberina, Rome, Italy
| | - Giuseppe Patti
- Università del Piemonte Orientale, Azienda Ospedaliero Universitaria "Maggiore Della Carita", Novara, Italy
| | - Fabrizio Oliva
- De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
| | - Giuseppe Arcidiacono
- Dipartimento di Medicina clinica e Sperimemtale, University of Messina, Messina, Italy
| | - Roberto Rordorf
- Division of Cardiology, Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Daniela Pini
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Giuseppe Pacileo
- Heart Failure Unit, AORN dei Colli, Monaldi Hospital, Naples, Italy
| | | | | | - Matteo Mariani
- Department of Cardiovascular Disease, Unit of Cardiology, Ospedale Civile di Legnano, Legnano, Italy
| | - Francesco Adamo
- Cardiology Division, Presidio Ospedaliero GB Grassi Ostia Lido, Rome, Italy
| | | | - Matteo Ruzzolini
- UOC Cardiologia, Ospedale Fatebenefratelli Isola Tiberina, Rome, Italy
| | - Chiara Ghiglieno
- Università del Piemonte Orientale, Azienda Ospedaliero Universitaria "Maggiore Della Carita", Novara, Italy
| | | | - Giorgio Firetto
- Dipartimento di Medicina clinica e Sperimemtale, University of Messina, Messina, Italy
| | - Nadia Aspromonte
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy
| | - Francesco Clemenza
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy
| | - Gaetano Maria De Ferrari
- AOU Città della Salute e della Scienza di Torino and Department of Medical Sciences, University Cardiology, Torino, Italy
| | - Michele Senni
- Cardiology Division, Cardiovascular Department, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Department of Biomedical, Surgical and Dentist Sciences, University of Milan, Milan, Italy
| | - Massimo Grimaldi
- Department of Cardiology, Ospedale Generale Regionale F. Muilli, Acquaviva delle Fonti, Italy
| | - Francesco Giallauria
- Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | | | - Procolo Marchese
- Department of Cardiology, Mazzoni Civil Hospital, Ascoli Piceno, Italy
| | - Mauro Biffi
- Cardiology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste, Trieste, Italy
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Teixeira RA, Fagundes AA, Baggio Junior JM, Oliveira JCD, Medeiros PDTJ, Valdigem BP, Teno LAC, Silva RT, Melo CSD, Elias Neto J, Moraes Júnior AV, Pedrosa AAA, Porto FM, Brito Júnior HLD, Souza TGSE, Mateos JCP, Moraes LGBD, Forno ARJD, D'Avila ALB, Cavaco DADM, Kuniyoshi RR, Pimentel M, Camanho LEM, Saad EB, Zimerman LI, Oliveira EB, Scanavacca MI, Martinelli Filho M, Lima CEBD, Peixoto GDL, Darrieux FCDC, Duarte JDOP, Galvão Filho SDS, Costa ERB, Mateo EIP, Melo SLD, Rodrigues TDR, Rocha EA, Hachul DT, Lorga Filho AM, Nishioka SAD, Gadelha EB, Costa R, Andrade VSD, Torres GG, Oliveira Neto NRD, Lucchese FA, Murad H, Wanderley Neto J, Brofman PRS, Almeida RMS, Leal JCF. Brazilian Guidelines for Cardiac Implantable Electronic Devices - 2023. Arq Bras Cardiol 2023; 120:e20220892. [PMID: 36700596 PMCID: PMC10389103 DOI: 10.36660/abc.20220892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
| | | | | | | | | | | | | | - Rodrigo Tavares Silva
- Universidade de Franca (UNIFRAN), Franca, SP - Brasil
- Centro Universitário Municipal de Franca (Uni-FACEF), Franca, SP - Brasil
| | | | - Jorge Elias Neto
- Universidade Federal do Espírito Santo (UFES), Vitória, ES - Brasil
| | - Antonio Vitor Moraes Júnior
- Santa Casa de Ribeirão Preto, Ribeirão Preto, SP - Brasil
- Unimed de Ribeirão Preto, Ribeirão Preto, SP - Brasil
| | - Anisio Alexandre Andrade Pedrosa
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Luis Gustavo Belo de Moraes
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | | | | | | | | | - Mauricio Pimentel
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
| | | | - Eduardo Benchimol Saad
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brasil
- Hospital Samaritano, Rio de Janeiro, RJ - Brasil
| | | | | | - Mauricio Ibrahim Scanavacca
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | - Martino Martinelli Filho
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | - Carlos Eduardo Batista de Lima
- Hospital Universitário da Universidade Federal do Piauí (UFPI), Teresina, PI - Brasil
- Empresa Brasileira de Serviços Hospitalares (EBSERH), Brasília, DF - Brasil
| | | | - Francisco Carlos da Costa Darrieux
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Sissy Lara De Melo
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Eduardo Arrais Rocha
- Hospital Universitário Walter Cantídio, Universidade Federal do Ceará (UFC), Fortaleza, CE - Brasil
| | - Denise Tessariol Hachul
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Silvana Angelina D'Orio Nishioka
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Roberto Costa
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Gustavo Gomes Torres
- Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN - Brasil
| | | | | | - Henrique Murad
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | | | | | - Rui M S Almeida
- Centro Universitário Fundação Assis Gurgacz, Cascavel, PR - Brasil
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Berrill M, Ashcroft E, Fluck D, John I, Beeton I, Sharma P, Baltabaeva A. Right Ventricular Dysfunction Predicts Outcome in Acute Heart Failure. Front Cardiovasc Med 2022; 9:911053. [PMID: 35665249 PMCID: PMC9157539 DOI: 10.3389/fcvm.2022.911053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 04/22/2022] [Indexed: 12/02/2022] Open
Abstract
Aim The severity of cardiac impairment in acute heart failure (AHF) predicts outcome, but challenges remain to identify prognostically important non-invasive parameters of cardiac function. Left ventricular ejection fraction (LVEF) is relevant, but only in those with reduced LV systolic function. We aimed to assess the standard and advanced parameters of left and right ventricular (RV) function from echocardiography in predicting long-term outcomes in AHF. Methods A total of 418 consecutive AHF patients presenting over 12 months were prospectively recruited and underwent bedside echocardiography within 24 h of recruitment. We retrospectively assessed 8 RV and 5 LV echo parameters of the cardiac systolic function to predict 2-year mortality, using both guideline-directed and study-specific cutoffs, based on the maximum Youden indices via ROC analysis. For the RV, these were the tricuspid annular plane systolic excursion, RV fractional area change, tissue Doppler imaging (TDI) peak tricuspid annular systolic wave velocity, both peak- and end-systolic RV free wall global longitudinal strain (RV GLS) and strain rate (mean RV GLSR), RV ejection fraction (RVEF) derived from a 2D ellipsoid model and the ratio of the TAPSE to systolic pulmonary artery pressure (SPAP). For the LV, these were the LVEF, mitral regurgitant ΔP/Δt (MR dP/dt), the lateral mitral annular TDI peak systolic wave velocity, LV GLS, and the LV GLSR. Results A total of 7/8 parameters of RV systolic function were predictive of 2-year outcome, with study cutoffs like international guidelines. A cutoff of < −1.8 s–1 mean RV GLSR was associated with worse outcome compared to > −1.8 s–1 [HR 2.13 95% CI 1.33–3.40 (p = 0.002)]. TAPSE:SPAP of > 0.027 cm/mmHg (vs. < 0.027 cm/mmHg) predicted worse outcome [HR 2.12 95% CI 1.53–2.92 (p < 0.001)]. A 3-way comparison of 2-year mortality by LVEF from the European Society of Cardiology (ESC) guideline criteria of LVEF > 50, 41–49, and < 40% was not prognostic [38.6% vs. 30.9 vs. 43.9% (p = 0.10)]. Of the 5 parameters of LV systolic function, only an MR dP/dt cutoff of < 570 mmHg was predictive of adverse outcome [HR 1.63 95% CI 1.01–2.62 (p = 0.047)]. Conclusion With cutoffs broadly like the ESC guidelines, we identified RV dysfunction to be associated with adverse prognosis, whereas LVEF could not identify patients at risk.
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Affiliation(s)
- Max Berrill
- Department of Cardiology, St. Peter’s Hospital, Surrey, United Kingdom
- Department of Research and Development, St. Peter’s Hospital, Surrey, United Kingdom
| | - Eshan Ashcroft
- Department of Cardiology, St. Peter’s Hospital, Surrey, United Kingdom
| | - David Fluck
- Department of Cardiology, St. Peter’s Hospital, Surrey, United Kingdom
- Department of Research and Development, St. Peter’s Hospital, Surrey, United Kingdom
- Institute of Cardiovascular Research, Royal Holloway, University of London, Egham, United Kingdom
| | - Isaac John
- Department of Research and Development, St. Peter’s Hospital, Surrey, United Kingdom
- Institute of Cardiovascular Research, Royal Holloway, University of London, Egham, United Kingdom
| | - Ian Beeton
- Department of Cardiology, St. Peter’s Hospital, Surrey, United Kingdom
| | - Pankaj Sharma
- Department of Research and Development, St. Peter’s Hospital, Surrey, United Kingdom
- Institute of Cardiovascular Research, Royal Holloway, University of London, Egham, United Kingdom
| | - Aigul Baltabaeva
- Department of Cardiology, St. Peter’s Hospital, Surrey, United Kingdom
- Department of Research and Development, St. Peter’s Hospital, Surrey, United Kingdom
- Institute of Cardiovascular Research, Royal Holloway, University of London, Egham, United Kingdom
- Department of Cardiology, Royal Brompton and Harefield Hospital, London, United Kingdom
- *Correspondence: Aigul Baltabaeva,
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5
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Echocardiographic Parameters as Predictors for the Efficiency of Resynchronization Therapy in Patients with Dilated Cardiomyopathy and HFrEF. Diagnostics (Basel) 2021; 12:diagnostics12010035. [PMID: 35054202 PMCID: PMC8774311 DOI: 10.3390/diagnostics12010035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/21/2021] [Accepted: 12/23/2021] [Indexed: 11/20/2022] Open
Abstract
Cardiac resynchronization therapy (CRT) represents an increasingly recommended solution to alleviate symptomatology and improve the quality of life in individuals with dilated cardiomyopathy (DCM) and heart failure (HF) with reduced ejection fraction (HFrEF) who remain symptomatic despite optimal medical therapy (OMT). However, this therapy does have the desired results all cases, in that sometimes low sensing and high voltage stimulation are needed to obtain some degree of resynchronization, even in the case of perfectly placed cardiac pacing leads. Our study aims to identify whether there is a relationship between several transthoracic echocardiographic (TTE) parameters characterizing left ventricular (LV) performance, especially strain results, and sensing and pacing parameters. Between 2020–2021, CRT was performed to treat persistent symptoms in 48 patients with a mean age of 64 (53.25–70) years, who were diagnosed with DCM and HFrEF, and who were still symptomatic despite OMT. We documented statistically significant correlations between global longitudinal strain, posterolateral strain, and ejection fraction and LV sensing (r = 0.65, 0.469, and 0.534, respectively, p < 0.001) and LV pacing parameters (r = −0.567, −0.555, and −0.363, respectively, p < 0.001). Modern imaging techniques, such as TTE with cardiac strain, are contributing to the evaluation of patients with HFrEF, increasing the chances of CRT success, and allowing physicians to anticipate and plan for case management.
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6
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Diao K, Wang D, Chen Z, Wu X, Ma M, Zhu Y, Zhang L, Wang H, Wang M, He S, Li C, Deng Q, Yan T, Wu T, Tang L, Huang B, Sun J, He Y. Rationale and design of a multi-center, prospective randomized controlled trial on the effects of sacubitril-valsartan versus enalapril on left ventricular remodeling in ST-elevation myocardial infarction: The PERI-STEMI study. Clin Cardiol 2021; 44:1709-1717. [PMID: 34668596 PMCID: PMC8715395 DOI: 10.1002/clc.23744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 10/02/2021] [Accepted: 10/06/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Angiotensin receptor neprilysin inhibitor (ARNI) sacubitril-valsartan has been recommended as one of the first-line therapies in heart failure with reduced ejection fraction. However, whether ARNI could benefit patients with ST-segment elevation myocardial infarction (STEMI) by improving left ventricular (LV) remodeling remains unknown. The primary objective of the PERI-STEMI trial is to assess whether sacubitril-valsartan is more effective in preventing adverse LV remodeling for patients with STEMI than enalapril. HYPOTHESIS We hypothesize that sacubitril/valsartan is superior to enalapril in preventing adverse LV remodeling evaluated by cardiovascular magnetic resonance imaging at the 6-month follow-up. METHODS PERI-STEMI is an investigator-initiated, prospective, multi-center, randomized, open-label, superiority trial with blinded evaluation of outcomes. A total of 376 first-time STEMI patients with primary percutaneous coronary intervention (PPCI) within 12 h after symptom onset will be randomized to sacubitril-valsartan or enalapril treatment. All the patients will receive a baseline cardiovascular magnetic resonance (CMR) examination at 4-7 days post-PPCI. The primary endpoint is the change of indexed LV mass at the 6-month follow-up CMR. RESULTS Enrollment of the first patient is planned in November 2021. Recruitment is anticipated to last for 12-18 months and patients will be followed for 5 years after randomization. The study is expected to complete in June 2027. CONCLUSIONS The results of the PERI-STEMI trial are expected to provide CMR evidence on whether ARNI could benefit patients with STEMI, so as to facilitate the strategy of CMR-based risk stratification and therapy selection for these patients. PERI-STEMI is registered at ClinicalTrials.gov (NCT04912167).
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Affiliation(s)
- Kaiyue Diao
- Department of RadiologyWest China Hospital of Sichuan UniversityChengduChina
| | - Duolao Wang
- Department of Clinical Sciences, Department of BiostatisticsLiverpool School of Tropical MedicineLiverpoolUK
| | - Zhongxiu Chen
- Department of CardiologyWest China Hospital of Sichuan UniversityChengduChina
| | - Xi Wu
- Department of RadiologyWest China Hospital of Sichuan UniversityChengduChina
| | - Min Ma
- Department of CardiologyWest China Hospital of Sichuan UniversityChengduChina
| | - Ye Zhu
- Department of CardiologyWest China Hospital of Sichuan UniversityChengduChina
| | - Li Zhang
- Department of CardiologyWest China Hospital of Sichuan UniversityChengduChina
| | - Hua Wang
- Department of CardiologyWest China Hospital of Sichuan UniversityChengduChina
| | - Mian Wang
- Department of CardiologyWest China Hospital of Sichuan UniversityChengduChina
| | - Sen He
- Department of CardiologyWest China Hospital of Sichuan UniversityChengduChina
| | - Chen Li
- Department of CardiologyWest China Hospital of Sichuan UniversityChengduChina
| | - Qiao Deng
- Department of RadiologyWest China Hospital of Sichuan UniversityChengduChina
| | - Ting Yan
- Department of CardiologyWest China Hospital of Sichuan UniversityChengduChina
- Nursing DepartmentWest China School of Nursing, West China Hospital, Sichuan UniversityChengduChina
| | - Tao Wu
- Department of RadiologyWest China Hospital of Sichuan UniversityChengduChina
| | - Lu Tang
- Department of RadiologyWest China Hospital of Sichuan UniversityChengduChina
| | - Baotao Huang
- Department of CardiologyWest China Hospital of Sichuan UniversityChengduChina
| | - Jiayu Sun
- Department of RadiologyWest China Hospital of Sichuan UniversityChengduChina
| | - Yong He
- Department of CardiologyWest China Hospital of Sichuan UniversityChengduChina
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7
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Xu L, Pagano J, Chow K, Oudit GY, Haykowsky MJ, Mikami Y, Howarth AG, White JA, Howlett JG, Dyck JRB, Anderson TJ, Ezekowitz JA, Thompson RB, Paterson DI. Cardiac remodelling predicts outcome in patients with chronic heart failure. ESC Heart Fail 2021; 8:5352-5362. [PMID: 34569184 PMCID: PMC8712825 DOI: 10.1002/ehf2.13626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/25/2021] [Accepted: 09/08/2021] [Indexed: 01/14/2023] Open
Abstract
Aims Surveillance imaging is often used to detect remodelling, a change in cardiac geometry, and/or function; however, there are limited data in patients with chronic heart failure (HF). We sought to characterize cardiac remodelling in patients with chronic HF and evaluate its association with outcome. Methods and results A prospective cohort of patients at risk for HF or with chronic HF underwent cardiac magnetic resonance (CMR) at baseline and 1 year. Ventricular function, volumes, mass, left atrial volume, global longitudinal strain, and myocardial scar were measured. The primary outcome was a composite of death or cardiovascular hospitalization up to 5 years from the 1 year scan. Cox regression was used to identify 1 year CMR predictors of outcome after adjusting for baseline risk. A total of 262 patients (median age 68 years, 57% males) including 96 at risk for HF, 97 with HF and preserved ejection fraction, and 69 with HF and reduced ejection fraction were included. In the patients with HF, 55 events were identified during follow‐up. After adjustment for baseline clinical risk, Cox proportion hazard regressions only identified 1 year change in left ventricular (LV) mass index as a CMR predictor of outcome, adjusted hazard ratio 1.21 (1.02, 1.44) per 10% increase, P = 0.031. Cardiac remodelling defined as a 1 year change in LV mass index ≥15% was observed in 35% of patients with HF. Patients with adverse remodelling of LV mass index had more events on Kaplan–Meier analyses compared to those with no remodelling, log‐rank P = 0.004 for overall cohort, P = 0.035 for heart failure with preserved ejection fraction and P = 0.035 for heart failure and reduced ejection fraction. Conclusions Cardiac remodelling is common during serial CMR assessment of patients with chronic HF. Change in LV mass predicted long‐term outcomes whereas change in left ventricular ejection fraction did not.
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Affiliation(s)
- Lingyu Xu
- Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Joseph Pagano
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Kelvin Chow
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Gavin Y Oudit
- Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Mark J Haykowsky
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Yoko Mikami
- Libin Cardiovascular Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Andrew G Howarth
- Libin Cardiovascular Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - James A White
- Libin Cardiovascular Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Jonathan G Howlett
- Libin Cardiovascular Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Jason R B Dyck
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Todd J Anderson
- Libin Cardiovascular Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Justin A Ezekowitz
- Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Richard B Thompson
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - D Ian Paterson
- Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
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8
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Aimo A, Fabiani I, Vergaro G, Arzilli C, Chubuchny V, Pasanisi EM, Petersen C, Poggianti E, Taddei C, Pugliese NR, Bayes-Genis A, Lupón J, Giannoni A, Ripoli A, Georgiopoulos G, Passino C, Emdin M. Prognostic value of reverse remodelling criteria in heart failure with reduced or mid-range ejection fraction. ESC Heart Fail 2021; 8:3014-3025. [PMID: 34002938 PMCID: PMC8318429 DOI: 10.1002/ehf2.13396] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/14/2021] [Accepted: 04/19/2021] [Indexed: 12/20/2022] Open
Abstract
Aims Reverse remodelling (RR) is the recovery from left ventricular (LV) dilatation and dysfunction. Many arbitrary criteria for RR have been proposed. We searched the criteria with the strongest prognostic yield for the hard endpoint of cardiovascular death. Methods and results We performed a systematic literature search of diagnostic criteria for RR. We evaluated their prognostic significance in a cohort of 927 patients with LV ejection fraction (LVEF) < 50% undergoing two echocardiograms within 12 ± 2 months. These patients were followed for a median of 2.8 years (interquartile interval 1.3–4.9) after the second echocardiogram, recording 123 cardiovascular deaths. Two prognostic models were defined. Model 1 included age, LVEF, N‐terminal pro‐B‐type natriuretic peptide, ischaemic aetiology, cardiac resynchronization therapy, estimated glomerular filtration rate, New York Heart Association, and LV end‐systolic volume (LVESV) index, and Model 2 the validated Cardiac and Comorbid Conditions Heart Failure score. We identified 25 criteria for RR, the most used being LVESV reduction ≥15% (12 studies out of 42). In the whole cohort, two criteria proved particularly effective in risk reclassification over Model 1 and Model 2. These criteria were (i) LVEF increase >10 U and (ii) LVEF increase ≥1 category [severe (LVEF ≤ 30%), moderate (LVEF 31–40%), mild LV dysfunction (LVEF 41–55%), and normal LV function (LVEF ≥ 56%)]. The same two criteria yielded independent prognostic significance and improved risk reclassification even in patients with more severe systolic dysfunction, namely, those with LVEF < 40% or LVEF ≤ 35%. Furthermore, LVEF increase >10 U and LVEF increase ≥1 category displayed a greater prognostic value than LVESV reduction ≥15%, both in the whole cohort and in the subgroups with LVEF < 40% or LVEF ≤ 35%. For example, LVEF increase >10 U independently predicted cardiovascular death over Model 1 and LVESV reduction ≥15% (hazard ratio 0.40, 95% confidence interval 0.18–0.90, P = 0.026), while LVESV reduction ≥15% did not independently predict cardiovascular death (P = 0.112). Conclusions Left ventricular ejection fraction increase >10 U and LVEF increase ≥1 category are stronger predictors of cardiovascular death than the most commonly used criterion for RR, namely, LVESV reduction ≥15%.
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Affiliation(s)
- Alberto Aimo
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy.,Cardiology Division, Fondazione Toscana Gabriele Monasterio, Piazza Martiri della Libertà 33, Pisa, 56124, Italy
| | - Iacopo Fabiani
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Piazza Martiri della Libertà 33, Pisa, 56124, Italy
| | - Giuseppe Vergaro
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy.,Cardiology Division, Fondazione Toscana Gabriele Monasterio, Piazza Martiri della Libertà 33, Pisa, 56124, Italy
| | | | - Vladyslav Chubuchny
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Piazza Martiri della Libertà 33, Pisa, 56124, Italy
| | - Emilio Maria Pasanisi
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Piazza Martiri della Libertà 33, Pisa, 56124, Italy
| | - Christina Petersen
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Piazza Martiri della Libertà 33, Pisa, 56124, Italy
| | - Elisa Poggianti
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Piazza Martiri della Libertà 33, Pisa, 56124, Italy
| | - Claudia Taddei
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Piazza Martiri della Libertà 33, Pisa, 56124, Italy
| | | | - Antoni Bayes-Genis
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.,Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Josep Lupón
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.,Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Alberto Giannoni
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy.,Cardiology Division, Fondazione Toscana Gabriele Monasterio, Piazza Martiri della Libertà 33, Pisa, 56124, Italy
| | - Andrea Ripoli
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Piazza Martiri della Libertà 33, Pisa, 56124, Italy
| | - Georgios Georgiopoulos
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Claudio Passino
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy.,Cardiology Division, Fondazione Toscana Gabriele Monasterio, Piazza Martiri della Libertà 33, Pisa, 56124, Italy
| | - Michele Emdin
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy.,Cardiology Division, Fondazione Toscana Gabriele Monasterio, Piazza Martiri della Libertà 33, Pisa, 56124, Italy
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9
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Mullens W, Auricchio A, Martens P, Witte K, Cowie MR, Delgado V, Dickstein K, Linde C, Vernooy K, Leyva F, Bauersachs J, Israel CW, Lund LH, Donal E, Boriani G, Jaarsma T, Berruezo A, Traykov V, Yousef Z, Kalarus Z, Cosedis Nielsen J, Steffel J, Vardas P, Coats A, Seferovic P, Edvardsen T, Heidbuchel H, Ruschitzka F, Leclercq C. Optimized implementation of cardiac resynchronization therapy: a call for action for referral and optimization of care: A joint position statement from the Heart Failure Association (HFA), European Heart Rhythm Association (EHRA), and European Association of Cardiovascular Imaging (EACVI) of the European Society of Cardiology. Eur J Heart Fail 2021; 22:2349-2369. [PMID: 33136300 DOI: 10.1002/ejhf.2046] [Citation(s) in RCA: 100] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 12/28/2022] Open
Abstract
Cardiac resynchronization therapy (CRT) is one of the most effective therapies for heart failure with reduced ejection fraction and leads to improved quality of life, reductions in heart failure hospitalization rates and all-cause mortality. Nevertheless, up to two-thirds of eligible patients are not referred for CRT. Furthermore, post-implantation follow-up is often fragmented and suboptimal, hampering the potential maximal treatment effect. This joint position statement from three European Society of Cardiology Associations, Heart Failure Association (HFA), European Heart Rhythm Association (EHRA) and European Association of Cardiovascular Imaging (EACVI), focuses on optimized implementation of CRT. We offer theoretical and practical strategies to achieve more comprehensive CRT referral and post-procedural care by focusing on four actionable domains: (i) overcoming CRT under-utilization, (ii) better understanding of pre-implant characteristics, (iii) abandoning the term 'non-response' and replacing this by the concept of disease modification, and (iv) implementing a dedicated post-implant CRT care pathway.
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Affiliation(s)
- Wilfried Mullens
- Ziekenhuis Oost Limburg, Genk, Belgium.,University Hasselt, Hasselt, Belgium
| | - Angelo Auricchio
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Pieter Martens
- Ziekenhuis Oost Limburg, Genk, Belgium.,University Hasselt, Hasselt, Belgium
| | - Klaus Witte
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Martin R Cowie
- Imperial College London (Royal Brompton Hospital), London, UK
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Cecilia Linde
- Heart and Vascular Theme, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Cardiology, Radboud University Medical Center (Radboudumc), Nijmegen, The Netherlands
| | | | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Carsten W Israel
- Department of Medicine - Cardiology, Diabetology and Nephrology, Bethel-Clinic, Bielefeld, Germany
| | - Lars H Lund
- Department of Medicine Karolinska Institutet, and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Erwan Donal
- Cardiologie, CHU Rennes - LTSI Inserm UMR 1099, Université Rennes-1, Rennes, France
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Tiny Jaarsma
- Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Health, Medicine and Caring Science, Linköping University, Linköping, Sweden
| | | | - Vassil Traykov
- Department of Cardiology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Zaheer Yousef
- Department of Cardiology, University Hospital of Wales & Cardiff University, Cardiff, UK
| | - Zbigniew Kalarus
- Department of Cardiology, Medical University of Silesia, Katowice, Poland
| | | | - Jan Steffel
- UniversitätsSpital Zürich, Zürich, Switzerland
| | - Panos Vardas
- Heart Sector, Hygeia Hospitals Group, Athens, Greece
| | | | - Petar Seferovic
- Faculty of Medicine, Serbian Academy of Science and Arts, Belgrade University, Belgrade, Serbia
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, and University of Oslo, Oslo, Norway
| | - Hein Heidbuchel
- Antwerp University and Antwerp University Hospital, Antwerp, Belgium
| | - Frank Ruschitzka
- Department of Cardiology, University Hospital, University Heart Center, Zurich, Switzerland
| | - Christophe Leclercq
- Cardiologie, CHU Rennes - LTSI Inserm UMR 1099, Université Rennes-1, Rennes, France
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10
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Yufu K, Abe I, Kondo H, Saito S, Fukui A, Okada N, Akioka H, Shinohara T, Teshima Y, Nakagawa M, Takahashi N. Distinctively different predictors for long-term outcomes between responders and nonresponders who underwent cardiac resynchronization therapy. J Arrhythm 2021; 37:173-181. [PMID: 33664900 PMCID: PMC7896449 DOI: 10.1002/joa3.12447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 09/11/2020] [Accepted: 10/08/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND It is common to develop heart failure (HF) events even in respondents to cardiac resynchronization therapy (CRT) during a long-term observation period. We investigated the predictors for long-term outcome in responders in comparison with nonresponders in patients diagnosed with HF along with implanted CRT. METHODS We enrolled 133 consecutive patients (mean age, 70 ± 10 years; 72 males) implanted with CRT from April 2010 to July 2019. Accurate follow-up information (mean follow-up period, 983 ± 801 days) was obtained from 66 responders and 53 nonresponders. RESULTS Kaplan-Meier event-free curves showed that major adverse cerebral and cardiovascular event (MACCE)-free ratio was significantly lower as the stage of renal function progresses (log rank, 19.5; P < .0001). The baseline estimated glomerular filtration rate (e-GFR) before CRT was not significantly different between nonresponders and responders. The e-GFR after judgment of CRT response was lower in patients with MACCEs than those without. Cox proportional hazards regression analysis revealed that low baseline e-GFR before CRT and after judgment of CRT response was closely related with MACCEs in responders, but not in nonresponders. The survival rate in responders without MACCEs assessed using Kaplan-Meier analysis was significantly larger in the preserved e-GFR (baseline value before CRT, >44 mL/min/1.73 m2) group than in the depressed group (log rank, 20.29; P < .0001). CONCLUSION We demonstrate that the factors for MACCEs during long follow-up periods were distinctively different between responders and nonresponders. Patients with depressed e-GFRs are suggested to have poor prognosis even if they are responders to CRT.
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Affiliation(s)
- Kunio Yufu
- Department of Cardiology and Clinical ExaminationFaculty of MedicineOita UniversityOitaJapan
| | - Ichitaro Abe
- Department of Cardiology and Clinical ExaminationFaculty of MedicineOita UniversityOitaJapan
| | - Hidekazu Kondo
- Department of Cardiology and Clinical ExaminationFaculty of MedicineOita UniversityOitaJapan
| | - Shotaro Saito
- Department of Cardiology and Clinical ExaminationFaculty of MedicineOita UniversityOitaJapan
| | - Akira Fukui
- Department of Cardiology and Clinical ExaminationFaculty of MedicineOita UniversityOitaJapan
| | - Norihiro Okada
- Department of Cardiology and Clinical ExaminationFaculty of MedicineOita UniversityOitaJapan
| | - Hidefumi Akioka
- Department of Cardiology and Clinical ExaminationFaculty of MedicineOita UniversityOitaJapan
| | - Tetsuji Shinohara
- Department of Cardiology and Clinical ExaminationFaculty of MedicineOita UniversityOitaJapan
| | - Yasushi Teshima
- Department of Cardiology and Clinical ExaminationFaculty of MedicineOita UniversityOitaJapan
| | - Mikiko Nakagawa
- Department of Cardiology and Clinical ExaminationFaculty of MedicineOita UniversityOitaJapan
| | - Naohiko Takahashi
- Department of Cardiology and Clinical ExaminationFaculty of MedicineOita UniversityOitaJapan
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11
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Onishi N, Kyo S, Oi M, Jinnai T, Kuroda M, Shimizu Y, Imamura S, Harita T, Nishiuchi S, Hanazawa K, Tamura T, Izumi C, Nakagawa Y, Kaitani K. Improvement in quality of life and cardiac function after catheter ablation for asymptomatic persistent atrial fibrillation. J Arrhythm 2021; 37:11-19. [PMID: 33664880 PMCID: PMC7896458 DOI: 10.1002/joa3.12457] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 10/17/2020] [Accepted: 10/29/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Catheter ablation (CA) for atrial fibrillation (AF) is widely performed. However, the indication for CA in patients with asymptomatic persistent AF is still controversial. METHODS Among 259 consecutive patients who were hospitalized for initial CA of AF, a total of 45 patients who had asymptomatic persistent AF were retrospectively analyzed. Quality of life (QOL) before and 1 year after CA was evaluated, and changes in the cardiac function over 5 years after CA were also examined. QOL was assessed using the AF QOL questionnaire (AFQLQ) developed by the Japanese Heart Rhythm Society. In addition, cardiac function was assessed by measuring the plasma B-type natriuretic peptide (BNP) level, left ventricular ejection fraction (LVEF), left atrial diameter (LAD) with transthoracic echocardiogram, and left atrial (LA) volume with computed tomography (CT). RESULTS The AFQLQ significantly improved after CA in terms of "symptom frequency" and "activity limits and mental anxiety." The plasma BNP level, LVEF, and LAD significantly improved in the first 3 months after the first CA, with no significant changes thereafter (from 149.0 pg/dL [95% confidence intervals {CI}, 114.5-183.5 pg/dL] to 49.8 pg/dL [95% CI, 26.5-70.1], P < .0001; from 60.8% [95% CI, 58.1%-63.6%] to 65.0% [95% CI, 62.6-67.4], P = .001; and from 41.3 mm [95% CI, 39.7-42.9] to 36.8 [95% CI, 34.5-39.1 mm], P < .0001, respectively). LA volume revealed LA reverse remodeling after CA. CONCLUSION Improvement in the QOL and cardiac function after CA of asymptomatic persistent AF was revealed. Asymptomatic persistent AF should be appropriately treated by CA.
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Affiliation(s)
- Naoaki Onishi
- Division of CardiologyTenri HospitalTenriJapan
- Japanese Red Cross Otsu HospitalOtsuJapan
| | - Shokan Kyo
- Japanese Red Cross Otsu HospitalOtsuJapan
| | - Maki Oi
- Japanese Red Cross Otsu HospitalOtsuJapan
| | | | | | - Yukiko Shimizu
- Division of CardiologyTenri HospitalTenriJapan
- Hyogo Prefectural Amagasaki General Medical CenterAmagasakiJapan
| | - Sari Imamura
- Division of CardiologyTenri HospitalTenriJapan
- Hidaka HospitalGoboJapan
| | - Takeshi Harita
- Division of CardiologyTenri HospitalTenriJapan
- Kitano HospitalOsakaJapan
| | | | - Koji Hanazawa
- Division of CardiologyTenri HospitalTenriJapan
- Japanese Red Cross Wakayama Medical CenterWakayamaJapan
| | | | - Chisato Izumi
- Division of CardiologyTenri HospitalTenriJapan
- National Cerebral and Cardiovascular CenterSuitaJapan
| | - Yoshihisa Nakagawa
- Division of CardiologyTenri HospitalTenriJapan
- Shiga University of Medical ScienceOtsuJapan
| | - Kazuaki Kaitani
- Division of CardiologyTenri HospitalTenriJapan
- Japanese Red Cross Otsu HospitalOtsuJapan
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12
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Filippatos G, Lu X, Tsintzos SI, Gold MR, Mullens W, Birnie D, Hersi AS, Kusano K, Leclercq C, Fagan DH, Wilkoff BL. Economic implications of adding a novel algorithm to optimize cardiac resynchronization therapy: rationale and design of economic analysis for the AdaptResponse trial. J Med Econ 2020; 23:1401-1408. [PMID: 33043737 DOI: 10.1080/13696998.2020.1835333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIMS Although cardiac resynchronization therapy (CRT) has proven beneficial in several randomized trials, a subset of patients have limited clinical improvement. The AdaptivCRT algorithm provides automated selection between synchronized left ventricular or biventricular pacing with optimization of atrioventricular delays. The rationale and design of the economic analysis of the AdaptResponse clinical trial are described. RATIONALE The costs associated with HF hospitalization are substantial and are compounded by a high rate of readmission. HF hospitalization payments range from $1,001 for Greece to $12,235 for US private insurance. When examining the breakdown of HF-related costs, it is clear that approximately 55% of the hospitalization costs are directly attributable to length of stay. Notably, the mean costs of a CRT patient in need of a HF-related hospitalization are currently estimated to be an average of $10,679. METHODS The economic analysis of the AdaptResponse trial has two main objectives. The hospital provider objective seeks to test the hypothesis that AdaptivCRT reduces the incidence of all-cause re-admissions after a heart failure admission within 30 days of the index event. A negative binomial regression model will be used to estimate and compare the number of readmissions after an index HF hospitalization. The payer economic objective will assess cost-effectiveness of CRT devices with the AdaptivCRT algorithm relative to traditional CRT programming. This analysis will be conducted from a U.S. payer perspective. A decision analytic model comprised of a 6-month decision tree and a Markov model for long term extrapolation will be used to evaluate lifetime costs and benefits. CONCLUSION AdaptivCRT may offer improvements over traditional device programming in patient outcomes. How the data from AdaptResponse will be used to demonstrate if these clinical benefits translate into substantial economic gains is herein described.
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Affiliation(s)
- Gerasimos Filippatos
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Xiaoxiao Lu
- Cardiac Rhythm and Heart Failure (CRHF), Medtronic plc, Mounds View, MN, USA
| | - Stelios I Tsintzos
- Cardiac Rhythm and Heart Failure (CRHF), Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - Michael R Gold
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Wilfried Mullens
- Department of Cardiology, Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - David Birnie
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
| | - Ahmad S Hersi
- Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre, Osaka, Japan
| | | | - Dedra H Fagan
- Cardiac Rhythm and Heart Failure (CRHF), Medtronic plc, Mounds View, MN, USA
| | - Bruce L Wilkoff
- Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, OH, USA
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13
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Huang HC, Chien KL, Chang YC, Lin LY, Wang J, Liu YB. Increases in repolarization heterogeneity predict left ventricular systolic dysfunction and response to cardiac resynchronization therapy in patients with left bundle branch block. J Cardiovasc Electrophysiol 2020; 31:1770-1778. [PMID: 32275338 DOI: 10.1111/jce.14488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/30/2020] [Accepted: 04/07/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION This study aimed to investigate the association between T-wave morphology and impaired left ventricular ejection fraction (LVEF) in patients with complete left bundle branch block (cLBBB), and the predictive value of T-wave morphology for response to cardiac resynchronization therapy (CRT). METHODS AND RESULTS We enrolled 189 patients with cLBBB on electrocardiogram performed between January 2007 and December 2011 who underwent standard echocardiography. Repolarization parameters, including the QRS-to-T angle (TCRT), T-wave morphology dispersion (TMD), T-wave loop area (PL), and T-wave residuum (TWR), were reconstructed from digital standard 12-lead electrocardiograms by T-wave morphology analysis. CRT response was defined as ≥15% reduction in left ventricular end-systolic volume at 12 months after CRT implantation. The clinical outcome endpoint was a composite of heart failure hospitalization, heart transplantation, or death during follow up (mean, 5.8 years). On logistic regression, a higher heart rate, longer QRS duration, increased TMD, and larger TWR were all independently associated with LVEF < 40%. Among 40 patients who underwent CRT, those with a larger TMD (P = .007), larger PL (P = .025), and more negative TCRT (P = .015) had better response to CRT. A large TMD (P = .018) and large PL (P = .003) were also independent predictors of the clinical outcome endpoint. CONCLUSIONS Increases in repolarization heterogeneity in patients with cLBBB are associated with impaired LVEF. A large TMD and large PL may be useful as additional predictors of response to CRT, improving patient selection for CRT.
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Affiliation(s)
- Hui-Chun Huang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kuo-Liong Chien
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.,Institute of Epidemiology, College of Public Health, Taipei, Taiwan
| | - Yi-Chung Chang
- Institute of Communication Engineering, National Taiwan University, Taipei, Taiwan
| | - Lian-Yu Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jui Wang
- Institute of Epidemiology, College of Public Health, Taipei, Taiwan
| | - Yen-Bin Liu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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14
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Kloosterman M, van Stipdonk AMW, Ter Horst I, Rienstra M, Van Gelder IC, Vos MA, Prinzen FW, Meine M, Vernooy K, Maass AH. Association between heart failure aetiology and magnitude of echocardiographic remodelling and outcome of cardiac resynchronization therapy. ESC Heart Fail 2020; 7:645-653. [PMID: 31991067 PMCID: PMC7160473 DOI: 10.1002/ehf2.12624] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 12/23/2019] [Accepted: 01/03/2020] [Indexed: 11/25/2022] Open
Abstract
Aims Echocardiographic response after cardiac resynchronization therapy (CRT) is often lesser in ischaemic cardiomyopathy (ICM) than non‐ischaemic dilated cardiomyopathy (NIDCM) patients. We assessed the association of heart failure aetiology on the amount of reverse remodelling and outcome of CRT. Methods and results Nine hundred twenty‐eight CRT patients were retrospectively included. Reverse remodelling and endpoint occurrence (all‐cause mortality, heart transplantation, or left ventricular assist device implantation) was assessed. Two response definitions [≥15% reduction left ventricular end systolic volume (LVESV) and ≥5% improvement left ventricular ejection fraction] and the most accurate cut‐off for the amount of reverse remodelling that predicted endpoint freedom were assessed. Mean follow‐up was 3.8 ± 2.4 years. ICM was present in 47%. ICM patients who were older (69 ± 7 vs. 63 ± 11), more often men (83% vs. 58%), exhibited less LVESV reduction (13 ± 31% vs. 23 ± 32%) and less left ventricular ejection fraction improvement (5 ± 11% vs. 10 ± 12%) than NIDCM patients (all P < 0.001). Nevertheless, every 1% LVESV reduction was associated with a relative reduction in endpoint occurrence: NIDCM 1.3%, ICM 0.9%, and absolute risk reduction was similar (0.4%). The most accurate cut‐off of LVESV reduction that predicted endpoint freedom was 17.1% in NIDCM and 13.2% in ICM. Conclusions ICM patients achieve less reverse remodelling than NIDCM, but the prognostic gain in terms of survival time is the same for every single percentage of reverse remodelling that does occur. The assessment and expected magnitude of reverse remodelling should take this effect of heart failure aetiology into account.
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Affiliation(s)
- Mariëlle Kloosterman
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, PO Box 30.001, Groningen, 9700, RB, The Netherlands
| | | | - Iris Ter Horst
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Michiel Rienstra
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, PO Box 30.001, Groningen, 9700, RB, The Netherlands
| | - Isabelle C Van Gelder
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, PO Box 30.001, Groningen, 9700, RB, The Netherlands
| | - Marc A Vos
- Department of Medical Physiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), University of Maastricht, Maastricht, the Netherlands
| | - Matthias Meine
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands.,Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), University of Maastricht, Maastricht, the Netherlands
| | - Alexander H Maass
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, PO Box 30.001, Groningen, 9700, RB, The Netherlands
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15
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Hakemi EU, Doukky R, Parzynski CS, Curtis JP, Madias C. Quadripolar versus bipolar leads in cardiac resynchronization therapy: An analysis of the National Cardiovascular Data Registry. Heart Rhythm 2019; 17:81-89. [PMID: 31369870 DOI: 10.1016/j.hrthm.2019.07.028] [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: 02/17/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The introduction of quadripolar (QP) cardiac resynchronization therapy (CRT) leads aimed to improve procedural and clinical outcomes. OBJECTIVE The National Cardiovascular Data Registry was analyzed to characterize the use as well as the procedural and clinical outcomes of QP leads in comparison with unipolar and bipolar (BP) leads. METHODS We evaluated data on 175,684 procedures reported between September 1, 2010, and December 31, 2015. Clinical outcomes were analyzed using Centers for Medicare & Medicaid Services claims data. RESULTS Among all CRT device implants, there was a drop in reported lead placement failure from 6.04% to 5.21% (P < .0001 for trend) and a drop in the reported diaphragmatic stimulation rates from 0.07% to 0.01% (P < .007 for trend) between the last quarters of 2010 and 2015. No significant difference in procedural complication rates between QP and BP leads occurred (1.34% and 1.39%, respectively; P = .50). Among patients linked to Centers for Medicare & Medicaid Services claims data, no statistically significant difference in the combined primary outcome of death, congestive heart failure admission, device malfunction, and reoperation between BP and QP leads was observed (34.15 and 34.19 events per 100 patient-years, respectively; P = .89). CONCLUSION Since the introduction of QP leads, there was a reduction in CRT lead placement failure rates and a reduction in diaphragmatic stimulation rates. However, no statistically significant difference in long-term clinical outcomes between BP and QP leads was observed in elderly patients undergoing CRT implantation.
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Affiliation(s)
- Emad Uddin Hakemi
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York; Division of Cardiology, Cook County Health and Hospitals System, Chicago, Illinois
| | - Rami Doukky
- Division of Cardiology, Cook County Health and Hospitals System, Chicago, Illinois
| | - Craig S Parzynski
- Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, Connecticut
| | - Jeptha P Curtis
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
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Hernández-Madrid A, Lu X, Tsintzos SI, Fagan DH, Klepfer RN, Matía R, Chung ES. Heart failure hospitalization reduction and cost savings achieved by improved delivery of effective biventricular pacing: economic implications of the OLE study under the US setting. CLINICOECONOMICS AND OUTCOMES RESEARCH 2019; 11:385-393. [PMID: 31239735 PMCID: PMC6559257 DOI: 10.2147/ceor.s205501] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 04/30/2019] [Indexed: 11/23/2022] Open
Abstract
Background: The hOLter for Efficacy analysis (OLE) study demonstrated that current device pacing diagnostics overestimate the amount of cardiac resynchronization therapy (CRT) pacing that effectively stimulates the cardiac tissue. Sub-optimal pacing increases mortality, hospitalizations, and associated health-care costs. We sought to estimate the expected number of hospital admissions due to heart failure (HF) and its respective financial impact in patients with maximized effective pacing versus conventional pacing. Methods: A Markov model was developed to project HF hospitalizations and quantify the costs that could be avoided if pacing was maximally effective. OLE data were used to inform the prevalence of ineffective pacing among CRT patients and and average loss of pacing by causes. Adaptive CRT trial data quantified the reduction in underlying hospitalization risk by increasing effective pacing delivered. Survival was informed by a meta-analysis of 5 randomized clinical trials. Costs were analyzed from a US payer perspective. Results: Projected average hospitalizations totaled 4.58 over a lifetime horizon for CRT patients with conventional pacing. Maximizing effective pacing delivery was projected to avoid 1.83 HF admissions/patient over the lifetime. This equates to a savings of 40% (US$22,802) compared with conventional pacing from the Medicare perspective. In a sensitivity analysis, CRT with effective pacing was projected to provide cost savings in all scenarios. Conclusions: Maximized effective pacing leads to a lower number of HF hospitalizations, thus allowing significant cost offsets in the US setting.
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Affiliation(s)
- Antonio Hernández-Madrid
- Arrhythmia Unit, Cardiology Department, Ramón y Cajal Hospital, Alcalá University, Madrid, Spain
| | | | | | | | | | - Roberto Matía
- Arrhythmia Unit, Cardiology Department, Ramón y Cajal Hospital, Alcalá University, Madrid, Spain
| | - Eugene S Chung
- The Christ Hospital Heart and Vascular Center, The Lindner Center for Research and Education, Cincinnati, OH, USA
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Costanzo MR, Ponikowski P, Coats A, Javaheri S, Augostini R, Goldberg LR, Holcomb R, Kao A, Khayat RN, Oldenburg O, Stellbrink C, McKane S, Abraham WT. Phrenic nerve stimulation to treat patients with central sleep apnoea and heart failure. Eur J Heart Fail 2018; 20:1746-1754. [PMID: 30303611 PMCID: PMC6607512 DOI: 10.1002/ejhf.1312] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 08/07/2018] [Accepted: 08/09/2018] [Indexed: 11/05/2022] Open
Abstract
AIMS The presence of central sleep apnoea (CSA) is associated with poor prognosis in patients with heart failure (HF). The aim of this analysis was to evaluate if using phrenic nerve stimulation to treat CSA in patients with CSA and HF was associated with changes in HF-specific metrics. METHODS AND RESULTS All patients randomized in the remedē System Pivotal Trial and identified at baseline with HF were included (n = 96). Effectiveness data from treatment and former control groups were pooled based on months since therapy activation. Changes from baseline to 6 and 12 months in sleep metrics, Epworth Sleepiness Scale, patient global assessment health-related quality of life, Minnesota Living with Heart Failure Questionnaire (MLHFQ), and echocardiographic parameters are reported. HF hospitalization, cardiovascular death, and the composite of HF hospitalization or cardiovascular death within 6 months are reported by the original randomized group assignment for safety assessment. Sleep metrics and quality of life improved from baseline to 6 and 12 months. At 12 months, MLHFQ scores changed by -6.8 ± 20.0 (P = 0.005). The 6-month rate of HF hospitalization was 4.7% in treatment patients (standard error = 3.3) and 17.0% in control patients (standard error = 5.5) (P = 0.065). Reported adverse events were as expected for a transvenous implantable system. CONCLUSIONS Phrenic nerve stimulation reduces CSA severity in patients with HF. In parallel, this CSA treatment was associated with benefits on HF quality of life.
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Affiliation(s)
| | | | | | | | | | | | | | - Andrew Kao
- Mid America Heart Institute, Kansas City, MO, USA
| | | | - Olaf Oldenburg
- Bad Oeynhausen Heart and Diabetes Center, Bad Oeynhausen, Germany
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Alvarez‐Alvarez B, García‐Seara J, Martínez‐Sande JL, Rodríguez‐Mañero M, Fernández López XA, González‐Melchor L, Agra Bermejo RM, Iglesias‐Alvarez D, Sampedro FG, Díaz‐Louzao C, González‐Juanatey JR. Cardiac resynchronization therapy outcomes in patients under nonoptimal medical therapy. J Arrhythm 2018; 34:548-555. [PMID: 30327701 PMCID: PMC6174433 DOI: 10.1002/joa3.12101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 06/19/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) is indicated in symptomatic heart failure (HF) patients after achieving optimal medical therapy (OMT). However, many patients may not be under OMT when the CRT device is implanted. Here, we evaluate the long-term benefits of CRT in symptomatic HF patients receiving or not OMT. METHODS We investigated the effect of OMT on HF developing or death in 328 consecutive patients with a CRT device implanted between 2005 and 2015 in a single tertiary center. After the CRT implant, we categorized the patients into three groups: no OMT, OMT at baseline and after 1 year of follow-up, and OMT only at the 1-year follow-up but not at baseline. We used multivariate Cox proportional hazards model to determine the effect of OMT on clinical outcomes. RESULTS One hundred and twenty-two patients (37.2%) received OMT prior to CRT. OMT at baseline was not associated with a reduced risk of death or HF (HR 0.72; 95% CI 0.50-1.02; P = 0.067) compared with no-basal-OMT patients. After CRT, patients without OMT had a higher risk of death or HF than patients who received OMT in follow-up (HR 1.72, 95% CI 1.07-2.78, P = 0.025), and the risk of the patients who received OMT at baseline and at the 1-year follow-up was similar to that of the patients who achieved OMT at the 1-year follow-up (HR 0.90, 95% CI 0.54-1.50, P = 0.682). CONCLUSION Basal OMT prior to CRT is not associated with better outcomes in terms of HF/death compared with no basal OMT. The subgroup of patients who achieved OMT at the 1-year follow-up exhibited a reduced risk of HF and death compared with patients who did not.
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Affiliation(s)
- Belén Alvarez‐Alvarez
- Cardiology DepartmentClinical University Hospital of Santiago de CompostelaSantiago de CompostelaSpain
| | - Javier García‐Seara
- Arrhythmia UnitClinical University Hospital of Santiago de CompostelaSantiago de CompostelaSpain
| | - Jose L. Martínez‐Sande
- Arrhythmia UnitClinical University Hospital of Santiago de CompostelaSantiago de CompostelaSpain
| | - Moisés Rodríguez‐Mañero
- Arrhythmia UnitClinical University Hospital of Santiago de CompostelaSantiago de CompostelaSpain
| | - Xesús A. Fernández López
- Arrhythmia UnitClinical University Hospital of Santiago de CompostelaSantiago de CompostelaSpain
| | - Laila González‐Melchor
- Arrhythmia UnitClinical University Hospital of Santiago de CompostelaSantiago de CompostelaSpain
| | - Rosa M. Agra Bermejo
- Cardiology DepartmentClinical University Hospital of Santiago de CompostelaSantiago de CompostelaSpain
| | - Diego Iglesias‐Alvarez
- Cardiology DepartmentClinical University Hospital of Santiago de CompostelaSantiago de CompostelaSpain
| | - Francisco Gude Sampedro
- Epidemiology DeparmentClinical University Hospital of Santiago de CompostelaSantiago de CompostelaSpain
| | - Carla Díaz‐Louzao
- Unit of BiostatisticsDepartment of Statistics, Mathematical Analysis, Faculty of Mathematics (USC)Santiago de CompostelaSpain
| | - José R. González‐Juanatey
- Cardiology DepartmentClinical University Hospital of Santiago de CompostelaSantiago de CompostelaSpain
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Liang Y, Wang Q, Zhang M, Wang J, Chen H, Yu Z, Gong X, Su Y, Ge J. Cessation of pacing in super‐responders of cardiac resynchronization therapy: A randomized controlled trial. J Cardiovasc Electrophysiol 2018; 29:1548-1555. [PMID: 30106214 DOI: 10.1111/jce.13711] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 08/03/2018] [Accepted: 08/06/2018] [Indexed: 01/04/2023]
Affiliation(s)
- Yixiu Liang
- Department of CardiologyShanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan UniversityShanghai China
| | - Qingqing Wang
- Department of CardiologyShanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan UniversityShanghai China
| | - Mingliang Zhang
- Department of CardiologyCentral Hospital of Tai’an Shandong China
| | - Jingfeng Wang
- Department of CardiologyShanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan UniversityShanghai China
| | - Haiyan Chen
- Department of EchocardiographyShanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan UniversityShanghai China
| | - Ziqing Yu
- Department of CardiologyShanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan UniversityShanghai China
| | - Xue Gong
- Department of CardiologyDeltahealth HospitalShanghai China
| | - Yangang Su
- Department of CardiologyShanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan UniversityShanghai China
| | - Junbo Ge
- Department of CardiologyShanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan UniversityShanghai China
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20
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Linde C, Abraham WT, Gold MR, Daubert JC, Tang ASL, Young JB, Sherfesee L, Hudnall JH, Fagan DH, Cleland JG. Predictors of short-term clinical response to cardiac resynchronization therapy. Eur J Heart Fail 2017; 19:1056-1063. [PMID: 28295869 DOI: 10.1002/ejhf.795] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 01/24/2017] [Accepted: 01/30/2017] [Indexed: 12/28/2022] Open
Abstract
AIMS Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in patients with symptomatic heart failure and QRS prolongation but there is uncertainty about which patient characteristics predict short-term clinical response. METHODS AND RESULTS In an individual patient meta-analysis of three double-blind, randomized trials, clinical composite score (CCS) at 6 months was compared in patients assigned to CRT programmed on or off. Treatment-covariate interactions were assessed to measure likelihood of improved CCS at 6 months. MIRACLE, MIRACLE ICD, and REVERSE trials contributed data for this analysis (n = 1591). Multivariable modelling identified QRS duration and left ventricular ejection fraction (LVEF) as predictors of CRT clinical response (P < 0.05). The odds ratio for a better CCS at 6 months increased by 3.7% for every 1% decrease in LVEF for patients assigned to CRT-on compared to CRT-off, and was greatest when QRS duration was between 160 and 180 ms. CONCLUSIONS In symptomatic chronic heart failure patients (NYHA class II-IV), longer QRS duration and lower LVEF independently predict early clinical response to CRT.
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Affiliation(s)
- Cecilia Linde
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - William T Abraham
- Division of Cardiovascular Medicine and the Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, USA
| | - Michael R Gold
- Medical University of South Carolina, Charleston, SC, USA
| | | | - Anthony S L Tang
- The Island Medical Program, University of British Columbia, Vancouver, Canada
| | - James B Young
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | | | | | | | - John G Cleland
- National Heart and Lung Institute, Imperial College London, London, UK
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21
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Warriner DR, Lawford P, Sheridan PJ. Cardiac Resynchronization Therapy Leads to Improvements in Handgrip Strength. Cardiol Res 2017; 7:95-103. [PMID: 28197275 PMCID: PMC5295515 DOI: 10.14740/cr475w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2016] [Indexed: 11/11/2022] Open
Abstract
Background A reduction in skeletal muscle performance measured by handgrip strength is common in heart failure. No trial has investigated the role of cardiac resynchronization therapy, which leads to improvements in cardiac performance, on the function of skeletal muscle in patients with heart failure. Methods Nineteen patients were recruited, 18 male, age 69 ± 8 years, New York Heart Association class II-IV, QRS duration 173 ± 21 ms and left ventricular ejection fraction 26±8%. Handgrip strength was measured at baseline before, and 6 and 12 months, following cardiac resynchronization therapy. Response was assessed using quality of life questionnaire, 6-minute walk distance, left ventricular end-diastolic volume, and cardiopulmonary exercise testing at the same time points. Results Fourteen patients were identified as responders, demonstrating significant improvements in all four markers of response. There was no significant difference at baseline in left or right handgrip strength between responders and non-responders. Compared to baseline, handgrip strength significantly increased in responders during follow-up, left (34.4 ± 11.4 to 40.3 ± 11.3 kgf, P < 0.001) and right (35.7 ± 12.5 to 42.2 ± 11.5 kgf, P < 0.001) at 12 months. No such improvement was seen in non-responders. Conclusions This study demonstrates that positive response to cardiac resynchronization therapy is associated with significant gains in handgrip strength, suggesting that cardiac resynchronization therapy may indirectly lead to secondary gains in skeletal muscle function.
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Affiliation(s)
- David R Warriner
- Medical Physics Group, Department of Cardiovascular Science, The Medical School, University of Sheffield, Sheffield, S10 2TN, UK; Department of Cardiology, Northern General Hospital, Sheffield Teaching Hospitals, Sheffield, S5 7AU, UK
| | - Patricia Lawford
- Medical Physics Group, Department of Cardiovascular Science, The Medical School, University of Sheffield, Sheffield, S10 2TN, UK
| | - Paul J Sheridan
- Department of Cardiology, Chesterfield Royal Hospital, Chesterfield, Derbyshire, S44 5BL, UK
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22
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Comparison between IEGM-based approach and echocardiography in AV/PV and VV delay optimization in CRT-D recipients (Quicksept study). Indian Pacing Electrophysiol J 2016; 16:59-65. [PMID: 27676162 PMCID: PMC5832617 DOI: 10.1016/j.ipej.2016.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 04/14/2016] [Accepted: 05/31/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AtrioVentricular (AV) and InterVentricular (VV) delay optimization can improve ventricular function in Cardiac Resynchronization Therapy (CRT) and is usually performed by means of echocardiography. St Jude Medical has developed an automated algorhythm which calculates the optimal AV and VV delays (QuickOpt™) based on Intracardiac ElectroGrams, (IEGM), within 2 min. So far, the efficacy of the algorhythm has been tested acutely with standard lead position at right ventricular (RV) apex. Aim of this project is to evaluate the algorhythm performance in the mid- and long-term with RV lead located in mid-septum. METHODS AV and VV delays optimization data were collected in 13 centers using both echocardiographic and QuickOpt™ guidance in CRTD implanted patients provided with this algorhythm. Measurements of the aortic Velocity Time Integral (aVTI) were performed with both methods in a random order at pre-discharge, 6-month and 12-month follow-up. RESULTS Fifty-three patients were studied (46 males; age 68 ± 10y; EF 28 ± 7%). Maximum aVTI obtained by echocardiography at different AV delays, were compared with aVTI acquired at AV delays suggested by QuickOpt. The AV Pearson correlations were 0.96 at pre-discharge, 0.95 and 0,98 at 6- and 12- month follow-up respectively. After programming optimal AV, the same approach was used to compare echocardiographic aVTI with aVTI corresponding to the VV values provided by QuickOpt. The VV Pearson Correlation were 0,92 at pre-discharge, 0,88 and 0.90 at 6-month and 12- month follow-up respectively. CONCLUSIONS IEGM-based optimization provides comparable results with echocardiographic method (maximum aVTI) used as reference with mid-septum RV lead location.
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Warriner DR, Lawford P, Sheridan PJ. Measures of endothelial dysfunction predict response to cardiac resynchronisation therapy. Open Heart 2016; 3:e000391. [PMID: 27335654 PMCID: PMC4908901 DOI: 10.1136/openhrt-2015-000391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 02/09/2016] [Accepted: 02/23/2016] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Cardiac resynchronisation therapy (CRT) improves morbidity and mortality in heart failure (HF). Impaired endothelial function, as measured by flow-mediated dilation (FMD) is associated with increased morbidity and mortality in HF and may help to differentiate responders from non-responders. METHODS 19 patients were recruited, comprising 94% men, mean age 69±8 years, New York Heart Association functional classes II-IV, QRSd 161±21 ms and mean left ventricular ejection fraction 26±8%. Markers of response and FMD were measured at baseline, 6 and 12 months following CRT. RESULTS 14 patients were responders to CRT. Responders had significant improvements in VO2 (12.6±1.7 to 14.7±1.5 mL/kg/min, p<0.05), quality of life score (44.4±22.9-24.1±21.3, p<0.01), left ventricular end diastolic volume (201.5±72.5 mL-121.3±72.0 mL, p<0.01) and 6-min walk distance (374.0±112.8 m at baseline to 418.1±105.3 m, p<0.05). Baseline FMD in responders was 2.9±1.9% and 7.4±3.73% in non-responders (p<0.05). CONCLUSIONS Response to CRT at 6 and 12 months is predicted by baseline FMD. This study confirms that FMD identifies responders to CRT, due to endothelium-dependent mechanisms alone.
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Affiliation(s)
- David R Warriner
- Medical Physics Group, Department of Cardiovascular Science, University of Sheffield, Sheffield, UK; Department of Cardiology, Northern General Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Patricia Lawford
- Medical Physics Group, Department of Cardiovascular Science , University of Sheffield , Sheffield , UK
| | - Paul J Sheridan
- Medical Physics Group, Department of Cardiovascular Science, University of Sheffield, Sheffield, UK; Department of Cardiology, Northern General Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
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Abstract
Phase analysis of gated myocardial perfusion single-photon emission computed tomography is a widely available and reproducible measure of left ventricular (LV) dyssynchrony, which also provides comprehensive assessment of LV function, global and regional scar burden, and patterns of LV mechanical activation. Preliminary studies indicate potential use in predicting cardiac resynchronization therapy response and elucidation of mechanisms. Because advances in technology may expand capabilities for precise LV lead placement in the future, identification of specific patterns of dyssynchrony may have a critical role in guiding cardiac resynchronization therapy.
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25
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Kutyifa V, Moss AJ, Solomon SD, McNitt S, Aktas MK, Barsheshet A, Merkely B, Zareba W, Goldenberg I. Reduced risk of life-threatening ventricular tachyarrhythmias with cardiac resynchronization therapy: relationship to left ventricular ejection fraction. Eur J Heart Fail 2015; 17:971-8. [DOI: 10.1002/ejhf.311] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 04/17/2015] [Accepted: 04/23/2015] [Indexed: 11/08/2022] Open
Affiliation(s)
| | - Arthur J. Moss
- University of Rochester Medical Center; Rochester NY USA
| | - Scott D. Solomon
- Brigham and Women's Hospital, Harvard Medical School; Boston MA USA
| | - Scott McNitt
- University of Rochester Medical Center; Rochester NY USA
| | | | - Alon Barsheshet
- University of Rochester Medical Center; Rochester NY USA
- Cardiology Department, Rabin Medical Center, Petah Tiqva, and Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Bela Merkely
- Semmelweis University, Heart Center; Budapest Hungary
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26
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Eschalier R, Ploux S, Ritter P, Haïssaguerre M, Ellenbogen KA, Bordachar P. Nonspecific intraventricular conduction delay: Definitions, prognosis, and implications for cardiac resynchronization therapy. Heart Rhythm 2015; 12:1071-9. [DOI: 10.1016/j.hrthm.2015.01.023] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Indexed: 11/26/2022]
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Eschalier R, Ploux S, Lumens J, Whinnett Z, Varma N, Meillet V, Ritter P, Jaïs P, Haïssaguerre M, Bordachar P. Detailed analysis of ventricular activation sequences during right ventricular apical pacing and left bundle branch block and the potential implications for cardiac resynchronization therapy. Heart Rhythm 2015; 12:137-43. [DOI: 10.1016/j.hrthm.2014.09.059] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Indexed: 11/29/2022]
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28
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Kutyifa V, Geller L, Bogyi P, Zima E, Aktas MK, Ozcan EE, Becker D, Nagy VK, Kosztin A, Szilagyi S, Merkely B. Effect of cardiac resynchronization therapy with implantable cardioverter defibrillator versus cardiac resynchronization therapy with pacemaker on mortality in heart failure patients: results of a high-volume, single-centre experience. Eur J Heart Fail 2014; 16:1323-30. [PMID: 25379962 PMCID: PMC4309510 DOI: 10.1002/ejhf.185] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 07/10/2014] [Accepted: 07/11/2014] [Indexed: 11/10/2022] Open
Abstract
Aims There are limited and contradictory data on the effects of CRT with implantable cardioverter defibrillator (CRT-D) on mortality as compared with CRT with pacemaker (CRT-P). Methods and results We evaluated the long-term outcome of patients implanted with a CRT-D or CRT-P device in our high-volume single-centre experience. Data on all-cause mortality were derived from clinic visits and the Hungarian National Healthcare Fund Death Registry. Kaplan–Meier survival analyses and multivariate Cox regression models were used to evaluate all-cause mortality in patients with CRT-D vs. CRT-P, stratified by the aetiology of cardiomyopathy. From 2000 to 2011, 1122 CRT devices, 693 CRT-P (LVEF 28.2 ± 7.4%) and 429 CRT-D (LVEF 27.6 ± 6.4%), were implanted at our centre. During the median follow-up of 28 months, 379 patients died from any cause, 250 patients (36%) with an implanted CRT-P and 129 patients (30%) with an implanted CRT-D. There was no evidence of mortality benefit in patients implanted with a CRT-D compared with a CRT-P in the total cohort [hazard ratio (HR) 0.98, 95% confidence interval (CI) 0.73–1.32, P = 0.884]. In patients with ischaemic cardiomyopathy, CRT-D treatment was associated with a significant 30% risk reduction in all-cause mortality compared with an implanted CRT-P (HR 0.70, 95% CI 0.51–0.97, P = 0.03). In non-ischaemic patients, there was no mortality benefit of CRT-D over CRT-P (HR 0.98, 95% CI 0.73–1.32, P = 0.894, interaction P-value = 0.15). Conclusions In heart failure patients with ischaemic cardiomyopathy, CRT-D was associated with a mortality benefit compared with CRT-P, but no benefit of CRT-D over CRT-P in mortality was observed in non-ischaemic cardiomyopathy.
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Affiliation(s)
- Valentina Kutyifa
- Semmelweis University, Heart and Vascular Center, Budapest, Hungary; University of Rochester, Medical Center, Rochester, NY, USA
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Bowater RJ, Hartley LC, Lilford RJ. Are cardiovascular trial results systematically different between North America and Europe? A study based on intra-meta-analysis comparisons. Arch Cardiovasc Dis 2014; 108:23-38. [PMID: 24997733 DOI: 10.1016/j.acvd.2014.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 03/24/2014] [Accepted: 03/25/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND It is often assumed that differences in the efficacy of treatments between countries (or regions) will be neither negligible nor minor and therefore cannot be overlooked when assessing the potential benefit of treatments in one country (or region) on the basis of trials conducted in another country (or region). AIM To assess differences in the results of cardiovascular trials between Europe and North America on the basis of data from an extensive collection of trials. METHODS A systematic search was conducted of Medline (from the year 2005 to 2008) and the Cochrane Library (from 2000 to 2008) for all meta-analyses of randomized controlled trials aimed at treating and preventing cardiovascular disease. Within each meta-analysis that satisfied given criteria, trial results were compared between Europe and North America with respect to a fatal and/or non-fatal endpoint by forming separate estimates of treatment efficacy for each of these continents. RESULTS The literature search found 59 meta-analyses that satisfied all the inclusion criteria. For most meta-analyses, it was the case that relative to the control, the intervention was more favoured in trials conducted in Europe than in North America with regard to both fatal endpoints (28 out of 43 meta-analyses) and non-fatal endpoints (28 out of 40 meta-analyses). However, it was only with regard to non-fatal endpoints that this imbalance turned out to be statistically significant at the 5% level (P=0.017). Also, the lack of statistically significant differences in trial results between Europe and North America within individual meta-analyses meant that it was not possible to determine for which types of intervention these intercontinental differences are likely to be more pronounced than others. CONCLUSION There is some evidence to support the theory that, relative to controls, interventions are more favoured in cardiovascular trials conducted in Europe than in North America, when treatment efficacy is measured in terms of a non-fatal endpoint. However, the overall support for systematic differences in cardiovascular trial results between Europe and North America is weak, which may be surprising given the amount of data collected.
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Affiliation(s)
- Russell J Bowater
- Faculty of Engineering, Universidad Autónoma de Querétaro, Cerro de las Campanas s/n, Col. Las Campanas, C.P. 76010, Santiago de Querétaro, Querétaro, Mexico.
| | - Louise C Hartley
- Statistics and Epidemiology, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Richard J Lilford
- Department of Public Health, Epidemiology & Biostatistics, University of Birmingham, Edgbaston, Birmingham, UK
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Foley PW, Chalil S, Khadjooi K, Irwin N, Smith RE, Leyva F. Left ventricular reverse remodelling, long-term clinical outcome, and mode of death after cardiac resynchronization therapy. Eur J Heart Fail 2014; 13:43-51. [DOI: 10.1093/eurjhf/hfq182] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Paul W.X. Foley
- Centre for Cardiovascular Sciences; University of Birmingham, Queen Elizabeth Hospital; Birmingham UK
| | - Shajil Chalil
- Centre for Cardiovascular Sciences; University of Birmingham, Queen Elizabeth Hospital; Birmingham UK
| | - Kayvan Khadjooi
- Department of Cardiology; Good Hope Hospital; Sutton Coldfield UK
| | - Nick Irwin
- Department of Cardiology; Good Hope Hospital; Sutton Coldfield UK
| | - Russell E.A. Smith
- Centre for Cardiovascular Sciences; University of Birmingham, Queen Elizabeth Hospital; Birmingham UK
| | - Francisco Leyva
- Centre for Cardiovascular Sciences; University of Birmingham, Queen Elizabeth Hospital; Birmingham UK
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Cleland JG, Coletta AP, Buga L, Antony R, Pellicori P, Freemantle N, Clark AL. Clinical trials update from the American Heart Association Meeting 2010: EMPHASIS-HF, RAFT, TIM-HF, Tele-HF, ASCEND-HF, ROCKET-AF, and PROTECT. Eur J Heart Fail 2014; 13:460-5. [DOI: 10.1093/eurjhf/hfr015] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- John G.F. Cleland
- Department of Cardiology, Hull York Medical School, Daisy Building; University of Hull, Castle Hill Hospital; Cottingham Kingston-upon-Hull HU16 5JQ UK
| | - Alison P. Coletta
- Department of Cardiology, Hull York Medical School, Daisy Building; University of Hull, Castle Hill Hospital; Cottingham Kingston-upon-Hull HU16 5JQ UK
| | - Laszlo Buga
- Department of Cardiology, Hull York Medical School, Daisy Building; University of Hull, Castle Hill Hospital; Cottingham Kingston-upon-Hull HU16 5JQ UK
| | - Renjith Antony
- Department of Cardiology, Hull York Medical School, Daisy Building; University of Hull, Castle Hill Hospital; Cottingham Kingston-upon-Hull HU16 5JQ UK
| | - Pierpaolo Pellicori
- Department of Cardiology, Hull York Medical School, Daisy Building; University of Hull, Castle Hill Hospital; Cottingham Kingston-upon-Hull HU16 5JQ UK
| | - Nick Freemantle
- School of Health and Population Sciences; University of Birmingham; Edgbaston Birmingham B15 2TT UK
| | - Andrew L. Clark
- Department of Cardiology, Hull York Medical School, Daisy Building; University of Hull, Castle Hill Hospital; Cottingham Kingston-upon-Hull HU16 5JQ UK
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Bogaard MD, Houthuizen P, Bracke FA, Doevendans PA, Prinzen FW, Meine M, van Gelder BM. Baseline left ventricular dP
/dt
max
rather than the acute improvement in dP
/dt
max
predicts clinical outcome in patients with cardiac resynchronization therapy. Eur J Heart Fail 2014; 13:1126-32. [DOI: 10.1093/eurjhf/hfr094] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Margot D. Bogaard
- Department of Cardiology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Patrick Houthuizen
- Department of Cardiology; Catharina Hospital; Eindhoven The Netherlands
- Department of Physiology, Cardiovascular Research Institute Maastricht; Maastricht University Medical Center; Maastricht The Netherlands
| | - Frank A. Bracke
- Department of Cardiology; Catharina Hospital; Eindhoven The Netherlands
| | - Pieter A. Doevendans
- Department of Cardiology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Frits W. Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht; Maastricht University Medical Center; Maastricht The Netherlands
| | - Mathias Meine
- Department of Cardiology; University Medical Center Utrecht; Utrecht The Netherlands
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Schaer BA, Osswald S, Di Valentino M, Soliman OI, Sticherling C, ten Cate FJ, Jordaens L, Theuns DA. Close connection between improvement in left ventricular function by cardiac resynchronization therapy and the incidence of arrhythmias in cardiac resynchronization therapy-defibrillator patients. Eur J Heart Fail 2014; 12:1325-32. [DOI: 10.1093/eurjhf/hfq171] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Beat A. Schaer
- Department of Cardiology; University of Basel Hospital; Petersgraben 4, 4031 Basel Switzerland
- Department of Cardiology; Thoraxcenter, Erasmus Medical Center; Rotterdam The Netherlands
| | - Stefan Osswald
- Department of Cardiology; University of Basel Hospital; Petersgraben 4, 4031 Basel Switzerland
| | - Marcello Di Valentino
- Department of Cardiology; University of Basel Hospital; Petersgraben 4, 4031 Basel Switzerland
| | - Osama I. Soliman
- Department of Cardiology; Thoraxcenter, Erasmus Medical Center; Rotterdam The Netherlands
| | - Christian Sticherling
- Department of Cardiology; University of Basel Hospital; Petersgraben 4, 4031 Basel Switzerland
| | - Folkert J. ten Cate
- Department of Cardiology; Thoraxcenter, Erasmus Medical Center; Rotterdam The Netherlands
| | - Luc Jordaens
- Department of Cardiology; Thoraxcenter, Erasmus Medical Center; Rotterdam The Netherlands
| | - Dominic A. Theuns
- Department of Cardiology; Thoraxcenter, Erasmus Medical Center; Rotterdam The Netherlands
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Chattopadhyay S, Alamgir MF, Nikitin NP, Fraser AG, Clark AL, Cleland JG. The effect of pharmacological stress on intraventricular dyssynchrony in left ventricular systolic dysfunction. Eur J Heart Fail 2014; 10:412-20. [DOI: 10.1016/j.ejheart.2008.02.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2007] [Revised: 12/03/2007] [Accepted: 02/04/2008] [Indexed: 10/22/2022] Open
Affiliation(s)
| | | | | | | | - Andrew L. Clark
- Department of Cardiology; University of Hull; Kingston-upon-Hull UK
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Braunschweig F, Hauptman PJ. Cardiac resynchronization therapy in the intensive care setting; the promise and peril of using implantable devices off label. Eur J Heart Fail 2014; 10:220-1. [DOI: 10.1016/j.ejheart.2008.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2008] [Accepted: 02/06/2008] [Indexed: 01/28/2023] Open
Affiliation(s)
- Frieder Braunschweig
- Karolinska Institutet, Department of Cardiology; Karolinska University Hospital; Stockholm Sweden
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Cleland JG, Abraham WT, Linde C, Gold MR, Young JB, Claude Daubert J, Sherfesee L, Wells GA, Tang AS. An individual patient meta-analysis of five randomized trials assessing the effects of cardiac resynchronization therapy on morbidity and mortality in patients with symptomatic heart failure. Eur Heart J 2013; 34:3547-56. [PMID: 23900696 PMCID: PMC3855551 DOI: 10.1093/eurheartj/eht290] [Citation(s) in RCA: 373] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 06/24/2013] [Accepted: 07/04/2013] [Indexed: 12/25/2022] Open
Abstract
AIMS Cardiac resynchronization therapy (CRT) with or without a defibrillator reduces morbidity and mortality in selected patients with heart failure (HF) but response can be variable. We sought to identify pre-implantation variables that predict the response to CRT in a meta-analysis using individual patient-data. METHODS AND RESULTS An individual patient meta-analysis of five randomized trials, funded by Medtronic, comparing CRT either with no active device or with a defibrillator was conducted, including the following baseline variables: age, sex, New York Heart Association class, aetiology, QRS morphology, QRS duration, left ventricular ejection fraction (LVEF), and systolic blood pressure. Outcomes were all-cause mortality and first hospitalization for HF or death. Of 3782 patients in sinus rhythm, median (inter-quartile range) age was 66 (58-73) years, QRS duration was 160 (146-176) ms, LVEF was 24 (20-28)%, and 78% had left bundle branch block. A multivariable model suggested that only QRS duration predicted the magnitude of the effect of CRT on outcomes. Further analysis produced estimated hazard ratios for the effect of CRT on all-cause mortality and on the composite of first hospitalization for HF or death that suggested increasing benefit with increasing QRS duration, the 95% confidence bounds excluding 1.0 at ∼140 ms for each endpoint, suggesting a high probability of substantial benefit from CRT when QRS duration exceeds this value. CONCLUSION QRS duration is a powerful predictor of the effects of CRT on morbidity and mortality in patients with symptomatic HF and left ventricular systolic dysfunction who are in sinus rhythm. QRS morphology did not provide additional information about clinical response. CLINICALTRIALSGOV NUMBERS NCT00170300, NCT00271154, NCT00251251.
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Affiliation(s)
- John G. Cleland
- National Heart and Lung Institute, Imperial College London (Royal Brompton & Harefield Hospitals) and Department of Cardiology, Castle Hill Hospital, University of Hull, Kingston-upon-Hull, UK
| | - William T. Abraham
- Division of Cardiovascular Medicine and the Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, USA
| | - Cecilia Linde
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | | | - James B. Young
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | | | | | | | - Anthony S.L. Tang
- The Island Medical Program, University of British Columbia, Vancouver, Canada
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Carroll SL, McGillion M, Stacey D, Healey JS, Browne G, Arthur HM, Thabane L. Development and feasibility testing of decision support for patients who are candidates for a prophylactic implantable defibrillator: a study protocol for a pilot randomized controlled trial. Trials 2013; 14:346. [PMID: 24148851 PMCID: PMC4015905 DOI: 10.1186/1745-6215-14-346] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 10/08/2013] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Patients, identified to be at risk for but who have never experienced a potentially lethal cardiac arrhythmia, have the option of receiving an implantable cardioverter defibrillator (ICD) as prophylaxis against sudden cardiac death - a primary prevention indication. In Canada, there is no clear framework to support patients' decision-making for these devices. Decision support, using a decision aid, could moderate treatment-related uncertainty and prepare patients to make well-informed decisions. Patient decision aids provide information on treatment options, risks, and benefits, to help patients clarify their values for outcomes of treatment options. The objectives of this research are: 1) develop a decision aid, 2) evaluate the decision aid, and 3) determine the feasibility of conducting a trial. METHODS/DESIGN A development panel comprised of the core investigative team, health service researchers, decision science experts, cardiovascular healthcare practitioners, and ICD patient representatives will collaborate to provide input on the content and format of the aid. To generate probabilities to include in the aid, we will synthesize primary prevention ICD evidence. To obtain anonymous input about the facts and content, we will employ a modified Delphi process. To evaluate the draft decision aid will invite ICD patients and their families (n = 30) to rate its acceptability. After we evaluate the aid, to determine the feasibility, we will conduct a feasibility pilot randomized controlled trial (RCT) in new ICD candidates (n = 80). Participants will be randomized to receive a decision aid prior to specialist consultation versus usual care. Results from the pilot RCT will determine the feasibility of research processes; inform sample size calculation, measure decision quality (knowledge, values, decision conflict) and the influence of health related quality of life on decision-making. DISCUSSION Our study seeks to develop a decision aid, for patients offered their first ICD for prophylaxis against sudden cardiac death. This paper outlines the background and methods of a pilot randomized trial which will inform a larger multicenter trial. Ultimately, decision support prior to specialist consultation could enhance the decision-making process between patients, physicians, and families, associated with life-prolonging medical devices like the ICD. TRIAL REGISTRATION ClinicalTrials.gov: NCT01876173.
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Affiliation(s)
- Sandra L Carroll
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Michael McGillion
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Heart and Stroke Foundation/Michael G DeGroote Endowed Chair in Cardiovascular Nursing, Hamilton, ON, Canada
| | - Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
- University Research Chair in Knowledge Translation to Patients, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Jeff S Healey
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada
- Hamilton Health Sciences, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Gina Browne
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Heather M Arthur
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Hamilton Health Sciences, Hamilton, ON, Canada
| | - Lehana Thabane
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada
- Departments of Clinical Epidemiology and Biostatistics, Pediatrics and Anesthesia, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit, St Joseph’s Healthcare - Hamilton, Hamilton, ON, Canada
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Toniolo M, Zanotto G, Rossi A, Tomasi L, Prioli MA, Vassanelli C. Long-term independent predictors of positive response to cardiac resynchronization therapy. J Cardiovasc Med (Hagerstown) 2013; 14:301-7. [PMID: 22395028 DOI: 10.2459/jcm.0b013e328351f243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Cardiac resynchronization therapy (CRT) is currently considered an important breakthrough in the treatment of selected patients with refractory heart failure. However, long-term predictors of mortality, morbidity and time to recovery of ventricular function for those patients who respond positively to CRT remain poorly investigated. METHODS This is a retrospective follow-up study involving one hospital. Between August 2004 and October 2008, 211 consecutive patients with refractory heart failure received a CRT device in the Cardiology Division of Ospedale Civile Maggiore in Verona. The clinical characteristics studied were age, sex, heart rhythm, left ventricular end-systolic volume/body surface area (LVESV/BSA), left ventricular ejection fraction, QRS duration, type of bundle-branch block, cause, New York Heart Failure Association functional class, pharmacological therapy and lead position. The objective of this study was to evaluate the effect of several baseline characteristics on long-term prognosis in heart failure patients treated with CRT. RESULTS Nonischemic cause, left bundle-branch block and a basal LVESV/BSA of 106 ml/m or less were the only independent predictors of a positive response to CRT (P < 0.005). Additionally, a reduction in LVESV/BSA after CRT was associated both with increased survival and reduced rehospitalization for heart failure (P < 0.005). CONCLUSION A better selection of patients on the basis of cause, type of bundle-branch block and basal LVESV/BSA can increase the number of patients that would benefit from CRT.
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Affiliation(s)
- Mauro Toniolo
- Division of Cardiology, Department of Biomedical and Surgical Sciences, University of Verona, Verona, Italy
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MANNE MAHESH, RICKARD JOHN, VARMA NIRAJ, CHUNG MINAK, TCHOU PATRICK. Normalization of Left Ventricular Ejection Fraction after Cardiac Resynchronization Therapy Also Normalizes Survival. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 36:970-7. [DOI: 10.1111/pace.12174] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Revised: 03/03/2013] [Accepted: 04/02/2013] [Indexed: 11/27/2022]
Affiliation(s)
- MAHESH MANNE
- Department of Internal Medicine; Cleveland Clinic; Cleveland; Ohio
| | - JOHN RICKARD
- Division of Cardiology; Johns Hopkins Bayview Medical Center; Baltimore; Maryland
| | - NIRAJ VARMA
- Department of Cardiovascular Medicine; Heart and Vascular Institute; Cleveland Clinic; Cleveland; Ohio
| | - MINA K. CHUNG
- Department of Cardiovascular Medicine; Heart and Vascular Institute; Cleveland Clinic; Cleveland; Ohio
| | - PATRICK TCHOU
- Department of Cardiovascular Medicine; Heart and Vascular Institute; Cleveland Clinic; Cleveland; Ohio
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van der Heide JA, Aly MFA, Kleijn SA, van Dijk J, Kamp O. A new quantification method for mechanical dyssynchrony with three-dimensional echocardiography; segmental time and volume loss for prediction of response to cardiac resynchronisation therapy. Int J Cardiovasc Imaging 2013; 28:1895-904. [PMID: 22302648 PMCID: PMC3485531 DOI: 10.1007/s10554-012-0019-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2011] [Accepted: 01/17/2012] [Indexed: 01/22/2023]
Abstract
A novel method to assess left ventricular (LV) mechanical dyssynchrony using three-dimensional echocardiography (3DE) and semi-automated border detection was investigated, which might be superior in prediction of response to cardiac resynchronisation therapy (CRT) compared to traditional measures that rely solely on segmental time-to-contraction. Twenty-eight heart failure patients underwent real-time 3DE before CRT and at 6–12 months follow-up. Analysis of 3DE was performed using TomTec Research-Arena software featuring semi-automated endocardial border detection. The following echocardiographic parameters were calculated in a 16-segment model: areas under segmental time-volume-curves (STV); delay between contraction of the earliest and latest segment (L-E); and standard deviation of segmental time-to-contraction (SDI). Response to CRT was defined as ≥10% decrease in LV end-systolic volume at follow-up. Baseline Pre-STV had a higher sensitivity than SDI for prediction of response (94 vs 67%, respectively), with equal specificity (78%) and a higher area under receiver operator characteristic curve. In contrast, L-E had a sensitivity of 83% and a specificity of 56%. Using 3DE, methods that combine segmental time-to-contraction with segmental contractility might improve LV dyssynchrony assessment compared to traditional methods based on segmental time-to-contraction alone. Pre-STV might be a better predictor of response to CRT than SDI.
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Affiliation(s)
- J. A. van der Heide
- Department of Cardiology, Institute for Cardiovascular Research (IcaR-VU), VU Medical Center, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Department of Cardiology, Institute for Cardiovascular Research (IcaR-VU), VU Medical Center, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - M. F. A. Aly
- Department of Cardiology, Institute for Cardiovascular Research (IcaR-VU), VU Medical Center, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Department of Cardiology, Institute for Cardiovascular Research (IcaR-VU), VU Medical Center, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - S. A. Kleijn
- Department of Cardiology, Institute for Cardiovascular Research (IcaR-VU), VU Medical Center, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Department of Cardiology, Institute for Cardiovascular Research (IcaR-VU), VU Medical Center, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - J. van Dijk
- Department of Cardiology, Institute for Cardiovascular Research (IcaR-VU), VU Medical Center, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Department of Cardiology, Institute for Cardiovascular Research (IcaR-VU), VU Medical Center, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - O. Kamp
- Department of Cardiology, Institute for Cardiovascular Research (IcaR-VU), VU Medical Center, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Department of Cardiology, Institute for Cardiovascular Research (IcaR-VU), VU Medical Center, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
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Bertoldi EG, Rohde LE, Zimerman LI, Pimentel M, Polanczyk CA. Cost-effectiveness of cardiac resynchronization therapy in patients with heart failure: The perspective of a middle-income country's public health system. Int J Cardiol 2013; 163:309-315. [DOI: 10.1016/j.ijcard.2011.06.046] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Accepted: 06/06/2011] [Indexed: 11/16/2022]
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Jiang M, He B, Zhang Q. Comparison of CRT and CRT-D in heart failure: Systematic review of controlled trials. Int J Cardiol 2012; 158:39-45. [DOI: 10.1016/j.ijcard.2010.12.091] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2010] [Revised: 11/10/2010] [Accepted: 12/24/2010] [Indexed: 10/18/2022]
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Siminiak T, Wu JC, Haude M, Hoppe UC, Sadowski J, Lipiecki J, Fajadet J, Shah AM, Feldman T, Kaye DM, Goldberg SL, Levy WC, Solomon SD, Reuter DG. Treatment of functional mitral regurgitation by percutaneous annuloplasty: results of the TITAN Trial. Eur J Heart Fail 2012; 14:931-8. [PMID: 22613584 PMCID: PMC3403476 DOI: 10.1093/eurjhf/hfs076] [Citation(s) in RCA: 228] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aims Functional mitral regurgitation (FMR) contributes to morbidity and mortality in heart failure (HF) patients. The aim of this study was to determine whether percutaneous mitral annuloplasty could safely and effectively reduce FMR and yield durable long-term clinical benefit. Methods and results The impact of mitral annuloplasty (Carillon Mitral Contour System) was evaluated in HF patients with at least moderate FMR. Patients in whom the device was placed then acutely recaptured for clinical reasons served as a comparator group. Quantitative measures of FMR, left ventricular (LV) dimensions, New York Heart Association (NYHA) class, 6 min walk distance (6MWD), and quality of life were assessed in both groups up to 12 months. Safety and key functional data were assessed in the implanted cohort up to 24 months. Thirty-six patients received a permanent implant; 17 had the device recaptured. The 30-day major adverse event rate was 1.9%. In contrast to the comparison group, the implanted cohort demonstrated significant reductions in FMR as represented by regurgitant volume [baseline 34.5 ±11.5 mL to 17.4 ±12.4 mL at 12 months (P < 0.001)]. There was a corresponding reduction in LV diastolic volume [baseline 208.5 ±62.0 mL to 178.9 ±48.0 mL at 12 months (P =0.015)] and systolic volume [baseline 151.8 ±57.1 mL to 120.7 ±43.2 mL at 12 months (P =0.015)], compared with progressive LV dilation in the comparator. The 6MWD markedly improved for the implanted patients by 102.5 ±164 m at 12 months (P =0.014) and 131.9 ±80 m at 24 months (P < 0.001). Conclusion Percutaneous reduction of FMR using a coronary sinus approach is associated with reverse LV remodelling. Significant clinical improvements persisted up to 24 months.
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Lucchetti G, Lucchetti ALG, Koenig HG. Impact of spirituality/religiosity on mortality: comparison with other health interventions. Explore (NY) 2012; 7:234-8. [PMID: 21724156 DOI: 10.1016/j.explore.2011.04.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Indexed: 11/16/2022]
Abstract
Scientists have been interested in the influence of religion on mortality for at least 130 years. Since this time, many debates have been held by researchers who believe or do not believe in this association. The objective of this study is to compare the impact of spirituality and religiosity (S/R) with other health interventions on mortality. The authors selected 25 well-known health interventions. Then, a search of online medical databases was performed. Meta-analyses between 1994 and 2009 involving mortality were chosen. The same was done for religiosity and spirituality. The combined hazard ratio was obtained directly by the systematic reviews and the mortality reductions by S/R and other health interventions were compared. Twenty-eight meta-analyses with mortality outcomes were selected (25 health interventions and three dealing with S/R). From these three meta-analyses, considering those with the most conservative results, persons with higher S/R had an 18% reduction in mortality. This result is stronger than 60.0% of the 25 systematic reviews analyzed (similar to consumption of fruits and vegetables for cardiovascular events and stronger than statin therapy). These results suggest that S/R plays a considerable role in mortality rate reductions, comparable to fruit and vegetable consumption and statin therapy.
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Tesselaar E, Schiffer A, Widdershoven J, Broers H, Hendriks E, Luijten K, Creusen J. Effect of cardiac resynchronization therapy on endothelium-dependent vasodilatation in the cutaneous microvasculature. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 35:377-84. [PMID: 22268627 DOI: 10.1111/j.1540-8159.2011.03313.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS Cardiac resynchronization therapy (CRT) improves hemodynamic parameters, exercise capacity, symptoms, functional status, and prognosis among patients with chronic heart failure (CHF). The role of the vascular endothelium in these improvements is largely unknown. In this study, we aimed to investigate whether the endothelium-dependent reactivity of the peripheral microcirculation improves in CHF patients during the first 2 months of CRT. METHODS We used local heating and iontophoresis of acetylcholine (ACh) and sodium nitroprusside (SNP) to measure endothelial function and smooth muscle function in the cutaneous microvasculature of 11 CHF patients before and 2 months after CRT. RESULTS We found that the perfusion response in the skin to local heating was increased 2 months post-CRT compared with baseline, both in terms of maximum perfusion (baseline: 113 [90-137] vs 2-months post-CRT: 137 [98-175], P=0.037) and area under curve (baseline: 1,601 [935-2,268] vs 2-months CRT: 2,205 [1,654-2,757], P=0.047). Also, the perfusion response to iontophoresis of ACh was improved (Emax: 23.9 [20.6-26.2]vs at 2-months CRT: 31.2 [29.3-33.4], P=0.005). No difference was found between the responses to SNP before and after CRT. CONCLUSION These results show that CRT improves endothelium-dependent vasodilatory capacity in the peripheral microcirculation within 2 months of therapy. The improvement in functional capacity that is seen in patients treated with CRT may, therefore, be in part mediated by an improvement of endothelium-dependent vasodilatory capacity.
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Affiliation(s)
- Erik Tesselaar
- Department of Clinical Physics, TweeSteden Ziekenhuis, Tilburg, the Netherlands.
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Atherton JJ. Chronic heart failure: we are fighting the battle, but are we winning the war? SCIENTIFICA 2012; 2012:279731. [PMID: 24278681 PMCID: PMC3820562 DOI: 10.6064/2012/279731] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 10/31/2012] [Indexed: 05/04/2023]
Abstract
Heart failure represents an end-stage phenotype of a number of cardiovascular diseases and is generally associated with a poor prognosis. A number of organized battles fought over the last two to three decades have resulted in considerable advances in treatment including the use of drugs that interfere with neurohormonal activation and device-based therapies such as implantable cardioverter defibrillators and cardiac resynchronization therapy. Despite this, the prevalence of heart failure continues to rise related to both the aging population and better survival in patients with cardiovascular disease. Registries have identified treatment gaps and variation in the application of evidenced-based practice, including the use of echocardiography and prescribing of disease-modifying drugs. Quality initiatives often coupled with multidisciplinary, heart failure disease management promote self-care and minimize variation in the application of evidenced-based practice leading to better long-term clinical outcomes. However, to address the rising prevalence of heart failure and win the war, we must also turn our attention to disease prevention. A combined approach is required that includes public health measures applied at a population level and screening strategies to identify individuals at high risk of developing heart failure in the future.
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Affiliation(s)
- John J. Atherton
- Cardiology Department, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD 4006, Australia
- School of Medicine, University of Queensland, Brisbane, QLD 4006, Australia
- *John J. Atherton:
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Bertoldi EG, Polanczyk CA, Cunha V, Ziegelmann PK, Beck-da-Silva L, Rohde LE. Mortality Reduction of Cardiac Resynchronization and Implantable Cardioverter-Defibrillator Therapy in Heart Failure: An Updated Meta-Analysis. Does Recent Evidence Change the Standard of Care? J Card Fail 2011; 17:860-6. [DOI: 10.1016/j.cardfail.2011.06.372] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 05/24/2011] [Accepted: 06/08/2011] [Indexed: 10/18/2022]
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Hasan A, Sun B. Defibrillators and Cardiac Resynchronization Therapy as a Bridge to Cardiac Transplantation. Heart Fail Clin 2011; 7:227-39, viii-ix. [DOI: 10.1016/j.hfc.2011.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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TABEREAUX PAULB, DOPPALAPUDI HARISH, KAY GNEAL, MCELDERRY HTHOMAS, PLUMB VANCEJ, EPSTEIN ANDREWE. Limited Response to Cardiac Resynchronization Therapy in Patients with Concomitant Right Ventricular Dysfunction. J Cardiovasc Electrophysiol 2010; 21:431-5. [DOI: 10.1111/j.1540-8167.2009.01634.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Clemens M, Nagy-Baló E, Herczku C, Karányi Z, Édes I, Csanádi Z. Correlation of body mass index and responder status in heart failure patients after cardiac resynchronization therapy: Does the obesity paradox exist? Interv Med Appl Sci 2010. [DOI: 10.1556/imas.2.2010.1.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Aims: We investigated the influence of body mass index (BMI) on the prevalence of responder status in chronic heart failure patients after cardiac resynchronization therapy (CRT).
Methods: Data on 169 patients with resynchronization therapy were analyzed. Patients were categorized on the basis of the BMI measured at device implantation according to the WHO classification, as normal (BMI: 18.5–24.9 kg/m2), overweight (BMI: 25–29.9 kg/m2) or obese (BMI:≥30 kg/m2). Patients were considered responders if left ventricular ejection fraction was increased by at least 5% at 6-month follow-up.
Results: The mean age in the study population was 60.9±10.86 years (females 29%). The BMI subgroups did not exhibit any significant differences in baseline characteristics (age, gender, left ventricular ejection fraction or NYHA class). Elevated BMIs were associated with higher prevalence of responder status (overweight: 71.4%, obese: 63.0%) relative to subjects with a normal BMI (44.7%) (p=0.015).
Conclusions: In this CRT population, overweight status was associated with a more favorable response to CRT, indicating that the response may possibly be influenced by factors other than those directly related to the heart status or the technical details of the CRT.
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Affiliation(s)
- Marcell Clemens
- 1 Department of Cardiology, University of Debrecen, Debrecen, Hungary
- 3 Department of Cardiology, University of Debrecen, Móricz Zs. krt. 22, H-4032, Debrecen, Hungary
| | - E. Nagy-Baló
- 1 Department of Cardiology, University of Debrecen, Debrecen, Hungary
| | - Cs. Herczku
- 1 Department of Cardiology, University of Debrecen, Debrecen, Hungary
| | - Zs. Karányi
- 2 Department of Internal Medicine, University of Debrecen, Debrecen, Hungary
| | - I. Édes
- 1 Department of Cardiology, University of Debrecen, Debrecen, Hungary
| | - Z. Csanádi
- 1 Department of Cardiology, University of Debrecen, Debrecen, Hungary
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