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Amaral Marques C, Laura Costa A, Martins E. Left bundle branch block-induced dilated cardiomyopathy: Definitions, pathophysiology, and therapy. Rev Port Cardiol 2024:S0870-2551(24)00081-7. [PMID: 38615881 DOI: 10.1016/j.repc.2024.02.004] [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: 05/03/2023] [Revised: 11/18/2023] [Accepted: 02/07/2024] [Indexed: 04/16/2024] Open
Abstract
Left bundle branch block (LBBB) is a frequent finding in patients with heart failure (HF), particularly in those with dilated cardiomyopathy (DCM). LBBB has been commonly described as a consequence of DCM development. However, a total recovery of left ventricular (LV) function after cardiac resynchronization therapy (CRT), observed in patients with LBBB and DCM, has led to increasing acknowledgement of LBBB-induced dilated cardiomyopathy (LBBB-iDCM) as a specific pathological entity. Its recognition has important clinical implications, as LBBB-iDCM patients may benefit from an early CRT strategy rather than medical HF therapy only. At present, there are no definitive diagnostic criteria enabling the universal identification of LBBB-iDCM, and no defined therapeutic approach in this subgroup of patients. This review compiles the main findings about LBBB-iDCM pathophysiology and the current proposed diagnostic criteria and therapeutic approach.
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Affiliation(s)
- Catarina Amaral Marques
- Faculty of Medicine - University of Porto, Porto, Portugal; Department of Cardiology, Centro Hospitalar Universitário São João, Porto, Portugal.
| | | | - Elisabete Martins
- Faculty of Medicine - University of Porto, Porto, Portugal; Department of Cardiology, Centro Hospitalar Universitário São João, Porto, Portugal
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2
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Kloosterman M, Loh KP, van Veen TAB. Left bundle branch block-induced cardiomyopathy: A distinctive form of cardiomyopathy that might require a dedicated form of treatment. Heart Rhythm 2024:S1547-5271(24)02376-2. [PMID: 38608919 DOI: 10.1016/j.hrthm.2024.04.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 04/08/2024] [Indexed: 04/14/2024]
Affiliation(s)
- Manon Kloosterman
- Division of Heart & Lungs, Department of Cardiology, University Medical Center Utrecht, The Netherlands
| | - K Peter Loh
- Division of Heart & Lungs, Department of Cardiology, University Medical Center Utrecht, The Netherlands
| | - Toon A B van Veen
- Division of Heart & Lungs, Department of Medical Physiology, University Medical Center Utrecht, The Netherlands.
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3
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NESTI M, RICCIARDI G, PIERAGNOLI P, FUMAGALLI S, PADELETTI M, PERINI AP, CAVARRETTA E, SCIARRA L. Incidence of ventricular arrhythmias after biventricular defibrillator replacement: impact on safety of downgrading from CRT-D to CRT-P. Minerva Cardiol Angiol 2022; 70:447-454. [DOI: 10.23736/s2724-5683.20.05352-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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4
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García-Rodeja Arias F, Gómez Otero MI, Bouzas Cruz N, García VEGA D, González Ferrero T, Minguito-Carazo C, Martínez Monzonís A, González Juanatey JR, Rodríguez-Mañero M. Effects of guideline-directed medical therapy in patients with left bundle branch block-induced cardiomyopathy. REVISTA ESPAÑOLA DE CARDIOLOGÍA (ENGLISH EDITION) 2022; 76:238-244. [PMID: 35878779 DOI: 10.1016/j.rec.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/07/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND OBJECTIVES Left bundle branch block (LBBB)-induced cardiomyopathy occurs in patients with long-standing LBBB. These patients characteristically exhibit hyperresponsiveness to cardiac resynchronization therapies (CRT). However, there is scarce information on their response to medical treatment. The aim of this study was to assess the change in left ventricular ejection fraction (LVEF) after a 3-month period following titration of guideline-directed medical therapy for heart failure. METHODS This retrospective analysis included all patients assessed in the heart failure unit of a Spanish University Hospital between 2020 and 2021, who presented with de novo ventricular dysfunction (LVEF <40%) and had a history of long-standing LBBB with no other possible causes of cardiomyopathy. RESULTS A total of 1497 patients were analyzed, of which 21 were finally eligible. Mean time from first diagnosis of LBBB to first consultation was 4.05± 4.1 years. Mean LVEF from first consultation to end of titration improved from 29.5±5.7% to 32.7±8.6% (P = .172), but none had recovered ventricular function at the end of follow-up. New York Heart Association functional class improved from 1.91±0.46 to 1.81±0.53 (P=.542). After CRT device implantation in 8 patients, LVEF improved by 18.1±6.4% (P=.003). CONCLUSIONS Guideline-directed medical therapy seems to be ineffective in improving LVEF and functional class in patients with de novo heart failure and LBBB-induced cardiomyopathy. Based on a positive response to CRT on LVEF improvement, early CRT implantation could be a reasonable strategy for these patients.
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Cardiac Resynchronization Therapy in Non-Ischemic Cardiomyopathy: Role of Multimodality Imaging. Diagnostics (Basel) 2021; 11:diagnostics11040625. [PMID: 33808474 PMCID: PMC8066641 DOI: 10.3390/diagnostics11040625] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 03/26/2021] [Accepted: 03/28/2021] [Indexed: 12/28/2022] Open
Abstract
Non-ischemic cardiomyopathy encompasses a heterogeneous group of diseases, with a generally unfavorable long-term prognosis. Cardiac resynchronization therapy (CRT) is a useful therapeutic option for patients with symptomatic heart failure, currently recommended by all available guidelines, with outstanding benefits, especially in non-ischemic dilated cardiomyopathy. Still, in spite of clear indications based on identifying a dyssynchronous pattern on the electrocardiogram (ECG,) a great proportion of patients are non-responders. The idea that multimodality cardiac imaging can play a role in refining the selection criteria and the implant technique and help with subsequent system optimization is promising. In this regard, predictors of CRT response, such as apical rocking and septal flash have been identified. Promising new data come from studies using cardiac magnetic resonance and nuclear imaging for showcasing myocardial dyssynchrony. Still, to date, no single imaging predictor has been included in the guidelines, probably due to lack of validation in large, multicenter cohorts. This review provides an up-to-date synthesis of the latest evidence of CRT use in non-ischemic cardiomyopathy and highlights the potential additional value of multimodality imaging for improving CRT response in this population. By incorporating all these findings into our clinical practice, we can aim toward obtaining a higher proportion of responders and improve the success rate of CRT.
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Ponnusamy SS, Vijayaraman P. Left Bundle Branch Block-induced Cardiomyopathy: Insights From Left Bundle Branch Pacing. JACC Clin Electrophysiol 2021; 7:1155-1165. [PMID: 33812829 DOI: 10.1016/j.jacep.2021.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The aim of the study was to report the efficacy of left bundle branch pacing (LBBP) in the management of left bundle branch block (LBBB)-induced cardiomyopathy (LIC). BACKGROUND Chronic LBBB is known to cause mechanical dyssynchrony and cardiomyopathy. Hyperresponse to cardiac resynchronization therapy (CRT) with biventricular pacing (BVP) is a hallmark of LIC. LBBP has recently shown promise as an alternative to BVP. METHODS Patients undergoing CRT between 2018 and 2020 were retrospectively screened, and those who met the criteria for LIC were included in the study. Duration of LBBB, CRT type, and response were documented. Pacing parameters, and electrocardiographic and echocardiographic data were collected. RESULTS Possible LIC was identified in 17 of 159 patients undergoing CRT and LBBP was successfully performed in 13 patients. Duration of LBBB before left ventricular dysfunction was 4.2 ± 3.9 years. Temporary His bundle pacing corrected underlying LBBB in all patients. During LBBP, there was significant reduction in QRS duration (167.8 ± 11.6 ms to 110.4 ± 13.1 ms; p < 0.0001) and repolarization parameters of QTc, Tpeak-Tend, and Tpeak-Tend/QTc ratio. LBBP threshold and R waves at implant were 0.53 ± 0.21 V/0.5 ms and 11.7 ± 7.1 mV and remained stable. Cardiac magnetic resonance imaging showed no evidence of scar (n = 8). During follow-up, left ventricular ejection fraction improved from 30.4 ± 6.6% to 57.4 ± 4.7% (p < 0.0001) and New York Heart Association functional class improved from 3.1 ± 0.3 to 1.2 ± 0.4 (p < 0.0001) compared with baseline. CONCLUSIONS LBBP is a reasonable option for CRT in patients with LIC, as it provides low and stable capture threshold with complete correction of underlying electrical and mechanical abnormalities associated with LBBB.
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Affiliation(s)
| | - Pugazhendhi Vijayaraman
- Geisinger Heart Institute, Geisinger Commonwealth School of Medicine, Wilkes-Barre, Pennsylvania, USA.
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Zhang N, Cai M, Hua W, Hu Y, Niu H, Cai C, Gu M, Zhang S. Prognostic effects of longitudinal changes in left ventricular ejection fraction with cardiac resynchronization therapy. ESC Heart Fail 2020; 8:368-379. [PMID: 33314797 PMCID: PMC7835623 DOI: 10.1002/ehf2.13082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/26/2020] [Accepted: 10/13/2020] [Indexed: 11/18/2022] Open
Abstract
Aims Left ventricular ejection fraction (LVEF) is considered an indicator of cardiac resynchronization therapy (CRT). Longitudinal studies on the predictive value of LVEF are scarce. We aimed to comprehensively evaluate the prognostic role of LVEF in the outcomes of Chinese patients with CRT. Methods and results Three hundred ninety‐two patients were divided into three tertiles of LVEF: ≤25%, 25–30%, and 30–35%, and four groups by LVEF changes: <0% (negative response); ≥0% and ≤5% (non‐response); >5% and ≤15% (response); and >15% (super‐response). One hundred six patients were super‐responders. During a median follow‐up of 3.6 years, 141 reached the composite endpoint. Odds ratios (ORs) for super‐response depicted a reversed U‐shaped relationship for baseline LVEF with a peak at 25–30%. Independent predictors of super‐response were smaller left atrial diameter [odds ratio 0.897, 95% confidence interval (CI) 0.844–0.955, P = 0.001], smaller left ventricular end‐diastolic diameter (OR 0.937, 95% CI 0.889–0.989, P = 0.018), and higher estimated glomerular filtration rate (OR 1.018, 95% CI 1.001–1.035, P = 0.042) in Tertile 1; atrial fibrillation (OR 0.278, 95% CI 0.086–0.901, P = 0.033), left bundle branch block (OR 4.096, 95% CI 1.046–16.037, P = 0.043), and left ventricular end‐diastolic diameter (OR 0.929, 95% CI 0.876–0.986, P = 0.016) in Tertile 2; while female sex (OR 2.778, 95% CI 1.082–7.132, P = 0.034) and higher systolic blood pressure (OR 1.045, 95% CI 1.013–1.079, P = 0.006) in Tertile 3. An inverse association with the composite endpoint was found in Tertile 1 vs. Tertile 2 (hazard ratio 1.934, 95% CI 1.248–2.996, P = 0.003). The prognostic effects of CRT response in Tertile 3 and Tertile 1 varied significantly (P for trend = 0.017 and <0.001). Among three tertiles in super‐responders, event‐free survival was similar (P for trend = 0.143). Conclusions Left ventricular ejection fraction of 25–30% is associated with a better prognosis of super‐response. Predictors of super‐response are different for LVEF tertiles. CRT responses would have better prognostic performance than LVEF tertiles at baseline, which should be considered when clinicians screening eligible patients for CRT.
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Affiliation(s)
- Nixiao Zhang
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular DiseaseChinese Academy of Medical Sciences and Peking Union Medical CollegeNo. 167 Beilishi Road, Xicheng DistrictBeijing100037China
| | - Minsi Cai
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular DiseaseChinese Academy of Medical Sciences and Peking Union Medical CollegeNo. 167 Beilishi Road, Xicheng DistrictBeijing100037China
| | - Wei Hua
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular DiseaseChinese Academy of Medical Sciences and Peking Union Medical CollegeNo. 167 Beilishi Road, Xicheng DistrictBeijing100037China
| | - Yiran Hu
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular DiseaseChinese Academy of Medical Sciences and Peking Union Medical CollegeNo. 167 Beilishi Road, Xicheng DistrictBeijing100037China
| | - Hongxia Niu
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular DiseaseChinese Academy of Medical Sciences and Peking Union Medical CollegeNo. 167 Beilishi Road, Xicheng DistrictBeijing100037China
| | - Chi Cai
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular DiseaseChinese Academy of Medical Sciences and Peking Union Medical CollegeNo. 167 Beilishi Road, Xicheng DistrictBeijing100037China
| | - Min Gu
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular DiseaseChinese Academy of Medical Sciences and Peking Union Medical CollegeNo. 167 Beilishi Road, Xicheng DistrictBeijing100037China
| | - Shu Zhang
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular DiseaseChinese Academy of Medical Sciences and Peking Union Medical CollegeNo. 167 Beilishi Road, Xicheng DistrictBeijing100037China
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Heart Failure Duration Combined with Left Atrial Dimension Predicts Super-Response and Long-Term Prognosis in Patients with Cardiac Resynchronization Therapy Implantation. BIOMED RESEARCH INTERNATIONAL 2019; 2019:2983752. [PMID: 31341894 PMCID: PMC6613035 DOI: 10.1155/2019/2983752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 05/15/2019] [Indexed: 11/24/2022]
Abstract
Background Response to cardiac resynchronization therapy (CRT) varies significantly among patients. This study aimed to identify baseline characteristics that could predict super-response to CRT and to evaluate the long-term prognosis in super-responders. Methods We retrospectively reviewed the data of 73 consecutive patients who received CRT. Patients were considered as super-responders after 6-month follow-up when NYHA class reduction to I or II combined with left ventricular ejection fraction (LVEF) ≥ 50% was observed. Patients were divided into super-responders group and non-super-responders group. All-cause mortality or hospitalization for heart failure (HF) was referred to the combined end point. Results 17 (23.3%) patients were super-responders. HF duration, left atrial dimension (LAD), and left bundle branch block (LBBB) were independent predictors of super-response to CRT. The combination of HF duration and LAD could provide more robust prediction of super-response than standalone HF duration (0.899 versus 0.789, Z = 2.207, P = 0.027) or standalone LAD (0.899 versus 0.775, Z = 2.487, P = 0.013). super-responders had excellent LV reverse remodeling. The cumulative incidences of combined end point were significantly lower in the super-responders group, LAD ≤ 42mm group, and combination of HF duration ≤ 48 months and LAD ≤ 42mm group. LBBB remained associated with a lowered risk of the combined end point (HR: 0.19, 95% CI: 0.07-0.57, P = 0.003), whereas LAD was associated with a raised risk of the combined end point (HR: 1.09, 95% CI: 1.02-1.17, P = 0.014). Conclusions HF duration, LAD, and LBBB independently predicted super-response. The combination of HF duration and LAD makes more robust prediction of CRT super-response. Super-responders had excellent LV reverse remodeling and decreased the incidences of the combined end point. LBBB and LAD were independently associated with the combined end point.
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Early Use of Cardiac Resynchronization Therapy to Accelerate Symptomatic Relief and Complete Left Ventricular Function Recovery in Peripartum Cardiomyopathy. ACTA ACUST UNITED AC 2019; 55:medicina55060246. [PMID: 31195624 PMCID: PMC6631786 DOI: 10.3390/medicina55060246] [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: 03/10/2019] [Revised: 04/07/2019] [Accepted: 05/30/2019] [Indexed: 11/25/2022]
Abstract
Peripartum cardiomyopathy (PPCM) is a rare cause of heart failure that develops during the last month of pregnancy or within first months of delivery. We report the case of a 40-year-old woman diagnosed with severely symptomatic PPCM characterized by left ventricular ejection fraction (LVEF) of 10% and significant dyssynchrony secondary to a left bundle branch block (LBBB). Early cardiac resynchronization therapy (CRT) was used to achieve remarkable functional and LVEF recovery. This case suggests that early CRT must be considered for patients suffering from severely symptomatic PPCM despite optimal medical therapy for whom advanced heart failure therapies are proposed.
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10
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Sanna GD, Merlo M, Moccia E, Fabris E, Masia SL, Finocchiaro G, Parodi G, Sinagra G. Left bundle branch block-induced cardiomyopathy: a diagnostic proposal for a poorly explored pathological entity. Int J Cardiol 2019; 299:199-205. [PMID: 31186131 DOI: 10.1016/j.ijcard.2019.06.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 05/06/2019] [Accepted: 06/03/2019] [Indexed: 12/21/2022]
Abstract
Despite being increasingly recognized as a specific disease, at the present time left bundle branch block (LBBB)-induced cardiomyopathy is neither formally included among unclassified cardiomyopathies nor among the acquired/non-genetic forms of dilated cardiomyopathy (DCM). Currently, a post-hoc diagnosis of LBBB-induced cardiomyopathy is possible when evaluating patients' response to cardiac resynchronization therapy (CRT). However, an early detection of a LBBB-induced cardiomyopathy could have significant clinical and therapeutic implications. Patients with the aforementioned form of dyssynchronopathy may benefit from early CRT and overall prognosis might be better as compared to patients with a primary muscle cell disorder (i.e. "true" DCM). The real underlying mechanisms, the possible genetic background as well as the early identification of this specific form of DCM remain largely unknown. In this review the complex relationship between LBBB and left ventricular non-ischaemic dysfunction is described. Furthermore, a multiparametric approach based on clinical, electrocardiographic and imaging red flags, is provided in order to allow an early detection of the LBBB-induced cardiomyopathy.
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Affiliation(s)
- Giuseppe D Sanna
- Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy.
| | - Marco Merlo
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata of Trieste "ASUITS", Trieste, Italy
| | - Eleonora Moccia
- Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy
| | - Enrico Fabris
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata of Trieste "ASUITS", Trieste, Italy
| | | | | | - Guido Parodi
- Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata of Trieste "ASUITS", Trieste, Italy.
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Larue-Grondin S, Philippon F, Sarrazin JF, Dubois-Sénéchal SM, Dubois M, Sénéchal M. Very Late Continued Reverse Remodelling After Cardiac Resynchronization Therapy in Patients With Extreme Left Ventricular Dilatation. Can J Cardiol 2017; 33:831.e1-831.e3. [PMID: 28545626 DOI: 10.1016/j.cjca.2017.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 02/06/2017] [Accepted: 02/18/2017] [Indexed: 11/16/2022] Open
Abstract
Response to cardiac resynchronization therapy (CRT) varies greatly among patients. We present 2 patients with severe heart failure symptoms (New York Heart Association class IV) and extreme initial left ventricular (LV) dilatation (LV end-diastolic diameter of 92 mm and 80 mm, respectively) and severe functional mitral regurgitation who underwent CRT device implantation. Long-term follow-up showed late (≥ 4 years) normalization of LV ejection fraction (LVEF), LV dimensions, and functional status. In a subgroup of patients with nonischemic dilated cardiomyopathy and complete left bundle branch block, late continued LV reverse remodelling may lead to normalization of LV volumes and LVEF and significant improvement in functional class.
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Affiliation(s)
- Samuel Larue-Grondin
- Department of Cardiology, Institut universitaire de cardiologie et de pneumologie de Québec, Laval University, Québec City, Québec, Canada
| | - François Philippon
- Department of Cardiology, Institut universitaire de cardiologie et de pneumologie de Québec, Laval University, Québec City, Québec, Canada
| | - Jean-François Sarrazin
- Department of Cardiology, Institut universitaire de cardiologie et de pneumologie de Québec, Laval University, Québec City, Québec, Canada
| | - Sacha-Michelle Dubois-Sénéchal
- Research Center, Institut universitaire de cardiologie et de pneumologie de Québec, Laval University, Québec City, Québec, Canada
| | - Michelle Dubois
- Research Center, Institut universitaire de cardiologie et de pneumologie de Québec, Laval University, Québec City, Québec, Canada
| | - Mario Sénéchal
- Department of Cardiology, Institut universitaire de cardiologie et de pneumologie de Québec, Laval University, Québec City, Québec, Canada.
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Petrovic M, Petrovic M, Milasinovic G, Vujisic Tesic B, Trifunovic D, Petrovic O, Nedeljkovic I, Petrovic I, Banovic M, Boricic-Kostic M, Petrovic J, Arena R, Popovic D. Gauging the response to cardiac resynchronization therapy: The important interplay between predictor variables and definition of a favorable outcome. Echocardiography 2017; 34:371-375. [PMID: 28075037 DOI: 10.1111/echo.13453] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AIMS Selection of patients who are viable candidates for cardiac resynchronization therapy (CRT), prediction of the response to CRT as well as an optimal definition of a favorable response, all require further exploration. The purpose of this study was to evaluate the interplay between the prediction of the response to CRT and the definition of a favorable outcome. METHODS Seventy patients who received CRT were included. All patients met current guideline criteria for CRT. Forty-three echocardiographic parameters were evaluated before CRT and at 1, 3, 6, and 12 months. M-mode, 2D echocardiography, and Doppler imaging were used to quantify left ventricular (LV) systolic and diastolic function, mitral regurgitation, right ventricular systolic function, pulmonary artery pressure, and myocardial mechanical dyssynchrony. The following definitions of a favorable CRT response were used: left ventricular ejection fraction (LVEF) improvement more >5% acutely following CRT, LVEF improvement >20% at 12-month follow-up, and a LV end-systolic volume (LVESV) decrease >15% at 12-month follow-up. RESULTS For the LVEF improvement >5%, the best predictor was isovolumetric relaxation time (IVRT; P=.035). For improvement of LVEF >20%, the best predictors were left ventricular stroke index (LVSI; P=.044) and left ventricular fractional shortening (LVFS; P=.031). For the drop in left ventricular systolic volume (LVESV >15%), the best predictor was septal-to-lateral wall delay (ΔT) (P=.043, RR=1.023, 95% CI for RR=1.001-1.045). CONCLUSION The definition of a favorable CRT response influenced the optimal predictor variable(s). Standardization of defining a favorable response to CRT is needed to guide clinical decision making processes.
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Affiliation(s)
- Milan Petrovic
- Clinic of Cardiology, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marija Petrovic
- Clinic of Cardiology, Clinical Center of Serbia, Belgrade, Serbia
| | - Goran Milasinovic
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Pacemaker Center, Clinical Center of Serbia, Belgrade, Serbia
| | - Bosiljka Vujisic Tesic
- Clinic of Cardiology, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Danijela Trifunovic
- Clinic of Cardiology, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Olga Petrovic
- Clinic of Cardiology, Clinical Center of Serbia, Belgrade, Serbia
| | - Ivana Nedeljkovic
- Clinic of Cardiology, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivana Petrovic
- Clinic of Cardiology, Clinical Center of Serbia, Belgrade, Serbia
| | - Marko Banovic
- Clinic of Cardiology, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Jelena Petrovic
- Clinic of Cardiology, Clinical Center of Serbia, Belgrade, Serbia
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Dejana Popovic
- Clinic of Cardiology, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
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13
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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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14
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Biton Y, Baman JR, Polonsky B. Roles and indications for use of implantable defibrillator and resynchronization therapy in the prevention of sudden cardiac death in heart failure. Heart Fail Rev 2016; 21:433-46. [DOI: 10.1007/s10741-016-9542-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Ajijola OA, Romero J, Vorobiof G, Suh WM, Shivkumar K, Tung R. Hyper-response to cardiac resynchronization with permanent His bundle pacing: Is parahisian pacing sufficient? HeartRhythm Case Rep 2015; 1:429-433. [PMID: 27722091 PMCID: PMC5053391 DOI: 10.1016/j.hrcr.2015.05.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Affiliation(s)
- Olujimi A Ajijola
- UCLA Cardiac Arrhythmia Center, Los Angeles, California; Division of Cardiology, UCLA Health System, University of California, Los Angeles, Los Angeles, California
| | - Jorge Romero
- UCLA Cardiac Arrhythmia Center, Los Angeles, California
| | - Gabriel Vorobiof
- Division of Cardiology, UCLA Health System, University of California, Los Angeles, Los Angeles, California
| | - William M Suh
- Division of Cardiology, UCLA Health System, University of California, Los Angeles, Los Angeles, California
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, Los Angeles, California; Division of Cardiology, UCLA Health System, University of California, Los Angeles, Los Angeles, California
| | - Roderick Tung
- UCLA Cardiac Arrhythmia Center, Los Angeles, California; Division of Cardiology, UCLA Health System, University of California, Los Angeles, Los Angeles, California
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Marijon E, Leclercq C, Narayanan K, Boveda S, Klug D, Lacaze-Gadonneix J, Defaye P, Jacob S, Piot O, Deharo JC, Perier MC, Mulak G, Hermida JS, Milliez P, Gras D, Cesari O, Hidden-Lucet F, Anselme F, Chevalier P, Maury P, Sadoul N, Bordachar P, Cazeau S, Chauvin M, Empana JP, Jouven X, Daubert JC, Le Heuzey JY. Causes-of-death analysis of patients with cardiac resynchronization therapy: an analysis of the CeRtiTuDe cohort study. Eur Heart J 2015; 36:2767-76. [PMID: 26330420 PMCID: PMC4628644 DOI: 10.1093/eurheartj/ehv455] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 08/17/2015] [Indexed: 01/14/2023] Open
Abstract
Aims The choice of resynchronization therapy between with (CRT-D) and without (CRT-P) a defibrillator remains a contentious issue. Cause-of-death analysis among CRT-P, compared with CRT-D, patients could help evaluate the extent to which CRT-P patients would have additionally benefited from a defibrillator in a daily clinical practice. Methods and results A total of 1705 consecutive patients implanted with a CRT (CRT-P: 535 and CRT-D: 1170) between 2008 and 2010 were enrolled in CeRtiTuDe, a multicentric prospective follow-up cohort study, with specific adjudication for causes of death at 2 years. Patients with CRT-P compared with CRT-D were older (P < 0.0001), less often male (P < 0.0001), more symptomatic (P = 0.0005), with less coronary artery disease (P = 0.003), wider QRS (P = 0.002), more atrial fibrillation (P < 0.0001), and more co-morbidities (P = 0.04). At 2-year follow-up, the annual overall mortality rate was 83.80 [95% confidence interval (CI) 73.41–94.19] per 1000 person-years. The crude mortality rate among CRT-P patients was double compared with CRT-D (relative risk 2.01, 95% CI 1.56–2.58). In a Cox proportional hazards regression analysis, CRT-P remained associated with increased mortality (hazard ratio 1.54, 95% CI 1.07–2.21, P = 0.0209), although other potential confounders may persist. By cause-of-death analysis, 95% of the excess mortality among CRT-P subjects was related to an increase in non-sudden death. Conclusion When compared with CRT-D patients, excess mortality in CRT-P recipients was mainly due to non-sudden death. Our findings suggest that CRT-P patients, as currently selected in routine clinical practice, would not potentially benefit with the addition of a defibrillator.
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Affiliation(s)
- Eloi Marijon
- Cardiology Department, European Georges Pompidou Hospital, Paris, France Paris Descartes University, Paris, France Paris Cardiovascular Research Centre, Paris, France
| | | | | | | | - Didier Klug
- Lille University Hospital and University of Lille, Lille, France
| | - Jonathan Lacaze-Gadonneix
- Cardiology Department, European Georges Pompidou Hospital, Paris, France Paris Descartes University, Paris, France
| | - Pascal Defaye
- Arrhythmia Department, University Hospital, Grenoble, France
| | | | - Olivier Piot
- Centre Cardiologique du Nord, Saint Denis, France
| | | | | | | | | | | | - Daniel Gras
- Nouvelles Cliniques Nantaises, Nantes, France
| | | | | | | | | | - Philippe Maury
- Cardiology Division, Rangueil University Hospital, Toulouse, France
| | - Nicolas Sadoul
- Cardiology Division, Nancy University Hospital, Nancy, France
| | | | | | | | | | - Xavier Jouven
- Cardiology Department, European Georges Pompidou Hospital, Paris, France Paris Descartes University, Paris, France Paris Cardiovascular Research Centre, Paris, France
| | | | - Jean-Yves Le Heuzey
- Cardiology Department, European Georges Pompidou Hospital, Paris, France Paris Descartes University, Paris, France Paris Cardiovascular Research Centre, Paris, France
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Abstract
PURPOSE OF REVIEW Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in patients with mild-to-severe heart failure. However, up to 40% of CRT recipients are nonresponders. This review addresses important aspects with regard to the identification and management of CRT nonresponders. RECENT FINDINGS Mid-term clinical or echocardiographic nonresponse is associated with worse clinical outcomes during the extended follow-up. A number of predictors are indicative of CRT response, which include patient characteristics, electrical determinants, and imaging techniques from preimplant to postimplant period, and can be grouped as modifiable and nonmodifiable contributors to treatment response. Advanced age, male sex, ischemic cause, end-stage heart failure, inadequate electrical delay, and absence of mechanical dyssynchrony are regarded as unfavorable but nonmodifiable factors, for which considering underutilization of CRT by refining patient selection is reasonable. On the contrary, more efforts should be made to optimize patient management by correcting those modifiable factors, such as suboptimal medical therapy, uncontrolled atrial fibrillation, left ventricular lead dislodgement or inappropriate location, loss of biventricular capture, and lack of device optimization. SUMMARY Proper management and careful selection of CRT recipients will transform a proportion of treatment nonresponders into responders, which is vital to improve patients' outcome.
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18
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Yang XW, Hua W, Wang J, Liu ZM, Ding LG, Chen KP, Zhang S. Native QRS narrowing reflects electrical reversal and associates with anatomical reversal in cardiac resynchronization therapy. J Interv Card Electrophysiol 2014; 41:161-8. [DOI: 10.1007/s10840-014-9936-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 07/01/2014] [Indexed: 10/24/2022]
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Yang XW, Hua W, Wang J, Liu ZM, Ding LG, Chen KP, Zhang S. Regression of fragmented QRS complex: a marker of electrical reverse remodeling in cardiac resynchronization therapy. Ann Noninvasive Electrocardiol 2014; 20:18-27. [PMID: 25040593 DOI: 10.1111/anec.12172] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Fragmented QRS (fQRS) marks inhomogeneous activation and asynchronous cardiac contraction. It has been proved that cardiac resynchronization therapy (CRT) could reverse geometrical remodeling as well as correct electrical dyssynchrony. We aimed to investigate whether fQRS changed corresponding to the therapeutic response to CRT. METHODS Patients who underwent de novo CRT implantation previously and had ≥1 follow-up between August 2012 and September 2013 in our hospital were investigated. Intrinsic electrocardiogram was recorded and fQRS in any lead was calculated. Response to CRT was defined as absolute improvement in left ventricular ejection fraction by ≥10% or by improvement >1 New York Heart Association class and without heart failure hospitalization. RESULTS A total of 75 patients (48 male, mean ages, 61 ± 9 years) were included in this study. At a median follow-up of 13 months, 57 patients had response to CRT. Responders had narrowed QRS (from 167 ± 23 ms to 158 ± 19 ms, P = 0.003) and reduced fQRS post-CRT. Nonresponders had QRS prolonging (from 151 ± 26 ms to 168 ± 16 ms, P = 0.033) and increase in fQRS. Eleven of 12 patients with reduced fQRS were responders and 8 of 12 with increased fQRS were nonresponders. Both changes in QRS and fQRS correlated strongly with CRT response (r = 0.389, P = 0.001 and r = 0.403, P = 0.000, respectively). Reduction of fQRS in ≥1 leads had high specificity (95%) in association to responders, though in low sensitivity (19%). CONCLUSIONS The changes in fQRS associated with therapeutic response to CRT. Regression of fQRS could be a maker of electrical reverse remodeling following CRT.
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Affiliation(s)
- Xin-wei Yang
- Center of Arrhythmia Diagnosis and Treatment, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Zecchin M, Proclemer A, Magnani S, Vitali-Serdoz L, Facchin D, Muser D, Nordio A, Barbati G, Puggia I, Sinagra G, Proclemer A. Long-term outcome of 'super-responder' patients to cardiac resynchronization therapy. Europace 2013; 16:363-71. [PMID: 24189477 DOI: 10.1093/europace/eut339] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
AIMS To evaluate the long-term changes of clinical and echocardiographic parameters, the incidence of cardiac events and parameters associated with late cardiac events in 'super-responders' to cardiac resynchronization therapy (CRT) with [CRT defibrillator (CRT-D)] or without defibrillator back-up. METHODS AND RESULTS In all consecutive patients treated with CRT in two Italian centres (Trieste and Udine) with left ventricular ejection fraction (LVEF) ≤0.35 at implantation (Timp) and LVEF > 0.50 1 and/or 2 years (Tnorm) after implantation, the long-term outcome and the evolution of echocardiographic parameters were assessed; factors associated with a higher risk of cardiac events, defined as hospitalization or death for heart failure (HF), sudden death, or CRT-D appropriate interventions, were also analysed. Among the 259 patients evaluated, 62 (24%) had LVEF ≥ 0.50 at Tnorm (n = 44 with at 1 year, n = 18 at 2 years). During a mean follow-up of 68 ± 30 months, one cardiac death (for HF) and eight cardiovascular events (two hospitalization for HF and six appropriate CRT-D interventions) occurred. At the last echo evaluation (Tfup) performed 51 ± 26 months after Timp, LVEF was <0.50 in five patients (>0.45 in four of them). At univariable analysis, only LV end-systolic volume evaluated at Tfup was associated with a higher risk of cardiac events during follow-up. CONCLUSION In 'super-responders' to CRT long-term outcome is excellent. However, cardiac events, mainly CRT-D appropriate interventions, can occur despite the persistence of LVEF > 0.50. Early identification of these patients is still an unsolved issue.
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Affiliation(s)
- Massimo Zecchin
- Cardiovascular Department, University and 'Ospedali Riuniti di Trieste' Hospital, Via Valdoni, 7, 34129 Trieste, Italy
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21
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Manfredi JA, Al-Khatib SM, Shaw LK, Thomas L, Fogel RI, Padanilam B, Rardon D, Vatthyam R, Gemma LW, Golden K, Prystowsky EN. Association Between Left Ventricular Ejection Fraction Post-Cardiac Resynchronization Treatment and Subsequent Implantable Cardioverter Defibrillator Therapy for Sustained Ventricular Tachyarrhythmias. Circ Arrhythm Electrophysiol 2013; 6:257-64. [DOI: 10.1161/circep.112.000214] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Joseph A. Manfredi
- From the AnMed Arrhythmia Specialists, Anderson, SC (J.A.M.); Duke Clinical Research Institute (L.K.S., L.T.), and Division of Cardiology (S.M.A.-K.), Duke University Medical Center, Durham, NC; and the St. Vincent Medical Group, Indianapolis, IN (R.I.F., B.P., D.R., R.V., L.W.G., K.G., E.N.P.)
| | - Sana M. Al-Khatib
- From the AnMed Arrhythmia Specialists, Anderson, SC (J.A.M.); Duke Clinical Research Institute (L.K.S., L.T.), and Division of Cardiology (S.M.A.-K.), Duke University Medical Center, Durham, NC; and the St. Vincent Medical Group, Indianapolis, IN (R.I.F., B.P., D.R., R.V., L.W.G., K.G., E.N.P.)
| | - Linda K. Shaw
- From the AnMed Arrhythmia Specialists, Anderson, SC (J.A.M.); Duke Clinical Research Institute (L.K.S., L.T.), and Division of Cardiology (S.M.A.-K.), Duke University Medical Center, Durham, NC; and the St. Vincent Medical Group, Indianapolis, IN (R.I.F., B.P., D.R., R.V., L.W.G., K.G., E.N.P.)
| | - Laine Thomas
- From the AnMed Arrhythmia Specialists, Anderson, SC (J.A.M.); Duke Clinical Research Institute (L.K.S., L.T.), and Division of Cardiology (S.M.A.-K.), Duke University Medical Center, Durham, NC; and the St. Vincent Medical Group, Indianapolis, IN (R.I.F., B.P., D.R., R.V., L.W.G., K.G., E.N.P.)
| | - Richard I. Fogel
- From the AnMed Arrhythmia Specialists, Anderson, SC (J.A.M.); Duke Clinical Research Institute (L.K.S., L.T.), and Division of Cardiology (S.M.A.-K.), Duke University Medical Center, Durham, NC; and the St. Vincent Medical Group, Indianapolis, IN (R.I.F., B.P., D.R., R.V., L.W.G., K.G., E.N.P.)
| | - Benzy Padanilam
- From the AnMed Arrhythmia Specialists, Anderson, SC (J.A.M.); Duke Clinical Research Institute (L.K.S., L.T.), and Division of Cardiology (S.M.A.-K.), Duke University Medical Center, Durham, NC; and the St. Vincent Medical Group, Indianapolis, IN (R.I.F., B.P., D.R., R.V., L.W.G., K.G., E.N.P.)
| | - David Rardon
- From the AnMed Arrhythmia Specialists, Anderson, SC (J.A.M.); Duke Clinical Research Institute (L.K.S., L.T.), and Division of Cardiology (S.M.A.-K.), Duke University Medical Center, Durham, NC; and the St. Vincent Medical Group, Indianapolis, IN (R.I.F., B.P., D.R., R.V., L.W.G., K.G., E.N.P.)
| | - Rosh Vatthyam
- From the AnMed Arrhythmia Specialists, Anderson, SC (J.A.M.); Duke Clinical Research Institute (L.K.S., L.T.), and Division of Cardiology (S.M.A.-K.), Duke University Medical Center, Durham, NC; and the St. Vincent Medical Group, Indianapolis, IN (R.I.F., B.P., D.R., R.V., L.W.G., K.G., E.N.P.)
| | - Lee W. Gemma
- From the AnMed Arrhythmia Specialists, Anderson, SC (J.A.M.); Duke Clinical Research Institute (L.K.S., L.T.), and Division of Cardiology (S.M.A.-K.), Duke University Medical Center, Durham, NC; and the St. Vincent Medical Group, Indianapolis, IN (R.I.F., B.P., D.R., R.V., L.W.G., K.G., E.N.P.)
| | - Keith Golden
- From the AnMed Arrhythmia Specialists, Anderson, SC (J.A.M.); Duke Clinical Research Institute (L.K.S., L.T.), and Division of Cardiology (S.M.A.-K.), Duke University Medical Center, Durham, NC; and the St. Vincent Medical Group, Indianapolis, IN (R.I.F., B.P., D.R., R.V., L.W.G., K.G., E.N.P.)
| | - Eric N. Prystowsky
- From the AnMed Arrhythmia Specialists, Anderson, SC (J.A.M.); Duke Clinical Research Institute (L.K.S., L.T.), and Division of Cardiology (S.M.A.-K.), Duke University Medical Center, Durham, NC; and the St. Vincent Medical Group, Indianapolis, IN (R.I.F., B.P., D.R., R.V., L.W.G., K.G., E.N.P.)
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23
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Ellenbogen KA, Huizar JF. Foreseeing Super-Response to Cardiac Resynchronization Therapy. J Am Coll Cardiol 2012; 59:2374-7. [DOI: 10.1016/j.jacc.2011.11.074] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 11/03/2011] [Accepted: 11/08/2011] [Indexed: 10/28/2022]
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Petrovic M, Petrovic MT, Milasinovic G, Vujisic-Tesic B, Trifunovic D, Nedeljkovic I, Calovic Z, Ivanovic B, Tesic M, Boricic M, Petrovic O, Petrovic IM, Banovic M, Draganic G, Ostojic M. Prediction of a Good Response to Cardiac Resynchronization Therapy in Patients with Severe Dilated Cardyomyopathy: Could Conventional Echocardiography Be the Answer after All? Echocardiography 2011; 29:267-75. [DOI: 10.1111/j.1540-8175.2011.01576.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Serdoz LV, Daleffe E, Merlo M, Zecchin M, Barbati G, Pecora D, Pinamonti B, Fantoni C, Lupo P, Di Lenarda A, Sinagra G, Cappato R. Predictors for restoration of normal left ventricular function in response to cardiac resynchronization therapy measured at time of implantation. Am J Cardiol 2011; 108:75-80. [PMID: 21529746 DOI: 10.1016/j.amjcard.2011.02.347] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 02/16/2011] [Accepted: 02/16/2011] [Indexed: 11/25/2022]
Abstract
There are no parameters predicting the individual probability of "full response" to cardiac resynchronization therapy (CRT). The aim of this work was to find prognostic factors of full clinical and echocardiographic responses (i.e., ≥50% left ventricular ejection fraction [LVEF] and New York Heart Association class I) after 1 year of CRT. This was a prospective follow-up study that involved 2 hospitals. Patients (n = 75) with advanced heart failure (64 ± 9 years of age, 87% men, LVEF 24 ± 7%) who received CRT were followed for 17 ± 9 months. Univariate and multivariate regression analyses were used to identify predictors of full CRT response. A nomogram predicting the individual probability of full CRT response during follow-up was calculated. There were 13 patients with restoration of normal LVEF versus 62 without (mean LVEF 56% ± 5% vs 31% ± 8%, respectively, p <0.001). Predictors of full response included cause of heart disease, baseline QRS width, and degree of QRS shortening in response to CRT. Patients with nonischemic heart disease, baseline QRS width ≤150 ms, and QRS shortening ≥40 ms in response to CRT had a >75% probability of restoration of normal LVEF. In conclusion, our nomogram using a combination of cause, baseline QRS width, and degree of QRS shortening in response to CRT allows assessment of individual probability of full response. This observation awaits further confirmation from larger series.
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Huizar JF, Ellenbogen KA. Hyperresponders to cardiac resynchronization therapy: timing is everything… but size still matters! J Cardiovasc Electrophysiol 2011; 22:912-4. [PMID: 21385266 DOI: 10.1111/j.1540-8167.2011.02040.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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ADELSTEIN EVAN, SCHWARTZMAN DAVID, GORCSAN III JOHN, SABA SAMIR. Predicting Hyperresponse Among Pacemaker-Dependent Nonischemic Cardiomyopathy Patients Upgraded to Cardiac Resynchronization. J Cardiovasc Electrophysiol 2011; 22:905-11. [DOI: 10.1111/j.1540-8167.2011.02018.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Castellant P, Orhan E, Bertault-Valls V, Fatemi M, Etienne Y, Blanc JJ. Is "hyper response" to cardiac resynchronization therapy in patients with nonischemic cardiomyopathy a recovery, a remission, or a control? Ann Noninvasive Electrocardiol 2011; 15:321-7. [PMID: 20946554 DOI: 10.1111/j.1542-474x.2010.00387.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Some patients treated by cardiac resynchronization therapy (CRT) recover "normal" left ventricular (LV) function and functional status. However, whether this "normalization" persists or reverts over time remains unknown. The aim of the present study was to evaluate the long-term outcomes of LV function in patients hyper responder to CRT. METHODS Eleven consecutive patients with nonischemic dilated cardiomyopathy, sinus rhythm, left bundle branch block (LBBB), New York Heart Association (NYHA) class III or IV, and optimal pharmacological treatment were hyper responder as they fulfilled concurrently the two following criteria: functional recovery (NYHA class I or II) and normalization of LV ejection fraction (LVEF). RESULTS After a mean follow-up of 65 ± 30 months between CRT implantation and last evaluation LVEF improved from 26 ± 9 to 59 ± 6% (P < 0.0001). One patient died from pulmonary embolism 31 months after implantation. Three patients exhibited LVEF ≤ 50% at their last follow-up visit (two at 40% and one at 45%). In eight patients, brief cessation of pacing was feasible (three were pacemaker-dependent). Mean QRS duration decreased from 181 ± 23 ms to 143 ± 22 ms (P = 0.006). In one patient, pacing was interrupted for 2 years and LVEF decreased markedly (from 65% to 31%) but returned to normal after a few months when pacing was resumed. CONCLUSION In hyper responder patients, "normalization" of LV function after CRT persists as long as pacing is maintained with an excellent survival.
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Affiliation(s)
- Philippe Castellant
- Department of Cardiology, Hôpital de la Cavale Blanche, Brest University Hospital, Boulevard Tanguy Prigent, Brest Cedex, France
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29
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Spragg DD, Dong J, Fetics BJ, Helm R, Marine JE, Cheng A, Henrikson CA, Kass DA, Berger RD. Optimal Left Ventricular Endocardial Pacing Sites for Cardiac Resynchronization Therapy in Patients With Ischemic Cardiomyopathy. J Am Coll Cardiol 2010; 56:774-81. [PMID: 20797490 DOI: 10.1016/j.jacc.2010.06.014] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2010] [Revised: 06/09/2010] [Accepted: 06/15/2010] [Indexed: 10/19/2022]
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Rickard J, Kumbhani DJ, Popovic Z, Verhaert D, Manne M, Sraow D, Baranowski B, Martin DO, Lindsay BD, Grimm RA, Wilkoff BL, Tchou P. Characterization of super-response to cardiac resynchronization therapy. Heart Rhythm 2010; 7:885-9. [DOI: 10.1016/j.hrthm.2010.04.005] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Accepted: 04/02/2010] [Indexed: 11/15/2022]
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Romero D, Sebastian R, Bijnens BH, Zimmerman V, Boyle PM, Vigmond EJ, Frangi AF. Effects of the purkinje system and cardiac geometry on biventricular pacing: a model study. Ann Biomed Eng 2010; 38:1388-98. [PMID: 20094915 DOI: 10.1007/s10439-010-9926-4] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Accepted: 01/07/2010] [Indexed: 11/25/2022]
Abstract
Heart failure leads to gross cardiac structural changes. While cardiac resynchronization therapy (CRT) is a recognized treatment for restoring synchronous activation, it is not clear how changes in cardiac shape and size affect the electrical pacing therapy. This study used a human heart computer model which incorporated anatomical structures such as myofiber orientation and a Purkinje system (PS) to study how pacing affected failing hearts. The PS was modeled as a tree structure that reproduced its retrograde activation feature. In addition to a normal geometry, two cardiomyopathies were modeled: dilatation and hypertrophy. A biventricular pacing protocol was tested in the context of atrio-ventricular block. The contribution of the PS was examined by removing it, as well as by increasing endocardial conductivity. Results showed that retrograde conduction into the PS was a determining factor for achieving intraventricular synchrony. Omission of the PS led to an overestimate of the degree of electrical dyssynchrony while assessing CRT. The activation patterns for the three geometries showed local changes in the order of activation of the lateral wall in response to the same pacing strategy. These factors should be carefully considered when determining lead placement and optimizing device parameters in clinical practice.
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Affiliation(s)
- Daniel Romero
- Computational Imaging & Simulation Technologies in Biomedicine, Universitat Pompeu Fabra, Carrer Tanger, 122-140 (Office N 55,123), 08018 Barcelona, Spain.
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