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Veres B, Fehérvári P, Engh MA, Hegyi P, Gharehdaghi S, Zima E, Duray G, Merkely B, Kosztin A. Time-trend treatment effect of cardiac resynchronization therapy with or without defibrillator on mortality: a systematic review and meta-analysis. Europace 2023; 25:euad289. [PMID: 37766466 PMCID: PMC10585357 DOI: 10.1093/europace/euad289] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
AIMS This study aimed to investigate the impact of cardiac resynchronization therapy with a defibrillator (CRT-D) on mortality, comparing it with CRT with a pacemaker (CRT-P). Additionally, the study sought to identify subgroups, evaluate the time trend in treatment effects, and analyze patient characteristics, considering the changing indications over the past decades. METHODS AND RESULTS PubMed, CENTRAL, and Embase up to October 2021 were screened for studies comparing CRT-P and CRT-D, focusing on mortality. Altogether 26 observational studies were selected comprising 128 030 CRT patients, including 55 469 with CRT-P and 72 561 with CRT-D device. Cardiac resynchronization therapy with defibrillator was able to reduce all-cause mortality by almost 20% over CRT-P [adjusted hazard ratio (HR): 0.85; 95% confidence interval (CI): 0.76-0.94; P < 0.01] even in propensity-matched studies (HR: 0.83; 95% CI: 0.80-0.87; P < 0.001) but not in those with non-ischaemic aetiology (HR: 0.95; 95% CI: 0.79-1.15; P = 0.19) or over 75 years (HR: 1.08; 95% CI 0.96-1.21; P = 0.17). When treatment effect on mortality was investigated by the median year of inclusion, there was a difference between studies released before 2015 and those thereafter. Time-trend effects could be also observed in patients' characteristics: CRT-P candidates were getting older and the prevalence of ischaemic aetiology was increasing over time. CONCLUSION The results of this systematic review of observational studies, mostly retrospective with meta-analysis, suggest that patients with CRT-D had a lower risk of mortality compared with CRT-P. However, subgroups could be identified, where CRT-D was not superior such as non-ischaemic and older patients. An improved treatment effect of CRT-D on mortality could be observed between the early and late studies partly related to the changed characteristics of CRT candidates.
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Affiliation(s)
- Boglárka Veres
- Heart and Vascular Center, Semmelweis University, Városmajor Str. 68, 1122 Budapest, Hungary
- Center for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Péter Fehérvári
- Center for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Biostatistics, University of Veterinary Medicine, Budapest, Hungary
| | - Marie Anne Engh
- Center for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Péter Hegyi
- Center for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Sara Gharehdaghi
- Center for Translational Medicine, Semmelweis University, Budapest, Hungary
- Gottsegen György National Cardiovascular Institute, Budapest, Hungary
| | - Endre Zima
- Heart and Vascular Center, Semmelweis University, Városmajor Str. 68, 1122 Budapest, Hungary
- Center for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Gábor Duray
- Center for Translational Medicine, Semmelweis University, Budapest, Hungary
- Central Hospital of Northern Pest-Military Hospital, Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Városmajor Str. 68, 1122 Budapest, Hungary
| | - Annamária Kosztin
- Heart and Vascular Center, Semmelweis University, Városmajor Str. 68, 1122 Budapest, Hungary
- Center for Translational Medicine, Semmelweis University, Budapest, Hungary
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Cheng S, Deng Y, Huang H, Yu Y, Niu H, Hua W. Effectiveness of adding a defibrillator with cardiac resynchronization therapy in heart failure according to the modified Model for End-stage Liver Disease-Albumin score. Europace 2023; 25:euad232. [PMID: 37539723 PMCID: PMC10401322 DOI: 10.1093/europace/euad232] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 07/18/2023] [Indexed: 08/05/2023] Open
Abstract
Current guidelines lack clear recommendations between the implantation of cardiac resynchronization therapy (CRT) with defibrillator (CRT-D) and CRT with pacemaker (CRT-P). We hypothesized that modified model for end-stage liver disease score including albumin (MELD-Albumin score), could be used to select patients who may not benefit from CRT-D. We consecutively included patients with CRT-P or CRT-D implantation between 2010 and 2022. The primary endpoint was the composite of all-cause mortality or worsening heart failure. We performed multivariable-adjusted Cox proportional hazard regression. We assessed the interaction between the MELD-Albumin score and the effect of adding a defibrillator with CRT.A total of 752 patients were included in this study, with 291 implanted CRT-P. During a median follow-up of 880 days, 205 patients reached the primary endpoint. MELD-Albumin score was significantly associated with the primary endpoint in the CRT-D group [HR 1.16 (1.09-1.24); P < 0.001] but not in the CRT-P group [HR 1.03 (0.95-1.12); P = 0.49]. There was a significant interaction between the MELD-Albumin score and the effect of CRTD (P = 0.013). The optimal cut-off value of the MELD-Albumin score was 12. For patients with MELD-Albumin ≥ 12, CRT-D was associated with a higher occurrence of the primary endpoint [HR 1.99 (1.10-3.58); P = 0.02], whereas not in patients with MELD-Albumin < 12 [HR 1.19 (0.83-1.70); P = 0.35). Our findings suggest that CRT-D is associated with an excess risk of composite clinical endpoints in HF patients with higher MELD-Albumin score.
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Affiliation(s)
- Sijing Cheng
- The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Beijing 100037, China
| | - Yu Deng
- The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Beijing 100037, China
| | - Hao Huang
- The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Beijing 100037, China
| | - Yu Yu
- The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Beijing 100037, China
| | - Hongxia Niu
- The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Beijing 100037, China
| | - Wei Hua
- The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Beijing 100037, China
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Effect of Digitalis on ICD or CRT-D Recipients: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12041686. [PMID: 36836221 PMCID: PMC9967079 DOI: 10.3390/jcm12041686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Digitalis has been widely utilized for heart failure therapy and several studies have demonstrated an association of digitalis and adverse outcome events in patients receiving implantable cardioverter defibrillators (ICDs) or cardiac resynchronization therapy defibrillators (CRT-Ds). Hence, we conducted this meta-analysis to assess the effect of digitalis on ICD or CRT-D recipients. METHODS We systematically retrieved relevant studies using the Cochrane Library, PubMed, and Embase database. A random effect model was used to pool the effect estimates (hazard ratios (HRs) and 95% confidence intervals (CIs)) when the studies were of high heterogeneity, otherwise a fixed effect model was used. RESULTS Twenty-one articles containing 44,761 ICD or CRT-D recipients were included. Digitalis was associated with an increased rate of appropriate shocks (HR = 1.65, 95% CI: 1.46-1.86, p < 0.001) and a shortened time to first appropriate shock (HR = 1.76, 95% CI: 1.17-2.65, p = 0.007) in ICD or CRT-D recipients. Furthermore, the all-cause mortality increased in ICD recipients with digitalis therapy (HR = 1.70, 95% CI: 1.34-2.16, p < 0.01), but the all-cause mortality was unchanged in CRT-D recipients (HR = 1.55, 95% CI: 0.92-2.60, p = 0.10) or patients who received ICD or CRT-D therapy (HR = 1.09, 95% CI: 0.80-1.48, p = 0.20). The sensitivity analyses confirmed the robustness of the results. CONCLUSION ICD recipients with digitalis therapy may tend to have higher mortality rates, but digitalis may not be associated with the mortality rate of CRT-D recipients. Further studies are required to confirm the effects of digitalis on ICD or CRT-D recipients.
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Influence of diabetes on mortality and ICD therapies in ICD recipients: a systematic review and meta-analysis of 162,780 patients. Cardiovasc Diabetol 2022; 21:143. [PMID: 35906611 PMCID: PMC9338523 DOI: 10.1186/s12933-022-01580-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background The influence of diabetes on the mortality and risk of implantable cardioverter defibrillator (ICD) therapies is still controversial, and a comprehensive assessment is lacking. We performed this systematic review and meta-analysis to address this controversy. Methods We systematically searched the PubMed, Embase, Web of Science and Cochrane Library databases to collect relevant literature. Fixed and random effects models were used to estimate the hazard ratio (HR) with 95% CIs. Results Thirty-six articles reporting on 162,780 ICD recipients were included in this analysis. Compared with nondiabetic ICD recipients, diabetic ICD recipients had higher all-cause mortality (HR = 1.45, 95% CI 1.36–1.55). The subgroup analysis showed that secondary prevention patients with diabetes may suffer a higher risk of all-cause mortality (HR = 1.89, 95% CI 1.56–2.28) (for subgroup analysis, P = 0.03). Cardiac mortality was also higher in ICD recipients with diabetes (HR = 1.68, 95% CI 1.35–2.08). However, diabetes had no significant effect on the risks of ICD therapies, including appropriate or inappropriate therapy, appropriate or inappropriate shock and appropriate anti-tachycardia pacing (ATP). Diabetes was associated with a decreased risk of inappropriate ATP (HR = 0.56, 95% CI 0.39–0.79). Conclusion Diabetes is associated with an increased risk of mortality in ICD recipients, especially in the secondary prevention patients, but does not significantly influence the risks of ICD therapies, indicating that the increased mortality of ICD recipients with diabetes may not be caused by arrhythmias. The survival benefits of ICD treatment in diabetes patients are limited. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01580-y.
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2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Translation of the document prepared by the Czech Society of Cardiology. COR ET VASA 2022. [DOI: 10.33678/cor.2022.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJ, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM. Grupo de trabajo sobre estimulación cardiaca y terapia de resincronización cardiaca de la Sociedad Europea de Cardiología (ESC). Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJS, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM, Leyva F, Linde C, Abdelhamid M, Aboyans V, Arbelo E, Asteggiano R, Barón-Esquivias G, Bauersachs J, Biffi M, Birgersdotter-Green U, Bongiorni MG, Borger MA, Čelutkienė J, Cikes M, Daubert JC, Drossart I, Ellenbogen K, Elliott PM, Fabritz L, Falk V, Fauchier L, Fernández-Avilés F, Foldager D, Gadler F, De Vinuesa PGG, Gorenek B, Guerra JM, Hermann Haugaa K, Hendriks J, Kahan T, Katus HA, Konradi A, Koskinas KC, Law H, Lewis BS, Linker NJ, Løchen ML, Lumens J, Mascherbauer J, Mullens W, Nagy KV, Prescott E, Raatikainen P, Rakisheva A, Reichlin T, Ricci RP, Shlyakhto E, Sitges M, Sousa-Uva M, Sutton R, Suwalski P, Svendsen JH, Touyz RM, Van Gelder IC, Vernooy K, Waltenberger J, Whinnett Z, Witte KK. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Europace 2022; 24:71-164. [PMID: 34455427 DOI: 10.1093/europace/euab232] [Citation(s) in RCA: 111] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Pathophysiology of heart failure and an overview of therapies. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00025-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJS, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J 2021; 42:3427-3520. [PMID: 34455430 DOI: 10.1093/eurheartj/ehab364] [Citation(s) in RCA: 778] [Impact Index Per Article: 259.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Pescariu SA, Tudoran C, Pop GN, Pescariu S, Timar RZ, Tudoran M. Impact of COVID-19 Pandemic on the Implantation of Intra-Cardiac Devices in Diabetic and Non-Diabetic Patients in the Western of Romania. ACTA ACUST UNITED AC 2021; 57:medicina57050441. [PMID: 34063702 PMCID: PMC8147827 DOI: 10.3390/medicina57050441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/19/2021] [Accepted: 04/27/2021] [Indexed: 12/28/2022]
Abstract
Background and Objectives: COVID-19 pandemic severely impacted public health services worldwide, determining a significant decrease of elective cardiovascular (CV) procedures, especially in patients with associated chronic diseases such as diabetes mellitus (DM). Materials and Methods: This study was first started in 2019 in the western of Romania, to analyze the differences regarding the implantations of intra-cardiac devices such as permanent pacemakers (PPM), cardiac resynchronization therapy (CRT), or implantable cardioverter-defibrillators (ICD) in 351 patients with and without DM and the situation was reanalyzed at the end of 2020. Results: of the first 351 patients with and without DM. 28.20% of these patients had type 2 DM (p = 0.022), exceeding more than twice the prevalence of DM in the general population (11%). Patients with DM were younger (p = 0.022) and required twice as often CRT (p = 0.002) as non-diabetic patients. The state of these procedures was reanalyzed at the end of 2020, a dramatic decrease of all new device implantations being observed, both in non-diabetic and in patients with type 2 DM (79.37%, respectively 81.82%). Conclusions: COVID-19 pandemic determined a drastic decrease, with around 75% reduction of all procedures of new intra-cardiac devices implantation, both in non-diabetics, this activity being reserved mostly for emergencies.
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Affiliation(s)
- Silvius Alexandru Pescariu
- Department VI, Cardiology, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania; (S.A.P.); (G.N.P.); (S.P.)
| | - Cristina Tudoran
- Department VII, Internal Medicine II, Discipline of Cardiology, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania;
- County Emergency Hospital, 300041 Timisoara, Romania
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania;
- County Emergency Hospital “Pius Brinzeu”, L. Rebreanu Str., Nr. 156, 300041 Timisoara, Romania
- Correspondence: ; Tel.: +40-722-669-086
| | - Gheorghe Nicusor Pop
- Department VI, Cardiology, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania; (S.A.P.); (G.N.P.); (S.P.)
| | - Sorin Pescariu
- Department VI, Cardiology, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania; (S.A.P.); (G.N.P.); (S.P.)
| | - Romulus Zorin Timar
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania;
- County Emergency Hospital “Pius Brinzeu”, L. Rebreanu Str., Nr. 156, 300041 Timisoara, Romania
- Department VII, Internal Medicine II, Division of Diabetes and Matabolic Diseases, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
| | - Mariana Tudoran
- Department VII, Internal Medicine II, Discipline of Cardiology, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania;
- County Emergency Hospital, 300041 Timisoara, Romania
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania;
- County Emergency Hospital “Pius Brinzeu”, L. Rebreanu Str., Nr. 156, 300041 Timisoara, Romania
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Cardiac resynchronization therapy with or without defibrillation: a long-standing debate. Cardiol Rev 2021; 30:221-233. [PMID: 33758120 DOI: 10.1097/crd.0000000000000388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Cardiac resynchronization therapy (CRT) was shown to improve cardiac function, reduce heart failure hospitalizations, improve quality of life and prolong survival in patients with severe left ventricular dysfunction and intraventricular conduction disturbances, mainly left bundle branch block, on optimal medical therapy with ACE-inhibitors, β-blockers and mineralocorticoid receptor antagonists up-titrated to maximum tolerated evidence-based doses. CRT can be achieved by means of pacemaker systems (CRT-P) or devices with defibrillation capabilities (CRT-D). CRT-Ds offer an undoubted advantage in the prevention of arrhythmic death, but such an advantage may be of lesser degree in non-ischemic heart failure aetiologies. Moreover, the higher CRT-D hardware complexity compared to CRT-P may predispose to device/lead malfunctions and the higher current drainage may cause a shorter battery duration with consequent premature replacements and the well-known incremental complications. In a period of financial constraints, also device costs should be carefully evaluated, with recent reports suggesting that CRT-Ps may be favoured over CRT-Ds in patients with non-ischemic cardiomyopathy and no prior history of cardiac arrhythmias from a cost-effectiveness point of view. The choice between a CRT-P or a CRT-D device should be patient-tailored whenever straightforward defibrillator indications are not present. The Goldenberg score may facilitate this decision-making process in ambiguous settings. Age, comorbidities, kidney disease, atrial fibrillation, advanced functional class, inappropriate therapy risk, implantable device infections and malfunctions are factors potentially reducing the expected benefit from defibrillating capabilities. Future prospective, randomized controlled trials are warranted to directly compare the efficacy and safety of CRT-Ps and CRT-Ds.
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Theuns DAMJ, Schaer BA, Caliskan K, Hoeks SE, Sticherling C, Yap SC, Alba AC. Application of the heart failure meta-score to predict prognosis in patients with cardiac resynchronization defibrillators. Int J Cardiol 2021; 330:73-79. [PMID: 33516838 DOI: 10.1016/j.ijcard.2021.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 12/23/2020] [Accepted: 01/03/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The Heart Failure (HF) Meta-score may be useful in predicting prognosis in patients with primary prevention cardiac resynchronization defibrillators (CRT-D) considering the competing risk of appropriate defibrillator shock versus mortality. METHODS Data from 648 consecutive patients from two centers were used for the evaluation of the performance of the HF Meta-score. The primary endpoint was mortality and the secondary endpoint was time to first appropriate implantable cardioverter-defibrillator (ICD) shock or death without prior appropriate ICD shock. Fine-Gray model was used for competing risk regression analysis. RESULTS In the entire cohort, 237 patients died over a median follow-up of 5.2 years. Five-year cumulative incidence of mortality ranged from 12% to 53%, for quintiles 1 through 5 of the HF Meta-score, respectively (log-rank P < 0.001). Compared with the lowest quintile, mortality risk was higher in the highest quintile (HR 6.9; 95%CI 3.7-12.8). The HF Meta-score had excellent calibration, accuracy, and good discrimination in predicting mortality (C-statistic 0.76 at 1-year and 0.71 at 5-year). The risk of death without appropriate ICD shock was higher in risk quintile 5 compared to quintile 1 (sub HR 5.8; 95%CI 3.1-11.0, P < 0.001). CONCLUSIONS Our study demonstrated a good ability of the HF Meta-score to predict survival in HF patients treated with CRT-D as primary prevention. The HF Meta-score proved to be useful in identifying a subgroup with a significantly poor prognosis despite a CRT-D.
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Affiliation(s)
| | - Beat A Schaer
- Dept. of Cardiology, University of Basel Hospital, Basel, Switzerland
| | - Kadir Caliskan
- Dept. of Cardiology, Erasmus MC, Rotterdam, the Netherlands
| | - Sanne E Hoeks
- Dept. of Anesthesiology, Erasmus MC, Rotterdam, the Netherlands
| | | | - Sing-Chien Yap
- Dept. of Cardiology, Erasmus MC, Rotterdam, the Netherlands
| | - Ana Carolina Alba
- Heart Failure/Transplant program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
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Long YX, Hu Y, Cui DY, Hu S, Liu ZZ. The benefits of defibrillator in heart failure patients with cardiac resynchronization therapy: A meta-analysis. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 44:225-234. [PMID: 33372697 DOI: 10.1111/pace.14150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 12/01/2020] [Accepted: 12/13/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Current guidelines did not provide recommendations on indications of an additional implantable cardioverter-defibrillator (ICD) to patients receiving cardiac resynchronization therapy (CRT), and it still remains controversial due to lack of evidence from randomized controlled trials. METHOD PubMed, Embase, and Cochrane CENTRAL from the inception to May 2020 were systematically screened for studies reporting on the comparison of cardiac resynchronization therapy with defibrillator (CRT-D) and cardiac resynchronization therapy with pacemaker (CRT-P), focusing on the adjusted hazard ratio (aHR) of all-cause mortality. We pooled the effects using a random-effect model. RESULTS Twenty-one studies encompassing 69,919 patients were included in this meta-analysis. With no restriction to characteristics of including population, CRT-D was associated with a lower all-cause mortality compared with CRT-P significantly (aHR: 0.80, 95% confidence interval [CI]: 0.74-0.87, I2 = 36.8%, p < .001). This mortality benefit was also observed in patients with ischemic cardiomyopathy (aHR: 0.74, 95% CI: 0.64-0.86, I2 = 0%, p < .001). However, there is no significant difference in patients with nonischemic cardiomyopathy (NICM) (aHR: 0.91, 95% CI: 0.82-1.01, I2 = 0%, p = .087), older age (age ≥75 years, aHR: 0.96, 95% CI: 0.83-1.12, I2 = 0%, p = .610). Subgroup analysis was performed and indicated the survival benefit of CRT-D for primary prevention compared with CRT-P (aHR: 0.87, 95% CI: 0.79-0.95, I2 = 0%, p = .003). CONCLUSION After adjusted the differences in clinical characteristics, additional ICD therapy was associated with a reduced all-cause mortality in patients receiving CRT. However, our work suggested that additional ICD may not be applied to elderly (≥75 years) or patients with NICM.
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Affiliation(s)
- Yu-Xiang Long
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yue Hu
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Di-Yu Cui
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shuang Hu
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zeng-Zhang Liu
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Huang D, Hua W, Fang Q, Yan J, Su Y, Liu B, Xu Y, Peng Y. Biventricular pacemaker and defibrillator implantation in patients with chronic heart failure in China. ESC Heart Fail 2020; 8:546-554. [PMID: 33169538 PMCID: PMC7835594 DOI: 10.1002/ehf2.13114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 10/08/2020] [Accepted: 10/29/2020] [Indexed: 02/05/2023] Open
Abstract
Aims This study aims to investigate the current status of biventricular pacemaker and defibrillator implantation in chronic heart failure (CHF) patients with indications for primary prevention of sudden cardiac death (SCD) in China and the effects of cardiac resynchronization therapy (CRT)‐pacemaker (P) and CRT‐defibrillator (D) implantation on the clinical prognosis of CHF among patients undergoing CRT. Methods and results Overall, 798 consecutive patients who had devices implanted (implantable cardioverter defibrillator: 199, CRT‐D: 362, and CRT‐P: 237) from May 2012 to July 2013 in POSCD‐China, a multicentric prospective cohort study, were enrolled. The primary endpoint was all‐cause death, and the secondary endpoint was SCD. In total, 71.3% of patients had non‐ischaemic CHF. The mean follow‐up time was 27.7 ± 12.0 months, and death occurred in 158 cases, with 35 cases of SCD. CHF was the main cause of death (68.4%), followed by sudden death (22.2%). In the CRT‐P group, the SCD rate was 8.0%, which was much higher than that in the CRT‐D (3.3%) and implantable cardioverter defibrillator (2.0%) groups. No significant differences were identified in the all‐cause death rate between the CRT‐D and CRT‐P groups (CRT‐D vs. CRT‐P, 20.4% vs. 19.4%, P = 0.840). Conclusions In China, among CHF patients with indications for primary prevention of SCD who received device implantation, non‐ischaemic CHF was the main aetiology, and the most important cause of death was heart failure. No differences in all‐cause death were observed between the CRT‐D and CRT‐P groups, but the CRT‐D group had a lower SCD rate than the CRT‐P group.
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Affiliation(s)
- Dejia Huang
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
| | - Wei Hua
- Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Quan Fang
- Department of Cardiology, Peking Union Medical College Hospital, Beijing, China
| | - Ji Yan
- Department of Cardiology, Anhui Provincial Hospital, Hefei, China
| | - Yangang Su
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Bing Liu
- Department of Cardiology, Xijing Hospital, Xi'an, China
| | - Yuanning Xu
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
| | - Yong Peng
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
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15
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Gras M, Bisson A, Bodin A, Herbert J, Babuty D, Pierre B, Clementy N, Fauchier L. Mortality and cardiac resynchronization therapy with or without defibrillation in primary prevention. Europace 2020; 22:1224-1233. [PMID: 32594143 DOI: 10.1093/europace/euaa096] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 04/03/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS Cardiac resynchronization therapy with (CRTD) or without (CRTP) defibrillator is recommended in selected patient with systolic chronic heart failure and wide QRS. There is no guideline firmly indicating choice between CRTP and CRTD in primary prevention, particularly in older patients. METHODS AND RESULTS Based on the French administrative hospital-discharge database, information was collected from 2010 to 2017 for all patients implanted with CRTP or CRTD in primary prevention. Outcome analyses were undertaken in the total study population and in propensity-matched samples. During follow-up (913 days, SD 841, median 701, IQR 151-1493), 45 697 patients were analysed (CRTP 19 266 and CRTD 26 431). Incidence rate (%patient/year) of all-cause mortality was higher in CRTP patients (11.6%) than in CRTD patients (6.8%) [hazard ratio (HR) 1.70, 95% confidence interval (CI) 1.63-1.76, P < 0.001]. After propensity-matched analyses, mortality of patients over 75 years old with non-ischaemic cardiomyopathy (NICM) was not different with CRTP and CRTD (HR 0.93, 95% CI 0.80-1.09, P = 0.39). The CRTP patients under 75 years old with NICM had a higher mortality than CRTD patients (HR 1.22, 95% CI 1.03-1.45, P = 0.02). Mortality rate was also higher with CRTP than with CRTD irrespectively of age in patients with ischaemic cardiomyopathy (ICM) (<75 years old: HR 1.22, 95% CI 1.08-1.37, P = 0.01; ≥75 years old: HR 1.13, 95% CI 1.04-1.22, P = 0.003). CONCLUSION In this real-life study, CRTD was associated with a significantly lower all-cause mortality than CRTP in patients with ICM and in patients with NICM under 75 years old. Patients over 75 years old with NICM did not have lower mortality with primary prevention CRTD implantation.
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Affiliation(s)
- Matthieu Gras
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université de Tours, EA7505 Tours, France
| | - Arnaud Bisson
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université de Tours, EA7505 Tours, France
| | - Alexandre Bodin
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université de Tours, EA7505 Tours, France
| | - Julien Herbert
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université de Tours, EA7505 Tours, France.,Service d'information médicale, d'épidémiologie et d'économie de la santé, Centre Hospitalier Universitaire et Faculté de Médecine, Université de Tours, EA7505 Tours, France
| | - Dominique Babuty
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université de Tours, EA7505 Tours, France
| | - Bertrand Pierre
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université de Tours, EA7505 Tours, France
| | - Nicolas Clementy
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université de Tours, EA7505 Tours, France
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université de Tours, EA7505 Tours, France
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16
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Liang Y, Wang J, Yu Z, Zhang M, Pan L, Nie Y, Su Y, Ge J. Comparison between cardiac resynchronization therapy with and without defibrillator on long-term mortality: A propensity score matched analysis. J Cardiol 2020; 75:432-438. [DOI: 10.1016/j.jjcc.2019.08.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/20/2019] [Accepted: 08/27/2019] [Indexed: 01/14/2023]
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17
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Foo FS, Lee M, Looi K, Larsen P, Clare GC, Heaven D, Stiles MK, Voss J, Boddington D, Jackson R, Kerr AJ. Implantable cardioverter defibrillator and cardiac resynchronization therapy use in New Zealand (ANZACS-QI 33). J Arrhythm 2020; 36:153-163. [PMID: 32071634 PMCID: PMC7011834 DOI: 10.1002/joa3.12244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/19/2019] [Accepted: 09/09/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The ANZACS-QI Cardiac Implanted Device Registry (ANZACS-QI DEVICE) collects nationwide data on cardiac implantable electronic devices in New Zealand (NZ). We used the registry to describe contemporary NZ use of implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy (CRT). METHODS All ICD and CRT Pacemaker implants recorded in ANZACS-QI DEVICE between 1 January 2014 and 31 December 2017 were analyzed. RESULTS Of 1579 ICD implants, 1152 (73.0%) were new implants, including 49.0% for primary prevention and 51.0% for secondary prevention. In both groups, median age was 62 years and patients were predominantly male (81.4% and 79.2%, respectively). Most patients receiving a primary prevention ICD had a history of clinical heart failure (80.4%), NYHA class II-III symptoms (77.1%) and LVEF ≤35% (96.9%). In the secondary prevention ICD cohort, 88.4% were for sustained ventricular tachycardia or survived cardiac arrest from ventricular arrhythmia. Compared to primary prevention CRT Defibrillators (n = 155), those receiving CRT Pacemakers (n = 175) were older (median age 74 vs 66 years) and more likely to be female (38.3% vs 19.4%). Of the 427 (27.0%) ICD replacements (mean duration 6.3 years), 46.6% had received appropriate device therapy while 17.8% received inappropriate therapy. The ICD implant rate was 119 per million population with regional variation in implant rates, ratio of primary prevention ICD implants, and selection of CRT modality. CONCLUSION In contemporary NZ practice three-quarters of ICD implants were new implants, of which half were for primary prevention. The majority met current guideline indications. Patients receiving CRT pacemaker were older and more likely to be female.
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Affiliation(s)
- Fang Shawn Foo
- Department of CardiologyMiddlemore HospitalAucklandNew Zealand
- Department of CardiologyAuckland City HospitalAucklandNew Zealand
| | - Mildred Lee
- Department of CardiologyMiddlemore HospitalAucklandNew Zealand
- University of AucklandAucklandNew Zealand
| | - Khang‐Li Looi
- Department of CardiologyAuckland City HospitalAucklandNew Zealand
| | - Peter Larsen
- Wellington Cardiovascular Research GroupWellington HospitalWellingtonNew Zealand
| | - Geoffrey C. Clare
- Department of CardiologyChristchurch HospitalChristchurchNew Zealand
- University of OtagoChristchurchNew Zealand
| | - David Heaven
- Department of CardiologyMiddlemore HospitalAucklandNew Zealand
| | | | - Jamie Voss
- Department of CardiologyMiddlemore HospitalAucklandNew Zealand
| | - Dean Boddington
- Department of CardiologyTauranga HospitalTaurangaNew Zealand
| | | | - Andrew J. Kerr
- Department of CardiologyMiddlemore HospitalAucklandNew Zealand
- University of AucklandAucklandNew Zealand
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18
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Koshy A, Witte K. Uses and potential for cardiac magnetic resonance imaging in patients with cardiac resynchronisation pacemakers. Expert Rev Med Devices 2019; 16:445-450. [DOI: 10.1080/17434440.2019.1618706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Aaron Koshy
- Leeds Institute for Cardiovascular and Metabolic Medicine LIGHT building, University of Leeds, Leeds, UK
| | - Klaus Witte
- Leeds Institute for Cardiovascular and Metabolic Medicine LIGHT building, University of Leeds, Leeds, UK
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19
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Laish-Farkash A, Bruoha S, Katz A, Goldenberg I, Suleiman M, Michowitz Y, Shlomo N, Einhorn-Cohen M, Khalameizer V. Morbidity and mortality with cardiac resynchronization therapy with pacing vs. with defibrillation in octogenarian patients in a real-world setting. Europace 2018; 19:1357-1363. [PMID: 27733457 DOI: 10.1093/europace/euw238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 07/04/2016] [Indexed: 11/13/2022] Open
Abstract
Aims Cardiac resynchronization therapy (CRT) with a defibrillator (CRT-D) has downsides of high cost and inappropriate shocks compared to CRT without a defibrillator (CRT-P). Recent data suggest that the survival benefit of implantable cardioverter defibrillator (ICD) therapy is attenuated in the older age group. We hypothesized that, among octogenarians eligible for cardiac resynchronization therapy, CRT-P confers similar morbidity and mortality benefits as CRT-D. Methods and results We compared morbidity and mortality outcomes between consecutive octogenarian patients eligible for CRT therapy who underwent CRT-P implantation at Barzilai MC (n = 142) vs. those implanted with CRT-D for primary prevention indication who were prospectively enrolled in the Israeli ICD Registry (n = 104). Among the 246 study patients, mean age was 84 ± 3 years, 74% were males, and 66% had ischaemic cardiomyopathy. Kaplan-Meier survival analysis showed that at 5 years of follow-up the rate of all-cause mortality was 43% in CRT-P vs. 57% in the CRT-D group [log-rank P = 0.13; adjusted hazard ratio (HR) = 0.79, 95% CI 0.46-1.35, P = 0.37]. Kaplan-Meier analysis also showed no significant difference in the rates of the combined endpoint of heart failure or death (46 vs. 60%, respectively, log-rank P = 0.36; adjusted HR was 0.85, 95% CI 0.51-1.44, P = 0.55). A Cox proportional hazard with competing risk model showed that re-hospitalizations for cardiac cause were not different for the two groups (adjusted HR 1.35, 95% CI 0.7-2.6, P = 0.37). Conclusion Our data suggest that, in octogenarians with systolic heart failure, CRT-P therapy is associated with similar morbidity and mortality outcomes as CRT-D therapy.
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Affiliation(s)
- Avishag Laish-Farkash
- Electrophysiology and Pacing Unit, Department of Cardiology, Barzilai University Medical Center, Ashkelon and Faculty of Health Sciences, Ben-Gurion University of the Negev, 2 Hahistadrut Street, Ashkelon 78278, Israel
| | - Sharon Bruoha
- Electrophysiology and Pacing Unit, Department of Cardiology, Barzilai University Medical Center, Ashkelon and Faculty of Health Sciences, Ben-Gurion University of the Negev, 2 Hahistadrut Street, Ashkelon 78278, Israel
| | - Amos Katz
- Electrophysiology and Pacing Unit, Department of Cardiology, Barzilai University Medical Center, Ashkelon and Faculty of Health Sciences, Ben-Gurion University of the Negev, 2 Hahistadrut Street, Ashkelon 78278, Israel
| | - Ilan Goldenberg
- The Israeli Association for Cardiovascular Trials, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
| | | | - Yoav Michowitz
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Nir Shlomo
- The Israeli Association for Cardiovascular Trials, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Michal Einhorn-Cohen
- The Israeli Association for Cardiovascular Trials, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Vladimir Khalameizer
- Electrophysiology and Pacing Unit, Department of Cardiology, Barzilai University Medical Center, Ashkelon and Faculty of Health Sciences, Ben-Gurion University of the Negev, 2 Hahistadrut Street, Ashkelon 78278, Israel
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20
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Semi-automated QRS score as a predictor of survival in CRT treated patients with strict left bundle branch block. J Electrocardiol 2017; 51:282-287. [PMID: 29203081 DOI: 10.1016/j.jelectrocard.2017.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Cardiac Resynchronization Therapy (CRT) is widely used for treating selected heart failure patients, but patients with myocardial scar respond worse to treatment. The Selvester QRS scoring system estimates myocardial scar burden using 12-lead ECG. This study's objective was to investigate the scores correlation to mortality in a CRT population. METHODS AND RESULTS Data on consecutive CRT patients was collected. 401 patients with LBBB and available ECG data were included in the study. QuAReSS software was used to perform Selvester scoring. Mean Selvester score was 6.4, corresponding to 19% scar burden. The endpoint was death or heart transplant; outcome was analyzed using Cox proportional hazards models. A Selvester score >8 was significantly associated with higher risk of the combined endpoint (HR 1.59, p=.014, CI 1.09-2.3). CONCLUSION Higher Selvester scores correlate to mortality in CRT patients with strict LBBB and might be of value in prognosticating survival.
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21
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Martens P, Verbrugge FH, Nijst P, Dupont M, Nuyens D, Herendael HV, Rivero-Ayerza M, Tang WH, Mullens W. Incremental benefit of cardiac resynchronisation therapy with versus without a defibrillator. Heart 2017; 103:1977-1984. [PMID: 28716973 DOI: 10.1136/heartjnl-2017-311423] [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: 02/23/2017] [Revised: 04/26/2017] [Accepted: 05/15/2017] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To determine the incremental value of implantable cardioverter defibrillators (ICD) in contemporary optimally treated patients with heart failure (HF) undergoing cardiac resynchronisation therapy (CRT). METHODS Consecutive patients with HF undergoing CRT-pacemaker (CRT-P) or CRT-defibrillator (CRT-D) implantation in a single tertiary care centre between October 2008 and August 2015 were retrospectively evaluated. For patients with a primary prevention indication of the CRT-D, no benefit of the ICD was defined as absence of appropriate therapy (device analysis) or lethal ventricular tachyarrhythmias (mode of death analysis) during follow-up. RESULTS 687 patients (CRT-P/CRT-D; n=361/326) were followed for 38±22 months. CRT-P recipients were older (75.7±9.1 vs 71.8±9.3 years; p<0.001) and had a higher comorbidity burden. Five patients with CRT-P (1%) experienced episodes of sustained ventricular-tachycardia vs 64 (20%) patients with CRT-D (p<0.001). Remote tele-monitoring detected the episodes of sustained ventricular tachycardia in four patients with CRT-P, allowing for elective upgrade to CRT-D. All-cause mortality was higher in patients with CRT-P versus CRT-D (21% vs 12%, p=0.003), even after adjusting for baseline characteristics (HR 2.5; 95% CI 1.36 to 4.60; p=0.003). However, mode of death analysis revealed a predominant non-cardiac mode of death in CRT-P recipients (n=47 (71%) vs n=13 (38%) in CRT-D, p=0.002). Multivariate analysis revealed that age >80 years, New York Heart Association class IV, intolerance to beta-blockers and underlying non-ischaemic cardiomyopathy were independently associated with little incremental value of a primary prevention ICD on top of CRT. CONCLUSIONS The majority of patients with contemporary HF as currently selected for CRT-P exhibit mainly non-cardiac-driven mortality. Weighing risk of ventricular-tachyarrhythmic death versus risk of all-cause mortality helps to address the incremental value of an ICD to CRT-P.
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Affiliation(s)
- Pieter Martens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | | | - Petra Nijst
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Matthias Dupont
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Dieter Nuyens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | | | | | - Wilson H Tang
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
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22
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Han Z, Chen Z, Lan R, Di W, Li X, Yu H, Ji W, Zhang X, Xu B, Xu W. Sex-specific mortality differences in heart failure patients with ischemia receiving cardiac resynchronization therapy. PLoS One 2017; 12:e0180513. [PMID: 28683134 PMCID: PMC5500352 DOI: 10.1371/journal.pone.0180513] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 06/18/2017] [Indexed: 01/01/2023] Open
Abstract
Background Recent studies have reported prognosis differences between male and female heart failure patients following cardiac resynchronization therapy (CRT). However, the potential clinical factors that underpin these differences remain to be elucidated. Methods A meta-analysis was performed to investigate the factors that characterize sex-specific differences following CRT. This analysis involved searching the Medline (Pubmed source) and Embase databases in the period from January 1980 to September 2016. Results Fifty-eight studies involving 33445 patients (23.08% of whom were women) were analyzed as part of this study. Only patients receiving CRT with follow-up greater than six months were included in our analysis. Compared with males, females exhibited a reduction of 33% (hazard ratio, 0.67; 95% confidence interval, 0.62–0.73; P < 0.0001) and 42% (hazard ratio, 0.58; 95% confidence interval, 0.46–0.74; P = 0.003) in all-cause mortality and heart failure hospitalization or heart failure, respectively. Following a stratified analysis of all-cause mortality, we observed that ischemic causes (p = 0.03) were likely to account for most of the sex-specific differences in relation to CRT. Conclusion These data suggest that women have a reduced risk of all-cause mortality and heart failure hospitalization or heart failure following CRT. Based on the results from the stratified analysis, we observed more optimal outcomes for females with ischemic heart disease. Thus, ischemia are likely to play a role in sex-related differences associated with CRT in heart failure patients. Further studies are required to determine other indications and the potential mechanisms that might be associated with sex-specific CRT outcomes.
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Affiliation(s)
- Zhonglin Han
- Department of Cardiology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, China
| | - Zheng Chen
- Department of Cardiology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, China
| | - Rongfang Lan
- Department of Cardiology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, China
| | - Wencheng Di
- Department of Cardiology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, China
| | - Xiaohong Li
- Department of Cardiology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, China
| | - Hongsong Yu
- Department of Cardiology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, China
| | - Wenqing Ji
- Department of Cardiology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, China
| | - Xinlin Zhang
- Department of Cardiology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, China
| | - Biao Xu
- Department of Cardiology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, China
| | - Wei Xu
- Department of Cardiology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, China
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Impact of baseline renal function on all-cause mortality in patients who underwent cardiac resynchronization therapy: A systematic review and meta-analysis. J Arrhythm 2017; 33:417-423. [PMID: 29021843 PMCID: PMC5634685 DOI: 10.1016/j.joa.2017.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 03/14/2017] [Accepted: 04/11/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) improves both morbidity and mortality in selected patients with heart failure and increased QRS duration. However, chronic kidney disease (CKD) may have an adverse effect on patient outcome. The aim of this systematic review was to analyze the existing data regarding the impact of baseline renal function on all-cause mortality in patients who underwent CRT. METHODS Medline database was searched systematically, and studies evaluating the effect of baseline renal function on all-cause mortality in patients who underwent CRT were retrieved. We performed three separate analyses according to the comparison groups included in each study. Data were analyzed using Review Manager software (RevMan version 5.3; Oxford, UK). RESULTS We included 16 relevant studies in our analysis. Specifically, 13 studies showed a statistically significant higher risk of all-cause mortality in patients with impaired baseline renal function who underwent CRT. The remaining three studies did not show a statistically significant result. The quantitative synthesis of five studies showed a 19% decrease in all-cause mortality per 10-unit increment in estimated glomerular filtration rate (eGFR) [HR: 0.81, 95% CI (0.73-0.90), p<0.01, 86% I2]. Additionally, we demonstrated that patients with an eGFR<60 mL/min/1.73 m2 had an all-cause mortality rate of 66% [HR: 1.66, 95% CI (1.37-2.02), p<0.01, 0% I2], which was higher than in those with an eGFR≥60 mL/min/1.73 m2. CONCLUSION Baseline renal dysfunction has an adverse effect on-all cause mortality in patients who underwent CRT.
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24
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Cardiac resynchronization therapy in ischemic and non-ischemic cardiomyopathy. J Arrhythm 2017; 33:410-416. [PMID: 29021842 PMCID: PMC5634673 DOI: 10.1016/j.joa.2017.03.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 03/05/2017] [Accepted: 03/14/2017] [Indexed: 01/06/2023] Open
Abstract
Cardiac resynchronization therapy (CRT) using a biventricular pacing system has been an effective therapeutic strategy in patients with symptomatic heart failure with a reduced left ventricular ejection fraction (LVEF) of 35% or less and a QRS duration of 130 ms or more. The etiology of heart failure can be classified as either ischemic or non-ischemic cardiomyopathy. Ischemic etiology of patients receiving CRT is prevalent predominantly in North America, moderately in Europe, and less so in Japan. CRT reduces mortality similarly in both ischemic and non-ischemic cardiomyopathy, whereas reverse structural left ventricular remodeling occurs more favorably in non-ischemic cardiomyopathy. Because the substrate for ventricular arrhythmias appears to be more severe in cases of ischemic as compared with non-ischemic cardiomyopathy, the use of an implantable cardioverter-defibrillator (ICD) backup method could prolong the long-term survival, especially of patients with ischemic cardiomyopathy, even in the presence of CRT. The aim of this review article is to summarize the effects of CRT on outcomes and the role of ICD backup in ischemic and non-ischemic cardiomyopathy.
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Nauffal V, Zhang Y, Tanawuttiwat T, Blasco-Colmenares E, Rickard J, Marine JE, Butcher B, Norgard S, Dickfeld TM, Ellenbogen KA, Guallar E, Tomaselli GF, Cheng A. Clinical decision tool for CRT-P vs. CRT-D implantation: Findings from PROSE-ICD. PLoS One 2017; 12:e0175205. [PMID: 28388657 PMCID: PMC5384669 DOI: 10.1371/journal.pone.0175205] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 03/22/2017] [Indexed: 12/01/2022] Open
Abstract
Background Cardiac resynchronization therapy (CRT) devices reduce mortality through pacing-induced cardiac resynchronization and implantable cardioverter defibrillator (ICD) therapy for ventricular arrhythmias (VAs). Whether certain factors can predict if patients will benefit more from implantation of CRT pacemakers (CRT-P) or CRT defibrillators (CRT-D) remains unclear. Methods and results We followed 305 primary prevention CRT-D recipients for the two primary outcomes of HF hospitalization and ICD therapy for VAs. Serum biomarkers, electrocardiographic and clinical variables were collected prior to implant. Multivariable analysis using Cox-proportional hazards model was used to fit the final models. Among 282 patients with follow-up outcome data, 75 (26.6%) were hospitalized for HF and 31 (11%) received appropriate ICD therapy. Independent predictors of HF hospitalization were atrial fibrillation (HR = 1.8 (1.1,2.9)), NYHA class III/IV (HR = 2.2 (1.3,3.6)), ejection fraction <20% (HR = 1.7 (1.1,2.7)), HS-IL6 >4.03pg/ml (HR = 1.7 (1.1,2.9)) and hemoglobin (<12g/dl) (HR = 2.2 (1.3,3.6)). Independent predictors of appropriate therapy included BUN >20mg/dL (HR = 3.0 (1.3,7.1)), HS-CRP >9.42mg/L (HR = 2.3 (1.1,4.7)), no beta blocker therapy (HR = 3.2 (1.4,7.1)) and hematocrit ≥38% (HR = 2.7 (1.03,7.0)). Patients with 0–1 risk factors for appropriate therapy (IR 1 per 100 person-years) and ≥3 risk factors for HF hospitalization (IR 23 per 100-person-years) were more likely to die prior to receiving an appropriate ICD therapy. Conclusions Clinical and biomarker data can risk stratify CRT patients for HF progression and VAs. These findings may help characterize subgroups of patients that may benefit more from the use of CRT-P vs. CRT-D systems. Trial registration ClinicalTrials.gov NCT00733590
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Affiliation(s)
- Victor Nauffal
- Department of Medicine, Division of Cardiology, Johns Hopkins Medical Institutes, Baltimore, Maryland, United States of America
| | - Yiyi Zhang
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Tanyanan Tanawuttiwat
- Department of Medicine, Division of Cardiology, Johns Hopkins Medical Institutes, Baltimore, Maryland, United States of America
| | - Elena Blasco-Colmenares
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - John Rickard
- Department of Medicine, Division of Cardiology, Johns Hopkins Medical Institutes, Baltimore, Maryland, United States of America
| | - Joseph E. Marine
- Department of Medicine, Division of Cardiology, Johns Hopkins Medical Institutes, Baltimore, Maryland, United States of America
| | - Barbara Butcher
- Department of Medicine, Division of Cardiology, Johns Hopkins Medical Institutes, Baltimore, Maryland, United States of America
| | - Sanaz Norgard
- Department of Medicine, Division of Cardiology, Johns Hopkins Medical Institutes, Baltimore, Maryland, United States of America
| | - Timm-Michael Dickfeld
- Department of Medicine, University of Maryland, Baltimore, Maryland, United States of America
| | - Kenneth A. Ellenbogen
- Department of Medicine, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Eliseo Guallar
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Gordon F. Tomaselli
- Department of Medicine, Division of Cardiology, Johns Hopkins Medical Institutes, Baltimore, Maryland, United States of America
| | - Alan Cheng
- Department of Medicine, Division of Cardiology, Johns Hopkins Medical Institutes, Baltimore, Maryland, United States of America
- * E-mail:
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Berthiaume J, Kirk J, Ranek M, Lyon R, Sheikh F, Jensen B, Hoit B, Butany J, Tolend M, Rao V, Willis M. Pathophysiology of Heart Failure and an Overview of Therapies. Cardiovasc Pathol 2016. [DOI: 10.1016/b978-0-12-420219-1.00008-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Barra S, Looi KL, Gajendragadkar PR, Khan FZ, Virdee M, Agarwal S. Applicability of a risk score for prediction of the long-term benefit of the implantable cardioverter defibrillator in patients receiving cardiac resynchronization therapy. Europace 2015; 18:1187-93. [DOI: 10.1093/europace/euv352] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 09/25/2015] [Indexed: 11/12/2022] Open
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Barra S, Providência R, Tang A, Heck P, Virdee M, Agarwal S. Importance of Implantable Cardioverter-Defibrillator Back-Up in Cardiac Resynchronization Therapy Recipients: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2015; 4:e002539. [PMID: 26546574 PMCID: PMC4845241 DOI: 10.1161/jaha.115.002539] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 09/28/2015] [Indexed: 01/18/2023]
Abstract
BACKGROUND It remains to be determined whether patients receiving cardiac resynchronization therapy (CRT) benefit from the addition of an implantable cardioverter-defibrillator (ICD). METHODS AND RESULTS We performed a literature search looking for studies of patients implanted with CRTs. Comparisons were performed between patients receiving CRT-defibrillator (CRT-D) versus CRT-pacemaker (CRT-P). The primary outcome was all-cause mortality. Data were pooled using a random-effects model. The relative risk (RR) and hazard ratio (HR, when available) were used as measurements of treatment effect. Nineteen entries were entitled for inclusion, comprising 12 378 patients (7030 receiving CRT-D and 5348 receiving CRT-P) and 29 799 patient-years of follow-up. Those receiving CRT-D were younger, were more often males, had lower NYHA class, lower prevalence of atrial fibrillation, higher prevalence of ischemic heart disease, and were more often on beta-blockers. Ten studies showed significantly lower mortality rates with the CRT-D device, while the remaining 9 were neutral. The pooled data of studies revealed that CRT-D patients had significantly lower mortality rates compared with CRT-P patients (mortality rates: CRT-D 16.6% versus CRT-P 27.1%; RR=0.69, 95% CI 0.62-0.76; P<0.00001). The number needed to treat to prevent one death was 10. The observed I(2) values showed moderate heterogeneity among studies (I(2)=48%). The benefit of CRT-D was more pronounced in ischemic cardiomyopathy (HR=0.70, 95% CI 0.59-0.83, P<0.001, I(2)=0%), but a trend for benefit, albeit of lower magnitude, could also be seen in non-ischemic dilated cardiomyopathy (HR=0.79, 95% CI 0.61-1.02, P=0.07, I(2)=36%). CONCLUSIONS The addition of the ICD associates with a reduction in the risk of all-cause mortality in CRT patients. This seems to be more pronounced in patients with ischemic cardiomyopathy.
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Affiliation(s)
- Sérgio Barra
- Cardiology DepartmentPapworth Hospital NHS Foundation TrustCambridgeUK
| | | | - Anthony Tang
- University of Western OntarioLondonOntarioCanada
| | - Patrick Heck
- Cardiology DepartmentPapworth Hospital NHS Foundation TrustCambridgeUK
| | - Munmohan Virdee
- Cardiology DepartmentPapworth Hospital NHS Foundation TrustCambridgeUK
| | - Sharad Agarwal
- Cardiology DepartmentPapworth Hospital NHS Foundation TrustCambridgeUK
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Witt CT, Kronborg MB, Nohr EA, Mortensen PT, Gerdes C, Jensen HK, Nielsen JC. Adding the implantable cardioverter-defibrillator to cardiac resynchronization therapy is associated with improved long-term survival in ischaemic, but not in non-ischaemic cardiomyopathy. Europace 2015; 18:413-9. [DOI: 10.1093/europace/euv212] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 05/13/2015] [Indexed: 01/09/2023] Open
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Sturdivant JL, Gold MR. Biventricular pacemaker/defibrillators versus biventricular pacemakers in patients with non-ischemic cardiomyopathy. Card Electrophysiol Clin 2015; 7:455-459. [PMID: 26304525 DOI: 10.1016/j.ccep.2015.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The decision to employ defibrillator therapy in patients with non-ischemic cardiomyopathy is driven by reduction in mortality. The strength of data supporting this therapy has led to its incorporation in medical guidelines and general practice across the world. Cardiac resynchronization therapy has also been proven to reduce heart failure hospitalization and improve quality of life. Although trends toward reduction in arrhythmic events have been observed, results in multicenter, randomized controlled trials have not been compelling for stand-alone use in most patients who currently meet criteria for defibrillator therapy.
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Affiliation(s)
- John Lacy Sturdivant
- Division of Cardiology, Medical University of South Carolina, 4065 Blackmoor Street, Mount Pleasant, Charleston, SC 29466, USA
| | - Michael R Gold
- Division of Cardiology, Medical University of South Carolina, 25 Courtenay Drive ART 7031, MSC 592, Charleston, SC 29425-5920, USA.
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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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Chatterjee NA, Roka A, Lubitz SA, Gold MR, Daubert C, Linde C, Steffel J, Singh JP, Mela T. Reduced appropriate implantable cardioverter-defibrillator therapy after cardiac resynchronization therapy-induced left ventricular function recovery: a meta-analysis and systematic review. Eur Heart J 2015; 36:2780-9. [PMID: 26264552 DOI: 10.1093/eurheartj/ehv373] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 07/15/2015] [Indexed: 01/25/2023] Open
Abstract
AIMS For patients undergoing cardiac resynchronization therapy (CRT) with implantable cardioverter-defibrillator (ICD; CRT-D), the effect of an improvement in left ventricular ejection fraction (LVEF) on appropriate ICD therapy may have significant implications regarding management at the time of ICD generator replacement. METHODS AND RESULTS We conducted a meta-analysis to determine the effect of LVEF recovery following CRT on the incidence of appropriate ICD therapy. A search of multiple electronic databases identified 709 reports, of which 6 retrospective cohort studies were included (n = 1740). In patients with post-CRT LVEF ≥35% (study n = 4), the pooled estimated rate of ICD therapy (5.5/100 person-years) was significantly lower than patients with post-CRT LVEF <35% [incidence rate difference (IRD): -6.5/100 person-years, 95% confidence interval (95% CI): -8.8 to -4.2, P < 0.001]. Similarly, patients with post-CRT LVEF ≥45% (study n = 4) demonstrated lower estimated rates of ICD therapy (2.3/100 person-years) compared with patients without such recovery (IRD: -5.8/100 person-years, 95% CI: -7.6 to -4.0, P < 0.001). Restricting analysis to studies discounting ICD therapies during LVEF recovery (study n = 3), patients with LVEF recovery (≥35 or ≥45%) had significantly lower rates of ICD therapy compared with patients without such recovery (P for both <0.001). Patients with primary prevention indication for ICD, regardless of LVEF recovery definition, had very low rates of ICD therapy (0.4 to 0.8/100-person years). CONCLUSION Recovery of LVEF post-CRT is associated with significantly reduced appropriate ICD therapy. Patients with improvement of LVEF ≥45% and those with primary prevention indication for ICD appear to be at lowest risk.
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Affiliation(s)
- Neal A Chatterjee
- Department of Medicine and the Cardiac Arrhythmia Service, GRB 109, Massachusetts General Hospital Heart Center, 55 Fruit Street, Boston, MA 02411, USA
| | - Attila Roka
- Department of Medicine and the Cardiac Arrhythmia Service, GRB 109, Massachusetts General Hospital Heart Center, 55 Fruit Street, Boston, MA 02411, USA
| | - Steven A Lubitz
- Department of Medicine and the Cardiac Arrhythmia Service, GRB 109, Massachusetts General Hospital Heart Center, 55 Fruit Street, Boston, MA 02411, USA
| | - Michael R Gold
- Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - Claude Daubert
- Cardiology Division, Rennes University Hospital, Rennes, France
| | - Cecilia Linde
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Jan Steffel
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Jagmeet P Singh
- Department of Medicine and the Cardiac Arrhythmia Service, GRB 109, Massachusetts General Hospital Heart Center, 55 Fruit Street, Boston, MA 02411, USA
| | - Theofanie Mela
- Department of Medicine and the Cardiac Arrhythmia Service, GRB 109, Massachusetts General Hospital Heart Center, 55 Fruit Street, Boston, MA 02411, USA
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Reitan C, Chaudhry U, Bakos Z, Brandt J, Wang L, Platonov PG, Borgquist R. Long-Term Results of Cardiac Resynchronization Therapy: A Comparison between CRT-Pacemakers versus Primary Prophylactic CRT-Defibrillators. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:758-67. [PMID: 25788040 DOI: 10.1111/pace.12631] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 02/02/2015] [Accepted: 03/12/2015] [Indexed: 01/23/2023]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) with or without a defibrillator has a positive effect on mortality and morbidity for patients with heart failure. However, comparisons between CRT-defibrillators (CRT-D) and CRT-pacemakers (CRT-P) are relatively scarce outside the clinical trial setting. This study aimed to assess baseline characteristics in relation to long-term prognosis in patients treated with CRT, and to investigate the potential benefit of CRT-D versus CRT-P. METHODS Data were retrospectively collected from the medical records of all consecutive patients treated with CRT-P or primary prophylactic CRT-D at a large tertiary care center between 1999 and 2012. Predictors of mortality were investigated, and time-dependent analysis was performed with all-cause mortality as the primary end point. RESULTS A total of 705 patients were included (69.6 ± 10 years, 78% New York Heart Association classes III-IV, left ventricular ejection fraction median 25%, 16% female, 36% CRT-D). The patients were followed for a median of 59 months. Annual mortality differed between CRT-D primary prophylactic and CRT-P groups (5.3% and 11.8%, respectively), but when adjusted for covariates, CRT-D treatment (compared to CRT-P) was not associated with better long-term survival. Independent predictors of survival were: age, use of loop diuretics, hemoglobin levels, and use of renin angiotensin aldosterone system blockers. CONCLUSIONS In CRT treatment outside of the clinical trial setting, CRT-D treatment was not an independent predictor of long-term survival. Future research should focus on correct selection of the patients who receive enough benefit of an added defibrillator to justify CRT-D implantation instead of CRT-P treatment only.
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Affiliation(s)
- Christian Reitan
- Lund University, Arrhythmia Clinic, Skane University Hospital, Lund, Sweden
| | - Uzma Chaudhry
- Lund University, Arrhythmia Clinic, Skane University Hospital, Lund, Sweden
| | - Zoltan Bakos
- Lund University, Arrhythmia Clinic, Skane University Hospital, Lund, Sweden
| | - Johan Brandt
- Lund University, Arrhythmia Clinic, Skane University Hospital, Lund, Sweden
| | - Lingwei Wang
- Lund University, Arrhythmia Clinic, Skane University Hospital, Lund, Sweden
| | - Pyotr G Platonov
- Lund University, Arrhythmia Clinic, Skane University Hospital, Lund, Sweden
| | - Rasmus Borgquist
- Lund University, Arrhythmia Clinic, Skane University Hospital, Lund, Sweden
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Herz ND, Engeda J, Zusterzeel R, Sanders WE, O'Callaghan KM, Strauss DG, Jacobs SB, Selzman KA, Piña IL, Caños DA. Sex differences in device therapy for heart failure: utilization, outcomes, and adverse events. J Womens Health (Larchmt) 2015; 24:261-71. [PMID: 25793483 DOI: 10.1089/jwh.2014.4980] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Multiple studies of heart failure patients demonstrated significant improvement in exercise capacity, quality of life, cardiac left ventricular function, and survival from cardiac resynchronization therapy (CRT), but the underenrollment of women in these studies is notable. Etiological and pathophysiological differences may result in different outcomes in response to this treatment by sex. The observed disproportionate representation of women suggests that many women with heart failure either do not meet current clinical criteria to receive CRT in trials or are not properly recruited and maintained in these studies. METHODS We performed a systematic literature review through May 2014 of clinical trials and registries of CRT use that stratified outcomes by sex or reported percent women included. One-hundred eighty-three studies contained sex-specific information. RESULTS Ninety percent of the studies evaluated included ≤ 35% women. Fifty-six articles included effectiveness data that reported response with regard to specific outcome parameters. When compared with men, women exhibited more dramatic improvement in specific parameters. In the studies reporting hazard ratios for hospitalization or death, women generally had greater benefit from CRT. CONCLUSIONS Our review confirms women are markedly underrepresented in CRT trials, and when a CRT device is implanted, women have a therapeutic response that is equivalent to or better than in men, while there is no difference in adverse events reported by sex.
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Affiliation(s)
- Naomi D Herz
- Center for Devices and Radiological Health, United States Food and Drug Administration , Silver Spring, Maryland
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Shuaib W, Shahid H, Khan MS, Alweis R, Sanchez LR. Outcome of prolonged QRS interval in dilated cardiomyopathy: role of implantable cardioverter-defibrillators on mortality. Ther Adv Cardiovasc Dis 2014; 9:36-9. [PMID: 25411353 DOI: 10.1177/1753944714559935] [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] [Indexed: 11/15/2022] Open
Abstract
AIM The main objectives of this study were to investigate the relationship between prolonged QRS interval and its prognosis in patients with dilated cardiomyopathy (DCM), and to determine the effects of cardiac pacing with an implantable cardioverter-defibrillator (ICD) on mortality in patients with a QRS width > 150 ms. METHODS We retrospectively queried the healthcare enterprise data warehouse and the patient medical records from January 2007 to December 2012 for 1453 cases of DCM at a university- affiliated hospital. Of the 1453 cases, 989 patients were included in the final analyses. Primary outcome variable was all-cause mortality. RESULTS Of the 989 patients, 20% (n = 198) of the patients had a QRS width > 150 ms. Compared with patients who had a QRS < 120 ms, patients with a QRS > 150 ms had significantly higher rates of death (p < 0.001). Among the subgroup of 198 patients who had a QRS width > 150 ms, survival (84.3%, n = 75) was significantly higher (p < 0.001) in patients with a pacemaker inserted compared with those (45.0%, n = 49) who had not been paced. CONCLUSIONS Prolonged QRS interval is significantly associated with a higher rate of mortality. However, we believe that cardiac pacing with an ICD in such patients can significantly improve outcomes.
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Affiliation(s)
- Waqas Shuaib
- Department of Radiology and Imaging Sciences, Emory University Hospital Midtown, 550 Peachtree Street NE, Atlanta, GA 02115, USA
| | - Hassan Shahid
- Department of Medicine, Reading Health System, West Reading, PA, USA
| | | | - Richard Alweis
- Department of Medicine, Reading Health System, West Reading, PA, USA
| | - Laura Rosemary Sanchez
- Department of Cardiology, Hospital Salvador Bienvenido Gautier, Santo Domingo, Dominican Republic
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Ruwald MH, Solomon SD, Foster E, Kutyifa V, Ruwald AC, Sherazi S, McNitt S, Jons C, Moss AJ, Zareba W. Left ventricular ejection fraction normalization in cardiac resynchronization therapy and risk of ventricular arrhythmias and clinical outcomes: results from the Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy (MADIT-CRT) trial. Circulation 2014; 130:2278-86. [PMID: 25301831 DOI: 10.1161/circulationaha.114.011283] [Citation(s) in RCA: 135] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Appropriate guideline criteria for use of implantable cardioverter-defibrillators (ICDs) do not take into account potential recovery of left ventricular ejection fraction (LVEF) in patients treated with CRT-defibrillator. METHODS AND RESULTS Patients randomized to CRT-defibrillator from the Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy (MADIT-CRT) trial who survived and had paired echocardiograms at enrollment and at 12 months (n=752) were included. Patients were evaluated by LVEF recovery in 3 groups (LVEF ≤35% [reference], 36%-50%, and >50%) on outcomes of ventricular tachyarrhythmias (VTAs), VTA ≥200 bpm, ICD shock, heart failure or death, and inappropriate ICD therapy by multivariable Cox models. A total of 7.3% achieved LVEF normalization (>50%). The average follow-up was 2.2±0.8 years. The risk of VTA was reduced in patients with LVEF >50% (hazard ratio [HR], 0.24; 95% confidence interval [CI], 0.07-0.82; P=0.023) and LVEF of 36% to 50% (HR, 0.44; 95% CI, 0.28-0.68; P<0.001). Among patients with LVEF >50%, only 1 patient had VTA ≥200 bpm (HR, 0.16; 95% CI, 0.02-1.51), none were shocked by the ICD, and 2 died of nonarrhythmic causes. The risk of HF or death was reduced with improvements in LVEF (LVEF >50%: HR, 0.29; 95% CI, 0.09-0.97; P=0.045; and LVEF of 36%-50%: HR, 0.44; 95% CI, 0.28-0.69; P<0.001). For inappropriate ICD therapy, no additional risk reduction for LVEF>50% was seen compared with an LVEF of 36% to 50%. A total of 6 factors were associated with LVEF normalization, and patients with all factors present (n=42) did not experience VTAs (positive predictive value, 100%). CONCLUSIONS Patients who achieve LVEF normalization (>50%) have very low absolute and relative risk of VTAs and a favorable clinical course within 2.2 years of follow-up. Risk of inappropriate ICD therapy is still present, and these patients could be considered for downgrade from CRT-defibrillator to CRT-pacemaker at the time of battery depletion if no VTAs have occurred. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT00180271.
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Affiliation(s)
- Martin H Ruwald
- From the Heart Research Follow-up Program, Division of Cardiology, University of Rochester Medical Center, Rochester, NY (M.H.R., V.K., A.-C.R., S.S., S.M., A.J.M., W.Z.); Department of Cardiology, Gentofte Hospital, Hellerup, Denmark (M.H.R., A.-C.R., C.J.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.D.S.); and Division of Cardiology, Department of Medicine, University of California, San Francisco (E.F.).
| | - Scott D Solomon
- From the Heart Research Follow-up Program, Division of Cardiology, University of Rochester Medical Center, Rochester, NY (M.H.R., V.K., A.-C.R., S.S., S.M., A.J.M., W.Z.); Department of Cardiology, Gentofte Hospital, Hellerup, Denmark (M.H.R., A.-C.R., C.J.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.D.S.); and Division of Cardiology, Department of Medicine, University of California, San Francisco (E.F.)
| | - Elyse Foster
- From the Heart Research Follow-up Program, Division of Cardiology, University of Rochester Medical Center, Rochester, NY (M.H.R., V.K., A.-C.R., S.S., S.M., A.J.M., W.Z.); Department of Cardiology, Gentofte Hospital, Hellerup, Denmark (M.H.R., A.-C.R., C.J.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.D.S.); and Division of Cardiology, Department of Medicine, University of California, San Francisco (E.F.)
| | - Valentina Kutyifa
- From the Heart Research Follow-up Program, Division of Cardiology, University of Rochester Medical Center, Rochester, NY (M.H.R., V.K., A.-C.R., S.S., S.M., A.J.M., W.Z.); Department of Cardiology, Gentofte Hospital, Hellerup, Denmark (M.H.R., A.-C.R., C.J.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.D.S.); and Division of Cardiology, Department of Medicine, University of California, San Francisco (E.F.)
| | - Anne-Christine Ruwald
- From the Heart Research Follow-up Program, Division of Cardiology, University of Rochester Medical Center, Rochester, NY (M.H.R., V.K., A.-C.R., S.S., S.M., A.J.M., W.Z.); Department of Cardiology, Gentofte Hospital, Hellerup, Denmark (M.H.R., A.-C.R., C.J.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.D.S.); and Division of Cardiology, Department of Medicine, University of California, San Francisco (E.F.)
| | - Saadia Sherazi
- From the Heart Research Follow-up Program, Division of Cardiology, University of Rochester Medical Center, Rochester, NY (M.H.R., V.K., A.-C.R., S.S., S.M., A.J.M., W.Z.); Department of Cardiology, Gentofte Hospital, Hellerup, Denmark (M.H.R., A.-C.R., C.J.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.D.S.); and Division of Cardiology, Department of Medicine, University of California, San Francisco (E.F.)
| | - Scott McNitt
- From the Heart Research Follow-up Program, Division of Cardiology, University of Rochester Medical Center, Rochester, NY (M.H.R., V.K., A.-C.R., S.S., S.M., A.J.M., W.Z.); Department of Cardiology, Gentofte Hospital, Hellerup, Denmark (M.H.R., A.-C.R., C.J.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.D.S.); and Division of Cardiology, Department of Medicine, University of California, San Francisco (E.F.)
| | - Christian Jons
- From the Heart Research Follow-up Program, Division of Cardiology, University of Rochester Medical Center, Rochester, NY (M.H.R., V.K., A.-C.R., S.S., S.M., A.J.M., W.Z.); Department of Cardiology, Gentofte Hospital, Hellerup, Denmark (M.H.R., A.-C.R., C.J.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.D.S.); and Division of Cardiology, Department of Medicine, University of California, San Francisco (E.F.)
| | - Arthur J Moss
- From the Heart Research Follow-up Program, Division of Cardiology, University of Rochester Medical Center, Rochester, NY (M.H.R., V.K., A.-C.R., S.S., S.M., A.J.M., W.Z.); Department of Cardiology, Gentofte Hospital, Hellerup, Denmark (M.H.R., A.-C.R., C.J.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.D.S.); and Division of Cardiology, Department of Medicine, University of California, San Francisco (E.F.)
| | - Wojciech Zareba
- From the Heart Research Follow-up Program, Division of Cardiology, University of Rochester Medical Center, Rochester, NY (M.H.R., V.K., A.-C.R., S.S., S.M., A.J.M., W.Z.); Department of Cardiology, Gentofte Hospital, Hellerup, Denmark (M.H.R., A.-C.R., C.J.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.D.S.); and Division of Cardiology, Department of Medicine, University of California, San Francisco (E.F.)
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37
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Cheng YJ, Zhang J, Li WJ, Lin XX, Zeng WT, Tang K, Tang AL, He JG, Xu Q, Mei MY, Zheng DD, Dong YG, Ma H, Wu SH. More Favorable Response to Cardiac Resynchronization Therapy in Women Than in Men. Circ Arrhythm Electrophysiol 2014; 7:807-15. [PMID: 25146838 DOI: 10.1161/circep.113.001786] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background—
Data on sex difference in response to cardiac resynchronization therapy (CRT) remain controversial. We conducted a meta-analysis to summarize all published studies to determine whether sex-based differences in response to CRT exist.
Methods and Results—
We performed a literature search using MEDLINE (source PubMed; January 1966 to March 2014) and EMBASE (January 1980 to March 2014) with no restrictions. Pooled effect estimates were obtained by using random-effects meta-analysis. Seventy-two studies involving 33 434 patients were identified. Overall, female patients had better outcomes from CRT compared with male patients, with a significant 33% reduction in the risk of death from any cause (hazard ratio, 0.67; 95% confidence interval, 0.61–0.74;
P
<0.001), 20% reduction in death or hospitalization for heart failure (hazard ratio, 0.80; 95% confidence interval, 0.71–0.90;
P
<0.001), 41% reduction in cardiac death (hazard ratio, 0.59; 95% confidence interval, 0.42–0.84;
P
<0.001), and 41% reduction in ventricular arrhythmias or sudden cardiac death (hazard ratio, 0.59; 95% confidence interval, 0.49–0.70;
P
<0.001). These more favorable responses to CRT in women were consistently associated with greater echocardiographic evidence of reverse cardiac remodeling in women than in men.
Conclusions—
Women obtained greater reductions in the risk of death from any cause, cardiac cause, death or hospitalization for heart failure, and ventricular arrhythmias or sudden cardiac death with CRT therapy compared with men, with consistently greater echocardiographic evidence of reverse cardiac remodeling in women than in men. Further studies are needed to investigate the exact reasons for these results and determine whether indications for CRT in women should be different from men.
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Affiliation(s)
- Yun-Jiu Cheng
- From the Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (Y.J.C., J.Z., W.J.L., X.X.L., W.T.Z., K.T., A.L.T., J.G.H., Q.X., W.Y.M., D.D.Z., Y.G.D., H.M., S.H.W.); and Department of Cardiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou, China (J.Z.)
| | - Jing Zhang
- From the Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (Y.J.C., J.Z., W.J.L., X.X.L., W.T.Z., K.T., A.L.T., J.G.H., Q.X., W.Y.M., D.D.Z., Y.G.D., H.M., S.H.W.); and Department of Cardiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou, China (J.Z.)
| | - Wei-Jie Li
- From the Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (Y.J.C., J.Z., W.J.L., X.X.L., W.T.Z., K.T., A.L.T., J.G.H., Q.X., W.Y.M., D.D.Z., Y.G.D., H.M., S.H.W.); and Department of Cardiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou, China (J.Z.)
| | - Xiao-Xiong Lin
- From the Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (Y.J.C., J.Z., W.J.L., X.X.L., W.T.Z., K.T., A.L.T., J.G.H., Q.X., W.Y.M., D.D.Z., Y.G.D., H.M., S.H.W.); and Department of Cardiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou, China (J.Z.)
| | - Wu-Tao Zeng
- From the Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (Y.J.C., J.Z., W.J.L., X.X.L., W.T.Z., K.T., A.L.T., J.G.H., Q.X., W.Y.M., D.D.Z., Y.G.D., H.M., S.H.W.); and Department of Cardiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou, China (J.Z.)
| | - Kai Tang
- From the Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (Y.J.C., J.Z., W.J.L., X.X.L., W.T.Z., K.T., A.L.T., J.G.H., Q.X., W.Y.M., D.D.Z., Y.G.D., H.M., S.H.W.); and Department of Cardiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou, China (J.Z.)
| | - An-li Tang
- From the Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (Y.J.C., J.Z., W.J.L., X.X.L., W.T.Z., K.T., A.L.T., J.G.H., Q.X., W.Y.M., D.D.Z., Y.G.D., H.M., S.H.W.); and Department of Cardiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou, China (J.Z.)
| | - Jian-Gui He
- From the Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (Y.J.C., J.Z., W.J.L., X.X.L., W.T.Z., K.T., A.L.T., J.G.H., Q.X., W.Y.M., D.D.Z., Y.G.D., H.M., S.H.W.); and Department of Cardiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou, China (J.Z.)
| | - Qing Xu
- From the Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (Y.J.C., J.Z., W.J.L., X.X.L., W.T.Z., K.T., A.L.T., J.G.H., Q.X., W.Y.M., D.D.Z., Y.G.D., H.M., S.H.W.); and Department of Cardiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou, China (J.Z.)
| | - Mei-Yi Mei
- From the Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (Y.J.C., J.Z., W.J.L., X.X.L., W.T.Z., K.T., A.L.T., J.G.H., Q.X., W.Y.M., D.D.Z., Y.G.D., H.M., S.H.W.); and Department of Cardiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou, China (J.Z.)
| | - Dong-Dan Zheng
- From the Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (Y.J.C., J.Z., W.J.L., X.X.L., W.T.Z., K.T., A.L.T., J.G.H., Q.X., W.Y.M., D.D.Z., Y.G.D., H.M., S.H.W.); and Department of Cardiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou, China (J.Z.)
| | - Yu-Gang Dong
- From the Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (Y.J.C., J.Z., W.J.L., X.X.L., W.T.Z., K.T., A.L.T., J.G.H., Q.X., W.Y.M., D.D.Z., Y.G.D., H.M., S.H.W.); and Department of Cardiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou, China (J.Z.)
| | - Hong Ma
- From the Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (Y.J.C., J.Z., W.J.L., X.X.L., W.T.Z., K.T., A.L.T., J.G.H., Q.X., W.Y.M., D.D.Z., Y.G.D., H.M., S.H.W.); and Department of Cardiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou, China (J.Z.)
| | - Su-Hua Wu
- From the Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (Y.J.C., J.Z., W.J.L., X.X.L., W.T.Z., K.T., A.L.T., J.G.H., Q.X., W.Y.M., D.D.Z., Y.G.D., H.M., S.H.W.); and Department of Cardiology, Liuzhou Municipal Liutie Central Hospital, Liuzhou, China (J.Z.)
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38
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Dewhurst MJ, Linker NJ. Current Evidence and Recommendations for Cardiac Resynchronisation Therapy. Arrhythm Electrophysiol Rev 2014; 3:9-14. [PMID: 26835058 DOI: 10.15420/aer.2011.3.1.9] [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: 10/05/2013] [Accepted: 03/13/2014] [Indexed: 11/04/2022] Open
Abstract
The number of people in Europe living with symptomatic heart failure is increasing. Since its advent in the 1990s, cardiac resynchronisation therapy (CRT) has proven beneficial in terms of morbidity and mortality in selected heart failure (HF) patient populations, when combined with optimal pharmacological therapy. We review the evidence for CRT and the populations of HF patients it is currently shown to benefit, and those in which more research needs to be performed.
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Affiliation(s)
| | - Nicholas J Linker
- Consultant Cardiologist, The James Cook University Hospital, Middlesbrough, UK
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39
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Reitan C, Bakos Z, Platonov PG, Höijer CJ, Brandt J, Wang L, Borgquist R. Patient-assessed short-term positive response to cardiac resynchronization therapy is an independent predictor of long-term mortality. Europace 2014; 16:1603-9. [PMID: 24681763 DOI: 10.1093/europace/euu058] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Cardiac resynchronization therapy (CRT) has a well-documented positive effect on mortality and heart failure morbidity. The aim of this study was to assess the long-term survival and the predictive value of self-assessed functional status on the long-term prognosis of patients treated with CRT-pacemaker (CRT-P). METHODS AND RESULTS Data were retrospectively collected from medical records of 446 consecutive patients implanted with CRT-P at a large-volume Swedish tertiary care centre. Primary outcome was all-cause mortality, predictive variables were assessed by log-rank test and univariate cox regression. Three hundred and nine patients had reliable information available on early improvement after implantation and were included in the multivariate analyses. The cohort was followed for a median of 79 months and was similar in baseline characteristics compared with major controlled trials. During follow-up 204 patients died, yearly mortality was 11.7%. Early improvement of self-assessed functional status was a strong independent predictor of survival [hazard ratio, HR 0.59, confidence interval (CI) 0.40-0.87, P = 0.007], together with well-known predictors; NYHA III-IV vs I-II (HR 1.66, CI 1.09-2.536, P = 0.018), age (HR 1.05, CI 1.03-1.08, P < 0.001), male gender (HR 2.0, CI 1.11-3.45, P = 0.021), and loop diuretic use (HR 4.41, CI 1.08-18.02). Patients with early improvement of self-assessed functional status had better 2-year and 5-year survival (P < 0.001). CONCLUSIONS Real-life patient characteristics and predictors of outcome compare well with those in published prospective trials. Self-assessed functional status is a strong predictor of long-term survival, which may have implications for a more active follow-up of patients without spontaneous improvement.
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Affiliation(s)
- Christian Reitan
- Department of Cardiology, Arrhythmia Clinic, Lund University, Skane University Hospital, Getingevägen, Lund S-221 85, Sweden
| | - Zoltan Bakos
- Department of Cardiology, Arrhythmia Clinic, Lund University, Skane University Hospital, Getingevägen, Lund S-221 85, Sweden
| | - Pyotr G Platonov
- Department of Cardiology, Arrhythmia Clinic, Lund University, Skane University Hospital, Getingevägen, Lund S-221 85, Sweden
| | - Carl-Johan Höijer
- Department of Cardiology, Arrhythmia Clinic, Lund University, Skane University Hospital, Getingevägen, Lund S-221 85, Sweden
| | - Johan Brandt
- Department of Cardiology, Arrhythmia Clinic, Lund University, Skane University Hospital, Getingevägen, Lund S-221 85, Sweden
| | - Lingwei Wang
- Department of Cardiology, Arrhythmia Clinic, Lund University, Skane University Hospital, Getingevägen, Lund S-221 85, Sweden
| | - Rasmus Borgquist
- Department of Cardiology, Arrhythmia Clinic, Lund University, Skane University Hospital, Getingevägen, Lund S-221 85, Sweden
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40
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Gold MR, Daubert JC, Abraham WT, Hassager C, Dinerman JL, Hudnall JH, Cerkvenik J, Linde C. Implantable Defibrillators Improve Survival in Patients With Mildly Symptomatic Heart Failure Receiving Cardiac Resynchronization Therapy. Circ Arrhythm Electrophysiol 2013; 6:1163-8. [DOI: 10.1161/circep.113.000570] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background—
Cardiac resynchronization therapy (CRT) decreases mortality, improves functional status, and induces reverse left ventricular remodeling in selected populations with heart failure. These benefits have been noted with both CRT-pacemakers as well as those devices with defibrillator backup (CRT-D). However, there are little data comparing mortality between these 2 device types.
Methods and Results—
REsynchronization reVErses Remodeling in Systolic left vEntricular dysfunction (REVERSE) was a multicenter, randomized trial of CRT among patients with mild heart failure. Long-term annual follow-up for 5 years was preplanned. The present analysis was confined to the 419 patients who were randomized to active CRT group. CRT-pacemakers or CRT-D devices were implanted based on national guidelines at the time of enrollment, with 74 patients receiving CRT pacemaker devices and the remaining 345 patients receiving CRT-D devices. After 12 months of CRT, changes in the clinical composite score, left ventricular end systolic volume index, 6-minute walk time, and quality of life indices were similar between CRT pacemaker and CRT-D patients. However, long-term follow-up showed lower morality in the CRT-D group. Specifically, multivariable analysis showed that CRT-D (hazard ratio, 0.35;
P
=0.003) was a strong independent predictor of survival. Female sex, longer unpaced QRS duration, and smaller baseline left ventricular end systolic volume index also were also associated with better survival.
Conclusions—
REVERSE demonstrated that the addition of implantable cardioverter-defibrillator therapy to CRT is associated with improved long-term survival compared with CRT pacing alone in mild heart failure.
Clinical Trial Registration—
URL:
http://clinicaltrials.gov
. Unique Identifier: NCT00271154.
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Affiliation(s)
- Michael R. Gold
- From the Division of Cardiology, Medical University of South Carolina, Charleston (M.R.G.); Department of Cardiology, University Hospital, CIC IT, INSERM 642, Rennes, France (J.-C.D.); Division of Cardiovascular Medicine, The Ohio State University, Columbus (W.T.A.); Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark (C.H.); Department of Cardiology, Heart Center Research, LLC, Huntsville, AL (J.L.D.); CRDM Clinical Research, Medtronic Inc., Minneapolis, MN
| | - Jean-Claude Daubert
- From the Division of Cardiology, Medical University of South Carolina, Charleston (M.R.G.); Department of Cardiology, University Hospital, CIC IT, INSERM 642, Rennes, France (J.-C.D.); Division of Cardiovascular Medicine, The Ohio State University, Columbus (W.T.A.); Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark (C.H.); Department of Cardiology, Heart Center Research, LLC, Huntsville, AL (J.L.D.); CRDM Clinical Research, Medtronic Inc., Minneapolis, MN
| | - William T. Abraham
- From the Division of Cardiology, Medical University of South Carolina, Charleston (M.R.G.); Department of Cardiology, University Hospital, CIC IT, INSERM 642, Rennes, France (J.-C.D.); Division of Cardiovascular Medicine, The Ohio State University, Columbus (W.T.A.); Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark (C.H.); Department of Cardiology, Heart Center Research, LLC, Huntsville, AL (J.L.D.); CRDM Clinical Research, Medtronic Inc., Minneapolis, MN
| | - Christian Hassager
- From the Division of Cardiology, Medical University of South Carolina, Charleston (M.R.G.); Department of Cardiology, University Hospital, CIC IT, INSERM 642, Rennes, France (J.-C.D.); Division of Cardiovascular Medicine, The Ohio State University, Columbus (W.T.A.); Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark (C.H.); Department of Cardiology, Heart Center Research, LLC, Huntsville, AL (J.L.D.); CRDM Clinical Research, Medtronic Inc., Minneapolis, MN
| | - Jay L. Dinerman
- From the Division of Cardiology, Medical University of South Carolina, Charleston (M.R.G.); Department of Cardiology, University Hospital, CIC IT, INSERM 642, Rennes, France (J.-C.D.); Division of Cardiovascular Medicine, The Ohio State University, Columbus (W.T.A.); Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark (C.H.); Department of Cardiology, Heart Center Research, LLC, Huntsville, AL (J.L.D.); CRDM Clinical Research, Medtronic Inc., Minneapolis, MN
| | - J. Harrison Hudnall
- From the Division of Cardiology, Medical University of South Carolina, Charleston (M.R.G.); Department of Cardiology, University Hospital, CIC IT, INSERM 642, Rennes, France (J.-C.D.); Division of Cardiovascular Medicine, The Ohio State University, Columbus (W.T.A.); Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark (C.H.); Department of Cardiology, Heart Center Research, LLC, Huntsville, AL (J.L.D.); CRDM Clinical Research, Medtronic Inc., Minneapolis, MN
| | - Jeff Cerkvenik
- From the Division of Cardiology, Medical University of South Carolina, Charleston (M.R.G.); Department of Cardiology, University Hospital, CIC IT, INSERM 642, Rennes, France (J.-C.D.); Division of Cardiovascular Medicine, The Ohio State University, Columbus (W.T.A.); Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark (C.H.); Department of Cardiology, Heart Center Research, LLC, Huntsville, AL (J.L.D.); CRDM Clinical Research, Medtronic Inc., Minneapolis, MN
| | - Cecilia Linde
- From the Division of Cardiology, Medical University of South Carolina, Charleston (M.R.G.); Department of Cardiology, University Hospital, CIC IT, INSERM 642, Rennes, France (J.-C.D.); Division of Cardiovascular Medicine, The Ohio State University, Columbus (W.T.A.); Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark (C.H.); Department of Cardiology, Heart Center Research, LLC, Huntsville, AL (J.L.D.); CRDM Clinical Research, Medtronic Inc., Minneapolis, MN
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