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Bijnens J, Trenson S, Voros G, Martens P, Ingelaere S, Betschart P, Voigt JU, Dupont M, Breitenstein A, Steffel J, Willems R, Ruschitzka F, Mullens W, Winnik S, Vandenberk B. Landmark Evolutions in Time and Indication for Cardiac Resynchronization Therapy: Results from a Multicenter Retrospective Registry. J Clin Med 2024; 13:1903. [PMID: 38610667 PMCID: PMC11012510 DOI: 10.3390/jcm13071903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Cardiac resynchronization therapy (CRT) has evolved into an established therapy for patients with chronic heart failure and a wide QRS complex. Data on long-term outcomes over time are scarce and the criteria for implantation remain a subject of investigation. Methods: An international, multicenter, retrospective registry includes 2275 patients who received CRT between 30 November 2000 and 31 December 2019, with a mean follow-up of 3.6 ± 2.7 years. Four time periods were defined, based on landmark trials and guidelines. The combined endpoint was a composite of all-cause mortality, heart transplantation, or left ventricular assist device implantation. Results: The composite endpoint occurred in 656 patients (29.2%). The mean annual implantation rate tripled from 31.5 ± 17.4/year in the first period to 107.4 ± 62.4/year in the last period. In the adjusted Cox regression analysis, the hazard ratio for the composite endpoint was not statistically different between time periods. When compared to sinus rhythm with left bundle branch block (LBBB), a non-LBBB conduction pattern (sinus rhythm: HR 1.51, 95% CI 1.12-2.03; atrial fibrillation: HR 2.08, 95% CI 1.30-3.33) and a QRS duration below 130 ms (HR 1.64, 95% CI 1.29-2.09) were associated with a higher hazard ratio. Conclusions: Despite innovations, an adjusted regression analysis revealed stable overall survival over time, which can at least partially be explained by a shift in patient characteristics.
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Affiliation(s)
- Jeroen Bijnens
- Department of Cardiology, University Hospitals Leuven, 3000 Leuven, Belgium (G.V.)
| | - Sander Trenson
- Department of Cardiology, University Hospitals Leuven, 3000 Leuven, Belgium (G.V.)
- Department of Cardiology, Sint-Jan Hospital Bruges, 8000 Bruges, Belgium
- Department of Cardiology, University Hospital Zurich, 8091 Zurich, Switzerland
- Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium
| | - Gabor Voros
- Department of Cardiology, University Hospitals Leuven, 3000 Leuven, Belgium (G.V.)
- Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium
| | - Pieter Martens
- Department of Cardiology, Ziekenhuis Oost-Limburg, 3600 Genk, Belgium (M.D.)
| | | | - Pascal Betschart
- Department of Cardiology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Jens-Uwe Voigt
- Department of Cardiology, University Hospitals Leuven, 3000 Leuven, Belgium (G.V.)
- Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium
| | - Matthias Dupont
- Department of Cardiology, Ziekenhuis Oost-Limburg, 3600 Genk, Belgium (M.D.)
| | | | - Jan Steffel
- Department of Cardiology, University Hospital Zurich, 8091 Zurich, Switzerland
- Hirslanden Heart Clinic, 8008 Zurich, Switzerland
| | - Rik Willems
- Department of Cardiology, University Hospitals Leuven, 3000 Leuven, Belgium (G.V.)
- Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium
| | - Frank Ruschitzka
- Department of Cardiology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost-Limburg, 3600 Genk, Belgium (M.D.)
- Department of Life Sciences, Hasselt University, 3500 Hasselt, Belgium
| | - Stephan Winnik
- Department of Cardiology, University Hospital Zurich, 8091 Zurich, Switzerland
- Zurich Regional Health Center Wetzikon, 8620 Zurich, Switzerland
| | - Bert Vandenberk
- Department of Cardiology, University Hospitals Leuven, 3000 Leuven, Belgium (G.V.)
- Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium
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