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Kuthi L, Schwertner W, Veres B, Merkel E, Behon A, Masszi R, Kovacs A, Osztheimer I, Molnar L, Zima E, Geller L, Kosztin A, Merkely B. The impact of frailty index on long-term outcome in CRT patients. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Frailty is a complex clinical syndrome associated with ageing and comorbidities resulting from multiple organ impairment by losing homeostatic reserves and increased vulnerability to physiological decompensation. Frailty can be measured by quantifying the “vulnerability status” by the range of comorbidities.
Purpose
We assessed the long-term all-cause mortality based on Frailty Index (FI) among patients who underwent Cardiac Resynchronization Therapy (CRT) implantation.
Methods
We calculated patients' FI individually using 30 clinical parameters from our retrospective single centre large-scale registry. The applied clinical features incorporated patients' medical history, anthropometric-, laboratory and echocardiographic parameters. Based on previous studies, patients with FI ≤0.210 were classified as non-frail, and patients above that value were considered frail. Frail patients were divided into two different subgroups (F1; F2) by a FI increment of 0.100 based on the Rockwood method. Primary endpoint was all-cause mortality, log-rank and Cox multivariate analysis were performed.
Results
Among 1010 included patients, 58 (6%) were considered as Non-frail, while 245 (24%) and 707 (70%) participants were categorized to F1- and F2 groups. Patients in F2 group were older [non-frail 62 years (IQR 57–68) vs. F1 66 years (IQR 57–73) vs. F2 70 years (IQR 63–76); p<0.001], had worse laboratory parameters as higher creatinine, uric acid, lower sodium or hemoglobin levels (p<0.001) and more comorbidities than patients of Non-frail or F1 groups. During the median follow-up time of 4.4 (2.3–6.9) years, 17 (29%) patients in the Non-frail group, 103 (42%) in Frail group 1 and 479 (68%) in the Frail group 2 reached the primary endpoint. Non-frail patients showed the best outcome, and patients in the Frail group 1 demonstrated a 46% (HR 0.46, 95% CI 0.39–0.55; p<0.001) lower all-cause mortality risk compared to Frail group 2. In the total cohort, mortality predictors were also assessed, NYHA functional class, serum sodium, creatinine and TAPSE were identified as independent predictors of all-cause mortality.
Conclusion
By calculating individual frailty index among CRT patients, distinct groups could be identified, of which mortality differed significantly. Those with the highest Frailty index demonstrated the worse outcome compared to lower index or non-frail patients. Frailty index can help selecting the most vulnerable patients, requiring a strict follow-up.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- L Kuthi
- Semmelweis University Heart and Vascular Center , Budapest , Hungary
| | - W Schwertner
- Semmelweis University Heart and Vascular Center , Budapest , Hungary
| | - B Veres
- Semmelweis University Heart and Vascular Center , Budapest , Hungary
| | - E Merkel
- Semmelweis University Heart and Vascular Center , Budapest , Hungary
| | - A Behon
- Semmelweis University Heart and Vascular Center , Budapest , Hungary
| | - R Masszi
- Semmelweis University Heart and Vascular Center , Budapest , Hungary
| | - A Kovacs
- Semmelweis University Heart and Vascular Center , Budapest , Hungary
| | - I Osztheimer
- Semmelweis University Heart and Vascular Center , Budapest , Hungary
| | - L Molnar
- Semmelweis University Heart and Vascular Center , Budapest , Hungary
| | - E Zima
- Semmelweis University Heart and Vascular Center , Budapest , Hungary
| | - L Geller
- Semmelweis University Heart and Vascular Center , Budapest , Hungary
| | - A Kosztin
- Semmelweis University Heart and Vascular Center , Budapest , Hungary
| | - B Merkely
- Semmelweis University Heart and Vascular Center , Budapest , Hungary
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Fabian A, Tolvaj M, Lakatos BK, Assabiny A, Ujvari A, Shiida K, Ferencz A, Schwertner W, Veres B, Kosztin A, Staub L, Sax B, Merkely B, Kovacs A. There is more than just longitudinal strain: prognostic significance of biventricular circumferential mechanics. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Global longitudinal strain is a well-established predictive parameter of adverse outcomes in several cardiac diseases, therefore, it is widely used in clinical practice. Despite the significant contribution of circumferential shortening to the global ventricular function, data are scarce concerning the biventricular circumferential strain phenotypes and their prognostic value on long-term mortality.
Accordingly, the aim of our study was to assess both left (LV) and right ventricular (RV) global circumferential strain (GCS) using 3D echocardiography in order to determine the prognostic importance of the deterioration of biventricular circumferential mechanics.
Three hundred and sixty-four patients with various established left-sided heart diseases were retrospectively identified (age: 64.8±15.0 years, 69% males) with a median follow-up of 41 months. All patients underwent clinically indicated transthoracic echocardiography and left (LV) and right ventricular (RV) ejection fractions (EF) were measured by 3D analysis. 3D LV and RV GCS were also quantified by dedicated softwares. In order to determine the prognostic power of the different patterns of biventricular circumferential mechanics, we divided the patient population into four groups using the median values of LV and RV GCS (absolute values of 27.1% and 17.9%, respectively). Group 1 consisted of patients with both LV and RV GCS above median values; Group 2 was defined as patients with LV GCS above the median, while RV GCS below the median, whereas in Group 3 patients had LV GCS values below the median, while RV GCS was above median. Group 4 was defined as patients with both LV and RV GCS below the median. The primary endpoint of our study was all-cause mortality.
Fifty-five patients (15.1%) met the primary endpoint. The overall patient population showed balanced values of LV and RV EF (49.0±15.7 and 48.2±9.4%, respectively). Comparing the population separated into the above-mentioned four groups based on LV and RV GCS values enabled a detailed risk stratification as shown on the Kaplan-Meier curve (Figure 1.) When comparing Group 1 vs. Group 4, patients who had lower LV and RV GCS values the risk of all-cause mortality was more than 5 times higher than in patients with both LV and RV GCS above the median (HR, 5.240 [95% CI, 2.750–9.985], p<0.001). By comparing Group 2 with Group 3, the associated risks for all-cause mortality did not show a difference (HR, 0.461 [95% CI, 0.178 to 1.194], p=NS) as shown on the Kapan-Meier curve (Figure 2).
Based on the different phenotypes of LV and RV GCS, decreased biventricular circumferential shortening was associated with a significantly increased risk of long-term all-cause mortality. Interestingly, decreased RV GCS with maintained LV GCS showed a similar risk of adverse outcomes than decreased LV GCS with maintained RV GCS. Our results emphasize the importance of the assessment of biventricular circumferential mechanics.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Fabian
- Semmelweis University, Heart and Vascular Center , Budapest , Hungary
| | - M Tolvaj
- Semmelweis University, Heart and Vascular Center , Budapest , Hungary
| | - B K Lakatos
- Semmelweis University, Heart and Vascular Center , Budapest , Hungary
| | - A Assabiny
- Semmelweis University, Heart and Vascular Center , Budapest , Hungary
| | - A Ujvari
- Semmelweis University, Heart and Vascular Center , Budapest , Hungary
| | - K Shiida
- Semmelweis University, Heart and Vascular Center , Budapest , Hungary
| | - A Ferencz
- Semmelweis University, Heart and Vascular Center , Budapest , Hungary
| | - W Schwertner
- Semmelweis University, Heart and Vascular Center , Budapest , Hungary
| | - B Veres
- Semmelweis University, Heart and Vascular Center , Budapest , Hungary
| | - A Kosztin
- Semmelweis University, Heart and Vascular Center , Budapest , Hungary
| | - L Staub
- Argus Cognitive , Lebanon , United States of America
| | - B Sax
- Semmelweis University, Heart and Vascular Center , Budapest , Hungary
| | - B Merkely
- Semmelweis University, Heart and Vascular Center , Budapest , Hungary
| | - A Kovacs
- Semmelweis University, Heart and Vascular Center , Budapest , Hungary
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3
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Veres B, Gharehdaghi S, Engh M, Schwertner W, Kuthi L, Merkel ED, Masszi R, Fehervari P, Behon A, Osztheimer I, Hegyi P, Kovacs A, Zima E, Kosztin A, Merkely B. The benefits of adding a defibrillator to cardiac resynchronization therapy – systematic review and meta-analysis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
There is an long-standing debate whether cardiac resynchronisation therapy-defibrillation (CRT-D) is preferred over CRT-pacemaker (CRT-P). No randomised controlled trials have been designed to compare these treatments. However, several observational studies have been performed so far providing controversial results.
Methods
PubMed, CENTRAL and Embase until October 2021 were screened for studies comparing CRT-P and CRT-D, focusing on all-cause mortality, cardiovascular mortality, sudden cardiac death, and non-cardiac death. Conference abstracts were excluded. Odds ratio with 95% confidence interval (CI) was calculated, data from the selected studies were pooled using a random effect model (Mantel-Haenszel method, where more than 5 studies with Hartung-Knapp adjustment). τ2 was estimated by Paule-Mandel method with CI calculated by Q profile method. Statistical heterogeneity was assessed by Cochrane Q test and I2 test. Results were summarized by Forest and drapery plots.
Results
Altogether 20 observational retrospective studies (69,124 patients) were included (CRT-P: 37,461, CRT-D: 31,663). CRT-D was superior to CRT-P regarding all-cause mortality in multivariate analysis (aHR: 0.79; 95% CI: 0.69–0.88; p<0.01). Based on propensity matched studies (25,040 patients; 12,520 CRT-P, 12,520 CRT-D) CRT-D showed significantly better survival compared to CRT-P (HR: 0.83; 95% CI: 0.79–0.87; p<0.001). Three studies (47,846 patients, CRT-P: 27,344, CRT-D: 20,502) compared cardiovascular mortality between CRT-D and CRT-P. Univariate analysis showed a significantly lower rate of cardiovascular mortality in patients implanted with a CRT-D device compared to patients with a CRT-P device (HR: 0.61; 95% CI: 0.50–0.73; p=0.002). Three studies (4,623 patients. CRT-P: 2,518, CRT-D: 2,105) reported on heart failure death, where CRT-D was associated with decreased heart failure mortality compared to CRT-P (HR: 0.68; 95% CI: 0.41–0.95; p=0.008). Five studies (6,434 patients. CRT-P: 3,475, CRT-D: 2,959) were analyzed for sudden cardiac death, CRT-D was superior in univariate analysis (HR: 0.33; 95% CI: 0.28–0.89; p=0.03). Three studies (48,770 patients, CRT-P: 28,398, CRT-D: 20,372) reported on non-cardiac death, CRT-D showed significantly better survival than CRT-P (HR: 0.58; 95% CI: 0.55–0.60; p<0.001).
Conclusion
Our meta-analysis demonstrated that patients with CRT-D had a lower risk of all-cause mortality compared to CRT-P based on those studies that used multivariate analysis and propensity score matching. Univariate analysis showed a significantly lower rate of cardiovascular heart failure mortality, sudden cardiac death, and non-cardiac death in patients implanted with a CRT-D device compared to patients with a CRT-P. However, due to the heterogeneity of the articles coming from the selection bias of patients for CRT-D/CRT-P implantation, this question requires further analysis.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): The research presented here, carried out by Semmelweis University was supported by Semmelweis 250+ Excellence Scholarship (EFOP-3.6.3-VEKOP-16-2017-00009)as well as the Centre for Translational Medicine, Semmelweis University. This work was financed by the Thematic Excellence Programme (2020-4.1.1.-TKP2020) of the Ministry for Innovation and Technology in Hungary, within the framework of the Therapeutic Development and Bioimaging thematic programmes of the Semmelweis University. - I agree that this information can be anonymised and then used for statistical purposes only
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Affiliation(s)
- B Veres
- Semmelweis University , Budapest , Hungary
| | - S Gharehdaghi
- Semmelweis University, Translational Medicine , Budapest , Hungary
| | - M Engh
- Semmelweis University, Translational Medicine , Budapest , Hungary
| | | | - L Kuthi
- Semmelweis University , Budapest , Hungary
| | - E D Merkel
- Semmelweis University , Budapest , Hungary
| | - R Masszi
- Semmelweis University , Budapest , Hungary
| | - P Fehervari
- Semmelweis University, Translational Medicine , Budapest , Hungary
| | - A Behon
- Semmelweis University , Budapest , Hungary
| | | | - P Hegyi
- Semmelweis University, Translational Medicine , Budapest , Hungary
| | - A Kovacs
- Semmelweis University , Budapest , Hungary
| | - E Zima
- Semmelweis University , Budapest , Hungary
| | - A Kosztin
- Semmelweis University , Budapest , Hungary
| | - B Merkely
- Semmelweis University , Budapest , Hungary
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4
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Veres B, Schwertner WR, Engh M, Masszi R, Kuthi L, Behon A, Merkel ED, Osztheimer I, Fehervari P, Ghare S, Pinter A, Zima E, Hegyi P, Kosztin A, Merkely B. The benefits of adding a defibrillator to cardiac resynchronization therapy - Systematic review and meta-analysis. Europace 2022. [DOI: 10.1093/europace/euac053.506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): The research presented here, carried out by Semmelweis University was supported by Semmelweis 250+ Excellence Scholarship (EFOP-3.6.3-VEKOP-16-2017-00009)as well as the Centre for Translational Medicine, Semmelweis University. This work was financed by the Thematic Excellence Programme (2020-4.1.1.-TKP2020) of the Ministry for Innovation and Technology in Hungary, within the framework of the Therapeutic Development and Bioimaging thematic programmes of the Semmelweis University.
Background
There is an enduring controversy whether cardiac resynchronisation therapy-defibrillation (CRT-D) is preferred over CRT-pacemaker (CRT-P). No head-to-head randomised controlled trials have been designed to compare the treatments. However, several observational studies were performed during previous years, but they got controversial results.
Methods
PubMed, CENTRAL and Embase until October 2021 were screened for studies comparing CRT-P and CRT-D, focusing on all-cause mortality, cardiovascular mortality, sudden cardiac death, and non-cardiac death. Both interventional and observational studies comparing CRT-D and CRT-P patients were included. Studies only available as conference abstracts were excluded. Odds ratio with 95% confidence interval (CI) was calculated, data from the selected studies were pooled using a random effect model (Mantel-Haenszel method, where more than 5 studies with Hartung-Knapp adjustment). τ2 was estimated by Paule-Mandel method with CI calculated by Q profile method. Statistical heterogeneity was assessed by Cochrane Q test and I2 test. Results were summarized by Forest and drapery plots.
Results: 16 observational studies(57,337 patients) were included(CRT-P: 32 591, CRT-D: 24 746). CRT-D was superior to CRT-P regarding all-cause mortality in univariate analysis(HR:0.73; 95% CI:0.64-0.83; p <0.01). The between-study heterogeneity (I2) value was not significant. The random-effects τ2 value was 0.02 (95% CI:0-0.06). Three studies(47,846 patients, CRT-P: 27,344, CRT-D: 20,502) compared cardiovascular mortality between CRT-D and CRT-P. Univariate analysis showed a significantly lower rate of cardiovascular mortality in patients implanted with a CRT-D device compared to patients with a CRT-P device.(HR:0.61; 95% CI:0.50-0.73; p=0.002) Five studies (6,434 patients. CRT-P:3,475, CRT-D:2,959) were analyzed for sudden cardiac death, CRT-D was superior in univariate analysis(HR:0.33; 95% CI:0.28-0.89; p=0.03). Three studies (4,623 patients. CRT-P:2,518, CRT-D:2,105) reported on heart failure death, CRT-D was associated with decreased heart failure mortality compared to CRT-P(HR:0.68; 95% CI: 0.41-0.95; p=0.008). Three studies(48,770 patients ,CRT-P:28,398, CRT-D: 20,372) reported on non-cardiac death, CRT-D showed significantly better survival than CRT-P(HR:0.58; 95% CI:0.55-0.60; p<0.0001).
Conclusion: Our work demonstrates an association between CRT-D and lower all-cause mortality, cardiovascular and heart failure mortality, sudden cardiac death, and non-cardiac death. However, due to the heterogeneity of the articles coming from the selection bias of patients for CRT-D/CRT-P implantation, this question requires further analysis.
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Affiliation(s)
- B Veres
- Semmelweis University, Budapest, Hungary
| | | | - M Engh
- Semmelweis University, Budapest, Hungary
| | - R Masszi
- Semmelweis University, Budapest, Hungary
| | - L Kuthi
- Semmelweis University, Budapest, Hungary
| | - A Behon
- Semmelweis University, Budapest, Hungary
| | - ED Merkel
- Semmelweis University, Budapest, Hungary
| | | | | | - S Ghare
- Semmelweis University, Budapest, Hungary
| | - A Pinter
- Semmelweis University, Budapest, Hungary
| | - E Zima
- Semmelweis University, Budapest, Hungary
| | - P Hegyi
- Semmelweis University, Budapest, Hungary
| | - A Kosztin
- Semmelweis University, Budapest, Hungary
| | - B Merkely
- Semmelweis University, Budapest, Hungary
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5
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Schwertner WR, Tokodi M, Behon A, Veres B, Merkel E, Kuthi L, Masszi R, Kovacs A, Zima E, Geller L, Osztheimer I, Kosztin A, Merkely B. Pacemaker upgrade to Cardiac Resynchronization Therapy-defibrillator or Cardiac Resynchronization Therapy-pacemaker without prior ventricular arrhythmias. Europace 2022. [DOI: 10.1093/europace/euac053.486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by the ÚNKP-21-3-II-SE-47, ÚNKP-20-3-I-SE-43 New National Excellence Program if the Ministry for Innovation and Technology in Hungary. Project no. NVKP_16-1–2016-0017 (’National Heart Program’) has been implemented with the support provided by the National Research, Development and Innovation Fund of Hungary, funded under the NVKP_16 funding scheme. The research was financed by the Thematic Excellence Programme (2020-4.1.1.-TKP2020) of the Ministry for Innovation and Technology in Hungary, within the framework of the Therapeutic Development and Bioimaging thematic programmes of the Semmelweis University. This work was also supported by the Semmelweis 250+ Excellence PhD Scholarship (EFOP-3.6.3-VEKOP-16-2017-00009).
Background
Cardiac Resynchronization Therapy (CRT) can reverse the harmful effects of right ventricular pacing (RVP). Data are scarce on comparing long-term survival among patients who undergone CRT-defibrillator (CRT-D) or CRT-pacemaker (CRT-P) upgrade from pacemakers (PM) without prior ventricular arrhythmias (VAs).
Purpose
We compared the differences in long-term all-cause mortality among PM patients receiving CRT-D or CRT-P upgrade.
Methods
Patients with conventional PMs developing heart failure despite optimal medical treatment and a high rate of RVP with no prior VAs were included. Altogether 326 patients were investigated, 117 (36%) upgraded to CRT-D, 209 (64%) to CRT-P in our retrospective registry. The primary endpoint was all-cause mortality. Subgroup analyses were performed by comorbidities and CRT device types. Using topological data analysis, we identified risk groups based on the primary endpoint.
Results
During the median follow-up time of 3.6 years, 33 (28%) CRT-D and 145 (69%) of CRT-P upgrade patients reached the primary endpoint. The CRT-D upgrade group showed a lower risk of all-cause mortality in the total cohort (HR: 0.55; 95% CI: 0.38-0.81; p=0.002) and by ischaemic aetiology (HR: 0.47; 95% CI: 0.29-0.76; p=0.002) compared to CRT-P. After adjustment, CRT-D, male gender and loop diuretics proved as independent predictors of all-cause mortality. Patients upgraded with CRT-D demonstrated favourable survival in the high-risk group over CRT-P.
Conclusions
Patients had survival benefit after CRT-D upgrade, compared to CRT-P, in the high-risk group and with ischaemic heart failre aetiology. However, no difference could be observed between the two groups among low- and intermediate-risk patients.
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Affiliation(s)
- W R Schwertner
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - M Tokodi
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - A Behon
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - B Veres
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - E Merkel
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - L Kuthi
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - R Masszi
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - A Kovacs
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - E Zima
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - L Geller
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - I Osztheimer
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - A Kosztin
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - B Merkely
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
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6
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Masszi R, Merkel E, Schwertner W, Veres B, Behon A, Pinter A, Osztheimer I, Zima E, Geller L, Becker D, Kosztin A, Merkely B. The effect of implantable cardioverter defibrillator in patients with cardiac resynchronizational therapy and diabetes mellitus. Europace 2022. [DOI: 10.1093/europace/euac053.494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): (NKFIA; NVKP_16-1-2016-0017 National Heart Program).
Background
Heart failure (HF) and diabetes mellitus (DM) are common causes of death on their own, but the coexistance of these two diseases are especially fatal. 1 In DM, sudden cardiac death (SCD) is more common than in non-DM patients, however in many cases, implantable cardioverter defibrillator (ICD) could not prevent SCD. 2
Purpose
Our aim is to decide which device warrant higher life expectancy, cardiac resynchronizational therapy with or without defibrillator.
Methods
We examined retrospectively 2525 CRT implanted patients, with a mean follow-up time of 4.6 years. Implantaions were based on the current guidelines. The primary endpoint was all-cause mortality, while our composite end-point were all-cause mortality and heart failure hospitalization.
Results
In our population, 928 people (36%) had diabetes. We did not find statistical differences between age (68 vs. 68 years; p<0.099), gender (26% women, 23% women; p<0.08) LVEF (28% vs. 29% p<0.1425), incidence of atrial fibrillation (37% vs. 38%; p<0.76), implantation of an ICD (53% vs. 54%; p<0.847), NT-proBNP median levels (2939 pg/ml vs. 2778 pg/ml; p<0.35), and NYHA I (0,5% vs. 0,5%; p<0.898), and NYHA IV stadium (11% vs. 11%; p<0,82). However DM patients had higher BMI (28 kg/m2 vs. 26 kg/m2; p<0.001), lower eGFR levels (57 ml/min/1,73m2 vs. 60 ml/min/1,73m2; p<0.011) higher prevalence of hypertonia (82% vs. 66%; p<0.001), NYHA III stadium (39% vs. 33%; p<0,0008), ischemic etiology (56% vs. 44%; p<0.001), previous acute myocardial infartion (42,9% vs. 36%; p<0.001), a percutan coronaria intervention (35% vs. 25%; p<0.001) compared to non-DM patients. Those patients with DM showed a 25% higher risk of all-cause mortality (HR 1.25; 95% CI 1.12-1.40; p‹0.01) then non-DM patientes, also observable after adjusting for relevant clinical covariates such as age, gender, atrial fibrillation and the addition of an ICD (HR 1.17; 95% CI 1.06-1.31; p‹0.01).
Conclusions
Adding an ICD for CRT patients with diabetes reduces the risk of all-cause mortality significantly by 32% (HR 0,68; CI 0,56-0,82; p‹0.001) during the first six years but diminished on longer follow-up time (HR 0,95; CI 0,80-1,12; p=0,54).
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Affiliation(s)
- R Masszi
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - E Merkel
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - W Schwertner
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - B Veres
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - A Behon
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - A Pinter
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - I Osztheimer
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - E Zima
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - L Geller
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - D Becker
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - A Kosztin
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - B Merkely
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
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7
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Schwertner W, Veres B, Kuthi L, Behon A, Eperke M, Tokodi M, Kosztin A, Kovacs A, Osztheimer I, Zima E, Geller L, Merkely B. Pacemaker upgrade to CRT-D or CRT-P without prior ventricular arrhythmias: a long-term single-centre retrospective analysis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cardiac Resynchronization Therapy (CRT) can reverse the harmful effects of right ventricular pacing (RVP). Data are sparse on comparing all-cause mortality among patients undergone CRT-defibrillator (CRT-D) or CRT-pacemaker (CRT-P) upgrade from pacemakers without prior ventricular arrhythmias (VAs).
Purpose
We compared the differences in long-term all-cause mortality, postprocedural complications and the occurrence of VAs among patients receiving CRT-D or CRT-P upgrade.
Methods
Patients with a previously implanted conventional pacemaker (PM) developing heart failure (HF) despite optimal medical treatment and high rates of RVP, were included. Altogether 270 patients were investigated, 83 (30.7%) upgraded to CRT-D, 187 (69.3%) to CRT-P in our retrospective registry. The primary endpoint was all-cause mortality, secondary endpoints were malignant VAs and implantation-related complications.
Results
CRT-D upgrade patients were more likely to be males, have a favourable renal function and lower left ventricular ejection fraction (LVEF). During the median follow-up time of 3.7 years, 25 (30.1%) of CRT-D and 131 (70.1%) of CRT-P upgrade patients reached the primary endpoint. The CRT-D upgrade group showed a lower risk of all-cause mortality in the total cohort (HR: 0.55; 95% CI: 0.38–0.78; p=0.004) and in the ischaemic subgroups compared to CRT-P. After adjustment, CRT-D, ischaemic HF aetiology and LVEF have been confirmed as independent predictors of all-cause mortality. Malignant VA occurrence was higher among CRT-D patients (10.8% vs 1.1%; p=0.001), while no difference was observed in the rate of complications between the two patient groups. However, lead removal was performed more frequently (13.3% vs 1.1%; p<0.001) during CRT-D upgrade procedures compared to CRT-P.
Conclusions
Patients among the total and ischaemic HF aetiology subgroup benefited more from the CRT-D upgrade, although VAs and lead removal were more common than in the CRT-P group.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by the ÚNKP-20-3-I-SE-43 New National Excellence Program if the Ministry for Innovation and Technology in Hungary. Project no. NVKP_16-1–2016-0017 (“National Heart Program”) has been implemented with the support provided by the National Research, Development and Innovation Fund of Hungary, financed under the NVKP_16 funding scheme. The research was financed by the Thematic Excellence Programme (2020-4.1.1.-TKP2020) of the Ministry for Innovation and Technology in Hungary, within the framework of the Therapeutic Development and Bioimaging thematic programmes of the Semmelweis University. All-cause mort of pts after UPG
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Affiliation(s)
- W.R Schwertner
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - B Veres
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - L Kuthi
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - A Behon
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - M Eperke
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - M Tokodi
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - A Kosztin
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - A Kovacs
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - I Osztheimer
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - E Zima
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - L Geller
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - B Merkely
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
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8
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Veres B, Schwertner W, Tokodi M, Kuthi L, Merkel E, Behon A, Zima E, Osztheimer I, Geller L, Kovacs A, Kosztin A, Merkely B. Long-term outcome after adding an ICD to CRT in non-ischemic patients. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
There are limited and contradictory data on the long-term mortality benefit of cardiac resyncronization therapy with implantable cardioverter defibrillator (CRT-D)as compared to Cardiac resynchonization therapy with pacemaker.
Purpose
Our aim was to evaluate the long-term all-cause mortality benefit of CRT-D compared to CRT-P by ischemic aetiology.
Methods
Between 2000 and 2018, patients, who underwent successful CRT implantation were registered. From 2524 patients, 1366 (54%) had a CRT-D implantation and 1099 (44%) had CRT-P implantation. 59 (2%) patients were excluded from the current analysis, who had an ICD upgrade with a CRT-P device during the follow-up. The primary composite endpoint was all-cause mortality, LVAD implantation or heart transplantation. Kaplan-Meier and multivariate Cox regression analyses were used to assess all-cause mortality in the total cohort and by ischemic aetiology.
Results
The median follow-up time was 3.6 years. During this time 1389 patients died from any cause, 692 patients (50%) with a CRT-D device, and 697 patients (50%) with a CRT-P. Patients in the CRT-D group were younger (67 years vs. 70 years; p<0.001), had a less advanced functional class (NYHA III/IV., 52.2% vs. 61.4%; p<0.001), wider QRS [160ms (140/180) vs. 160ms (140/170); p=0.03] and less females (18.9% vs. 33.3%; p<0.001) with an ischemic aetiology (57.7% vs. 40.2%; p<0.0001). CRT-D patients had a better renal function [eGFR, 60.5 (ml/min/1.73m2) vs. 57 (ml/min/1.73m2); p=0.02], decreased ejection fraction (28% vs. 30%; p=0.002), had more frequently ventricular arrhythmia (36% vs. 9.8%; p<0.001). CRT-D patients took more amount of beta-blockers (90.2% vs. 87.3%; p=0.03), MRA (72.2% vs. 61.6%; p<0.001) and amiodaron (32.2% vs. 20%; p<0.001). By multivariate analysis in the total cohort gender, renal function, functional class, aetiology, and the presence of ICD were independent predictors of all-cause mortality. By multivariate analysis, patients with a CRT-D device showed a 25% decreased risk of long-term mortality compared to CRT-P alone in the total cohort. (aHR 0.75; 95% CI 0.58–0.97; p=0.03). When patients were analysed by their etiology, those with non-ischemic cardiomyopathy showed a significant mortality benefit from ICD even after adjusting for relevant clinical variables (aHR 0.45; 95% CI 0.28–0.72; p<0.01). In ischemic patients despite of having a clear mid-term mortality benefit of ICD, it is decreasing after 5 years and less considerable after adjusting for clinical variables (aHR 0.92; 95% CI 0.67–1.27; p=0.60).
Conclusions
Although, CRT-D had a notable mid-term mortality benefit in ischemic patients compared to CRT-P alone, after 5 years it became less pronounced. While in non-ischemic patients, the benefit of adding an ICD to CRT lasts over 10 years.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Project no. NVKP_16-1–2016-0017 (“National Heart Program”) has been implemented with the support provided by the National Research, Development and Innovation Fund of Hungary, financed under the NVKP_16 funding scheme. The research was financed by the Thematic Excellence Programme (2020-4.1.1.-TKP2020) of the Ministry for Innovation and Technology in Hungary, within the framework of the Therapeutic Development and Bioimaging thematic programmes of the Semmelweis University. All-cause mortality
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Affiliation(s)
- B Veres
- Semmelweis University, Budapest, Hungary
| | | | - M Tokodi
- Semmelweis University, Budapest, Hungary
| | - L Kuthi
- Semmelweis University, Budapest, Hungary
| | - E.D Merkel
- Semmelweis University, Budapest, Hungary
| | - A Behon
- Semmelweis University, Budapest, Hungary
| | - E Zima
- Semmelweis University, Budapest, Hungary
| | | | - L Geller
- Semmelweis University, Budapest, Hungary
| | - A Kovacs
- Semmelweis University, Budapest, Hungary
| | - A Kosztin
- Semmelweis University, Budapest, Hungary
| | - B Merkely
- Semmelweis University, Budapest, Hungary
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9
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Schwertner WR, Kosztin A, Behon A, Merkel E, Kuthi L, Veres B, Tokodi M, Kovacs A, Osztheimer I, Kiraly Á, Geller L, Merkely B. Long-term mortality benefit of CRT-D vs. CRT-P upgrade procedures from conventional devices without prior ventricular arrhythmias. Europace 2021. [DOI: 10.1093/europace/euab116.461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by the ÚNKP-20-3-I New National Excellence Program if the Ministry for Innovation and Technology in Hungary, the National Research, Development, and Innovation Office of Hungary (NKFIA; NVKP_16-1-2016-0017 National Heart Program), and the Higher Education Institutional Excellence Program of the Ministry for Innovation and Technology in Hungary, within the framework of the Therapeutic Development thematic program of the Semmelweis University. This work was also supported by the Artificial Intelligence Research Filed Excellence Program of the National Research, Development and Innovation Office of the Ministry of Innovation and Technology in Hungary (TKP/ITM/NKFIH). The research was also financed by the Thematic Excellence Program (Tématerületi Kiválósági Program, 2020-4.1.1-TKP2020) of the Ministry for Innovation and Technology in Hungary, within the framework of the Bioimaging thematic program of the Semmelweis University.
Background
Cardiac Resynchronization Therapy (CRT) upgrade can reverse pacing-induced cardiomyopathy (PiCMP) and related major ventricular arrhythmias (MVA). However, there is a lack of data comparing mortality benefit of adding an ICD to CRT during upgrade procedures in those without prior malignant ventricular arrhythmias (VAs).
Purpose
We aimed to compare the all-cause mortality, echocardiographic response, MVA occurrence and the rate of complications of patients with prior pacemakers (PM) upgraded to CRT-P or CRT-D devices.
Methods
Between 2000-2018 patients who underwent a successful CRT upgrade procedure from conventional pacemaker without a prior MVAs were collected. From 270 patients 83 (30.7%) upgraded to CRT-D, 187 (69.3%) to CRT-P device. The primary endpoint was all-cause mortality, secondary endpoints were echocardiographic response defined as left ventricular ejection fraction (LVEF) increase ≥5%, the occurrence of subsequent MVAs and the rate of periprocedural complications.
Results
CRT-D upgrade patients were more likely to be males, have a favourable renal function and lower LVEF compared to CRT-P group. During the median follow-up time of 3.7 years, 25 (30%) CRT-D and 131 (70%) CRT-P upgrade patients reached the primary endpoint. By univariate analysis, CRT-D upgrade patients showed 45% (HR 0.55; 95%CI 0.38-0.78; p < 0.01) lower all-cause mortality risk than CRT-P group. By multivariate analysis CRT-D (HR 0.39; 95%CI 0.23-0.66; p < 0.01), male sex (HR 1.60; 95%CI 1.03-2.47; p = 0.04), LVEF (HR 0.97; 95%CI 0.94-0.99; p < 0.01) have confirmed as independent predictors of all-cause mortality. Assessing secondary endpoints, LVEF response (66% vs 63%; p = 0.72), MVA occurrence (3.4% vs 0.8%; p < 0.01) and the rate of periprocedural complications were comparable in the two groups (14.8% vs 7%; p = 0.87), despite the higher number of lead explantations during CRT-D procedures than CRT-P upgrade (13% vs 1%; p < 0.001).
Conclusions
Adding an ICD during CRT upgrade procedures showed 45% lower all-cause mortality risk than CRT-P alone in patients with a pacemaker and no previous ventricular arrhythmias. This beneficial effect was independent of the echocardiographic response, safety or subsequent ventricular arrhythmias. Abstract Figure.
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Affiliation(s)
- WR Schwertner
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - A Kosztin
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - A Behon
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - E Merkel
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - L Kuthi
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - B Veres
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - M Tokodi
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - A Kovacs
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - I Osztheimer
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - Á Kiraly
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - L Geller
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - B Merkely
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
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10
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Behon A, Schwertner W, Merkel E, Kovacs A, Lakatos B, Zima E, Geller L, Kutyifa V, Kosztin A, Merkely B. Lateral left ventricular lead position is superior to posterior position in long-term outcome of patients underwent cardiac resynchronization therapy. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Preferring side branch of coronary sinus during cardiac resynchronization therapy (CRT) implantation is empirical due to the limited data on the association of left ventricular (LV) lead position and long-term clinical outcome.
Purpose
We evaluated the long-term all-cause mortality by LV lead non-apical positions and further characterized them by interlead electrical delay (IED).
Methods
In our retrospective database 2087 patients were registered between 2000 and 2018. Those with non-apical LV lead locations were classified into anterior (n=108), posterior (n=643), and lateral (n=1336) groups. All-cause mortality was assessed by Kaplan-Meier and Cox analyses. Echocardiographic response was measured 6 months after CRT implantation.
Results
During the median follow-up time of 3.7 years, 1150 (55.1%) patients died, 710 (53.1%) with lateral, 78 (72.2%) with anterior and 362 (56.3%) with posterior positions. Patients with lateral position had significantly better outcome in all-cause mortality compared to others (HR 0.80; 95% CI: 0.71–0.90; p<0.0001), which was also confirmed by multivariate analysis after adjusting for relevant clinical covariates (HR 0.81; 95% CI: 0.72–0.91; p<0.0001). When echocardiographic response was evaluated in the lateral group, patients with an IED longer than 110 ms (ROC AUC 0.63; 95% CI: 0.53–0.73; p=0.012) showed 2.1 times higher odds of improvement in echocardiographic response 6 months after the implantation.
Conclusions
In this study we proved that after CRT implantation only the lateral LV lead location was associated with long-term mortality benefit. Moreover, patients with this position showed the greatest echocardiographic response over 110 ms IED.
Survival of total patient cohort
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Behon
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - W.R Schwertner
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - E.D Merkel
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - A Kovacs
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - B.K Lakatos
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - E Zima
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - L Geller
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - V Kutyifa
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - A Kosztin
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - B Merkely
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
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11
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Tokodi M, Behon A, Merkel E, Kovacs A, Toser Z, Sarkany A, Csakvari M, Lakatos B, Schwertner W, Merkely B, Kosztin A. Exploring sex-specific patterns of mortality predictors among patients undergoing cardiac resynchronization therapy: a machine learning approach. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The relative importance of variables explaining sex differences in outcomes is scarcely explored in patients undergoing cardiac resynchronization therapy (CRT).
Purpose
We sought to implement and evaluate machine learning (ML) algorithms for the prediction of 1- and 3-year all-cause mortality in patients undergoing CRT implantation. We also aimed to assess the sex-specific differences and similarities in the predictors of mortality using ML approaches.
Methods
A retrospective registry of 2191 CRT patients (75% males) was used in the current analysis. ML models were implemented in 6 partially overlapping patient subsets (all patients, females or males with 1- or 3-year follow-up data available). Each cohort was randomly split into a training (80%) and a test set (20%). After hyperparameter tuning with 10-fold cross-validation in the training set, the best performing algorithm was also evaluated in the test set. Model discrimination was quantified using the area under the receiver-operating characteristic curves (AUC) and the associated 95% confidence intervals. The most important predictors were identified using the permutation feature importances method.
Results
Conditional inference random forest exhibited the best performance with AUCs of 0.728 [0.645–0.802] and 0.732 [0.681–0.784] for the prediction of 1- and 3-year mortality, respectively. Etiology of heart failure, NYHA class, left ventricular ejection fraction and QRS morphology had higher predictive power in females, whereas hemoglobin was less important than in males. The importance of atrial fibrillation and age increased, whereas the relevance of serum creatinine decreased from 1- to 3-year follow-up in both sexes.
Conclusions
Using advanced ML techniques in combination with easily obtainable clinical features, our models effectively predicted 1- and 3-year all-cause mortality in patients undergoing CRT implantation. The in-depth analysis of features has revealed marked sex differences in mortality predictors. These results support the use of ML-based approaches for the risk stratification of patients undergoing CRT implantation.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Research, Development and Innovation Office of Hungary
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Affiliation(s)
- M Tokodi
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - A Behon
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - E.D Merkel
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - A Kovacs
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - Z Toser
- Argus Cognitive, Inc., Lebanon, NH, United States of America
| | - A Sarkany
- Argus Cognitive, Inc., Lebanon, NH, United States of America
| | - M Csakvari
- Argus Cognitive, Inc., Lebanon, NH, United States of America
| | - B.K Lakatos
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - W.R Schwertner
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - B Merkely
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - A Kosztin
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
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12
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Czimbalmos C, Papp R, Szabo L, Toth A, Csecs I, Suhai F, Molnar L, Kosztin A, Geller L, Merkely B, Vago H. Cardiac changes after cardiac resynchronization therapy assessed using cardiac magnetic resonance imaging during biventricular pacing. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Cardiac magnetic resonance (CMR) is a valuable tool in the assessment of left and right ventricular volumes and functions therefore establishing the effect of cardiac resynchronization therapy (CRT), but in majority of the devices MR safe mode does not include biventricular pacing as an option. We aimed to assess the effect of cardiac resynchronization using CMR with resynchronization on.
NYHA class II-III patients with LVEF≤35% despite optimal medical therapy and complete LBBB with broad QRS (>150 ms) were prospectively recruited (n=16, 65±7 years, 56% male, 69% nonischaemic). CMR examination was performed at baseline and at 6-month follow-up, applying both biventricular and AOO pacing. The following data were measured: conventional CMR parameters including left and right ventricular ejection fraction (LVEF), end-diastolic index (LVEDVi) and end-systolic volume index (LVESVi), stroke volume and mass, remodelling indices such as 3D sphericity and relative wall thickness (RWT: 2x end-diastolic wall thickness /end-diastolic long-axis diameter). Using feature tracking analysis global longitudinal, circumferential, radial strain, global dyssynchrony (mechanical dispersion (MD)) and regional dyssynchrony was measured.
Comparing the baseline and follow-up CMR parameters measured during biventricular pacing, we found a significant increase in LVEF (27±7 vs 45±9%; p<0.001) and decrease in LVEDVi and LVESVi (LVEDVi: 149±28 vs 91±20ml/m2; LVESVi: 108±31 vs 51±17ml/m2; p<0.001). Based on decrease in LVESVi 14 patients were classified as super-responder (>30%), one responder (>15%) and one non-responder (<15%). ProBNP levels significantly decreased (1186±83 vs 323±271 pg/ml, p<0.05). LV remodelling indices (3D sphericity: 0.46±0.13 vs 0.61±0.11, RWT: 0.33±0.07 vs 0.43±0.10), global longitudinal, circumferential and radial strain values showed significant improvement. Circumferential MD decreased (18.3±6.7 vs 13.3±3.4, p<0.01), while longitudinal MD did not change. Regional dyssynchrony drastically improved (358±108 vs 98±61ms, p<0.001). Applying AOO pacing resulted in an immediate deterioration in LVEF (45±9 vs 38±9%), LVESVi (51±17 vs 58±19 ml/m2), global circumferential and radial strain and regional dyssynchrony.
In conclusion CMR imaging during biventricular pacing is feasible and enables a more precise quantification of LV function, morphology and mechanics. As a result, it may contribute to a better understanding of the effects of resynchronization therapy and might improve responder rate in the future.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Research, Development and Innovation Office of Hungary (NKFIA)
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Affiliation(s)
- C Czimbalmos
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - R Papp
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - L Szabo
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - A Toth
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - I Csecs
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - F.I Suhai
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - L Molnar
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - A Kosztin
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - L Geller
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - B Merkely
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - H Vago
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
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13
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Merkel ED, Behon A, Schwertner WR, Pinter A, Osztheimer I, Geller L, Zima E, Becker DP, Kosztin A, Merkely B. P1167Effect of diabetes on all-cause mortality in CRT patients. Europace 2020. [DOI: 10.1093/europace/euaa162.322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Heart failure patients with diabetes mellitus (DM) have a higher risk for all-cause mortality and also for sudden cardiac death. We lack data on the effect of adding an implantable cardioverter defibrillator (ICD) to cardiac resynchronization therapy (CRT) on all-cause mortality in diabetic heart failure patients.
Purpose
We aimed to investigate the risk of DM on all-cause mortality in CRT patients, and to examine the beneficial effect of adding an ICD on all-cause mortality by left ventricular ejection fraction in CRT patients with or without DM.
Methods
We examined retrospectively 2525 patients who underwent CRT implantation based on the current guidelines at our clinic between June 2000 and September 2018, of which 928 (36%) had diabetes. The primary endpoint was all-cause mortality, also expressed as events per 100 person-year by quintiles of ejection fraction (EF) with or without an ICD or DM. Time to event data was investigated by Kaplan Meier and multivariate Cox regressional analysis.
Results
During our mean follow-up time of 4.6 years, 1432 (56%) patients reached the primary endpoint, of which 553 (38%) had DM. In the DM group, hypertension (82% vs. 66%; p‹0.01), ischemic etiology (56% vs. 44%; p‹0.01), myocardial infarction (43% vs. 36%; p‹0.01) was more frequent compared to non-DM group. There was no difference between the two groups regarding the implantation of an ICD (54% vs. 53%; p = 0,84). Those with DM showed a 25% higher risk of all-cause mortality (HR 1.25; 95% CI 1.12-1.40; p‹0.01), also observable after adjusting for relevant clinical covariates such as age, gender, atrial fibrillation and the addition of an ICD (HR 1.17; 95% CI 1.06-1.31; p‹0.01). Examined as all-cause mortality per 100 person-year follow up, patients with EF›30% and DM (13,7 events/ 100 person-year follow-up for an EF 30-35%) showed similar risk as those without DM and a severely impaired left ventricular function with EF‹25% (14 events/100 person-year follow-up for an EF <25%). Investigating the composite end-point of all-cause mortality and heart failure hospitalization, those with DM showed a 21% higher risk than non-DM CRT patients (HR 1.21; CI 1.09-1.34; p = 0 < 0.001). Adding an ICD for CRT patients with DM reduces the risk of all-cause mortality significantly by 32% (HR 0,68; CI 0,56 to 0,82; p < 0.001) during the first six years but diminished on longer follow-up time.
Conclusions
Diabetes was found as an independent predictor of all-cause mortality in CRT patients. Those with a left ventricular ejection fraction above 30% have comparable risk of mortality as non-diabetic patients with a severely impaired left ventricular function. In diabetic CRT patients the addition of an ICD reduces the risk of all-cause mortality mostly seen in the first six years. These findings might implicate the relevance of adding an ICD to CRT even at a higher ejection fraction in those with severe comorbidities such as diabetes.
Abstract Figure. All-cause mortality in CRT, DM patients
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Affiliation(s)
- E D Merkel
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - A Behon
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - W R Schwertner
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - A Pinter
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - I Osztheimer
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - L Geller
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - E Zima
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - D P Becker
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - A Kosztin
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - B Merkely
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
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14
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Kosztin A, Schwertner WR, Behon A, Merkel E, Zima E, Geller L, Becker D, Merkely B. P577Effect of adding an implantable cardioverter defibrillator on long-term survival in non-ischemic CRT patients stratified by Goldenberg risk score. Europace 2020. [DOI: 10.1093/europace/euaa162.369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
There are limited and incomprehensive long-term data on the effects of adding an implantable cardioverter defibrillator (ICD) to cardiac resynchronization therapy (CRT) in patients with non-ischemic heart failure.
Purpose
We compared the long-term all-cause mortality and relative risk reduction in mortality of non-ischemic patients after CRT-P vs. CRT-D implantation stratified by their Goldenberg risk score.
Methods
In our retrospective registry, data of 1196 non-ischemic patients who underwent CRT implantation between 2000 to 2018 were collected. Goldenberg sudden cardiac risk score was calculated by the presence of atrial fibrillation, NYHA class > 2, age > 70 years, blood urea nitrogen > 26mg/dl and QRS width.
Results
In our registry from 1196 CRT implanted patients with non-ischemic heart failure, 716 patients had all the required data to calculate the Goldenberg score. From this cohort 379 (53%) had CRT-P and 337 (47%) CRT-D implantation. The mean value of the Goldenberg score was 2.7 in the total cohort, while a significantly higher score was found in the CRT-P group (CRT-P 2.9 ± 1.1 vs. CRT-D 2.5 ± 1.1 p < 0.001). During the median follow-up time of 4.9 years, 345 (48%) patients reached the primary endpoint, 220 patients (64%) with CRT-P and 125 patients (36%) with CRT-D. After comparing patients by low (≤3) and high (>3) Goldenberg score, we found that CRT-D patients with lower risk score showed mortality benefit compared to CRT-P (HR 0.69; 95%, CI 0.53-0.89; p = 0.001). In the contrary there was no apparent mortality benefit in CRT-D patients compared to CRT-P when high Goldenberg score subgroup was analyzed (HR 0.99; 95%, CI 0.67-1.45; p = 0.95).
Conclusions
In non-ischemic heart failure patients, Goldenberg sudden cardiac risk score can be also applied. In CRT-D patients those with less co-morbidities and lower (≤3) Goldenberg risk score showed mortality benefit compared to CRT-P patients, while among patients with higher score (>3) adding an ICD had no additional effect on all-cause mortality.
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Affiliation(s)
- A Kosztin
- Semmelweis University, Heart Center, Budapest, Hungary
| | | | - A Behon
- Semmelweis University, Heart Center, Budapest, Hungary
| | - E Merkel
- Semmelweis University, Heart Center, Budapest, Hungary
| | - E Zima
- Semmelweis University, Heart Center, Budapest, Hungary
| | - L Geller
- Semmelweis University, Heart Center, Budapest, Hungary
| | - D Becker
- Semmelweis University, Heart Center, Budapest, Hungary
| | - B Merkely
- Semmelweis University, Heart Center, Budapest, Hungary
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15
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Behon A, Schwertner WR, Merkel ED, Kovacs A, Kutyifa V, Lakatos B, Zima E, Geller L, Kosztin A, Merkely B. 40Lateral left ventricular lead position and long interlead electrical delay predict long-term all-cause mortality in cardiac resynchronization therapy patients. Europace 2020. [DOI: 10.1093/europace/euaa162.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
There is limited data on the association of left ventricular (LV) lead position and long-term clinical outcome in patients after cardiac resynchronization therapy (CRT).
Purpose
We evaluated the mid-term echocardiographic response and long-term all-cause mortality of patients who underwent CRT implantation by LV lead non-apical positions and further characterized them by right to left ventricular, interlead electrical delay (IED).
Methods
In our retrospective registry patients after CRT implantation between 2000 and 2018 were registered. Those with non-apical LV lead location were classified into anterior (n = 111), posterior (n = 652), and lateral (n = 1373) positions. Primary endpoint was all-cause mortality assessed by univariate- and Cox multivariate analyses. Secondary endpoint was echocardiographic response within 6 months after CRT implantation.
Results
From 2136 patients 1180 (55.2%) reached the primary endpoint during the mean follow up time of 4.5 years. Univariate analysis showed patients with lateral position had significantly better outcome compared to others (HR 0.80; 95% CI: 0.71-0.90; p < 0.01), which was also confirmed by Cox multivariate analysis (HR 0.69; 95% CI: 0.50-0.93; p = 0.02) after adjusting for relevant clinical covariates such as IED and LBBB. The median value of IED was 106 (89/124) ms in the total patient cohort, which was significantly longer in the lateral group [anterior 80 (60/100) ms vs. lateral 110 (91/128) ms vs. posterior 100 (85/120) ms; p< 0.01]. When echocardiographic response was further evaluated in patients with lateral position, those with an IED longer than 110 ms (ROC AUC 0.64, 95% CI: 0.54-0.74; p = 0.01) showed the greatest benefit within 6 months.
Conclusions
After CRT implantation the most beneficial outcome was associated with lateral left ventricular lead location, moreover the greatest echocardiographic response was found when interlead electrical delay was longer than 110 ms in this group.
Abstract Figure. All-cause mortality of total cohort
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Affiliation(s)
- A Behon
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - W R Schwertner
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - E D Merkel
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - A Kovacs
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - V Kutyifa
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - B Lakatos
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - E Zima
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - L Geller
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - A Kosztin
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - B Merkely
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
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16
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Tokodi M, Toser Z, Boros AM, Schwertner W, Kovacs A, Perge P, Szeplaki G, Geller L, Kosztin A, Merkely B. 5107Survival prediction in patients undergoing cardiac resynchronization therapy: a machine learning based risk stratification system. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Cardiac Resynchronization Therapy (CRT) has well-known beneficial effects in patients with advanced heart failure, reduced ejection fraction and wide QRS complex. However, mortality rates still remain high in this patient population. Therefore, precise risk stratification would be essential, nonetheless, the currently available risk scores have several shortcomings which hamper their utilization in the everyday clinical practice.
Purpose
Accordingly, our objective was to design and validate a machine learning based risk stratification system to predict 2-year and 5-year mortality from pre-implant parameters of patients undergoing CRT implantation.
Methods
We trained two models separately to predict 2-year (model 1) and 5-year mortality (model 2). As training cohort of model 1 we used 1678 patients (67±10 years, 1251 [75%] males) undergoing CRT implantation. From this population, 1320 patients (66±10 years, 1005 [76%] males) also completed 5-year follow-up and they served as the training cohort for model 2. Forty-seven pre-implant parameters (demographics, cardiovascular risk factors and clinical characteristics) were used to train the models. Our models were designed in a way to tolerate missing values. Among non-linear classifiers, random forest demonstrated the best performance. We validated our models, along with the Seattle Heart Failure Model (SHFM), VALID-CRT risk score and EAARN score on an independent cohort of 136 patients (66±10 years, 110 [81%] males). Based on the predicted probability of survival, patients were split into quartiles and survival was plotted via Kaplan-Meier (KM) curves.
Results
There were 358 (21%) deaths in the 2-year, 697 (53%) deaths in the 5-year training cohort. In the validation cohort, there were 30 (22%) deaths at 2 years and 58 (43%) deaths at 5 years after CRT implantation. For the prediction of 2-year mortality, the Area Under the Receiver-Operating Characteristic Curve (AUC) for model 1 was 0.77 (95% CI: 0.67–0.87; p=0.002), for SHFM was 0.54 (95% CI: 0.39–0.69; p=0.006), for EAARN was 0.57 (95% CI: 0.46–0.68, p=0.002), and for VALID-CRT was 0.62 (95% CI: 0.52–0.71; p=0.002). To predict 5-year mortality, the AUC for model 2 was 0.85 (95% CI: 0.78–0.91; p=0.001), for SHFM was 0.62 (95% CI: 0.51–0.74; p=0.003), for EAARN was 0.61 (95% CI: 0.51–0.70, p=0.002), for VALID-CRT was 0.65 (95% CI: 0.56–0.74; p=0.002). The AUCs of the machine learning based models were significantly higher than the AUCs of the pre-existing scores (DeLong test, all p<0.05). The KM curves of the quartiles were significantly separating in both models (Log-rank test, both p<0.001).
Conclusion
Our results indicate that machine learning algorithms can outperform the already existing linear model based scores. By capturing the non-linear association of predictors, the utilization of these state-of-the-art approaches may facilitate optimal candidate selection and prognostication of patients undergoing CRT implantation.
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Affiliation(s)
- M Tokodi
- Semmelweis University Heart Center, Budapest, Hungary
| | - Z Toser
- Argus Cognitive, Inc., Dover, United States of America
| | - A M Boros
- Semmelweis University Heart Center, Budapest, Hungary
| | - W Schwertner
- Semmelweis University Heart Center, Budapest, Hungary
| | - A Kovacs
- Semmelweis University Heart Center, Budapest, Hungary
| | - P Perge
- Semmelweis University Heart Center, Budapest, Hungary
| | - G Szeplaki
- Semmelweis University Heart Center, Budapest, Hungary
| | - L Geller
- Semmelweis University Heart Center, Budapest, Hungary
| | - A Kosztin
- Semmelweis University Heart Center, Budapest, Hungary
| | - B Merkely
- Semmelweis University Heart Center, Budapest, Hungary
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Kosztin A, Schwertner WR, Tokodi M, Toser ZS, Kovacs A, Veres B, Zima E, Geller L, Merkely B. P1631Machine-learning defined predictors of mortality in ischemic and non-ischemic heart failure patients undergoing CRT-P or CRT-D implantation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Both Cardiac Resynchronization Therapy Pacemakers (CRT-P) and CRT Defibrillators (CRT-D) improve mortality in heart failure patients with reduced ejection fraction and wide QRS complex. However, not every patient benefits equally from each type of treatment and determinants of mortality may vary across the subgroups of patients with different etiologies and devices.
Purpose
Our aim was to investigate the differences in the predictors of long-term mortality in heart failure patients with different etiologies undergoing CRT-P or CRT-D implantation using machine learning.
Methods
We created 4 separate random forest models to predict 5-year all-cause mortality (models for ischemic and non-ischemic etiology in both CRT-P and CRT-D subgroups). A registry of 1650 patients (66±10 years, 1258 [76%] males, 751 [46%] CRT-D) was used as the training cohort for the prediction models. Forty-seven pre-implant parameters including cardiovascular risk factors and clinical variables were utilized to train our models. For each clinical parameter, we calculated the mean decrease in Gini impurity (dG). Based on the extent of decline, the 10 most important features were selected for each model. To keep the data comparable between the different models, we took the union of these features and plotted the results on radar charts.
Results
There were 879 (53%) deaths during the follow-up period. The mortality benefit of adding an Implantable Cardioverter Defibrillator could be observed only in ischemic patients (Hazard Ratio = 0.83, 95% Confidence Interval: 0.72–0.97, p<0.005), but not in the entire cohort or in patients with non-ischemic etiology. In patients with non-ischemic etiology, the pattern of mortality predictors were almost similar: in CRT-P patients the most important predictors were age, serum urea levels and left ventricular ejection fraction (LVEF) (dG: 0.114, 0.054 and 0.053, respectively) whereas in the CRT-D subgroup these factors were age, LVEF and serum sodium (dG: 0.116, 0.060 and 0.052, respectively). In CRT-P patients with non-ischemic etiology, the most relevant variables were age serum urea and LVEF in decreasing order (dG: 0.085, 0.060 and 0.050, respectively). The strongest predictors of mortality were age, hemoglobin and serum creatinine in ischemic patients with CRT-D (dG: 0.088, 0.060 and 0.052, respectively).
CRT-P vs. CRT-D by ischemic etiology
Conclusions
In patients with ischemic heart failure, CRT-D was associated with a mortality benefit compared to CRT-P. Our results also suggest that machine-learning may identify distinct patterns in clinical characteristics for a better mortality prediction. Taking these factors into consideration during the management of heart failure patients with CRT, risk stratification and outcomes could be improved.
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Affiliation(s)
- A Kosztin
- Semmelweis University, Heart Center, Budapest, Hungary
| | | | - M Tokodi
- Semmelweis University, Heart Center, Budapest, Hungary
| | - Z S Toser
- Semmelweis University, Heart Center, Budapest, Hungary
| | - A Kovacs
- Semmelweis University, Heart Center, Budapest, Hungary
| | - B Veres
- Semmelweis University, Heart Center, Budapest, Hungary
| | - E Zima
- Semmelweis University, Heart Center, Budapest, Hungary
| | - L Geller
- Semmelweis University, Heart Center, Budapest, Hungary
| | - B Merkely
- Semmelweis University, Heart Center, Budapest, Hungary
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Nagy VK, Merkely B, Geller L, Kosztin A, Solomon S, McNitt S, Goldenberg I, Kutyifa V. 3152Right ventricular function and long-term outcomes in cardiac resynchronization therapy patients enrolled in MADIT-CRT. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Long-term predictive value of baseline right ventricular (RV) function and CRT-induced changes of RV function for the clinical outcomes, mortality or heart failure are not well understood, especially in mild HF patients implanted with CRT-D.
Methods
MADIT-CRT enrolled 1,820 patients at 110 centers worldwide, with either ischemic cardiomyopathy (New York Heart Association [NYHA] functional class I or II), or non-ischemic cardiomyopathy (NYHA functional class II only), sinus rhythm, ejection fraction of 30% or less, and a QRS duration of 130 ms or more. We assessed right ventricular function (RVF) as RV fractional area change by echocardiography at baseline and after 1 year of therapy in patients with LBBB assigned to CRT arm (n=633). Kaplan-Meier survival analyses and multivariate Cox models were utilized to identify RV parameters predicting long-term outcomes of HF or death events.
Results
During the median follow up of 5.6 years 192 (30.3%) patients had heart failure or death. CRT-D LBBB patients with below or above median RV end-systolic area (RVS) had lower cumulative probabilities of HF/death (p=0.02). Lower, than the median value of both RVS and RVF were associated with higher risk of HF events alone (p=0.004; p=0.01 respectively). In multivariate analysis, after adjustment of relevant clinical covariates more RV reverse remodeling in the terms of RV end-diastolic area (RVD) decrease proved to be an independent predictor for 5-year all-cause mortality (HR: 0.4; p=0.03).
Kaplan-Meier analysis of baseline RVF
Conclusions
Based on our results RV geometry and function before CRT implant and also significant RV reverse remodeling at 12 months follow up are significant predictors of long-term outcomes.
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Affiliation(s)
- V K Nagy
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - B Merkely
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - L Geller
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - A Kosztin
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - S Solomon
- University of Rochester, Medical Center, Rochester, United States of America
| | - S McNitt
- University of Rochester, Medical Center, Rochester, United States of America
| | - I Goldenberg
- University of Rochester, Medical Center, Rochester, United States of America
| | - V Kutyifa
- University of Rochester, Medical Center, Rochester, United States of America
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Nagy K, Merkely B, Gellér L, Kosztin A, McNitt S, Solomon S, Kutyifa V. PO074 Quality of Life to Predict Long-term Outcomes In Cardiac Resynchronization Therapy Patients Enrolled In MADIT-CRT. Glob Heart 2018. [DOI: 10.1016/j.gheart.2018.09.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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20
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Tokodi M, Schwertner WR, Kovacs A, Lakatos BK, Kerulo M, Shrestha S, Geller L, Kosztin A, Merkely B. P1945Machine learning to identify high-risk clusters of patients undergoing cardiac resynchronization therapy. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Tokodi
- Semmelweis University Heart Center, Budapest, Hungary
| | | | - A Kovacs
- Semmelweis University Heart Center, Budapest, Hungary
| | - B K Lakatos
- Semmelweis University Heart Center, Budapest, Hungary
| | - M Kerulo
- Semmelweis University Heart Center, Budapest, Hungary
| | - S Shrestha
- WVU Heart & Vascular Institute, Morgantown, United States of America
| | - L Geller
- Semmelweis University Heart Center, Budapest, Hungary
| | - A Kosztin
- Semmelweis University Heart Center, Budapest, Hungary
| | - B Merkely
- Semmelweis University Heart Center, Budapest, Hungary
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21
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Nagy KV, Merkely B, Geller L, Kosztin A, McNitt S, Polonsky S, Goldenberg I, Zareba W, Moss AJ, Kutyifa V. P1943Quality of life predicting long-term outcomes in cardiac resynchronization therapy patients. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K V Nagy
- Semmelweis University, Heart Center, Budapest, Hungary
| | - B Merkely
- Semmelweis University, Heart and Vascular Center, Budapest, Hungary
| | - L Geller
- Semmelweis University, Heart and Vascular Center, Budapest, Hungary
| | - A Kosztin
- Semmelweis University, Heart and Vascular Center, Budapest, Hungary
| | - S McNitt
- University of Rochester, Medical Center, Rochester, United States of America
| | - S Polonsky
- University of Rochester, Medical Center, Rochester, United States of America
| | - I Goldenberg
- University of Rochester, Medical Center, Rochester, United States of America
| | - W Zareba
- University of Rochester, Medical Center, Rochester, United States of America
| | - A J Moss
- University of Rochester, Medical Center, Rochester, United States of America
| | - V Kutyifa
- University of Rochester, Medical Center, Rochester, United States of America
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Kosztin A, Schwertner W, Kovacs A, Zima E, Geller L, Kutyifa V, Merkely B. P327Long-term clinical outcome of patients after cardiac resynchronization therapy upgrade: a high volume, single center experience. Europace 2018. [DOI: 10.1093/europace/euy015.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Kosztin
- Semmelweis University, Heart Center, Budapest, Hungary
| | - W Schwertner
- Semmelweis University, Heart Center, Budapest, Hungary
| | - A Kovacs
- Semmelweis University, Heart Center, Budapest, Hungary
| | - E Zima
- Semmelweis University, Heart Center, Budapest, Hungary
| | - L Geller
- Semmelweis University, Heart Center, Budapest, Hungary
| | - V Kutyifa
- University of Rochester, Cardiology Division, Rochester, United States of America
| | - B Merkely
- Semmelweis University, Heart Center, Budapest, Hungary
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Kosztin A, Vamos M, Aradi D, Schwertner R, Kovacs A, Nagy K, Zima E, Geller L, Duray G, Kutyifa V, Merkely B. P5475De novo implantation vs. upgrade cardiac resynchronization therapy: a systematic review and meta-analysis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Doronina A, Kovacs A, Lakatos B, Kantor Z, Edes I, Kosztin A, Abramov A, Merkely B. P1538Gender differences in right ventricular function of athlete's heart. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Kosztin A, Schwertner W, Bojtar Z, Kovacs A, Zima E, Geller L, Kutyifa V, Merkely B. P5491Long-term clinical outcome of patients after de novo vs. upgrade cardiac resynchronization therapy: a high volume, single center experience. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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26
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Kosztin A, Vamos M, Aradi D, Schweltner W, Bojtar ZS, Kovacs A, Geller L, Zima E, Kutyifa V, Merkely B. P264De novo implantation vs. upgrade cardiac resynchronization therapy: a systematic review and meta-analysis. Europace 2017. [DOI: 10.1093/ehjci/eux171.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Mirea O, Mirea O, Karuzas A, Nestaas E, Lakatos BK, Ancona R, Plokhova EV, Lebedev D, Pagourelias ED, Duchenne J, Bogaert J, Thomas JD, Badano LP, Voigt JU, Pagourelias ED, Duchenne J, Thomas JD, Badano LP, Voigt JU, Viezelis M, Zemaitis M, Rumbinaite E, Baronaite-Dudoniene K, Puodziukynas A, Vaskelyte JJ, Sarvari S, Hopp E, Gjesdal O, Smedsrud MK, Haugaa KH, Edvardsen T, Toser Z, Tokodi M, Kosztin A, Sax B, Merkely B, Kovacs A, Comenale Pinto S, Caso P, Coppola MG, Monteforte I, Calabro R, Akasheva DU, Tkacheva ON, Strazhesko ID, Dudinskaya EN, Kruglikova AS, Pykhtina VS, Streltsova LI, Boytsov SA, Smorgon AV, Usenkov SYU, Archakov EA, Batalov RE, Popov SV. Moderated Posters: Deformation imagingP96How accurate can different strain analysis tools detect regional function?abnormalities, a report from the second inter-vendor comparison?studyP97Variability and reproducibility of segmental longitudinal strain measurements, a report form the second intervendor comparison studyP98Systolic and diastolic left atrial deformation parameters before and after optimization of dual chamber pacemaker parametersP99The timing of the post systolic shortening in prediction of scarred myocardiumP100Altered contribution of longitudinal and radial motion to right ventricular ejection and filling in heart transplant recipientsP101Left ventricular and atrial function in old patients underwent transcatheter aortic valve implantation, evaluated by two and three-dimensional speckle tracking at eighteen-month follow-upP102Age-related changes in left ventricular strain measured by speckle-tracking echocardiography and association with telomere length in healthy peopleP103Intracardiac speckle tracking echocardiography-based method for assessment of pulmonary vein isolation in patients with atrial fibrillation. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Targher G, Dauriz M, Laroche C, Temporelli PL, Hassanein M, Seferovic PM, Drozdz J, Ferrari R, Anker S, Coats A, Filippatos G, Crespo‐Leiro MG, Mebazaa A, Piepoli MF, Maggioni AP, Tavazzi L, Crespo‐Leiro M, Anker S, Coats A, Ferrari R, Filippatos G, Maggioni A, Mebazaa A, Piepoli M, Amir O, Chioncel O, Dahlström U, Jimenez JD, Drozdz J, Erglis A, Fazlibegovic E, Fonseca C, Fruhwald F, Gatzov P, Goncalvesova E, Hassanein M, Hradec J, Kavoliuniene A, Lainscak M, Logeart D, Merkely B, Metra M, Otljanska M, Seferovic P, Kostovska ES, Temizhan A, Tousoulis D, Andarala M, Ferreira T, Fiorucci E, Gracia G, Laroche C, Pommier C, Taylor C, Cuculici A, Gaulhofer C, Casado EP, Szymczyk E, Ramani F, Mulak G, Schou IL, Semenka J, Stojkovic J, Mehanna R, Mizarienne V, Auer J, Ablasser K, Fruhwald F, Dolze T, Brandner K, Gstrein S, Poelzl G, Moertl D, Reiter S, Podczeck‐Schweighofer A, Muslibegovic A, Vasilj M, Fazlibegovic E, Cesko M, Zelenika D, Palic B, Pravdic D, Cuk D, Vitlianova K, Katova T, Velikov T, Kurteva T, Gatzov P, Kamenova D, Antova M, Sirakova V, Krejci J, Mikolaskova M, Spinar J, Krupicka J, Malek F, Hegarova M, Lazarova M, Monhart Z, Hassanein M, Sobhy M, El Messiry F, El Shazly A, Elrakshy Y, Youssef A, Moneim A, Noamany M, Reda A, Dayem TA, Farag N, Halawa SI, Hamid MA, Said K, Saleh A, Ebeid H, Hanna R, Aziz R, Louis O, Enen M, Ibrahim B, Nasr G, Elbahry A, Sobhy H, Ashmawy M, Gouda M, Aboleineen W, Bernard Y, Luporsi P, Meneveau N, Pillot M, Morel M, Seronde M, Schiele F, Briand F, Delahaye F, Damy T, Eicher J, Groote P, Fertin M, Lamblin N, Isnard R, Lefol C, Thevenin S, Hagege A, Jondeau G, Logeart D, Le Marcis V, Ly J, Coisne D, Lequeux B, Le Moal V, Mascle S, Lotton P, Behar N, Donal E, Thebault C, Ridard C, Reynaud A, Basquin A, Bauer F, Codjia R, Galinier M, Tourikis P, Stavroula M, Tousoulis D, Stefanadis C, Chrysohoou C, Kotrogiannis I, Matzaraki V, Dimitroula T, Karavidas A, Tsitsinakis G, Kapelios C, Nanas J, Kampouri H, Nana E, Kaldara E, Eugenidou A, Vardas P, Saloustros I, Patrianakos A, Tsaknakis T, Evangelou S, Nikoloulis N, Tziourganou H, Tsaroucha A, Papadopoulou A, Douras A, Polgar L, Merkely B, Kosztin A, Nyolczas N, Nagy AC, Halmosi R, Elber J, Alony I, Shotan A, Fuhrmann AV, Amir O, Romano S, Marcon S, Penco M, Di Mauro M, Lemme E, Carubelli V, Rovetta R, Metra M, Bulgari M, Quinzani F, Lombardi C, Bosi S, Schiavina G, Squeri A, Barbieri A, Di Tano G, Pirelli S, Ferrari R, Fucili A, Passero T, Musio S, Di Biase M, Correale M, Salvemini G, Brognoli S, Zanelli E, Giordano A, Agostoni P, Italiano G, Salvioni E, Copelli S, Modena M, Reggianini L, Valenti C, Olaru A, Bandino S, Deidda M, Mercuro G, Dessalvi CC, Marino P, Di Ruocco M, Sartori C, Piccinino C, Parrinello G, Licata G, Torres D, Giambanco S, Busalacchi S, Arrotti S, Novo S, Inciardi R, Pieri P, Chirco P, Galifi MA, Teresi G, Buccheri D, Minacapelli A, Veniani M, Frisinghelli A, Priori S, Cattaneo S, Opasich C, Gualco A, Pagliaro M, Mancone M, Fedele F, Cinque A, Vellini M, Scarfo I, Romeo F, Ferraiuolo F, Sergi D, Anselmi M, Melandri F, Leci E, Iori E, Bovolo V, Pidello S, Frea S, Bergerone S, Botta M, Canavosio F, Gaita F, Merlo M, Cinquetti M, Sinagra G, Ramani F, Fabris E, Stolfo D, Artico J, Miani D, Fresco C, Daneluzzi C, Proclemer A, Cicoira M, Zanolla L, Marchese G, Torelli F, Vassanelli C, Voronina N, Erglis A, Tamakauskas V, Smalinskas V, Karaliute R, Petraskiene I, Kazakauskaite E, Rumbinaite E, Kavoliuniene A, Vysniauskas V, Brazyte‐Ramanauskiene R, Petraskiene D, Stankala S, Switala P, Juszczyk Z, Sinkiewicz W, Gilewski W, Pietrzak J, Orzel T, Kasztelowicz P, Kardaszewicz P, Lazorko‐Piega M, Gabryel J, Mosakowska K, Bellwon J, Rynkiewicz A, Raczak G, Lewicka E, Dabrowska‐Kugacka A, Bartkowiak R, Sosnowska‐Pasiarska B, Wozakowska‐Kaplon B, Krzeminski A, Zabojszcz M, Mirek‐Bryniarska E, Grzegorzko A, Bury K, Nessler J, Zalewski J, Furman A, Broncel M, Poliwczak A, Bala A, Zycinski P, Rudzinska M, Jankowski L, Kasprzak J, Michalak L, Soska KW, Drozdz J, Huziuk I, Retwinski A, Flis P, Weglarz J, Bodys A, Grajek S, Kaluzna‐Oleksy M, Straburzynska‐Migaj E, Dankowski R, Szymanowska K, Grabia J, Szyszka A, Nowicka A, Samcik M, Wolniewicz L, Baczynska K, Komorowska K, Poprawa I, Komorowska E, Sajnaga D, Zolbach A, Dudzik‐Plocica A, Abdulkarim A, Lauko‐Rachocka A, Kaminski L, Kostka A, Cichy A, Ruszkowski P, Splawski M, Fitas G, Szymczyk A, Serwicka A, Fiega A, Zysko D, Krysiak W, Szabowski S, Skorek E, Pruszczyk P, Bienias P, Ciurzynski M, Welnicki M, Mamcarz A, Folga A, Zielinski T, Rywik T, Leszek P, Sobieszczanska‐Malek M, Piotrowska M, Kozar‐Kaminska K, Komuda K, Wisniewska J, Tarnowska A, Balsam P, Marchel M, Opolski G, Kaplon‐Cieslicka A, Gil R, Mozenska O, Byczkowska K, Gil K, Pawlak A, Michalek A, Krzesinski P, Piotrowicz K, Uzieblo‐Zyczkowska B, Stanczyk A, Skrobowski A, Ponikowski P, Jankowska E, Rozentryt P, Polonski L, Gadula‐Gacek E, Nowalany‐Kozielska E, Kuczaj A, Kalarus Z, Szulik M, Przybylska K, Klys J, Prokop‐Lewicka G, Kleinrok A, Aguiar CT, Ventosa A, Pereira S, Faria R, Chin J, De Jesus I, Santos R, Silva P, Moreno N, Queirós C, Lourenço C, Pereira A, Castro A, Andrade A, Guimaraes TO, Martins S, Placido R, Lima G, Brito D, Francisco A, Cardiga R, Proenca M, Araujo I, Marques F, Fonseca C, Moura B, Leite S, Campelo M, Silva‐Cardoso J, Rodrigues J, Rangel I, Martins E, Correia AS, Peres M, Marta L, Silva GF, Severino D, Durao D, Leao S, Magalhaes P, Moreira I, Cordeiro AF, Ferreira C, Araujo C, Ferreira A, Baptista A, Radoi M, Bicescu G, Vinereanu D, Sinescu C, Macarie C, Popescu R, Daha I, Dan G, Stanescu C, Dan A, Craiu E, Nechita E, Aursulesei V, Christodorescu R, Otasevic P, Seferovic P, Simeunovic D, Ristic A, Celic V, Pavlovic‐Kleut M, Lazic JS, Stojcevski B, Pencic B, Stevanovic A, Andric A, Iric‐Cupic V, Jovic M, Davidovic G, Milanov S, Mitic V, Atanaskovic V, Antic S, Pavlovic M, Stanojevic D, Stoickov V, Ilic S, Ilic MD, Petrovic D, Stojsic S, Kecojevic S, Dodic S, Adic NC, Cankovic M, Stojiljkovic J, Mihajlovic B, Radin A, Radovanovic S, Krotin M, Klabnik A, Goncalvesova E, Pernicky M, Murin J, Kovar F, Kmec J, Semjanova H, Strasek M, Iskra MS, Ravnikar T, Suligoj NC, Komel J, Fras Z, Jug B, Glavic T, Losic R, Bombek M, Krajnc I, Krunic B, Horvat S, Kovac D, Rajtman D, Cencic V, Letonja M, Winkler R, Valentincic M, Melihen‐Bartolic C, Bartolic A, Vrckovnik MP, Kladnik M, Pusnik CS, Marolt A, Klen J, Drnovsek B, Leskovar B, Anguita MF, Page JG, Martinez FS, Andres J, Genis A, Mirabet S, Mendez A, Garcia‐Cosio L, Roig E, Leon V, Gonzalez‐Costello J, Muntane G, Garay A, Alcade‐Martinez V, Fernandez SL, Rivera‐Lopez R, Puga‐Martinez M, Fernandez‐Alvarez M, Serrano‐Martinez J, Crespo‐Leiro M, Grille‐Cancela Z, Marzoa‐Rivas R, Blanco‐Canosa P, Paniagua‐Martin M, Barge‐Caballero E, Cerdena IL, Baldomero IFH, Padron AL, Rosillo SO, Gonzalez‐Gallarza RD, Montanes OS, Manjavacas AI, Conde AC, Araujo A, Soria T, Garcia‐Pavia P, Gomez‐Bueno M, Cobo‐Marcos M, Alonso‐Pulpon L, Cubero JS, Sayago I, Gonzalez‐Segovia A, Briceno A, Subias PE, Hernandez MV, Cano MR, Sanchez MG, Jimenez JD, Garrido‐Lestache EB, Pinilla JG, Villa BG, Sahuquillo A, Marques RB, Calvo FT, Perez‐Martinez M, Gracia‐Rodenas M, Garrido‐Bravo IP, Pastor‐Perez F, Pascual‐Figal D, Molina BD, Orus J, Gonzalo FE, Bertomeu V, Valero R, Martinez‐Abellan R, Quiles J, Rodrigez‐Ortega J, Mateo I, ElAmrani A, Fernandez‐Vivancos C, Valero DB, Almenar‐Bonet L, Sanchez‐Lazaro I, Marques‐Sule E, Facila‐Rubio L, Perez‐Silvestre J, Garcia‐Gonzalez P, Ridocci‐Soriano F, Garcia‐Escriva D, Pellicer‐Cabo A, Fuente Galan L, Diaz JL, Platero AR, Arias J, Blasco‐Peiro T, Julve MS, Sanchez‐Insa E, Aured‐Guallar C, Portoles‐Ocampo A, Melin M, Hägglund E, Stenberg A, Lindahl I, Asserlund B, Olsson L, Dahlström U, Afzelius M, Karlström P, Tengvall L, Wiklund P, Olsson B, Kalayci S, Temizhan A, Cavusoglu Y, Gencer E, Yilmaz M, Gunes H. In‐hospital and 1‐year mortality associated with diabetes in patients with acute heart failure: results from the
ESC‐HFA
Heart Failure Long‐Term Registry. Eur J Heart Fail 2016; 19:54-65. [DOI: 10.1002/ejhf.679] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 08/24/2016] [Accepted: 09/20/2016] [Indexed: 12/28/2022] Open
Affiliation(s)
- Giovanni Targher
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine University and Azienda Ospedaliera Universitaria Integrata of Verona Verona Italy
| | - Marco Dauriz
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine University and Azienda Ospedaliera Universitaria Integrata of Verona Verona Italy
| | - Cécile Laroche
- EURObservational Research Programme European Society of Cardiology Sophia‐Antipolis France
| | | | | | | | | | - Roberto Ferrari
- Department of Cardiology and LTTA Centre, University Hospital of Ferrara and Maria Cecilia Hospital, GVM Care & Research E.S: Health Science Foundation Cotignola Italy
| | - Stephan Anker
- Innovative Clinical Trials, Department of Cardiology & Pneumology University Medical Center Göttingen (UMG) Göttingen Germany
| | - Andrew Coats
- Monash University Australia and University of Warwick Coventry UK
| | | | - Maria G. Crespo‐Leiro
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Complexo Hospitalario Universitario A Coruna CHUAC La Coruna Spain
| | - Alexandre Mebazaa
- Inserm 942, Hôpital Lariboisière Université Paris Diderot Paris France
| | - Massimo F. Piepoli
- Department of Cardiology Polichirurgico Hospital G. da Saliceto Piacenza Italy
| | - Aldo Pietro Maggioni
- EURObservational Research Programme European Society of Cardiology Sophia‐Antipolis France
- ANMCO Research Center Florence Italy
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care & Research E.S. Health Science Foundation Cotignola Italy
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Kovács A, Kosztin A, Tokodi M, Merkely B. PS242 Separate Quantification of Radial and Longitudinal Motion of the Right Ventricle Using 3D Echocardiography. Glob Heart 2016. [DOI: 10.1016/j.gheart.2016.03.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Merkely B, Kosztin A, Szeplaki G, Kovacs A, Foldes G, Szokodi I, Nagy V, Kutyifa V, Geller L, Becker D, Aradi D. PS112 The Role of CT-apelin on Identifying Non-Responders to Cardiac Resynchronization Therapy. Glob Heart 2016. [DOI: 10.1016/j.gheart.2016.03.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Becker D, Kosztin A, Barczi G, Heltai K, Zima E, Vago H, Merkely B. PM136 The Effect of the Primary Care System on the Long Term Prognosis of Patients With St Segment Elevation Myocardial Infarction. Glob Heart 2016. [DOI: 10.1016/j.gheart.2016.03.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Gara E, Skopal J, Kosztin A, Merkely B, Harding SE, Foldes G. 47Angiogenic potential of human pluripotent stem cell-derived arterial and venous endothelial cells. Cardiovasc Res 2014. [DOI: 10.1093/cvr/cvu080.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Foldes G, Gara E, Lendvai Z, Mathe D, Skopal J, Leja T, Kosztin A, Merkely B, Harding SE. P78Signalling via pi3k/foxo1a pathway modulates formation and survival of human embryonic stem cell-derived endothelial cells. Cardiovasc Res 2014. [DOI: 10.1093/cvr/cvu082.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Caiani E, Pellegrini A, Carminati M, Lang R, Auricchio A, Vaida P, Obase K, Sakakura T, Komeda M, Okura H, Yoshida K, Zeppellini R, Noni M, Rigo T, Erente G, Carasi M, Costa A, Ramondo B, Thorell L, Akesson-Lindow T, Shahgaldi K, Germanakis I, Fotaki A, Peppes S, Sifakis S, Parthenakis F, Makrigiannakis A, Richter U, Sveric K, Forkmann M, Wunderlich C, Strasser R, Djikic D, Potpara T, Polovina M, Marcetic Z, Peric V, Ostenfeld E, Werther-Evaldsson A, Engblom H, Ingvarsson A, Roijer A, Meurling C, Holm J, Radegran G, Carlsson M, Tabuchi H, Yamanaka T, Katahira Y, Tanaka M, Kurokawa T, Nakajima H, Ohtsuki S, Saijo Y, Yambe T, D'alto M, Romeo E, Argiento P, D'andrea A, Vanderpool R, Correra A, Sarubbi B, Calabro' R, Russo M, Naeije R, Saha SK, Warsame TA, Caelian AG, Malicse M, Kiotsekoglou A, Omran AS, Sharif D, Sharif-Rasslan A, Shahla C, Khalil A, Rosenschein U, Erturk M, Oner E, Kalkan A, Pusuroglu H, Ozyilmaz S, Akgul O, Aksu H, Akturk F, Celik O, Uslu N, Bandera F, Pellegrino M, 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Y, Ikeda U, Florescu C, Niemann M, Liu D, Hu K, Herrmann S, Gaudron P, Scholz F, Stoerk S, Ertl G, Weidemann F, Marchel M, Serafin A, Kochanowski J, Piatkowski R, Madej-Pilarczyk A, Filipiak K, Hausmanowa-Petrusewicz I, Opolski G, Meimoun P, M'barek D, Clerc J, Neikova A, Elmkies F, Tzvetkov B, Luycx-Bore A, Cardoso C, Zemir H, Mansencal N, Arslan M, El Mahmoud R, Pilliere R, Dubourg O, Ikonomidis I, Lambadiari V, Pavlidis G, Koukoulis C, Kousathana F, Varoudi M, Tritakis V, Triantafyllidi H, Dimitriadis G, Lekakis I, Kovacs A, Kosztin A, Solymossy K, Celeng C, Apor A, Faludi M, Berta K, Szeplaki G, Foldes G, Merkely B, Kimura K, Daimon M, Nakajima T, Motoyoshi Y, Komori T, Nakao T, Kawata T, Uno K, Takenaka K, Komuro I, Gabric ID, Vazdar L, Pintaric H, Planinc D, Vinter O, Trbusic M, Bulj N, Nobre Menezes M, Silva Marques J, Magalhaes R, Carvalho V, Costa P, Brito D, Almeida A, Nunes-Diogo A, Davidsen ES, Bergerot C, Ernande L, Barthelet M, Thivolet S, Decker-Bellaton A, Altman M, 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R, Praus R, Vasatova M, Vojacek J, Palicka V, Hulek P, Pradel S, Mohty D, Damy T, Echahidi N, Lavergne D, Virot P, Aboyans V, Jaccard A, Mateescu A, La Carrubba S, Vriz O, Di Bello V, Carerj S, Zito C, Ginghina C, Popescu B, Nicolosi G, Antonini-Canterin F, Doulaptsis C, Symons R, Matos A, Florian A, Masci P, Dymarkowski S, Janssens S, Bogaert J, Lestuzzi C, Moreo A, Celik S, Lafaras C, Dequanter D, Tomkowski W, De Biasio M, Cervesato E, Massa L, Imazio M, Watanabe N, Kijima Y, Akagi T, Toh N, Oe H, Nakagawa K, Tanabe Y, Ikeda M, Okada K, Ito H, Milanesi O, Biffanti R, Varotto E, Cerutti A, Reffo E, Castaldi B, Maschietto N, Vida V, Padalino M, Stellin G, Bejiqi R, Retkoceri R, Bejiqi H, Retkoceri A, Surdulli S, Massoure P, Cautela J, Roche N, Chenilleau M, Gil J, Fourcade L, Akhundova A, Cincin A, Sunbul M, Sari I, Tigen M, Basaran Y, Suermeci G, Butz T, Schilling I, Sasko B, Liebeton J, Van Bracht M, Tzikas S, Prull M, Wennemann R, Trappe H, Attenhofer Jost CH, Pfyffer M, Scharf C, 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Poster session Friday 13 December - PM: 13/12/2013, 14:00-18:00 * Location: Poster area. Eur Heart J Cardiovasc Imaging 2013. [DOI: 10.1093/ehjci/jet206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Kutyifa V, Zima E, Szilagyi SZ, Roka A, Szucs G, Kosztin A, Molnar L, Szeplaki G, Geller L, Merkely B. Intraoperative right to left ventricular interlead delay predicts outcome in CRT recipients. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.52] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gara E, Skopal J, Kosztin A, Bagyura ZS, Nemeth T, Merkely B, Foldes G. Differentiation of arterial and venous endothelial cells from human embryonic stem cells: approach to vessel generation. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p1471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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