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Siddiqui A, Tasouli-Drakou V, Ringor M, DiCaro MV, Yee B, Lei K, Tak T. Recent Advances in Cardiac Resynchronization Therapy: Current Treatment and Future Direction. J Clin Med 2025; 14:889. [PMID: 39941560 PMCID: PMC11818169 DOI: 10.3390/jcm14030889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2025] [Revised: 01/20/2025] [Accepted: 01/23/2025] [Indexed: 02/16/2025] Open
Abstract
Cardiac Resynchronization Therapy (CRT) has been established as a major component of heart failure management, resulting in a significant reduction in patient morbidity and death for patients with increased QRS duration, low left ventricular ejection fraction (LVEF), and high risk of arrhythmias. The ability to synchronize both ventricles, lower heart failure hospitalizations, and optimize clinical outcomes are some of the attractive characteristics of biventricular pacing, or CRT. However, the high rate of CRT non-responders has led to the development of new modalities including leadless CRT pacemakers (CRT-P) and devices focused on conduction system pacing (CSP). This comprehensive review aims to present recent findings from CRT clinical trials and systematic reviews that have been published that will likely guide future directions in patient care.
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Affiliation(s)
- Arsalan Siddiqui
- Department of Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV 89102, USA; (V.T.-D.); (M.R.); (M.V.D.); (B.Y.); (K.L.); (T.T.)
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Zhou Z, Ma F, Zhu J, Wang J, Zhang J, Zhao D. Potential Underestimation of Left Ventricular Mechanical Dyssynchrony in Dyssynchrony and Outcomes Assessment. J Multidiscip Healthc 2024; 17:1721-1729. [PMID: 38659634 PMCID: PMC11041968 DOI: 10.2147/jmdh.s450264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 04/05/2024] [Indexed: 04/26/2024] Open
Abstract
Objective Left ventricular (LV) mechanical dyssynchrony (LVMD) is fundamental to the progression of heart failure and ventricular remodeling. The status of LVMD in different patterns of bundle branch blocks (BBB) is unclear. In this study, we analyzed the relationship between LVMD and left ventricular systolic dysfunction using real-time three-dimensional echocardiography (RT-3DE). Methods RT-3DE and conventional two-dimensional echocardiography were performed on 68 patients with left bundle branch block (LBBB group), 106 patients with right bundle branch block (RBBB group), and 103 patients without BBB (Normal group). The RT-3DE data sets provided time-volume analysis for global and segmental LV volumes. The LV systolic dyssynchrony index (LVSDI) was calculated using the standard deviation (SD) and maximal difference (Dif) of time to minimum segmental volume (tmsv) for LV segments adjusted by the R-R interval. LVMD was considered if the LVSDI (Tmsv-16-SD) was greater than or equal to 5%. Results LVSDI is negatively and significantly correlated with left ventricular ejection fraction (LVEF), but not with BBB or QRS duration. The proportion of LVMD in the LBBB, RBBB, and Normal group was 30.88%, 28.30%, and 25.24%, respectively, and there was no significant difference. Conclusion In dilated cardiomyopathy, LVMD is more closely related to LVEF reduction than QRS morphology and duration.
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Affiliation(s)
- Zhongyin Zhou
- Department of Echocardiography, Affiliated Hospital 2 of Nantong University, First People’s Hospital of Nantong City, Nantong, 226000, People’s Republic of China
| | - Feiyan Ma
- Department of Ultrasound, the People’s Hospital of Rugao, Nantong, 226000, People’s Republic of China
| | - Jianxiang Zhu
- Department of Echocardiography, Affiliated Hospital 2 of Nantong University, First People’s Hospital of Nantong City, Nantong, 226000, People’s Republic of China
| | - Jialing Wang
- Department of Echocardiography, Affiliated Hospital 2 of Nantong University, First People’s Hospital of Nantong City, Nantong, 226000, People’s Republic of China
| | - Jing Zhang
- Department of Electroencephalogram, Affiliated Hospital 2 of Nantong University, First People’s Hospital of Nantong City, Nantong, 226000, People’s Republic of China
| | - Dongsheng Zhao
- Department of Cardiology, Affiliated Hospital 2 of Nantong University, First People’s Hospital of Nantong City, Nantong, 226000, People’s Republic of China
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Yildiz M, Haude M, Sievert H, Fichtlscherer S, Lehmann R, Klein N, Witte K, Degen H, Pfeiffer D, Goldberg SL. The CINCH-FMR postmarket registry: Real-world long-term outcomes with percutaneous mitral valve repair with the Carillon Mitral Contour System®. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 60:35-40. [PMID: 37838620 DOI: 10.1016/j.carrev.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 09/17/2023] [Accepted: 09/22/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND The Carillon® Mitral Contour System® has been studied in 4 prospective controlled studies in the treatment of functional mitral regurgitation (FMR) where it has been found to reduce mitral regurgitation, reduce left ventricular and atrial volumes, and be associated with improvements in clinical parameters. AIMS The CINCH post-market registry is designed to evaluate immediate, mid-term and long-term outcomes from a post-approval study of the Carillon® device evaluated in real-world practice. METHODS The CINCH post-market registry is a single-arm study of percutaneous mitral annuloplasty with the Carillon device in patients with functional (secondary) mitral regurgitation and symptomatic congestive heart failure when utilized in real-world conditions. Patient selection, echocardiographic hemodynamic measurements, and patient follow-up requirements were performed per standard of care at each institution. RESULTS A total of 101 patients treated with the Carillon device at 13 sites in Germany were enrolled in the CINCH registry. The mean age was 75 ± 9 years, 57 % were male, and patient presentation included primarily NYHA class III (69 %) with MR grade 3 (68 %). Over 5 years of follow-up, all-cause mortality was 40.1 %, the incidence of HFH was 53.9 %, and the composite outcome of HFH or death was 66.4 %. At each follow-up interval through 5 years, statistically significant reductions in NYHA class (p < 0.05) and MR grade (p < 0.01) were reported. CONCLUSIONS In this "real world" registry of the Carillon Mitral Contour System, procedural safety and medium-term follow-up outcomes is similar to the outcomes seen in the prospective, controlled clinical trials, despite being used in populations of patients that extend outside of those studied in the trials. The use of this therapy in patients with atrial functional mitral regurgitation, and heart failure with preserved ejection fraction, was notable, since these types of patients were excluded from the prospective, controlled trials. This supports possible additional patient populations who might benefit from this type of mechanical therapy. The safety profile of this therapy in this registry and in the earlier trials may support a potential role in earlier forms of secondary mitral regurgitation.
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Affiliation(s)
| | | | | | | | - Ralf Lehmann
- Universitätsklinik Frankfurt, Frankfurt, Germany; UMM Universitätsklinik Mannheim, Mannheim, Germany
| | - Norbert Klein
- Universitätsklinik Leipzig AöR, Leipzig, Germany; Leipzig Klinikum St. Georg, Leipzig, Germany
| | - Klaus Witte
- Universitätsklinik Aachen AöR, Aachen, Germany
| | | | | | - Steven L Goldberg
- Private practice, Monterey, CA, United States of America; Cardiac Dimensions, Kirkland, WA, United States of America.
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Chung ES, Rickard J, Lu X, DerSarkissian M, Zichlin ML, Cheung HC, Swartz N, Greatsinger A, Duh MS. Real-world clinical burden among patients with and without heart failure worsening after cardiac resynchronization therapy. Curr Med Res Opin 2022; 38:1489-1498. [PMID: 35727103 DOI: 10.1080/03007995.2022.2092374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Cardiac resynchronization therapy (CRT) can improve cardiac function in patients with heart failure (HF); however, in some patients, HF worsens despite CRT. This study characterized the long-term clinical burden of patients with and without HF worsening (HFW) within 6 months post CRT implantation. METHODS A claims database (2007-2018) was used to identify two cohorts of adults: those with HFW within 180 days post-CRT and those with no HFW (NHFW). The evaluated clinical outcomes were cardiovascular events/complications, HF-related interventions, hospice enrollment, and all-cause mortality. Inverse probability of treatment weighting (IPTW) was used to adjust for confounders; adjusted comparisons were assessed using weighted Cox proportional hazard ratios (HRs). RESULTS Among the 12,753 adults analyzed (HFW: N = 4,785; NHFW: N = 7,968), the mean age was 72 years and the mean duration of follow-up was approximately 2 years. The clinical burden was greater for HFW than for NHFW in terms of all-cause mortality (19.7% vs. 12.1%) and occurrence of atrial fibrillation (57.4% vs. 51.2%). In the IPTW-adjusted Cox proportional hazard analyses, patients with HFW had a 54% higher average hazard of experiencing all-cause mortality compared to NHFW (adjusted average HR = 1.54, 95% confidence interval [CI]: 1.41-1.70; p < .001). Of the clinical events experienced by ≥5% of patients, the greatest differences in average hazard were for HF decompensation (adjusted average HR = 1.83, 95% CI: 1.60-2.09) and HF decompensation or death (HR = 1.63, 95%CI: 1.50-1.77). CONCLUSION Patients with early HFW post-CRT experienced a significantly higher clinical burden than those without HFW. Vigilance for signs of worsening HF in the first 6 months post-CRT is warranted.
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Affiliation(s)
- Eugene S Chung
- The Lindner Clinical Research Center at The Christ Hospital, Cincinnati, OH, USA
| | | | - Xiaoxiao Lu
- Medtronic Global CRHF Headquarters, Mounds View, MN, USA
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Chung ES, Rickard J, Lu X, DerSarkissian M, Zichlin ML, Cheung HC, Swartz N, Greatsinger A, Duh MS. Real-World Economic Burden Among Patients With And Without Heart Failure Worsening After Cardiac Resynchronization Therapy. Adv Ther 2021; 38:441-467. [PMID: 33141415 DOI: 10.1007/s12325-020-01536-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/14/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Although cardiac resynchronization therapy (CRT) has the potential to improve cardiac function in patients with heart failure (HF), a considerable portion of patients do not respond to therapy. This study assessed the economic burden among patients with and without HF worsening after receiving CRT in real-world practice. METHODS In this retrospective claims-based study using Optum's de-identified Clinformatics® Data Mart Database (January 2007-December 2018), adults who received CRT were stratified into two cohorts based on whether they showed evidence of HF worsening within 180 days post-CRT implantation. Inverse probability of treatment weighting (IPTW) was used to adjust for confounding, accounting for demographics (e.g., age, sex), the Quan-Charlson Comorbidity Index, other clinical characteristics, healthcare resource utilization (HRU), and healthcare costs during the 180 days pre-CRT (baseline period). Annualized all-cause and congestive HF-related HRU and healthcare costs from payer and patient perspectives were assessed from day 181 post-CRT (follow-up period), and compared between cohorts using incidence rate ratios (IRRs) and cost ratios (CRs). RESULTS This study included 12,753 patients (n = 4785 with HF worsening; n = 7968 without). Mean age was 72 years and roughly two-thirds were male. Baseline characteristics were balanced between cohorts post-IPTW. During follow-up, patients with HF worsening had significantly greater annual all-cause inpatient [adjusted IRR (95% confidence interval) = 1.55 (1.44, 1.66), p < 0.001], outpatient [adjusted IRR = 1.46 (1.32, 1.61), p < 0.001], and emergency department [adjusted IRR = 1.31 (1.22, 1.41), p < 0.001] visits. Mean annual total per patient payer-paid amounts were significantly higher for patients with HF worsening versus without HF worsening [adjusted CR = 1.68 (1.56, 1.80), p < 0.001]. Annual patient-paid medical costs were also higher for patients with HF worsening [adjusted CR = 1.31 (1.25, 1.38), p < 0.001]. Results were similar for congestive HF-related HRU and costs. CONCLUSIONS The incremental economic burden among patients with HF worsening following CRT is substantial. Efforts aimed at CRT optimization may help reduce this burden.
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Lipiecki J, Kaye DM, Witte KK, Haude M, Kapadia S, Sievert H, Goldberg SL, Levy WC, Siminiak T. Long-Term Survival Following Transcatheter Mitral Valve Repair: Pooled Analysis of Prospective Trials with the Carillon Device. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:712-716. [DOI: 10.1016/j.carrev.2020.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/28/2020] [Accepted: 02/12/2020] [Indexed: 01/17/2023]
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Delayed prolongation of the QRS interval in patients with left ventricular dysfunction. Int J Cardiol 2019; 296:71-75. [DOI: 10.1016/j.ijcard.2019.07.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/15/2019] [Accepted: 07/08/2019] [Indexed: 11/21/2022]
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Yu S, Wu Q, Chen BL, An YP, Bu J, Zhou S, Wang YM. Biventricular pacing for treating heart failure in children: A case report and review of the literature. World J Clin Cases 2019; 7:396-404. [PMID: 30746382 PMCID: PMC6369388 DOI: 10.12998/wjcc.v7.i3.396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 12/27/2018] [Accepted: 01/08/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) can be used as an escalated therapy to improve heart function in patients with cardiac dysfunction due to long-term right ventricular pacing. However, guidelines are only targeted at adults. CRT is rarely used in children.
CASE SUMMARY This case aimed to implement biventricular pacing in one child with heart failure who had a left ventricular ejection fraction < 35% at 4 years after implantation of an atrioventricular sequential pacemaker due to atrioventricular block. Postoperatively, echocardiography showed atrial sensing ventricular pacing and QRS wave duration of 120-130 ms, and cardiac function significantly improved after upgrading pacemaker.
CONCLUSION Patients whose cardiac function is deteriorated to a level to upgrade to CRT should be upgraded to reverse myocardial remodeling as soon as possible.
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Affiliation(s)
- Shan Yu
- Department of Cardiology, Guizhou Provincial People’s Hospital, Guiyang 550002, Guizhou Province, China
| | - Qiang Wu
- Department of Cardiology, Guizhou Provincial People’s Hospital, Guiyang 550002, Guizhou Province, China
| | - Bao-Lin Chen
- Department of Cardiology, Guizhou Provincial People’s Hospital, Guiyang 550002, Guizhou Province, China
| | - Ya-Ping An
- Department of Cardiology, Guizhou Provincial People’s Hospital, Guiyang 550002, Guizhou Province, China
| | - Jie Bu
- Department of Cardiology, Guizhou Provincial People’s Hospital, Guiyang 550002, Guizhou Province, China
| | - Song Zhou
- Department of Radiology, Guizhou Provincial People’s Hospital, Guiyang 550002, Guizhou Province, China
| | - Yong-Mei Wang
- Department of Cardiology, Guizhou Provincial People’s Hospital, Guiyang 550002, Guizhou Province, China
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Koyak Z, de Groot JR, Krimly A, Mackay TM, Bouma BJ, Silversides CK, Oechslin EN, Hoke U, van Erven L, Budts W, Van Gelder IC, Mulder BJM, Harris L. Cardiac resynchronization therapy in adults with congenital heart disease. Europace 2018; 20:315-322. [PMID: 28108550 DOI: 10.1093/europace/euw386] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 11/02/2016] [Indexed: 11/14/2022] Open
Abstract
Aims In adults with congenital heart disease (CHD) heart failure is one of the leading causes of morbidity and mortality but experience with and reported outcome of cardiac resynchronization therapy (CRT) is limited. We investigated the efficacy of CRT in adults with CHD. Methods and results This was a retrospective study including 48 adults with CHD who received CRT since 2003 in four tertiary referral centres. Responders were defined as patients who showed improvement in NYHA functional class and/or systemic ventricular ejection fraction by at least one category. Ventricular function was assessed by echocardiography and graded on a four point ordinal scale. Median age at CRT was 47 years (range 18-74 years) and 77% was male. Cardiac diagnosis included tetralogy of Fallot in 29%, (congenitally corrected) transposition of great arteries in 23%, septal defects in 25%, left sided lesions in 21%, and Marfan syndrome in 2% of the patients. The median follow-up duration after CRT was 2.6 years (range 0.1-8.8). Overall, 37 out of 48 patients (77%) responded to CRT either by improvement of NYHA functional class and/or systemic ventricular function. There were 11 non-responders to CRT. Of these, three patients died and four underwent heart transplantation. Conclusion In this cohort of older CHD patients, CRT was accomplished with a success rate comparable to those with acquired heart disease despite the complex anatomy and technical challenges frequently encountered in this population. Further studies are needed to establish appropriate guidelines for patient selection and long term outcome.
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Affiliation(s)
- Zeliha Koyak
- Department of Cardiology, Academic Medical Center Amsterdam, The Netherlands.,Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands
| | - Joris R de Groot
- Department of Cardiology, Academic Medical Center Amsterdam, The Netherlands
| | - Ahmed Krimly
- Division of Cardiology, Peter Munk Cardiac Center, Toronto Congenital Cardiac Center for Adults, and University of Toronto, Toronto, Canada
| | - Tara M Mackay
- Department of Cardiology, Academic Medical Center Amsterdam, The Netherlands
| | - Berto J Bouma
- Department of Cardiology, Academic Medical Center Amsterdam, The Netherlands
| | - Candice K Silversides
- Division of Cardiology, Peter Munk Cardiac Center, Toronto Congenital Cardiac Center for Adults, and University of Toronto, Toronto, Canada
| | - Erwin N Oechslin
- Division of Cardiology, Peter Munk Cardiac Center, Toronto Congenital Cardiac Center for Adults, and University of Toronto, Toronto, Canada
| | - Ulas Hoke
- Leiden University Medical Center, Leiden, The Netherlands
| | | | - Werner Budts
- Department of Cardiology, UZ Leuven, Leuven, Belgium
| | - Isabelle C Van Gelder
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Barbara J M Mulder
- Department of Cardiology, Academic Medical Center Amsterdam, The Netherlands.,Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands
| | - Louise Harris
- Division of Cardiology, Peter Munk Cardiac Center, Toronto Congenital Cardiac Center for Adults, and University of Toronto, Toronto, Canada
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Boyle NG, Wilkoff BL. Overview of Lead Management. Card Electrophysiol Clin 2018; 10:549-559. [PMID: 30396571 DOI: 10.1016/j.ccep.2018.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Lead management describes a comprehensive approach to cardiac implantable electronic device lead utilization, encompassing lead and device selection, vascular access, implant techniques, handling lead failures and recalls, managing infectious and other complications, and performing device and lead extraction. Device and lead selection should be based on the latest guidelines and the available data to choose the optimal device system for each patient. Lead extraction is a highly specialized procedure and should be carried out by a team of personnel extensively trained in the procedure at centers with cardiac surgical support.
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Affiliation(s)
- Noel G Boyle
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, 100 UCLA Medical Plaza, Suite 660, Los Angeles, CA 90095, USA.
| | - Bruce L Wilkoff
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic Lerner College of Medicine of CWRU, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Brugada J, Delnoy PP, Brachmann J, Reynolds D, Padeletti L, Noelker G, Kantipudi C, Rubin Lopez JM, Dichtl W, Borri-Brunetto A, Verhees L, Ritter P, Singh JP. Contractility sensor-guided optimization of cardiac resynchronization therapy: results from the RESPOND-CRT trial. Eur Heart J 2018; 38:730-738. [PMID: 27941020 PMCID: PMC5353752 DOI: 10.1093/eurheartj/ehw526] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 10/06/2016] [Indexed: 12/20/2022] Open
Abstract
Aims Although cardiac resynchronization therapy (CRT) is effective in patients with systolic heart failure (HF) and a wide QRS interval, a substantial proportion of patients remain non-responsive. The SonR contractility sensor embedded in the right atrial lead enables individualized automatic optimization of the atrioventricular (AV) and interventricular (VV) timings. The RESPOND-CRT study investigated the safety and efficacy of the contractility sensor system in HF patients undergoing CRT. Methods and results RESPOND-CRT was a prospective, randomized, double-blinded, multicentre, non-inferiority trial. Patients were randomized (2:1, respectively) to receive weekly, automatic CRT optimization with SonR vs. an Echo-guided optimization of AV and VV timings. The primary efficacy endpoint was the rate of clinical responders (patients alive, without adjudicated HF-related events, with improvement in New York Heart Association class or quality of life), at 12 months. The study randomized 998 patients. Responder rates were 75.0% in the SonR arm and 70.4% in the Echo arm (mean difference, 4.6%; 95% CI, −1.4% to 10.6%; P < 0.001 for non-inferiority margin −10.0%) (Table 2). At an overall mean follow-up of 548 ± 190 days SonR was associated with a 35% risk reduction in HF hospitalization (hazard ratio, 0.65; 95% CI, 0.46–0.92; log-rank P = 0.01). Conclusion Automatic AV and VV optimization using the contractility sensor was safe and as effective as Echo-guided AV and VV optimization in increasing response to CRT. ClinicalTrials.gov number NCT01534234
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Affiliation(s)
- Josep Brugada
- Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | | | | | - Luigi Padeletti
- University of Florence, Italy and IRCCS Multimedica, Milan, Italy
| | | | | | | | - Wolfgang Dichtl
- Department of Internal Medicine III, Innsbruck Medical University, Innsbruck, Austria
| | | | | | | | - Jagmeet P Singh
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Normand C, Linde C, Singh J, Dickstein K. Indications for Cardiac Resynchronization Therapy. JACC-HEART FAILURE 2018; 6:308-316. [DOI: 10.1016/j.jchf.2018.01.022] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 12/18/2017] [Accepted: 01/23/2018] [Indexed: 12/21/2022]
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13
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Wu H, Li L, Niu P, Huang X, Liu J, Zhang F, Shen W, Tan W, Wu Y, Huo Y. The Structure-function remodeling in rabbit hearts of myocardial infarction. Physiol Rep 2018. [PMID: 28637704 PMCID: PMC5492201 DOI: 10.14814/phy2.13311] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Animal models are of importance to investigate basic mechanisms for ischemic heart failure (HF). The objective of the study was to create a rabbit model through multiple coronary artery ligations to investigate the postoperative structure‐function remodeling of the left ventricle (LV) and coronary arterial trees. Here, we hypothesize that the interplay of the degenerated coronary vasculature and increased ventricle wall stress relevant to cardiac fibrosis in vicinity of myocardial infarction (MI) precipitates the incidence and progression of ischemic HF. Echocardiographic measurements showed an approximately monotonic drop of fractional shortening and ejection fraction from 40% and 73% down to 28% and 58% as well as persistent enlargement of LV cavity and slight mitral regurgitation at postoperative 12 weeks. Micro‐CT and histological measurements showed that coronary vascular rarefaction and cardiac fibrosis relevant to inflammation occurred concurrently in vicinity of MI at postoperative 12 weeks albeit there was compensatory vascular growth at postoperative 6 weeks. These findings validate the proposed rabbit model and prove the hypothesis. The post‐MI rabbit model can serve as a reference to test various drugs for treatment of ischemic HF.
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Affiliation(s)
- Haotian Wu
- School of Basic Medical Sciences, Nanjing University of Traditional Chinese Medicine, Nanjing, China.,Hebei Yiling Pharmaceutical Research Institute, Shijiazhuang, China
| | - Li Li
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, China
| | - Pei Niu
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, China.,College of Medicine, Hebei University, Baoding, China
| | - Xu Huang
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, China
| | - Jinyi Liu
- College of Medicine, Hebei University, Baoding, China
| | | | - Wenzeng Shen
- College of Medicine, Hebei University, Baoding, China
| | - Wenchang Tan
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, China.,Shenzhen Graduate School, Peking University, Shenzhen, China.,PKU-HKUST Shenzhen-Hongkong Institution, Shenzhen, China
| | - Yiling Wu
- School of Basic Medical Sciences, Nanjing University of Traditional Chinese Medicine, Nanjing, China .,Hebei Yiling Pharmaceutical Research Institute, Shijiazhuang, China.,Key Laboratory, State Administration of Traditional Chinese Medicine (Cardiovascular and cerebrovascular collateral diseases), Shijiazhuang, China.,Hebei Province Key Laboratory of Collateral Diseases, Shijiazhuang, China
| | - Yunlong Huo
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, China .,PKU-HKUST Shenzhen-Hongkong Institution, Shenzhen, China
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Khazanie P, Greiner MA, Al-Khatib SM, Piccini JP, Turakhia MP, Varosy PD, Masoudi FA, Curtis LH, Hernandez AF. Comparative Effectiveness of Cardiac Resynchronization Therapy Among Patients With Heart Failure and Atrial Fibrillation: Findings From the National Cardiovascular Data Registry's Implantable Cardioverter-Defibrillator Registry. Circ Heart Fail 2017; 9:CIRCHEARTFAILURE.115.002324. [PMID: 27296396 DOI: 10.1161/circheartfailure.115.002324] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 04/28/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND Atrial fibrillation is common in patients with heart failure, but outcomes of patients with both conditions who receive cardiac resynchronization therapy with defibrillator (CRT-D) compared with an implantable cardioverter-defibrillator (ICD) alone are unclear. METHODS AND RESULTS Using the National Cardiovascular Data Registry's ICD Registry linked with Medicare claims, we identified 8951 patients with atrial fibrillation who were eligible for CRT-D and underwent first-time device implantation for primary prevention between April 2006 and December 2009. We used Cox proportional hazards models and inverse probability-weighted estimates to compare outcomes with CRT-D versus ICD alone. Cumulative incidence of mortality (744 [33%] for ICD; 1893 [32%] for CRT-D) and readmission (1788 [76%] for ICD; 4611 [76%] for CRT-D) within 3 years and complications within 90 days were similar between groups. After inverse weighting for the probability of receiving CRT-D, risks of mortality (hazard ratio, 0.83; 95% confidence interval, 0.75-0.92), all-cause readmission (hazard ratio, 0.86; 95% confidence interval, 0.80-0.92), and heart failure readmission (hazard ratio, 0.68; 95% confidence interval, 0.62-0.76) were lower with CRT-D compared with ICD alone. There was no significant difference in the 90-day complication rate (hazard ratio, 0.88; 95% confidence interval, 0.60-1.29). We observed hospital-level variation in the use of CRT-D among patients with atrial fibrillation. CONCLUSIONS Among eligible patients with heart failure and atrial fibrillation, CRT-D was associated with lower risks of mortality, all-cause readmission, and heart failure readmission, as well as with a similar risk of complications compared with ICD alone.
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Affiliation(s)
- Prateeti Khazanie
- From the Duke Clinical Research Institute (P.K., M.A.G., S.M.A.-K., J.P.P., L.H.C., A.F.H.) and Department of Medicine (P.K., S.M.A.-K., J.P.P., L.H.C., A.F.H.), Duke University School of Medicine, Durham, NC; Veterans Affairs Eastern Colorado Healthcare System, Denver, CO (P.D.V.); University of Colorado Anschutz Medical Campus, Aurora, CO (F.A.M.); and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA and Stanford University School of Medicine, CA (M.P.T.)
| | - Melissa A Greiner
- From the Duke Clinical Research Institute (P.K., M.A.G., S.M.A.-K., J.P.P., L.H.C., A.F.H.) and Department of Medicine (P.K., S.M.A.-K., J.P.P., L.H.C., A.F.H.), Duke University School of Medicine, Durham, NC; Veterans Affairs Eastern Colorado Healthcare System, Denver, CO (P.D.V.); University of Colorado Anschutz Medical Campus, Aurora, CO (F.A.M.); and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA and Stanford University School of Medicine, CA (M.P.T.)
| | - Sana M Al-Khatib
- From the Duke Clinical Research Institute (P.K., M.A.G., S.M.A.-K., J.P.P., L.H.C., A.F.H.) and Department of Medicine (P.K., S.M.A.-K., J.P.P., L.H.C., A.F.H.), Duke University School of Medicine, Durham, NC; Veterans Affairs Eastern Colorado Healthcare System, Denver, CO (P.D.V.); University of Colorado Anschutz Medical Campus, Aurora, CO (F.A.M.); and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA and Stanford University School of Medicine, CA (M.P.T.)
| | - Jonathan P Piccini
- From the Duke Clinical Research Institute (P.K., M.A.G., S.M.A.-K., J.P.P., L.H.C., A.F.H.) and Department of Medicine (P.K., S.M.A.-K., J.P.P., L.H.C., A.F.H.), Duke University School of Medicine, Durham, NC; Veterans Affairs Eastern Colorado Healthcare System, Denver, CO (P.D.V.); University of Colorado Anschutz Medical Campus, Aurora, CO (F.A.M.); and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA and Stanford University School of Medicine, CA (M.P.T.)
| | - Mintu P Turakhia
- From the Duke Clinical Research Institute (P.K., M.A.G., S.M.A.-K., J.P.P., L.H.C., A.F.H.) and Department of Medicine (P.K., S.M.A.-K., J.P.P., L.H.C., A.F.H.), Duke University School of Medicine, Durham, NC; Veterans Affairs Eastern Colorado Healthcare System, Denver, CO (P.D.V.); University of Colorado Anschutz Medical Campus, Aurora, CO (F.A.M.); and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA and Stanford University School of Medicine, CA (M.P.T.)
| | - Paul D Varosy
- From the Duke Clinical Research Institute (P.K., M.A.G., S.M.A.-K., J.P.P., L.H.C., A.F.H.) and Department of Medicine (P.K., S.M.A.-K., J.P.P., L.H.C., A.F.H.), Duke University School of Medicine, Durham, NC; Veterans Affairs Eastern Colorado Healthcare System, Denver, CO (P.D.V.); University of Colorado Anschutz Medical Campus, Aurora, CO (F.A.M.); and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA and Stanford University School of Medicine, CA (M.P.T.)
| | - Frederick A Masoudi
- From the Duke Clinical Research Institute (P.K., M.A.G., S.M.A.-K., J.P.P., L.H.C., A.F.H.) and Department of Medicine (P.K., S.M.A.-K., J.P.P., L.H.C., A.F.H.), Duke University School of Medicine, Durham, NC; Veterans Affairs Eastern Colorado Healthcare System, Denver, CO (P.D.V.); University of Colorado Anschutz Medical Campus, Aurora, CO (F.A.M.); and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA and Stanford University School of Medicine, CA (M.P.T.)
| | - Lesley H Curtis
- From the Duke Clinical Research Institute (P.K., M.A.G., S.M.A.-K., J.P.P., L.H.C., A.F.H.) and Department of Medicine (P.K., S.M.A.-K., J.P.P., L.H.C., A.F.H.), Duke University School of Medicine, Durham, NC; Veterans Affairs Eastern Colorado Healthcare System, Denver, CO (P.D.V.); University of Colorado Anschutz Medical Campus, Aurora, CO (F.A.M.); and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA and Stanford University School of Medicine, CA (M.P.T.)
| | - Adrian F Hernandez
- From the Duke Clinical Research Institute (P.K., M.A.G., S.M.A.-K., J.P.P., L.H.C., A.F.H.) and Department of Medicine (P.K., S.M.A.-K., J.P.P., L.H.C., A.F.H.), Duke University School of Medicine, Durham, NC; Veterans Affairs Eastern Colorado Healthcare System, Denver, CO (P.D.V.); University of Colorado Anschutz Medical Campus, Aurora, CO (F.A.M.); and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA and Stanford University School of Medicine, CA (M.P.T.).
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15
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Linde C, Abraham WT, Gold MR, Daubert JC, Tang ASL, Young JB, Sherfesee L, Hudnall JH, Fagan DH, Cleland JG. Predictors of short-term clinical response to cardiac resynchronization therapy. Eur J Heart Fail 2017; 19:1056-1063. [PMID: 28295869 DOI: 10.1002/ejhf.795] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 01/24/2017] [Accepted: 01/30/2017] [Indexed: 12/28/2022] Open
Abstract
AIMS Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in patients with symptomatic heart failure and QRS prolongation but there is uncertainty about which patient characteristics predict short-term clinical response. METHODS AND RESULTS In an individual patient meta-analysis of three double-blind, randomized trials, clinical composite score (CCS) at 6 months was compared in patients assigned to CRT programmed on or off. Treatment-covariate interactions were assessed to measure likelihood of improved CCS at 6 months. MIRACLE, MIRACLE ICD, and REVERSE trials contributed data for this analysis (n = 1591). Multivariable modelling identified QRS duration and left ventricular ejection fraction (LVEF) as predictors of CRT clinical response (P < 0.05). The odds ratio for a better CCS at 6 months increased by 3.7% for every 1% decrease in LVEF for patients assigned to CRT-on compared to CRT-off, and was greatest when QRS duration was between 160 and 180 ms. CONCLUSIONS In symptomatic chronic heart failure patients (NYHA class II-IV), longer QRS duration and lower LVEF independently predict early clinical response to CRT.
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Affiliation(s)
- Cecilia Linde
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - William T Abraham
- Division of Cardiovascular Medicine and the Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, USA
| | - Michael R Gold
- Medical University of South Carolina, Charleston, SC, USA
| | | | - Anthony S L Tang
- The Island Medical Program, University of British Columbia, Vancouver, Canada
| | - James B Young
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | | | | | | | - John G Cleland
- National Heart and Lung Institute, Imperial College London, London, UK
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16
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ZIPSE MATTHEWM, TZOU WENDYS. Resynchronization Therapy in Cardiac Sarcoidosis and Severe Heart Failure: When Good May Not Be Good Enough. J Cardiovasc Electrophysiol 2017; 28:182-184. [DOI: 10.1111/jce.13144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- MATTHEW M. ZIPSE
- Section of Cardiac Electrophysiology; University of Colorado; Aurora Colorado USA
| | - WENDY S. TZOU
- Section of Cardiac Electrophysiology; University of Colorado; Aurora Colorado USA
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18
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Kim BJ, Kim BI, Byun SH, Kim E, Sung SY, Jung JY. Cardiac arrest in a patient with anterior fascicular block after administration of dexmedetomidine with spinal anesthesia: A case report. Medicine (Baltimore) 2016; 95:e5278. [PMID: 27787391 PMCID: PMC5089120 DOI: 10.1097/md.0000000000005278] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Dexmedetomidine is a sedative and analgesic agent that is administered intravenously as an adjunct to spinal anesthesia. It does not suppress the respiratory system significantly, but has adverse effects on the cardiovascular system, for example, bradycardia and hypotension. We here report a patient who underwent cardiac arrest during spinal anesthesia after intravenous infusion of dexmedetomidine. METHODS A 57-year-old woman with no significant medical history underwent spinal anesthesia for arthroscopic meniscus resection after rupturing the right knee meniscus. Preoperative electrocardiogram revealed sinus bradycardia (54 beats/min) and a left anterior fascicular block. Spinal anesthesia was performed with 11 mg of 0.5% heavy bupivacaine, and the upper level of sensory loss was at T6. Dexmedetomidine infusion was planned at a loading dose of 1.0 mcg kg min over 10 minutes, followed by 0.7 mcg kg min intravenously, as a sedative. Two minutes after dexmedetomidine injection, her heart rate decreased to 31 beats/min and asystole was observed within 10 seconds. RESULTS After a few minutes of cardiopulmonary resuscitation, spontaneous circulation returned and surgery was completed under general anesthesia. The patient was discharged, and experienced no complications. CONCLUSION Dexmedetomidine can decrease blood pressure and heart rate, and may cause asystole in some cases. We suggest that dexmedetomidine should be carefully administered under close observation when the parasympathetic nerve system is activated during spinal anesthesia.
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Affiliation(s)
| | | | | | | | | | - Jin Yong Jung
- Department of Anesthesiology and Pain Medicine, School of Medicine, Catholic University of Daegu, Daegu, Republic of Korea
- Correspondence: Jin Yong Jung, Department of Anesthesiology and Pain Medicine, School of Medicine, Catholic University of Daegu, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu 42472, Republic of Korea (e-mail: )
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19
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Abstract
Despite >100 clinical trials, only 2 new drugs had been approved by the US Food and Drug Administration for the treatment of chronic heart failure in more than a decade: the aldosterone antagonist eplerenone in 2003 and a fixed dose combination of hydralazine-isosorbide dinitrate in 2005. In contrast, 2015 has witnessed the Food and Drug Administration approval of 2 new drugs, both for the treatment of chronic heart failure with reduced ejection fraction: ivabradine and another combination drug, sacubitril/valsartan or LCZ696. Seemingly overnight, a range of therapeutic possibilities, evoking new physiological mechanisms, promise great hope for a disease that often carries a prognosis worse than many forms of cancer. Importantly, the newly available therapies represent a culmination of basic and translational research that actually spans many decades. This review will summarize newer drugs currently being used in the treatment of heart failure, as well as newer strategies increasingly explored for their utility during the stages of the heart failure syndrome.
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Affiliation(s)
- Anjali Tiku Owens
- From the Cardiovascular Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Susan C Brozena
- From the Cardiovascular Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Mariell Jessup
- From the Cardiovascular Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia.
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20
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Khan SG, Klettas D, Kapetanakis S, Monaghan MJ. Clinical utility of speckle-tracking echocardiography in cardiac resynchronisation therapy. Echo Res Pract 2016; 3:R1-R11. [PMID: 27249816 PMCID: PMC5402657 DOI: 10.1530/erp-15-0032] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 03/08/2016] [Indexed: 11/08/2022] Open
Abstract
Cardiac resynchronisation therapy (CRT) can profoundly improve outcome in selected patients with heart failure; however, response is difficult to predict and can be absent in up to one in three patients. There has been a substantial amount of interest in the echocardiographic assessment of left ventricular dyssynchrony, with the ultimate aim of reliably identifying patients who will respond to CRT. The measurement of myocardial deformation (strain) has conventionally been assessed using tissue Doppler imaging (TDI), which is limited by its angle dependence and ability to measure in a single plane. Two-dimensional speckle-tracking echocardiography is a technique that provides measurements of strain in three planes, by tracking patterns of ultrasound interference ('speckles') in the myocardial wall throughout the cardiac cycle. Since its initial use over 15 years ago, it has emerged as a tool that provides more robust, reproducible and sensitive markers of dyssynchrony than TDI. This article reviews the use of two-dimensional and three-dimensional speckle-tracking echocardiography in the assessment of dyssynchrony, including the identification of echocardiographic parameters that may hold predictive potential for the response to CRT. It also reviews the application of these techniques in guiding optimal LV lead placement pre-implant, with promising results in clinical improvement post-CRT.
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Affiliation(s)
- Sitara G Khan
- King's College London British Heart Foundation Centre, London, UK Department of Cardiology, King's College Hospital, London, UK
| | | | | | - Mark J Monaghan
- King's College London British Heart Foundation Centre, London, UK Department of Cardiology, King's College Hospital, London, UK
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21
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Abstract
This review discusses the state of the art of knowledge to help decision making in patients who are candidates for cardiac resynchronization therapy (CRT) and to analyze the long-term total and cardiac mortality, sudden death, and CRT with a defibrillator intervention rate, as well as the evolution of echocardiographic parameters in patients with a left ventricular (LV) ejection fraction of greater than 50% after CRT implantation. Owing to normalization of LV function in super-responders, the need for a persistent defibrillator backup is also considered.
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Affiliation(s)
| | - Daniele Muser
- Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Domenico Facchin
- University Hospital Santa Maria della Misericordia, Udine 33100, Italy
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22
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Ma CY, Liu S, Yang J, Tang L, Zhang LM, Li N, Yu B. Evaluation of global longitudinal strain of left ventricle and regional longitudinal strain in the region of left ventricular leads predicts the response to cardiac resynchronization therapy in patients with ischemic heart failure. Cell Biochem Biophys 2015; 70:143-8. [PMID: 24619820 DOI: 10.1007/s12013-014-9870-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Myocardium viability in ischemic heart failure (HF) may affect the effect of cardiac resynchronization therapy (CRT). We hypothesized that longitudinal strain of 2D-STE, which reflects myocardium viability, can predict the response to CRT in patients with ischemic HF. 2D-STE was performed in 42 patients with HF, 1 week before and 1 year after CRT. GLS, RLS, and the LV synchrony index (SI), defined as the difference in timing to peak radial strain between LV anterior septal and posterior wall in LV short axis view, were calculated. A decrease in the LV end-systolic volume (LVESV) value of ≥ 15 % 1 year after CRT was defined as response to CRT. Twenty-nine patients responded to CRT (CRT-R group), while 13 patients did not respond and were assigned as CRT-NR group. Pre-CRT RLS and GLS were higher, while SI is lower, in CRT-R patients compared with CRT-NR group (p < 0.001). The ROC curve revealed that RLS of -11.5 % predicted response to CRT with sensitivity of 80.0 % and specificity of 77.9 % (AUC = 0.84, p < 0.001). Further, GLS of -13 % predicted response to CRT with sensitivity of 73.0 % and specificity of 73.4 % (AUC = 0.79, p < 0.001). In conclusion, LV dyssynchrony, GLS, and RLS calculated by 2D-STE can predict long-term response to CRT in patients with ischemic HF.
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Affiliation(s)
- Chun-Yan Ma
- Department of Cardiovascular Ultrasound, The First Affiliated Hospital of China Medical University, 155 Nanjing North Street, Heping, Shenyang, 110001, Liaoning, China,
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23
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Herweg B, Singh R, Barold SS. Cardiac resynchronization therapy is appropriate for all patients requiring chronic right ventricular pacing: the pro perspective. Card Electrophysiol Clin 2015; 7:433-44. [PMID: 26304523 DOI: 10.1016/j.ccep.2015.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Long-term right ventricular pacing has deleterious effects on the left ventricle (LV). The risk of pacemaker-induced cardiomyopathy (PICM) seems to be lower in patients with a normal LV ejection fraction (LVEF). Patients developing PICM respond favorably to a cardiac resynchronization therapy upgrade, suggesting that the dysfunction is partially reversible. Biventricular pacing has emerged as a treatment and/or prevention of PICM. Cumulative pacing greater than 40% of the time is considered the most important risk factor for PICM. No organizational guidelines exist for preventive biventricular pacing. The decision to pursue biventricular pacing should be individualized.
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Affiliation(s)
- Bengt Herweg
- Electrophysiology and Arrhythmia Services, Department of Cardiovascular Disease, Tampa General Hospital, University of South Florida Morsani College of Medicine, South Tampa Campus (5th Floor), Two Tampa General Circle, Tampa, FL 33606, USA.
| | - Robin Singh
- Department of Cardiovascular Disease, Tampa General Hospital, University of South Florida Morsani College of Medicine, South Tampa Campus (5th Floor), Two Tampa General Circle, Tampa, FL 33606, USA
| | - S Serge Barold
- Clinical Cardiac Electrophysiology, Department of Cardiovascular Disease, University of Rochester Medical Center, 2613 W Henrietta Road, Rochester, NY 14623, USA
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24
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Colquitt JL, Mendes D, Clegg AJ, Harris P, Cooper K, Picot J, Bryant J. Implantable cardioverter defibrillators for the treatment of arrhythmias and cardiac resynchronisation therapy for the treatment of heart failure: systematic review and economic evaluation. Health Technol Assess 2015; 18:1-560. [PMID: 25169727 DOI: 10.3310/hta18560] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND This assessment updates and expands on two previous technology assessments that evaluated implantable cardioverter defibrillators (ICDs) for arrhythmias and cardiac resynchronisation therapy (CRT) for heart failure (HF). OBJECTIVES To assess the clinical effectiveness and cost-effectiveness of ICDs in addition to optimal pharmacological therapy (OPT) for people at increased risk of sudden cardiac death (SCD) as a result of ventricular arrhythmias despite receiving OPT; to assess CRT with or without a defibrillator (CRT-D or CRT-P) in addition to OPT for people with HF as a result of left ventricular systolic dysfunction (LVSD) and cardiac dyssynchrony despite receiving OPT; and to assess CRT-D in addition to OPT for people with both conditions. DATA SOURCES Electronic resources including MEDLINE, EMBASE and The Cochrane Library were searched from inception to November 2012. Additional studies were sought from reference lists, clinical experts and manufacturers' submissions to the National Institute for Health and Care Excellence. REVIEW METHODS Inclusion criteria were applied by two reviewers independently. Data extraction and quality assessment were undertaken by one reviewer and checked by a second. Data were synthesised through narrative review and meta-analyses. For the three populations above, randomised controlled trials (RCTs) comparing (1) ICD with standard therapy, (2) CRT-P or CRT-D with each other or with OPT and (3) CRT-D with OPT, CRT-P or ICD were eligible. Outcomes included mortality, adverse events and quality of life. A previously developed Markov model was adapted to estimate the cost-effectiveness of OPT, ICDs, CRT-P and CRT-D in the three populations by simulating disease progression calculated at 4-weekly cycles over a lifetime horizon. RESULTS A total of 4556 references were identified, of which 26 RCTs were included in the review: 13 compared ICD with medical therapy, four compared CRT-P/CRT-D with OPT and nine compared CRT-D with ICD. ICDs reduced all-cause mortality in people at increased risk of SCD, defined in trials as those with previous ventricular arrhythmias/cardiac arrest, myocardial infarction (MI) > 3 weeks previously, non-ischaemic cardiomyopathy (depending on data included) or ischaemic/non-ischaemic HF and left ventricular ejection fraction ≤ 35%. There was no benefit in people scheduled for coronary artery bypass graft. A reduction in SCD but not all-cause mortality was found in people with recent MI. Incremental cost-effectiveness ratios (ICERs) ranged from £14,231 per quality-adjusted life-year (QALY) to £29,756 per QALY for the scenarios modelled. CRT-P and CRT-D reduced mortality and HF hospitalisations, and improved other outcomes, in people with HF as a result of LVSD and cardiac dyssynchrony when compared with OPT. The rate of SCD was lower with CRT-D than with CRT-P but other outcomes were similar. CRT-P and CRT-D compared with OPT produced ICERs of £27,584 per QALY and £27,899 per QALY respectively. The ICER for CRT-D compared with CRT-P was £28,420 per QALY. In people with both conditions, CRT-D reduced the risk of all-cause mortality and HF hospitalisation, and improved other outcomes, compared with ICDs. Complications were more common with CRT-D. Initial management with OPT alone was most cost-effective (ICER £2824 per QALY compared with ICD) when health-related quality of life was kept constant over time. Costs and QALYs for CRT-D and CRT-P were similar. The ICER for CRT-D compared with ICD was £27,195 per QALY and that for CRT-D compared with OPT was £35,193 per QALY. LIMITATIONS Limitations of the model include the structural assumptions made about disease progression and treatment provision, the extrapolation of trial survival estimates over time and the assumptions made around parameter values when evidence was not available for specific patient groups. CONCLUSIONS In people at risk of SCD as a result of ventricular arrhythmias and in those with HF as a result of LVSD and cardiac dyssynchrony, the interventions modelled produced ICERs of < £30,000 per QALY gained. In people with both conditions, the ICER for CRT-D compared with ICD, but not CRT-D compared with OPT, was < £30,000 per QALY, and the costs and QALYs for CRT-D and CRT-P were similar. A RCT comparing CRT-D and CRT-P in people with HF as a result of LVSD and cardiac dyssynchrony is required, for both those with and those without an ICD indication. A RCT is also needed into the benefits of ICD in non-ischaemic cardiomyopathy in the absence of dyssynchrony. STUDY REGISTRATION This study is registered as PROSPERO number CRD42012002062. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Jill L Colquitt
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Diana Mendes
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Andrew J Clegg
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Petra Harris
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Keith Cooper
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Joanna Picot
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Jackie Bryant
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
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Schiller O, Dham N, Greene EA, Heath DM, Alexander ME, Berul CI. Pediatric Dilated Cardiomyopathy Patients Do Not Meet Traditional Cardiac Resynchronization Criteria. J Cardiovasc Electrophysiol 2015; 26:885-889. [PMID: 25884372 DOI: 10.1111/jce.12690] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 03/09/2015] [Accepted: 04/13/2015] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Cardiac resynchronization therapy (CRT) is an effective device-based intervention for adults with heart failure (HF) with specific indications, based on large, multicenter randomized clinical trials. The criteria for CRT in adult HF include significant symptoms, ventricular systolic dysfunction, prolonged QRS duration, and left bundle branch block (LBBB) pattern on electrocardiogram (ECG). Despite having less data, CRT is also being widely utilized in children with HF. The shortage of evidence-based CRT criteria in pediatrics prompted us to review a cohort of children with dilated cardiomyopathy and evaluate their potential eligibility for CRT using the traditional adult criteria. METHODS Single-center data of all pediatric patients with dilated cardiomyopathy were extracted from the heart failure registry and retrospectively reviewed. Patients who had at least 2 separate visits that included HF scoring, electrocardiogram, and echocardiogram were included. Patients who were ventricular paced were excluded. RESULTS Data for 52 patients meeting inclusion criteria were analyzed. The mean ejection fraction was 25% on the first clinical evaluation and 27% on the second visit. No patient and 2 patients met the adult criteria for prolonged QRS on the first and second encounters, respectively. No patients had an LBBB pattern on ECG. CONCLUSIONS None of the pediatric HF patients in our study met the published Class I criteria for CRT device therapy in adults. These findings suggest that extrapolation of adult HF data to pediatrics is not sufficient for CRT criteria. Specific guidelines for device implantation in children must be based on scientific investigation including pediatric clinical trials.
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Affiliation(s)
- Ofer Schiller
- Division of Cardiology, Children's National Medical Center and the Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Niti Dham
- Division of Cardiology, Children's National Medical Center and the Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia, USA
| | - E Anne Greene
- Division of Cardiology, Children's National Medical Center and the Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Deneen M Heath
- Division of Cardiology, Children's National Medical Center and the Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Mark E Alexander
- Department of Cardiology, Boston Children's Hospital and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Charles I Berul
- Division of Cardiology, Children's National Medical Center and the Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia, USA
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Hammer KP, Hohendanner F, Blatter LA, Pieske BM, Heinzel FR. Variations in local calcium signaling in adjacent cardiac myocytes of the intact mouse heart detected with two-dimensional confocal microscopy. Front Physiol 2015; 5:517. [PMID: 25628569 PMCID: PMC4290493 DOI: 10.3389/fphys.2014.00517] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 12/18/2014] [Indexed: 11/13/2022] Open
Abstract
Dyssynchronous local Ca release within individual cardiac myocytes has been linked to cellular contractile dysfunction. Differences in Ca kinetics in adjacent cells may also provide a substrate for inefficient contraction and arrhythmias. In a new approach we quantify variation in local Ca transients between adjacent myocytes in the whole heart. Langendorff-perfused mouse hearts were loaded with Fluo-8 AM to detect Ca and Di-4-ANEPPS to visualize cell membranes. A spinning disc confocal microscope with a fast camera allowed us to record Ca signals within an area of 465 μm by 315 μm with an acquisition speed of 55 fps. Images from multiple transients recorded at steady state were registered to their time point in the cardiac cycle to restore averaged local Ca transients with a higher temporal resolution. Local Ca transients within and between adjacent myocytes were compared with regard to amplitude, time to peak and decay at steady state stimulation (250 ms cycle length). Image registration from multiple sequential Ca transients allowed reconstruction of high temporal resolution (2.4 ± 1.3 ms) local CaT in 2D image sets (N = 4 hearts, n = 8 regions). During steady state stimulation, spatial Ca gradients were homogeneous within cells in both directions and independent of distance between measured points. Variation in CaT amplitudes was similar across the short and the long side of neighboring cells. Variations in TAU and TTP were similar in both directions. Isoproterenol enhanced the CaT but not the overall pattern of spatial heterogeneities. Here we detected and analyzed local Ca signals in intact mouse hearts with high temporal and spatial resolution, taking into account 2D arrangement of the cells. We observed significant differences in the variation of CaT amplitude along the long and short axis of cardiac myocytes. Variations of Ca signals between neighboring cells may contribute to the substrate of cardiac remodeling.
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Affiliation(s)
- Karin P Hammer
- Department of Cardiology, Medical University of Graz Graz, Austria ; Department of Internal Medicine II, University Hospital Regensburg Regensburg, Germany
| | - Felix Hohendanner
- Molecular Biophysics and Physiology, Rush Medical College, Rush University Chicago, IL, USA
| | - Lothar A Blatter
- Molecular Biophysics and Physiology, Rush Medical College, Rush University Chicago, IL, USA
| | - Burkert M Pieske
- Department of Cardiology, Medical University of Graz Graz, Austria ; Department of Cardiology, Charité-Universitaetsmedizin Berlin Berlin, Germany
| | - Frank R Heinzel
- Department of Cardiology, Medical University of Graz Graz, Austria ; Department of Cardiology, Charité-Universitaetsmedizin Berlin Berlin, Germany
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Guglin M, Barold SS. The role of biventricular pacing in the prevention and therapy of pacemaker-induced cardiomyopathy. Ann Noninvasive Electrocardiol 2015; 20:224-39. [PMID: 25564929 DOI: 10.1111/anec.12245] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Right ventricular (RV) pacing produces well-known long-term deleterious effects not only on already compromised, but also on the normal left ventricle (LV). The activation pattern mimicks that of left bundle branch block, with delayed activation of the LV free wall, and results in electrical and mechanical dyssynchrony. Long-term mandatory (100%) RV pacing, increases LV dimensions and decreases the ejection fraction. Many of these negative effects of pacing can be overcome by biventricular pacing. In this review, we describe the characteristics of pacemaker-induced cardiomyopathy, its incidence, and the use of cardiac resynchronization therapy (CRT) for its therapy and prevention. The gaps in the current organizational guidelines for using CRT in the treatment of bradycardia are identified, and goals for future research are discussed.
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Affiliation(s)
| | - S Serge Barold
- University of Rochester School of Medicine and Dentistry, Rochester, NY
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Hai OY, Mentz RJ, Zannad F, Gasparini M, De Ferrari GM, Daubert JC, Holzmeister J, Lam CS, Pochet T, Vincent A, Linde C. Cardiac resynchronization therapy in heart failure patients with less severe left ventricular dysfunction. Eur J Heart Fail 2014; 17:135-43. [DOI: 10.1002/ejhf.208] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Revised: 10/20/2014] [Accepted: 10/24/2014] [Indexed: 01/14/2023] Open
Affiliation(s)
- Ofek Y. Hai
- Division of Cardiovascular Medicine, Department of Medicine; State University of New York (SUNY) Downstate Medical Center; Brooklyn NY USA
| | - Robert J. Mentz
- Division of Cardiology, Department of Medicine; Duke University Medical Center; Durham NC USA
| | - Faiez Zannad
- INSERM, Centre d'Investigations Cliniques; Université de Lorraine and CHU de Nancy; Nancy France
| | | | - Gaetano M. De Ferrari
- Department of Cardiology and Cardiovascular Clinical Research Center; Fondaizone IRCCS Policlinico San Matteo; Pavia Italy
| | - Jean-Claude Daubert
- Cardiology Department and CIC-IT U804; Centre Hospitalier Universitaire; Rennes France
| | - Johannes Holzmeister
- Cardiovascular Center, Cardiology; University Hospital Zurich; Zurich Switzerland
| | | | - Thierry Pochet
- Global Clinical Trials; Rhythm Management, Boston Scientific; Diegem Belgium
| | | | - Cecilia Linde
- Karolinska Institutet, Department of Medicine, and Karolinska University Hospital; Department of Cardiology; Stockholm Sweden
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Kumar P, Schwartz JD. Device therapies: new indications and future directions. Curr Cardiol Rev 2014; 11:33-41. [PMID: 25391852 PMCID: PMC4347207 DOI: 10.2174/1573403x1101141106121553] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 07/09/2013] [Accepted: 09/27/2013] [Indexed: 01/29/2023] Open
Abstract
Implantable cardioverter-defibrillator (ICDs), cardiac resynchronization (CRT) and combination (CRT-D) therapy have become an integral part of the management of patients with heart failure with reduced ejection fraction (HFrEF). ICDs treat ventricular arrhythmia and CRTs improve left ventricular systolic function by resynchronizing ventricular contraction. Device therapies (ICD, CRT-D), have been shown to reduce all-cause mortality, including sudden cardiac death. Hospitalizations are reduced with CRT and CRT-D therapy. Major device related complications include device infection, inappropriate shocks, lead malfunction and complications related to extraction of devices. Improvements in device design and implantation have included progressive miniaturization and increasing battery life of the device, optimization of response to CRT, and minimizing inappropriate device therapy. Additionally, better definition of the population with the greatest benefit is an area of active research.
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Affiliation(s)
| | - Jennifer D Schwartz
- University of North Carolina at Chapel Hill, Heart and Vascular, 160 Dental Circle, CB 7075, Chapel Hill NC 27599, USA.
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Khazanie P, Hammill BG, Qualls LG, Fonarow GC, Hammill SC, Heidenreich PA, Al-Khatib SM, Piccini JP, Masoudi FA, Peterson PN, Curtis JP, Hernandez AF, Curtis LH. Clinical effectiveness of cardiac resynchronization therapy versus medical therapy alone among patients with heart failure: analysis of the ICD Registry and ADHERE. Circ Heart Fail 2014; 7:926-34. [PMID: 25227768 PMCID: PMC4244212 DOI: 10.1161/circheartfailure.113.000838] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Supplemental Digital Content is available in the text. Background— Cardiac resynchronization therapy with defibrillator (CRT-D) reduces morbidity and mortality among selected patients with heart failure in clinical trials. The effectiveness of this therapy in clinical practice has not been well studied. Methods and Results— We compared a cohort of 4471 patients from the National Cardiovascular Data Registry’s Implantable Cardioverter-Defibrillator (ICD) Registry hospitalized primarily for heart failure and who received CRT-D between April 1, 2006, and December 31, 2009, to a historical control cohort of 4888 patients with heart failure without CRT-D from the Acute Decompensated Heart Failure National Registry (ADHERE) hospitalized between January 1, 2002, and March 31, 2006. Both registries were linked with Medicare claims to evaluate longitudinal outcomes. We included patients from the ICD Registry with left ventricular ejection fraction ≤35% and QRS duration ≥120 ms who were admitted for heart failure. We used Cox proportional hazards models to compare outcomes with and without CRT-D after adjustment for important covariates. After multivariable adjustment, CRT-D was associated with lower 3-year risks of death (hazard ratio, 0.52; 95% confidence interval, 0.48–0.56; P<0.001), all-cause readmission (hazard ratio, 0.69; 95% confidence interval, 0.65–0.73; P<0.001), and cardiovascular readmission (hazard ratio, 0.60; 95% confidence interval, 0.56–0.64; P<0.001). The association of CRT-D with mortality did not vary significantly among subgroups defined by age, sex, race, QRS duration, and optimal medical therapy. Conclusions— CRT-D was associated with lower risks of mortality, all-cause readmission, and cardiovascular readmission than medical therapy alone among patients with heart failure in community practice.
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Affiliation(s)
- Prateeti Khazanie
- From the Duke Clinical Research Institute (P.K., B.G.H., L.G.Q., S.M.A.-K., J.P.P., A.F.H., L.H.C.) and Department of Medicine (P.K., S.M.A.-K., J.P.P., A.F.H., L.H.C.), Duke University School of Medicine, Durham, NC; Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Colorado, Aurora (F.A.M., P.N.P.); Department of Medicine, Denver Health Medical Center, CO (P.N.P.); Department of Medicine, Mayo Clinic, Rochester, MN (S.C.H.); Department of Medicine, VA Palo Alto Healthcare System, CA (P.A.H., J.P.C.); Department of Medicine, Yale University School of Medicine, New Haven, CT (J.P.C.)
| | - Bradley G Hammill
- From the Duke Clinical Research Institute (P.K., B.G.H., L.G.Q., S.M.A.-K., J.P.P., A.F.H., L.H.C.) and Department of Medicine (P.K., S.M.A.-K., J.P.P., A.F.H., L.H.C.), Duke University School of Medicine, Durham, NC; Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Colorado, Aurora (F.A.M., P.N.P.); Department of Medicine, Denver Health Medical Center, CO (P.N.P.); Department of Medicine, Mayo Clinic, Rochester, MN (S.C.H.); Department of Medicine, VA Palo Alto Healthcare System, CA (P.A.H., J.P.C.); Department of Medicine, Yale University School of Medicine, New Haven, CT (J.P.C.)
| | - Laura G Qualls
- From the Duke Clinical Research Institute (P.K., B.G.H., L.G.Q., S.M.A.-K., J.P.P., A.F.H., L.H.C.) and Department of Medicine (P.K., S.M.A.-K., J.P.P., A.F.H., L.H.C.), Duke University School of Medicine, Durham, NC; Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Colorado, Aurora (F.A.M., P.N.P.); Department of Medicine, Denver Health Medical Center, CO (P.N.P.); Department of Medicine, Mayo Clinic, Rochester, MN (S.C.H.); Department of Medicine, VA Palo Alto Healthcare System, CA (P.A.H., J.P.C.); Department of Medicine, Yale University School of Medicine, New Haven, CT (J.P.C.)
| | - Gregg C Fonarow
- From the Duke Clinical Research Institute (P.K., B.G.H., L.G.Q., S.M.A.-K., J.P.P., A.F.H., L.H.C.) and Department of Medicine (P.K., S.M.A.-K., J.P.P., A.F.H., L.H.C.), Duke University School of Medicine, Durham, NC; Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Colorado, Aurora (F.A.M., P.N.P.); Department of Medicine, Denver Health Medical Center, CO (P.N.P.); Department of Medicine, Mayo Clinic, Rochester, MN (S.C.H.); Department of Medicine, VA Palo Alto Healthcare System, CA (P.A.H., J.P.C.); Department of Medicine, Yale University School of Medicine, New Haven, CT (J.P.C.)
| | - Stephen C Hammill
- From the Duke Clinical Research Institute (P.K., B.G.H., L.G.Q., S.M.A.-K., J.P.P., A.F.H., L.H.C.) and Department of Medicine (P.K., S.M.A.-K., J.P.P., A.F.H., L.H.C.), Duke University School of Medicine, Durham, NC; Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Colorado, Aurora (F.A.M., P.N.P.); Department of Medicine, Denver Health Medical Center, CO (P.N.P.); Department of Medicine, Mayo Clinic, Rochester, MN (S.C.H.); Department of Medicine, VA Palo Alto Healthcare System, CA (P.A.H., J.P.C.); Department of Medicine, Yale University School of Medicine, New Haven, CT (J.P.C.)
| | - Paul A Heidenreich
- From the Duke Clinical Research Institute (P.K., B.G.H., L.G.Q., S.M.A.-K., J.P.P., A.F.H., L.H.C.) and Department of Medicine (P.K., S.M.A.-K., J.P.P., A.F.H., L.H.C.), Duke University School of Medicine, Durham, NC; Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Colorado, Aurora (F.A.M., P.N.P.); Department of Medicine, Denver Health Medical Center, CO (P.N.P.); Department of Medicine, Mayo Clinic, Rochester, MN (S.C.H.); Department of Medicine, VA Palo Alto Healthcare System, CA (P.A.H., J.P.C.); Department of Medicine, Yale University School of Medicine, New Haven, CT (J.P.C.)
| | - Sana M Al-Khatib
- From the Duke Clinical Research Institute (P.K., B.G.H., L.G.Q., S.M.A.-K., J.P.P., A.F.H., L.H.C.) and Department of Medicine (P.K., S.M.A.-K., J.P.P., A.F.H., L.H.C.), Duke University School of Medicine, Durham, NC; Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Colorado, Aurora (F.A.M., P.N.P.); Department of Medicine, Denver Health Medical Center, CO (P.N.P.); Department of Medicine, Mayo Clinic, Rochester, MN (S.C.H.); Department of Medicine, VA Palo Alto Healthcare System, CA (P.A.H., J.P.C.); Department of Medicine, Yale University School of Medicine, New Haven, CT (J.P.C.)
| | - Jonathan P Piccini
- From the Duke Clinical Research Institute (P.K., B.G.H., L.G.Q., S.M.A.-K., J.P.P., A.F.H., L.H.C.) and Department of Medicine (P.K., S.M.A.-K., J.P.P., A.F.H., L.H.C.), Duke University School of Medicine, Durham, NC; Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Colorado, Aurora (F.A.M., P.N.P.); Department of Medicine, Denver Health Medical Center, CO (P.N.P.); Department of Medicine, Mayo Clinic, Rochester, MN (S.C.H.); Department of Medicine, VA Palo Alto Healthcare System, CA (P.A.H., J.P.C.); Department of Medicine, Yale University School of Medicine, New Haven, CT (J.P.C.)
| | - Frederick A Masoudi
- From the Duke Clinical Research Institute (P.K., B.G.H., L.G.Q., S.M.A.-K., J.P.P., A.F.H., L.H.C.) and Department of Medicine (P.K., S.M.A.-K., J.P.P., A.F.H., L.H.C.), Duke University School of Medicine, Durham, NC; Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Colorado, Aurora (F.A.M., P.N.P.); Department of Medicine, Denver Health Medical Center, CO (P.N.P.); Department of Medicine, Mayo Clinic, Rochester, MN (S.C.H.); Department of Medicine, VA Palo Alto Healthcare System, CA (P.A.H., J.P.C.); Department of Medicine, Yale University School of Medicine, New Haven, CT (J.P.C.)
| | - Pamela N Peterson
- From the Duke Clinical Research Institute (P.K., B.G.H., L.G.Q., S.M.A.-K., J.P.P., A.F.H., L.H.C.) and Department of Medicine (P.K., S.M.A.-K., J.P.P., A.F.H., L.H.C.), Duke University School of Medicine, Durham, NC; Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Colorado, Aurora (F.A.M., P.N.P.); Department of Medicine, Denver Health Medical Center, CO (P.N.P.); Department of Medicine, Mayo Clinic, Rochester, MN (S.C.H.); Department of Medicine, VA Palo Alto Healthcare System, CA (P.A.H., J.P.C.); Department of Medicine, Yale University School of Medicine, New Haven, CT (J.P.C.)
| | - Jeptha P Curtis
- From the Duke Clinical Research Institute (P.K., B.G.H., L.G.Q., S.M.A.-K., J.P.P., A.F.H., L.H.C.) and Department of Medicine (P.K., S.M.A.-K., J.P.P., A.F.H., L.H.C.), Duke University School of Medicine, Durham, NC; Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Colorado, Aurora (F.A.M., P.N.P.); Department of Medicine, Denver Health Medical Center, CO (P.N.P.); Department of Medicine, Mayo Clinic, Rochester, MN (S.C.H.); Department of Medicine, VA Palo Alto Healthcare System, CA (P.A.H., J.P.C.); Department of Medicine, Yale University School of Medicine, New Haven, CT (J.P.C.)
| | - Adrian F Hernandez
- From the Duke Clinical Research Institute (P.K., B.G.H., L.G.Q., S.M.A.-K., J.P.P., A.F.H., L.H.C.) and Department of Medicine (P.K., S.M.A.-K., J.P.P., A.F.H., L.H.C.), Duke University School of Medicine, Durham, NC; Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Colorado, Aurora (F.A.M., P.N.P.); Department of Medicine, Denver Health Medical Center, CO (P.N.P.); Department of Medicine, Mayo Clinic, Rochester, MN (S.C.H.); Department of Medicine, VA Palo Alto Healthcare System, CA (P.A.H., J.P.C.); Department of Medicine, Yale University School of Medicine, New Haven, CT (J.P.C.)
| | - Lesley H Curtis
- From the Duke Clinical Research Institute (P.K., B.G.H., L.G.Q., S.M.A.-K., J.P.P., A.F.H., L.H.C.) and Department of Medicine (P.K., S.M.A.-K., J.P.P., A.F.H., L.H.C.), Duke University School of Medicine, Durham, NC; Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Colorado, Aurora (F.A.M., P.N.P.); Department of Medicine, Denver Health Medical Center, CO (P.N.P.); Department of Medicine, Mayo Clinic, Rochester, MN (S.C.H.); Department of Medicine, VA Palo Alto Healthcare System, CA (P.A.H., J.P.C.); Department of Medicine, Yale University School of Medicine, New Haven, CT (J.P.C.).
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Agacdiken Agir A, Celikyurt U, Sahin T, Yılmaz I, Karauzum K, Bozyel S, Ural D, Vural A. What is the lowest value of left ventricular baseline ejection fraction that predicts response to cardiac resynchronization therapy? Med Sci Monit 2014; 20:1641-6. [PMID: 25218410 PMCID: PMC4172093 DOI: 10.12659/msm.891036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Cardiac resynchronization therapy (CRT) is an effective treatment option for patients with refractory heart failure. However, many patients do not respond to therapy. Although it has been thought that there was no relation between response to CRT and baseline ejection fraction (EF), the response rate of patients with different baseline LVEF to CRT has not been evaluated in severe left ventricular systolic dysfunction. We aimed to investigate any difference in response to CRT between the severe heart failure patients with different baseline LVEF. Material/Methods In this study, 141 consecutive patients (mean age 59±13 years; 89 men) with severe heart failure and complete LBBB were included. Patients were divided into 3 groups according to their baseline LVEF: 5–15%, Group 1; 15–25%, Group 2, and 25–35%, Group 3. NYHA functional class, LVEF, LV volumes, and diameters were assessed at baseline and after 6 months of CRT. A response to CRT was defined as a decrease in LVSVi (left ventricular end-systolic volume index) ≥10% on echocardiography at 6 months. Results After 6 months, a significant increase of EF and a significant decrease of LVESVi and LVEDVi after 6 months of CRT were observed in all groups. Although the magnitude of improvement in EF was biggest in the first group, the percentage of decrease in LVESVi and LVEDVi was similar between the groups. The improvement in NYHA functional class was similar in all EF subgroups. At 6-month follow-up, 100 (71%) patients showed a reduction of >10% in LVESVi (mean reduction: −15.5±26.1 ml/m2) and were therefore classified as responders to CRT. Response rate to CRT was similar in all groups. It was 67%, 75%, and 70% in Group 1, 2, and 3, respectively, at 6-month follow-up (p>0.05). There was no statistically significant relation between the response rate to CRT and baseline LVEF, showing that the CRT has beneficial effects even in patients with very low LVEF. Conclusions It seems there is no lower limit for baseline LVEF to predict non-response to CRT in eligible patients according to current guidelines.
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Affiliation(s)
- Aysen Agacdiken Agir
- Department of Cardiology, Medical Faculty of Kocaeli University, Kocaeli, Turkey
| | - Umut Celikyurt
- Department of Cardiology, Medical Faculty of Kocaeli University, Kocaeli, Turkey
| | - Tayfun Sahin
- Department of Cardiology, Medical Faculty of Kocaeli University, Kocaeli, Turkey
| | - Irem Yılmaz
- Department of Cardiology, Medical Faculty of Kocaeli University, Kocaeli, Turkey
| | - Kurtulus Karauzum
- Department of Cardiology, Medical Faculty of Kocaeli University, Kocaeli, Turkey
| | - Serdar Bozyel
- Department of Cardiology, Medical Faculty of Kocaeli University, Kocaeli, Turkey
| | - Dilek Ural
- Department of Cardiology, Medical Faculty of Kocaeli University, Kocaeli, Turkey
| | - Ahmet Vural
- Department of Cardiology, Medical Faculty of Kocaeli University, Kocaeli, Turkey
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Linde C, Stahlberg M, Benson L, Braunschweig F, Edner M, Dahlstrom U, Alehagen U, Lund LH. Gender, underutilization of cardiac resynchronization therapy, and prognostic impact of QRS prolongation and left bundle branch block in heart failure. Europace 2014; 17:424-31. [DOI: 10.1093/europace/euu205] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Adelstein E, Schwartzman D, Bazaz R, Jain S, Gorcsan III J, Saba S. Outcomes in pacemaker-dependent patients upgraded from conventional pacemakers to cardiac resynchronization therapy-defibrillators. Heart Rhythm 2014; 11:1008-14. [DOI: 10.1016/j.hrthm.2014.03.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Indexed: 10/25/2022]
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Chen Y, Duan C, Liu F, Shen S, Chen P, Bin J. Impact of etiology on the outcomes in heart failure patients treated with cardiac resynchronization therapy: a meta-analysis. PLoS One 2014; 9:e94614. [PMID: 24732141 PMCID: PMC3986107 DOI: 10.1371/journal.pone.0094614] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 03/17/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) has been extensively demonstrated to benefit heart failure patients, but the role of underlying heart failure etiology in the outcomes was not consistently proven. This meta-analysis aimed to determine whether efficacy and effectiveness of CRT is affected by underlying heart failure etiology. METHODS AND RESULTS Searches of MEDLINE, EMBASE and Cochrane databases were conducted to identify RCTs and observational studies that reported clinical and functional outcomes of CRT in ischemic cardiomyopathy (ICM) and non-ischemic cardiomyopathy (NICM) patients. Efficacy of CRT was assessed in 7 randomized controlled trials (RCTs) with 7072 patients and effectiveness of CRT was evaluated in 14 observational studies with 3463 patients In the pooled analysis of RCTs, we found that CRT decreased mortality or heart failure hospitalization by 29% in ICM patients (95% confidence interval [CI], 21% to 35%), and by 28% (95% CI, 18% to 37%) in NICM patients. No significant difference was observed between the 2 etiology groups (P = 0.55). In the pooled analysis of observational studies, however, we found that ICM patients had a 54% greater risk for mortality or HF hospitalization than NICM patients (relative risk: 1.54; 95% CI: 1.30-1.83; P<0.001). Both RCTs and observational studies demonstrated that NICM patients had greater echocardiographic improvements in the left ventricular ejection fraction and end-systolic volume, as compared with ICM patients (both P<0.001). CONCLUSION CRT might reduce mortality or heart failure hospitalization in both ICM and NICM patients similarly. The improvement of the left ventricular function and remodeling is greater in NICM patients.
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Affiliation(s)
- Yanmei Chen
- Department of Cardiology and National Key Lab for Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Chongyang Duan
- Department of Biostatistics, Southern Medical University, Guangzhou, China
| | - Feng Liu
- Department of Cardiology and National Key Lab for Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shuxin Shen
- Department of Cardiology and National Key Lab for Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Pingyan Chen
- Department of Biostatistics, Southern Medical University, Guangzhou, China
| | - Jianping Bin
- Department of Cardiology and National Key Lab for Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
- * E-mail:
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Akaishi M. Editorial: Reappraisal of increasing heart rate for cardiac performance. J Cardiol Cases 2014; 9:170-171. [PMID: 30546794 PMCID: PMC6281553 DOI: 10.1016/j.jccase.2013.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Indexed: 11/20/2022] Open
Affiliation(s)
- Makoto Akaishi
- Department of Cardiology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
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Brugada J, Brachmann J, Delnoy PP, Padeletti L, Reynolds D, Ritter P, Borri-Brunetto A, Singh JP. Automatic optimization of cardiac resynchronization therapy using SonR-rationale and design of the clinical trial of the SonRtip lead and automatic AV-VV optimization algorithm in the paradym RF SonR CRT-D (RESPOND CRT) trial. Am Heart J 2014; 167:429-36. [PMID: 24655689 DOI: 10.1016/j.ahj.2013.12.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 12/03/2013] [Indexed: 11/17/2022]
Abstract
Although cardiac resynchronization therapy (CRT) is effective in most patients with heart failure (HF) and ventricular dyssynchrony, a significant minority of patients (approximately 30%) are non-responders. Optimal atrioventricular and interventricular delays often change over time and reprogramming these intervals might increase CRT effectiveness. The SonR algorithm automatically optimizes atrioventricular and interventricular intervals each week using an accelerometer to measure change in the SonR signal, which was shown previously to correlate with hemodynamic improvement (left ventricular [LV] dP/dtmax). The RESPOND CRT trial will evaluate the effectiveness and safety of the SonR optimization system in patients with HF New York Heart Association class III or ambulatory IV eligible for a CRT-D device. Enrolled patients will be randomized in a 2:1 ratio to either SonR CRT optimization or to a control arm employing echocardiographic optimization. All patients will be followed for at least 24 months in a double-blinded fashion. The primary effectiveness end point will be evaluated for non-inferiority, with a nested test of superiority, based on the proportion of responders (defined as alive, free from HF-related events, with improvements in New York Heart Association class or improvement in Kansas City Cardiomyopathy Questionnaire quality of life score) at 12 months. The required sample size is 876 patients. The two primary safety end points are acute and chronic SonR lead-related complication rates, respectively. Secondary end points include proportion of patients free from death or HF hospitalization, proportion of patients worsened, and lead electrical performance, assessed at 12 months. The RESPOND CRT trial will also examine associated reverse remodeling at 1 year.
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Affiliation(s)
- Josep Brugada
- Hospital Clinic, University of Barcelona, Barcelona, Spain.
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Bordachar P, Eschalier R, Lumens J, Ploux S. Optimal Strategies on Avoiding CRT Nonresponse. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2014; 16:299. [PMID: 24633974 DOI: 10.1007/s11936-014-0299-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OPINION STATEMENT The high rate of nonresponse to cardiac resynchronization therapy (CRT) has remained nearly unchanged since the treatment was introduced. We believe that this is directly related to the many persisting unknowns regarding the mechanical function of asynchronous hearts and the use of electrical stimulation to counteract the deleterious effects of that asynchrony. As a consequence, the key questions pertaining to the pre-implant, intra-implant, and postimplant phases remain unanswered or only partially answered. QRS duration is an imperfect selection criterion, as it does not discriminate the activation pattern. The inclusion of QRS morphology in the international professional practice guidelines is an important first step toward increasing the yield of this therapy. The invasive and the noninvasive electrical mapping techniques seem highly promising and need to be tested in large trials. The site of stimulation is a key element of the response to CRT; additional research must be pursued in this field.
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Garnier F, Eicher JC, Jazayeri S, Bertaux G, Bouchot O, Aho LS, Wolf JE, Laurent G. Usefulness and limitations of contractile reserve evaluation in patients with low-flow, low-gradient aortic stenosis eligible for cardiac resynchronization therapy. Eur J Heart Fail 2014; 16:648-54. [DOI: 10.1002/ejhf.78] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 02/03/2014] [Accepted: 02/07/2014] [Indexed: 11/10/2022] Open
Affiliation(s)
- Fabien Garnier
- Department of Cardiology, Unité de Rythmologie et Insuffisance Cardiaque; University Hospital; Dijon France
| | - Jean-Christophe Eicher
- Department of Cardiology, Unité de Rythmologie et Insuffisance Cardiaque; University Hospital; Dijon France
| | - Saed Jazayeri
- Department of Cardiovascular Surgery; University Hospital; Dijon France
| | - Géraldine Bertaux
- Department of Cardiology, Unité de Rythmologie et Insuffisance Cardiaque; University Hospital; Dijon France
| | - Olivier Bouchot
- Department of Cardiovascular Surgery; University Hospital; Dijon France
- Laboratoire LE2I UMR CNRS 5158; Université de Bourgogne; Dijon France
| | - Ludwig-Serge Aho
- Department of Hygiene and Epidemiology; University Hospital; Dijon France
| | - Jean-Eric Wolf
- Department of Cardiology, Unité de Rythmologie et Insuffisance Cardiaque; University Hospital; Dijon France
- Laboratoire LE2I UMR CNRS 5158; Université de Bourgogne; Dijon France
| | - Gabriel Laurent
- Department of Cardiology, Unité de Rythmologie et Insuffisance Cardiaque; University Hospital; Dijon France
- Laboratoire LE2I UMR CNRS 5158; Université de Bourgogne; Dijon France
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39
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Abstract
Initial studies established patient selection criteria for cardiac resynchronization therapy (CRT) as left ventricular ejection fraction less than or equal to 35%, QRS greater than or equal to 120 ms, and New York Heart Association 3-4. Based on newer data, post hoc analyses, and meta-analyses, these criteria have been refined and guidelines updated, highlighting left bundle branch morphology and QRS greater than 150 ms in selecting patients with a likelihood of favorable outcomes. Guidelines will change as more data become available; the decision to apply CRT should be based on patient clinical profile and the balance of risk tolerance and likelihood of benefit.
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40
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Holm T, Færestrand S, Larsen AI, Jønland KB, Gullestad L, Dickstein K, Köpp U, Sirnes PA, Tande PM, Steen T, Kongsgård E. Kardial resynkroniseringsterapi ved hjertesvikt – norske retningslinjer. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2014; 134:E1-17. [DOI: 10.4045/tidsskr.13.0628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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41
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Cleland JG, Abraham WT, Linde C, Gold MR, Young JB, Claude Daubert J, Sherfesee L, Wells GA, Tang AS. An individual patient meta-analysis of five randomized trials assessing the effects of cardiac resynchronization therapy on morbidity and mortality in patients with symptomatic heart failure. Eur Heart J 2013; 34:3547-56. [PMID: 23900696 PMCID: PMC3855551 DOI: 10.1093/eurheartj/eht290] [Citation(s) in RCA: 402] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 06/24/2013] [Accepted: 07/04/2013] [Indexed: 12/25/2022] Open
Abstract
AIMS Cardiac resynchronization therapy (CRT) with or without a defibrillator reduces morbidity and mortality in selected patients with heart failure (HF) but response can be variable. We sought to identify pre-implantation variables that predict the response to CRT in a meta-analysis using individual patient-data. METHODS AND RESULTS An individual patient meta-analysis of five randomized trials, funded by Medtronic, comparing CRT either with no active device or with a defibrillator was conducted, including the following baseline variables: age, sex, New York Heart Association class, aetiology, QRS morphology, QRS duration, left ventricular ejection fraction (LVEF), and systolic blood pressure. Outcomes were all-cause mortality and first hospitalization for HF or death. Of 3782 patients in sinus rhythm, median (inter-quartile range) age was 66 (58-73) years, QRS duration was 160 (146-176) ms, LVEF was 24 (20-28)%, and 78% had left bundle branch block. A multivariable model suggested that only QRS duration predicted the magnitude of the effect of CRT on outcomes. Further analysis produced estimated hazard ratios for the effect of CRT on all-cause mortality and on the composite of first hospitalization for HF or death that suggested increasing benefit with increasing QRS duration, the 95% confidence bounds excluding 1.0 at ∼140 ms for each endpoint, suggesting a high probability of substantial benefit from CRT when QRS duration exceeds this value. CONCLUSION QRS duration is a powerful predictor of the effects of CRT on morbidity and mortality in patients with symptomatic HF and left ventricular systolic dysfunction who are in sinus rhythm. QRS morphology did not provide additional information about clinical response. CLINICALTRIALSGOV NUMBERS NCT00170300, NCT00271154, NCT00251251.
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Affiliation(s)
- John G. Cleland
- National Heart and Lung Institute, Imperial College London (Royal Brompton & Harefield Hospitals) and Department of Cardiology, Castle Hill Hospital, University of Hull, Kingston-upon-Hull, UK
| | - William T. Abraham
- Division of Cardiovascular Medicine and the Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, USA
| | - Cecilia Linde
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | | | - James B. Young
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | | | | | | | - Anthony S.L. Tang
- The Island Medical Program, University of British Columbia, Vancouver, Canada
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Anguita M, Comin J, Almenar L, Crespo M, Delgado J, Gonzalez-Costello J, Hernandez-Madrid A, Manito N, Perez de la Sota E, Segovia J, Segura C, Alonso-Gomez AM, Anguita M, Cequier A, Comin J, Diaz-Buschmann I, Fernandez-Lozano I, Fernandez-Ortiz A, Gomez de Diego JJ, Pan M, Worner F, Alonso-Pulpon L, Bover R, Castro A, Diaz-Molina B, Gomez-Bueno M, Gonzalez-Juanatey JR, Lage E, Lopez-Granados A, Lupon J, Martinez-Dolz L, Munoz R, Pascual D, Ridocci F, Roig E, Varela A, Vazquez de Prada JA. Comments on the ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. A report of the Task Force of the Clinical Practice Guidelines Committee of the Spanish Society of Cardiology. Rev Esp Cardiol 2013; 65:874-8. [PMID: 22999110 DOI: 10.1016/j.recesp.2012.07.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 07/21/2012] [Indexed: 02/07/2023]
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Impact of Ejection Fraction on the Clinical Response to Cardiac Resynchronization Therapy in Mild Heart Failure. Circ Heart Fail 2013; 6:1180-9. [DOI: 10.1161/circheartfailure.113.000326] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background—
Current guidelines recommend cardiac resynchronization therapy (CRT) in mild heart failure (HF) patients with QRS prolongation and ejection fraction (EF) ≤30%. To assess the effect of CRT in less severe systolic dysfunction, outcomes in the REsynchronization reVErses Remodeling in Systolic left vEntricular dysfunction (REVERSE) study were evaluated in which patients with left ventricular (LV) ejection fraction (LVEF) >30% were included.
Methods and Results—
The results of patients with baseline EF >30% (n=177) and those with EF ≤30% (n=431), as determined by a blinded core laboratory, were compared. In the LVEF >30% subgroup, there was a trend for improvement in the clinical composite response with CRT ON versus CRT OFF (
P
=0.06) and significant reductions in LV end systolic volume index (−6.7±21.1 versus 2.1±17.6 mL/m
2
;
P
=0.01) and LV mass (−20.6±50.5 versus 5.0±42.4 g;
P
=0.04) after 12 months. The time to death or first HF hospitalization was significantly prolonged with CRT (hazard ratio, 0.26;
P
=0.012). In the LVEF <30% subgroup, significant improvements in clinical composite response (
P
=0.02), reverse remodeling parameters, and time to death or first HF hospitalization (hazard ratio, 0.58;
P
=0.047) were observed. After adjusting for important covariates, the CRT ON assignment remained independently associated with improved time to death or first HF hospitalization (hazard ratio, 0.54;
P
=0.035), whereas there was no significant interaction with LVEF.
Conclusions—
Among subjects with mild HF, QRS prolongation, and LVEF >30%, CRT produced reverse remodeling and similar clinical benefit compared with subjects with more severe LV systolic dysfunction.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00271154.
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MERCHANT FAISALM, KELLA DANESH, BOOK WENDYM, LANGBERG JONATHANJ, LLOYD MICHAELS. Cardiac Resynchronization Therapy in Adult Patients with Repaired Tetralogy of Fallot and Left Ventricular Systolic Dysfunction. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 37:321-8. [DOI: 10.1111/pace.12284] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 08/03/2013] [Accepted: 08/14/2013] [Indexed: 11/28/2022]
Affiliation(s)
| | - DANESH KELLA
- Emory University School of Medicine; Atlanta Georgia
| | - WENDY M. BOOK
- Emory University School of Medicine; Atlanta Georgia
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VALDERRABANO MIGUEL, GREENBERG STEVEN, RAZAVI HEDI, MORE ROHAN, RYU KYUNGMOO, HEIST EKEVIN. 3D Cardiovascular Navigation System: Accuracy and Reduction in Radiation Exposure in Left Ventricular Lead Implant. J Cardiovasc Electrophysiol 2013; 25:87-93. [DOI: 10.1111/jce.12290] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 07/09/2013] [Accepted: 08/02/2013] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | | | | | - E. KEVIN HEIST
- Massachusetts General Hospital; Boston Massachusetts USA
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46
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Hohendanner F, Ljubojević S, MacQuaide N, Sacherer M, Sedej S, Biesmans L, Wakula P, Platzer D, Sokolow S, Herchuelz A, Antoons G, Sipido K, Pieske B, Heinzel FR. Intracellular dyssynchrony of diastolic cytosolic [Ca²⁺] decay in ventricular cardiomyocytes in cardiac remodeling and human heart failure. Circ Res 2013; 113:527-38. [PMID: 23825358 DOI: 10.1161/circresaha.113.300895] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
RATIONALE Synchronized release of Ca²⁺ into the cytosol during each cardiac cycle determines cardiomyocyte contraction. OBJECTIVE We investigated synchrony of cytosolic [Ca²⁺] decay during diastole and the impact of cardiac remodeling. METHODS AND RESULTS Local cytosolic [Ca²⁺] transients (1-µm intervals) were recorded in murine, porcine, and human ventricular single cardiomyocytes. We identified intracellular regions of slow (slowCaR) and fast (fastCaR) [Ca²⁺] decay based on the local time constants of decay (TAUlocal). The SD of TAUlocal as a measure of dyssynchrony was not related to the amplitude or the timing of local Ca²⁺ release. Stimulation of sarcoplasmic reticulum Ca²⁺ ATPase with forskolin or istaroxime accelerated and its inhibition with cyclopiazonic acid slowed TAUlocal significantly more in slowCaR, thus altering the relationship between SD of TAUlocal and global [Ca²⁺] decay (TAUglobal). Na⁺/Ca²⁺ exchanger inhibitor SEA0400 prolonged TAUlocal similarly in slowCaR and fastCaR. FastCaR were associated with increased mitochondrial density and were more sensitive to the mitochondrial Ca²⁺ uniporter blocker Ru360. Variation in TAUlocal was higher in pig and human cardiomyocytes and higher with increased stimulation frequency (2 Hz). TAUlocal correlated with local sarcomere relengthening. In mice with myocardial hypertrophy after transverse aortic constriction, in pigs with chronic myocardial ischemia, and in end-stage human heart failure, variation in TAUlocal was increased and related to cardiomyocyte hypertrophy and increased mitochondrial density. CONCLUSIONS In cardiomyocytes, cytosolic [Ca²⁺] decay is regulated locally and related to local sarcomere relengthening. Dyssynchronous intracellular [Ca²⁺] decay in cardiac remodeling and end-stage heart failure suggests a novel mechanism of cellular contractile dysfunction.
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Affiliation(s)
- Felix Hohendanner
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Bartos JA, Francis GS. The High-Risk Patient With Heart Failure With Reduced Ejection Fraction: Treatment Options and Challenges. Clin Pharmacol Ther 2013; 94:509-18. [DOI: 10.1038/clpt.2013.137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 07/08/2013] [Indexed: 12/17/2022]
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Wang NC, Piccini JP, Fonarow GC, Knight BP, Harinstein ME, Butler J, Lahiri MK, Metra M, Vaduganathan M, Gheorghiade M. The potential role of nonpharmacologic electrophysiology-based interventions in improving outcomes in patients hospitalized for heart failure. Heart Fail Clin 2013; 9:331-43, vi-vii. [PMID: 23809419 DOI: 10.1016/j.hfc.2013.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Hospitalization for heart failure (HHF) is commonly associated with symptomatic improvement in response to standard medical therapy, yet there remains a substantial risk of rehospitalization and death. Clinically stable outpatients and decompensated inpatients represent two types of patients with chronic heart failure. In the former, treatment of common heart rhythm disorders with nonpharmacologic electrophysiology-based interventions is of substantial benefit in select patients. The potential benefits of these interventions in the hospitalized setting are not well studied. In this review, current knowledge is discussed and future research directions are suggested with nonpharmacologic electrophysiology-based interventions to reduce the morbidity and mortality associated with patients with HHF.
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Affiliation(s)
- Norman C Wang
- Heart and Vascular Institute, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA
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Current status of cardiac resynchronization therapy with defibrillators and factors influencing its prognosis in Japan. J Arrhythm 2013. [DOI: 10.1016/j.joa.2013.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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50
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Noninvasive Electrocardiographic Mapping to Improve Patient Selection for Cardiac Resynchronization Therapy. J Am Coll Cardiol 2013; 61:2435-2443. [DOI: 10.1016/j.jacc.2013.01.093] [Citation(s) in RCA: 158] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 11/10/2012] [Accepted: 01/08/2013] [Indexed: 01/23/2023]
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