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Pubblicazioni recenti - cardiac resynchronization
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Characteristics and Outcomes of Patients Who Are Denied From a Percutaneous Edge-to-Edge Mitral Valve Repair After Being Referred to a Transcatheter Mitral Valve Program: Impact of a Dedicated Multidisciplinary Mitral Heart Team Approach.
J Invasive Cardiol2020 Jun;32(6):E151-E157.
Poulin Anthony, Beaupré Frédéric, Gravel Caroline, Hadjadj Sandra, Bernier Mathieu, Beaudoin Jonathan, O'Connor Kim, Ferreira-Neto Alfredo Nunes, Wintzer Jérôme, Dumont Eric, Dagenais François, Rodés-Cabau Josep, Paradis Jean-Michel,
Abstract
BACKGROUND:
Many patients referred for a MitraClip intervention are finally refused for this intervention, and data are very scarce on their outcomes. Our study sought to determine the characteristics and outcomes of patients who are referred to a mitral valve clinic and are finally denied from a percutaneous mitral edge-to-edge repair.
METHODS:
A total of 210 patients referred to our clinic for severe mitral regurgitation were retrospectively analyzed. Fifty-seven patients underwent a MitraClip procedure. For exploratory purposes, a propensity-matched cohort comparing the patients accepted for a MitraClip procedure and those refused for any mitral intervention was analyzed.
RESULTS:
Among the 153 patients who were refused for MitraClip, 46% had functional MR, 42% had degenerative MR, and 11% had mixed disease. Reasons for denial included unfavorable anatomy, patient refusal, mitral valve surgery referral, cardiac resynchronization therapy, other advanced heart failure therapies, and palliative care. After a mean follow-up of 13 months, 50% were in New York Heart Association class I or II, 63% had less than severe MR, and mortality rate was 29%. In the propensity-matched cohort, there was no difference in symptoms improvement, but there was less overall mortality (P=.01), cardiovascular mortality (P<.01) and severe MR (P<.01) in the MitraClip group.
CONCLUSIONS:
A multidisciplinary heart team evaluation for complex MR patients can be useful not solely for selecting the ideal MitraClip eligible patients, but also to select the best treatment strategy in each individualized context.
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Advances in Cardiac Resynchronization Therapy.
J Innov Card Rhythm Manag2019 Jun;10(6):3681-3693. doi: 10.19102/icrm.2019.100604.
Jafferani Asif, Leal Miguel A,
Abstract
The development of cardiac resynchronization therapy (CRT) has been crucial in reducing morbidity and mortality in patients with advanced heart failure. However, a significant proportion of patients who receive CRT fail to derive significant clinical benefits from this therapy. Successful CRT depends on a multitude of factors, including appropriate patient selection, left ventricular lead positioning, and postimplant management. Newer device-based algorithms, multipoint ventricular pacing, and the development of leadless CRT devices constitute important facets of both the present and near-future evolution of this therapy.
Copyright: © 2019 Innovations in Cardiac Rhythm Management.
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His-bundle Pacing to Left Bundle Branch Pacing: Evolution of His-Purkinje Conduction System Pacing.
J Innov Card Rhythm Manag2019 May;10(5):3668-3673. doi: 10.19102/icrm.2019.100504.
Vijayaraman Pugazhendhi,
Abstract
His-bundle pacing (HBP) constitutes an excellent alternative to right ventricular pacing. Recently, several studies have reported on the success and efficacy of HBP in patients with left bundle branch block requiring cardiac resynchronization therapy. Nonetheless, HBP may not always be feasible due to high capture thresholds or disease in the distal His bundle. The present report discusses the utility and feasibility of pacing in the left bundle branch area located distal to the site of conduction block.
Copyright: © 2019 Innovations in Cardiac Rhythm Management.
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A Novel and Practical Method of Performing Atrioventricular Nodal Ablation via a Superior Approach in Patients with Refractory Atrial Fibrillation Undergoing Cardiac Resynchronization Device Implantation.
J Innov Card Rhythm Manag2019 Dec;10(12):3924-3928. doi: 10.19102/icrm.2019.101201.
Acosta Helbert, Viafara Lina M, Hanif Nayyab, Acosta Steven, Pagadala Manasa, Acosta Byron, Pothula Shravya, Peckosh Courtney, Bear Julie, Alzate Sergio, Ballesteros Humberto, De Las Salas Angela, Martin Toni, Doepke Matthew,
Abstract
Atrioventricular node (AVN) ablation is a strategy to manage patients with drug-refractory atrial fibrillation (AF) and heart failure in whom cardiac resynchronization therapy (CRT) device implantation has been prescribed. This study describes a practical method to perform these two procedures using the same surgical site. Twenty-seven patients were indicated for AVN ablation and concurrent CRT device implantation while presenting with AF and rapid ventricular response (RVR) refractory to medical therapy. After placement of the right and left ventricular leads, a third puncture was made in the axillary vein to obtain access to perform the ablation. After hand-injecting contrast media through a RAMP? (Abbott Laboratories, Chicago, IL, USA) sheath positioned in the right atrial cavity, the anatomical area corresponding to the AVN was identified using fluoroscopy cine runs obtained in the right anterior oblique and left anterior oblique projections. The adequate site for ablation was confirmed by the bipolar recording of a His-bundle deflection at the tip of the ablation catheter. Radiofrequency energy was delivered to achieve complete heart block. Subsequently, device implant was completed. The method was successfully applied in 27 consecutive cases, achieving permanent complete heart block in all patients. The mean radiofrequency time to achieve heart block was 110 seconds ± 43 seconds. The average procedural time including AVN ablation and device implant was 87 minutes ± 21 minutes. The images obtained with the hand-injected contrast media provided adequate information to readily identify the anatomical area corresponding to the AVN with 100% accuracy. This study suggests that ablation of the AVN can be safely and effectively accomplished via a superior approach in patients undergoing a CRT device implant.
Copyright: © 2019 Innovations in Cardiac Rhythm Management.
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A Cautionary Tale on Atrial Capture Management, Biventricular Pacing, and Recurrent Asystole.
J Innov Card Rhythm Manag2019 Oct;10(10):3848-3852. doi: 10.19102/icrm.2019.101001.
Johnsrude Christopher L, Lau Kelvin C,
Abstract
Capture management algorithms in current cardiac implantable electronic devices (CIEDs) can enhance device performance and battery longevity. Although generally safe, these algorithms have on rare occasions been implicated in the onset of significant complications, especially in pacemaker-dependent patients. CIEDs implanted in patients with postoperative congenital heart disease (CHD) often require epicardial pacing leads rather than transvenous leads; unfortunately, epicardial leads can experience higher rates of malfunction. We herein report on a young adult with a status of postoperative CHD and complete atrioventricular block following implantation of a epicardial dual-chamber cardiac resynchronization therapy pacemaker (CRT-P; Consulta; Medtronic, Minneapolis, MN, USA) who developed frequent periods of asystole after malfunction of one of the ventricular leads. The underlying cause of asystole was found to be due to the atrial capture management (ACM) algorithm of the CRT-P device, temporarily converting biventricular to right ventricular-only pacing as part of the algorithm. This case highlights implications of the ACM algorithm in devices with a similar platform for pacemaker-dependent patients.
Copyright: © 2019 Innovations in Cardiac Rhythm Management.
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Nonpharmacological Treatment of Atrial Fibrillation: What Is the Role of Device Therapy?
Int J Angiol2020 Jun;29(2):113-122. doi: 10.1055/s-0040-1708529.
Riedlbauchová Lucie, Durdil Václav, Hon?k Jakub, Veselka Josef,
Abstract
Atrial fibrillation is the most common arrhythmia in the adult population, and its incidence and prevalence are still rising. Cardiac devices are widely used in clinical practice in the management of various rhythm disturbances and heart failure treatment. Many patients who receive a pacemaker, implantable cardioverter-defibrillator, or cardiac resynchronization therapy also experience atrial fibrillation in the course of their life. Therefore, this review aims to describe the role of these devices in the treatment and prevention of atrial fibrillation in the device recipients. In addition, all these implantable devices also serve as permanent ECG (electrocardiogram) monitors, thus providing important information about the presence and characteristics of atrial fibrillation that may or may not be detected by the patient but can modify our therapeutical approach with regard to the stroke prevention.
© Thieme Medical Publishers.
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Clinical impact of left ventricular paced conduction disturbance in cardiac resynchronization therapy.
Heart Rhythm2020 May;():. doi: S1547-5271(20)30527-0.
Ueda Nobuhiko, Noda Takashi, Nakajima Ikutaro, Ishibashi Kohei, Nakajima Kenzaburo, Kamakura Tsukasa, Wada Mitsuru, Yamagata Kenichiro, Inoue Yuko, Miyamoto Koji, Nagase Satoshi, Aiba Takeshi, Kiso Keisuke, Kanzaki Hideaki, Izumi Chisato, Noguchi Teruo, Yasuda Satoshi, Kusano Kengo,
Abstract
BACKGROUND:
Myocardial scarring is associated with non-response to cardiac resynchronization therapy (CRT) and conduction delay. Little is known about the significance and cause of left ventricular (LV) paced conduction disturbance (LPCD).
OBJECTIVE:
The purpose of this study was to investigate the clinical impact of paced interlead electrical delay and the difference in each conduction time from LV pace to right ventricular (RV) sense (LVp-RVs) and from RV pace to LV sense (RVp-LVs) [(LVp-RVs) - (RVp-LVs)], in CRT.
METHODS:
Among 137 patients who underwent CRT implantation, LVp-RVs and RVp-LVs were measured intraoperatively. The relationships between [(LVp-RVs) - (RVp-LVs)] and perfusion defects on myocardial perfusion single photon emission computed tomography (SPECT) imaging or [(LVp-RVs) - (RVp-LVs)] and clinical outcomes were also assessed.
RESULTS:
After CRT implantation, 81 patients (59%) responded to CRT. [(LVp-RVs) - (RVp-LVs)] was significantly longer in non-responders than in responders (9.7±47.3 vs. -4.5±33.2 ms, p=0.042). Patients with LPCD [(LVp-RVs) > (RVp-LVs)] had higher perfusion defects in the anterolateral region (2.7±2.7 vs. 1.1±1.6, p=0.0015) on SPECT. Multivariate analysis showed that LPCD was the independent predictor of non-response to CRT (odds ratio: 0.40 [95% confidence interval (CI): 0.17-0.90], p=0.026). During a median follow-up of 2.3 years (interquartile range: 1.3-5.5), LPCD was the independent predictor of cardiac death and/or heart failure hospitalization in multivariate analysis (hazard ratio: 1.82, 95%CI: 1.11-3.03, p=0.018).
CONCLUSIONS:
The LPCD could predict non-response to CRT and poor outcome. Further intervention, such as adjustment of pacing timing or multi-point/site pacing, may be needed in such patients.
Copyright © 2020. Published by Elsevier Inc.
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Quality Matters: Erectile Dysfunction and Cardiac Resynchronization Therapy.
Hellenic J Cardiol2020 May;():. doi: S1109-9666(20)30088-9.
Bonios Michael J, Adamopoulos Stamatis N, Drakos Stavros G,
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Navigating Challenging Left Ventricular Lead Placements for Cardiac Resynchronization Therapy.
J Innov Card Rhythm Manag2020 May;11(5):4107-4117. doi: 10.19102/icrm.2020.110505.
Pothineni Naga Venkata K, Supple Gregory E,
Abstract
Cardiac resynchronization therapy (CRT) is a mainstay in the management of heart failure patients with electrical dyssynchrony. Left ventricular (LV) lead positioning remains an important variable that predicts the response to CRT. Anatomical and technical challenges can hinder optimal LV lead placement using traditional lead implantation approaches. Knowledge of normal anatomical variants and common anomalies is essential for successful LV lead implants. With advancements in tools and techniques for LV lead delivery, the implanting electrophysiologist can target the optimal LV pacing site, rather than accepting a suboptimal location that is less likely to provide clinical benefit. In this review, we discuss various challenges to achieving optimal LV lead implantation and present strategies to overcome them.
Copyright: © 2020 Innovations in Cardiac Rhythm Management.
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SANS FLUORO Optimized: A Case Report of Pulmonary Vein Isolation in a Patient with Cardiac Resynchronization Therapy Defibrillator and the Optimizer? III Device.
J Innov Card Rhythm Manag2020 May;11(5):4086-4089. doi: 10.19102/icrm.2020.110502.
Percell Hyacinth C, Saeger Lynn, Sharpe Erin, Saalfeld Rose, Percell Robert L,
Abstract
We offer the first reported case of a pulmonary vein isolation (PVI) procedure performed in a patient with two devices, specifically a cardiac resynchronization therapy defibrillator (CRT-D) and an Optimizer? III device (Impulse Dynamics, Mount Laurel, NJ, USA), using the SANS FLUORO technique with zero fluoroscopy. In total, this patient had six leads traversing the right atrium, including two right atrial leads, three right ventricular leads-two associated with the Optimizer? system and one implantable cardiac defibrillator lead-and a left ventricular lead.
Copyright: © 2020 Innovations in Cardiac Rhythm Management.
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The use of MitraClip in secondary mitral regurgitation and heart failure.
Cardiovasc Revasc Med2020 May;():. doi: S1553-8389(20)30262-1.
Boudoulas Konstantinos Dean, Vallakati Ajay, Pitsis Antonios A, Orsinelli David A, Abraham William T,
Abstract
Secondary (also known as functional) mitral regurgitation (MR) has increased substantially over the last several decades due to an increase in the prevalence of dilated cardiomyopathy (ischemic and non-ischemic). Mortality and morbidity in patients with dilated cardiomyopathy is much greater when associated with MR as compared to without MR. MR will result in further left ventricular (LV) volume overload, LV dilation, and pupillary muscle displacement resulting in deterioration of the severity of MR leading to a vicious cycle. Optimization of heart failure medical therapy, and cardiac resynchronization therapy for those that qualify, can improve severity of MR; however, significant MR will persist in certain patients. Transcatheter mitral valve repair to treat significant MR using the MitraClip (Abbott, Menlo Park, California), which grasps and coapts the posterior and anterior mitral valve leaflets, in appropriately selected patients with dilated cardiomyopathy and secondary MR has been shown to improve quality of life and prolong survival.
Copyright © 2020 Elsevier Inc. All rights reserved.
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Parameters of left ventricular systolic and diastolic dyssynchrony on radionuclide imaging to improve cardiac resynchronization therapy in heart failure patients with dilated cardiomyopathy.
J Nucl Cardiol2020 May;():. doi: 10.1007/s12350-020-02202-4.
Sreenivasan Jayakumar, Jain Diwakar,
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Functional mitral regurgitation and cardiac resynchronization therapy in the "era" of trans-catheter interventions: Is it time to move from a staged strategy to a tailored therapy?
Int J Cardiol2020 Mar;():. doi: S0167-5273(19)35293-3.
Gavazzoni Mara, Taramasso Maurizio, Zuber Michel, Pozzoli Alberto, Miura Mizuki, Oliveira Dinaldo, Maisano Francesco,
Abstract
Cardiac resynchronization therapy (CRT) has been associated to left ventricle (LV) remodelling, reduction of functional mitral regurgitation (FMR) and clinical improvement in patients with heart failure and reduced ejection fraction (HFrEF). The prevalence of significant FMR in patients with LV dyssynchrony that are candidate to CRT is up to 40%. Current approach in patients with FMR undergoing CRT consists of re-evaluation of the amount of FMR following a waiting period of at least 3 months after the implant. In case of persistent significant FMR despite CRT and guideline directed medical therapy, trancatheter Mitral Valve repair (TMVR) is an important option to improve quality of life and prognosis. This stepwise approach does not take into account the probability of the individual response to CRT and the availability of TMVR solutions that are safe and effective in high risk patients. We reviewed the effects of CRT on FMR, the prognostic role of persistence of FMR after CRT treatment and the impact of treatment of FMR in patients CRT non responders. We aimed to point out the limits of current step-wised approach in light on more recent evidence regarding FMR treatment. A new, "tailored" approached is proposed.
Copyright © 2020 Elsevier B.V. All rights reserved.
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Interatrial conduction time from electrograms of cardiac resynchronization therapy devices with left ventricular sensing.
Pacing Clin Electrophysiol2020 May;():. doi: 10.1111/pace.13960.
Marinaccio Leonardo, Giacopelli Daniele, Resta Margherita, Clelia Fabbian, Romanato Giuseppe, Borgato Martina, Vetta Francesco, Marchese Domenico,
Abstract
BACKGROUND:
The interatrial conduction time (IACT) is relevant for atrioventricular (AV) delay optimization in cardiac resynchronization therapy (CRT) devices. However, this information cannot be easily used as it requires invasive measurements. We tested if electrical activation of left atrium (LA) could be detected in CRT devices with left ventricular (LV) sensing and used to estimate IACT.
METHODS:
The presence of LA activation on LV channel was evaluated in consecutive patients implanted with CRT and quadripolar LV leads whose sensing was temporarily set in the most proximal polarity (Ring LV4-housing). Estimates of IACT during sinus rhythm and atrial pacing were measured and compared with the values obtained with invasive catheterization of coronary sinus.
RESULTS:
Among 6 patients (50% female; mean age 73.3±4.9 years) included in the analysis, 4 (66%) had a visible LA signal on the LV channel. The mean IACT measured with device electrograms was 71 ± 8 ms and 133 ± 15 ms during sinus rhythm and atrial pacing, respectively. These values were equivalent to the measurements obtained during invasive catheterization. Both patients without evidence of LA activation had a LV lead with a short total inter-electrodes distance (46 mm) resulting in a significant anatomical distance between Ring LV4 and LA.
CONCLUSIONS:
In CRT devices with left ventricular sensing, LA signal could be detected and used to estimate IACT especially if long-spaced electrodes are used. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
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Evaluation of an Integrated Device Diagnostics Algorithm to Risk Stratify Heart Failure Patients?- Results From the SCAN-HF Study.
Circ J2020 May;():. doi: 10.1253/circj.CJ-19-1143.
Okumura Ken, Sasaki Shingo, Kusano Kengo, Mine Takanao, Fujii Kenshi, Iwasa Atsushi, Sunagawa Osahiko, Yamabe Hiroshige, Takahashi Naohiko, Ishii Shunsuke, Takeishi Yasuchika, Tsuboi Naoya, Shizuta Satoshi, Aonuma Kazutaka, Shimane Akira, Tada Hiroshi, Ishikawa Toshiyuki, Tsunoda Ryusuke, Numata Tetsuya, Mukai Yasushi, Kihara Yasuki, Koehler Jodi, Hidaka Kazuhiro, Sharma Vinod,
Abstract
BACKGROUND:
Integrated device diagnostics, Triage-HF, is useful in risk stratifying patients with heart failure (HF), but its performance for Japanese patients remains unknown. This is a prospective study of Japanese patients treated with a cardiac resynchronization therapy defibrillator (CRT-D), with a Medtronic OptiVol 2.0 feature.Methods?and?Results:A total of 320 CRT-D patients were enrolled from 2013 to 2017. All received HF treatment in the prior 12 months. Following enrollment, they were followed every 6 months for 48 months (mean, 22 months). Triage-HF-stratified patients at low, medium and high risk statuses at every 30-day period, and HF-related hospitalization occurring for the subsequent 30 days, were evaluated and repeated. The primary endpoint was to assess Triage-HF performance in predicting HF-related hospitalization risk. All device data were available for 279 of 320 patients (NYHA class II or III in 93%; mean left ventricular ejection fraction, 31%). During a total of 5,977 patient-month follow-ups, 89 HF-related hospitalization occurred in 72 patients. The unadjusted event numbers for Low, Medium and High statuses were 19 (0.7%), 42 (1.6%) and 28 (4.1%), respectively. Relative risk of Medium to Low status was 2.18 (95% CI 1.23-3.85) and 5.78 (95% CI 3.34-10.01) for High to Low status. Common contributing factors among the diagnostics included low activity, OptiVol threshold crossing, and elevated night heart rate.
CONCLUSIONS:
Triage-HF effectively stratified Japanese patients at risk of HF-related hospitalization.
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Improvement in circulating endothelial progenitor cells pool after cardiac resynchronization therapy: increasing the list of benefits.
Stem Cell Res Ther2020 May;11(1):194. doi: 10.1186/s13287-020-01713-8.
Cristóvão Gonçalo, Milner James, Sousa Pedro, Ventura Miguel, Cristóvão João, Elvas Luís, Paiva Artur, Gonçalves Lino, Ribeiro Carlos Fontes, António Natália,
Abstract
BACKGROUND:
Recent studies suggest that circulating endothelial progenitor cells (EPCs) may influence the response to cardiac resynchronization therapy (CRT). The aim of this study was to evaluate the effect of CRT on EPC levels and to assess the impact of EPCs on long-term clinical outcomes.
POPULATION AND METHODS:
Prospective study of 50 patients submitted to CRT. Two populations of circulating EPCs were quantified previously to CRT implantation: CD34KDR and CD133KDR cells. EPC levels were reassessed 6?months after CRT. Endpoints during the long-term follow-up were all-cause mortality, heart transplantation, and hospitalization for heart failure (HF) management.
RESULTS:
The proportion of non-responders to CRT was 42% and tended to be higher in patients with an ischemic vs non-ischemic etiology (64% vs 35%, p =?0.098). Patients with ischemic cardiomyopathy (ICM) showed significantly lower CD34KDR EPC levels when compared to non-ischemic dilated cardiomyopathy patients (DCM) (0.0010?±?0.0007 vs 0.0030?±?0.0024 cells/100 leukocytes, p =?0.032). There were no significant differences in baseline EPC levels between survivors and non-survivors nor between patients who were rehospitalized for HF management during follow-up or not. At 6-month follow-up, circulating EPC levels were significantly higher than baseline levels (0.0024?±?0.0023 vs 0.0047?±?0.0041 CD34KDR cells/100 leukocytes, p =?0.010 and 0.0007?±?0.0004 vs 0.0016 vs 0.0013 CD133/KDR cells/100 leukocytes, p =?0.007).
CONCLUSIONS:
Patients with ICM showed significantly lower levels of circulating EPCs when compared to their counterparts. CRT seems to improve the pool of endogenously circulating EPCs and reduced baseline EPC levels seem not to influence long-term outcomes after CRT.
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Completely Leadless Cardiac Resynchronization Defibrillator System.
JACC Clin Electrophysiol2020 May;6(5):588-589. doi: S2405-500X(20)30168-7.
Sidhu Baldeep S, Gould Justin, Porter Bradley, Elliott Mark, Mehta Vishal, Niederer Steven, Rinaldi Christopher A,
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Effect of Pressure-controlled intermittent Coronary Sinus Occlusion (PiCSO) on infarct size in anterior STEMI: PiCSO in ACS study.
Int J Cardiol Heart Vasc2020 Jun;28():100526. doi: 10.1016/j.ijcha.2020.100526.
Egred Mohaned, Bagnall Alan, Spyridopoulos Ioakim, Purcell Ian F, Das Rajiv, Palmer Nick, Grech Ever D, Jain Ajay, Stone Gregg W, Nijveldt Robin, McAndrew Thomas, Zaman Azfar,
Abstract
Background:
The aim of this clinical research was to investigate the effects of Pressure-controlled intermittent Coronary Sinus Occlusion (PiCSO) on infarct size at 5 days after primary percutaneous coronary intervention (pPCI) in patients with ST-segment elevation myocardial infarction (STEMI).
Methods and results:
This comparative study was carried out in four UK hospitals. Forty-five patients with anterior STEMI presenting within 12 h of symptom onset received pPCI plus PiCSO (initiated after reperfusion; n = 45) and were compared with a propensity score-matched control cohort from INFUSE-AMI (n = 80). Infarct size (% of LV mass, median [interquartile range]) measured by cardiac magnetic resonance (CMR) at day 5 was significantly lower in the PiCSO group (14.3% [95% CI 9.2-19.4%] vs. 21.2% [95% CI 18.0-24.4%]; p = 0.023). There were no major adverse cardiac events (MACE) related to the PiCSO intervention.
Conclusions:
PiCSO, as an adjunct to pPCI, was associated with a lower infarct size at 5 days after anterior STEMI in a propensity score-matched population.
© 2020 The Authors.
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Soluble ST2 and Soluble Markers of Fibrosis: Emerging Roles for Prognosis and Guiding Therapy.
Curr Cardiol Rep2020 May;22(6):41. doi: 10.1007/s11886-020-01288-z.
Sharim Justin, Daniels Lori B,
Abstract
PURPOSE OF REVIEW:
Biomarkers of cardiac fibrosis closely track the disease state that gives rise to heart failure. The purpose of this review is to highlight recent data on the use of soluble ST2, galectin-3, and procollagen, three markers of cardiac fibrosis, for aiding with prognostication, and to explore the use of these biomarkers for guiding therapy.
RECENT FINDINGS:
Soluble ST2, galectin-3, and procollagen are prognostic in both acute and chronic heart failure, and data are emerging as to their potential uses for guiding therapies. Mortality benefit from exercise, cardiac resynchronization therapy, statin use, as well as anti-fibrotic therapies such as aldosterone antagonism may vary based upon levels of these fibrosis markers. Soluble ST2, galectin-3, and procollagen provide independent prognostic information for heart failure morbidity and mortality. Markers of cardiac fibrosis may also help identify the subsets of patients who are most likely to benefit from various therapies. However, further studies are needed prior to formalizing individual patient care algorithms guided by fibrosis biomarkers.
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Implantable Cardiac Defibrillator or Cardiac Resynchronization Therapy in Severe Cardiomyopathy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Am J Ther
