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Pubblicazioni recenti - cardiac resynchronization
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Continued versus Suspended Cardiac Resynchronization Therapy after Left Ventricular Assist Device Implantation.
Sci Rep2020 Feb;10(1):2573. doi: 10.1038/s41598-020-59117-w.
Roukoz Henri, Bhan Adarsh, Ravichandran Ashwin, Ahmed Mustafa M, Bhat Geetha, Cowger Jennifer, Abdullah Munazzah, Dhawan Rahul, Trivedi Jaimin R, Slaughter Mark S, Gopinathannair Rakesh,
Abstract
Cardiac resynchronization therapy (CRT) improves outcomes in heart failure patients with wide QRS complex. However, CRT management following continuous flow Left Ventricular Assist Device (LVAD) implant vary: some centers continue CRT while others turn off the left ventricular (LV) lead at LVAD implant. We sought to study the effect of continued CRT versus turning off CRT pacing following continuous flow LVAD implantation. A comprehensive retrospective multicenter cohort of 295 patients with LVAD and pre-existing CRT was studied. CRT was programmed off after LVAD implant in 44 patients. We compared their outcomes to the rest of the cohort using univariate and multivariate models. Mean age was 60?±?12 years, 83% were males, 52% had ischemic cardiomyopathy and 54% were destination therapy. Mean follow-up was 2.4?±?2.0 years, and mean LVAD support time was 1.7?±?1.4 years. Patients with CRT OFF had a higher Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) mean profile (3.9 vs 3.3, p?=?0.01), more secondary prevention indication for a defibrillator (64.9% vs 44.5%, p?=?0.023), and more pre-LVAD ventricular arrhythmias (VA) (77% vs 60%, p?=?0.048). There were no differences between the CRT OFF and CRT ON groups in overall mortality (Log rank p?=?0.32, adjusted HR?=?1.14 [0.54-2.22], p?=?0.71), heart transplantation, cardiac and noncardiac mortality, all cause hospitalizations, hospitalizations for ICD shocks, and number and frequency of ICD shocks or anti-tachycardia pacing therapy. There were no differences in post LVAD atrial arrhythmias (AA) (Adjusted OR?=?0.45 [0.18-1.06], p?=?0.31) and ventricular arrhythmias (OR?=?0.65 [0.41-1.78], p?=?0.41). There was no difference in change in LVEF, LV end diastolic and end systolic diameters between the 2 groups. Our study suggests that turning off CRT pacing after LVAD implantation in patients with previous CRT pacing did not affect mortality, heart transplantation, device therapies or arrhythmia burden. A prospective study is needed to confirm these findings.
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Cardiac implantable electrical devices in patients with hypertrophic cardiomyopathy: single center implant data extracted from the Swedish pacemaker and ICD registry.
Scand Cardiovasc J2020 Feb;():1-9. doi: 10.1080/14017431.2020.1727000.
Valzania Cinzia, Gadler Fredrik, Boriani Giuseppe, Rapezzi Claudio, Eriksson Maria J,
Abstract
To investigate cardiac implantable electrical device (CIED) first implants in patients with hypertrophic cardiomyopathy (HCM) in a Swedish tertiary university hospital. Clinical and technical data on pacemaker, implantable cardioverter defibrillator (ICD), and cardiac resynchronization therapy (CRT) first implants performed in HCM patients at the Karolinska University Hospital from 2005 to 2016 were extracted from the Swedish Pacemaker and ICD Registry. Echocardiographic data were obtained by review of hospital recordings. The number of first pacemaker implants in HCM patients was 70 (1.5% of total pacemaker implants). The mean age of HCM pacemaker patients was 71?±?10?years. Pacemaker implants were almost uniformly distributed between genders. Dual-chamber pacemakers with or without CRT properties were prevalent (6 and 93%, respectively). The number of first ICD implants in HCM patients was 99 (5.1% of total ICD implants). HCM patients receiving an ICD were 53?±?15?years and prevalently men (70%). Sixty-five (66%) patients were implanted for primary prevention. Dual-chamber ICDs with or without CRT were 21 and 65%, respectively. Obstructive HCM was present in 47% pacemaker patients and 25% ICD patients with available pre-implant echo. This retrospective registry-based study provides a picture of CIED first implants in HCM patients in a Swedish tertiary university hospital. ICDs were the most commonly implanted devices, covering 59% of CIED implants. HCM patients receiving a pacemaker or an ICD had different epidemiological and clinical profiles.
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Clinical Implication of Echocardiographic-Based Right Ventriculo-arterial Coupling in Cardiac Resynchronization Referred Patients.
J Cardiovasc Imaging -
Echocardiographic Assessment of Right Ventriculo-arterial Coupling: Clinical Correlates and Prognostic Impact in Heart Failure Patients Undergoing Cardiac Resynchronization Therapy.
J Cardiovasc Imaging2020 Jan;():. doi: 10.4250/jcvi.2019.0094.
Bragança Bruno, Trępa Maria, Santos Raquel, Silveira Inęs, Fontes-Oliveira Marta, Sousa Maria Joăo, Reis Hipólito, Torres Severo, Santos Mário,
Abstract
BACKGROUND:
Right ventriculo-arterial coupling (RV-PA) can be estimated by echocardiography using the ratio between tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP) and it has prognostic value in the general heart failure (HF) population. We aimed to study the clinical correlates and prognostic value of RV-PA in HF patients undergoing cardiac resynchronization therapy (CRT).
METHODS:
We retrospectively studied 70 HF patients undergoing CRT implantation.
RESULTS:
RV-PA coupling was estimated by TAPSE/PASP ratio using baseline echocardiography. Non-response to CRT was defined as improvement of left ventricular ejection fraction < 5% in a follow-up echo 6-12 months after CRT. Those with lower TAPSE/PASP ratios (worse RV-PA coupling) had higher NT-proBNP concentrations and increased E/e' ratio. TAPSE/PASP ratio and PASP, but not TAPSE, predicted nonresponse to CRT with TAPSE/PASP ratio showing the best discriminative ability with a sensitivity of 76% and specificity of 71%. Among these parameters, PASP independently predicted all-cause mortality.
CONCLUSIONS:
RV-PA coupling estimated by TAPSE/PASP ratio was associated with established prognostic markers in HF. It numerically outperformed PASP and TAPSE in predicting the response to CRT. Our data suggest that this simple and widely available echocardiographic parameter conveys significant pathophysiological and prognostic meaning in HF patients undergoing CRT.
Copyright © 2020 Korean Society of Echocardiography.
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[The Pacemaker and Implantable Cardioverter-Defibrillator Registry of the Italian Association of Arrhythmology and Cardiac Pacing - Annual report 2018].
G Ital Cardiol (Rome)2020 Feb;21(2):157-169. doi: 10.1714/3300.32710.
Proclemer Alessandro, Zecchin Massimo, D'Onofrio Antonio, Boriani Giuseppe, Ricci Renato Pietro, Rebellato Luca, Ghidina Marco, Bianco Giulia, Bernardelli Emanuela, Miconi Antonella, Zorzin Anna Fantasia, Gregori Dario,
Abstract
BACKGROUND:
The pacemaker (PM) and implantable cardioverter-defibrillator (ICD) Registry of the Italian Association of Arrhythmology and Cardiac Pacing (AIAC) monitors the main epidemiological data in real-world practice. The survey for the 2018 activity collects information about demographics, clinical characteristics, main indications for PM/ICD therapy and device types from the Italian collaborating centers.
METHODS:
The Registry collects prospectively national PM and ICD implantation activity on the basis of European cards.
RESULTS:
PM Registry: data about 23 912 PM implantations were collected (20 084 first implants and 3828 replacements). The number of collaborating centers was 180. Median age of treated patients was 81 years (75 quartile I; 86 quartile III). ECG indications included atrioventricular conduction disorders in 34.5% of first PM implants, sick sinus syndrome in 18.3%, atrial fibrillation plus bradycardia in 13.0%, other in 34.2%. Among atrioventricular conduction defects, third-degree atrioventricular block was the most common type (19.2% of first implants). Use of single-chamber PMs was reported in 24.9% of first implants, of dual-chamber PMs in 67.6%, of PMs with cardiac resynchronization therapy (CRT) in 1.6%, and of single lead atrial-synchronized ventricular stimulation (VDD/R PMs) in 5.9%. ICD Registry: data about 18 353 ICD implantations were collected (13 944 first implants and 4359 replacements). The number of collaborating centers was 433. Median age of treated patients was 71 years (63 quartile I; 78 quartile III). Primary prevention indication was reported in 84.3% of first implants, secondary prevention in 15.7% (cardiac arrest in 5.3%). A single-chamber ICD was used in 27.9% of first implants, dual-chamber ICD in 31.9% and biventricular ICD in 40.2%.
CONCLUSIONS:
The PM and ICD Registry appears fundamental for monitoring PM and ICD utilization on a large national scale with rigorous examination of demographics and clinical indications. The PM Registry showed stable electrocardiographic and symptom indications, with an important prevalence of dual-chamber pacing. The use of CRT-PM regards a very limited number of patients. The ICD Registry documented a large use of prophylactic and biventricular ICD, reflecting a favorable adherence to trials and guidelines in clinical practice. In order to increase and optimize the cooperation of Italian implanting centers, online data entry (http://www.aiac.it/riprid) should be adopted at large scale.
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Phase analysis of gated myocardial perfusion SPECT and cardiac resynchronization therapy: The good, the bad, and the ugly.
J Nucl Cardiol2020 Feb;():. doi: 10.1007/s12350-020-02056-w.
de Souza Filho Erito Marques, Mesquita Claudio Tinoco,
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Causes of impaired biventricular pacing in cardiac resynchronization devices with left ventricular sensing.
Pacing Clin Electrophysiol2020 Feb;():. doi: 10.1111/pace.13883.
Haeberlin Andreas, Ploux Sylvain, Noel Antoine, Chauvel Rémi, Welte Nicolas, Marchand Hugo, Haďssaguerre Michel, Ritter Philippe, Eschalier Romain, Bordachar Pierre,
Abstract
BACKGROUND:
Loss of biventricular stimulation can result in nonresponse to cardiac resynchronization therapy (CRT). Problems associated with the left ventricular (LV) lead and LV sensing can be challenging to detect and their incidence is unclear. The purpose of this study was to investigate mechanisms of loss of biventricular pacing due to LV lead- and LV sensing-associated problems.
METHODS:
In this bicentric study, CRT patients were surveilled using a novel remote monitoring algorithm from Biotronik (Germany) that registers LV electrograms (EGMs) during intermittent loss of resynchronization. The episodes were analyzed to assess the mechanisms of resynchronization interruptions.
RESULTS:
We analyzed 582 EGMs from 61 patients. During a median follow-up of 6 months, 59% of the patients had such episodes. The majority of the episodes (61%) were related to inappropriate inhibition of LV pacing, mostly due to upper rate lock-in caused by LV sensing (58%). In contrast, 8% of episodes showed intermittent loss of LV capture, which was identified thanks to LV sensing. The remaining 31% of episodes were due to physiological reasons for resynchronization interruptions (eg, supraventricular tachycardia [18%], premature beats [8%], and others [5%]). Patients with CRT interruption episodes had lower resynchronization rates (median: 98.5% vs 100%, P = .044).
CONCLUSIONS:
Inadequate programming (active LV sensing with T-wave protection) is the main cause of impaired resynchronization in devices with LV sensing. In general, we recommend the deactivation of the LV T-wave protection function.
© 2020 Wiley Periodicals, Inc.
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Ischemic and non-ischemic patterns of late gadolinium enhancement in heart failure with reduced ejection fraction.
Cardiol J2020 Feb;():. doi: 10.5603/CJ.a2020.0009.
Matusik Patrycja S, Bryll Amira, Matusik Pawe? T, Popiela Tadeusz J,
Abstract
BACKGROUND:
Late gadolinium enhancement (LGE) by cardiac magnetic resonance (CMR) may reveal myocardial fibrosis which is associated with adverse clinical outcomes in patients undergoing implantable cardioverter-defibrillator (ICD) placement. At the same time, transmural LGE in the posterolateral wall is related to nonresponse to conventional cardiac resynchronization therapy (CRT). Herein, the aim was to assess the presence and determinants of LGE in CMR in heart failure (HF) with reduced ejection fraction.
METHODS:
67 patients were included (17.9% female, aged 45 [29-60] years), who underwent LGE-CMR and had left ventricular ejection fraction (LVEF) as determined by echocardiography.
RESULTS:
In HF patients with LVEF ? 35% (n = 29), ischemic and non-ischemic patterns of LGE were observed in 51.7% and 34.5% of patients, respectively. In controls (n = 38), these patterns were noted in 23.7% and 42.1% of patients, respectively. HF patients with LVEF ? 35% and transmural LGE in the posterolateral wall (31.0%) were characterized by older age, coronary artery disease (CAD) and previous myocardial infarction (MI) (61 ± 6 vs. 49 ± 16 years, p = 0.008, 100% vs. 40%, p = 0.003 and 78% vs. 25%, p = 0.014, respectively). In patients with LVEF ? 35%, LGE of any type, diagnosed in 86.2% of patients, was associated with CAD (68% vs. 0%, p = 0.02), while only trends were observed for its association with older age and previous MI (p = 0.08 and p = 0.12, respectively).
CONCLUSIONS:
Among HF patients with LVEF ? 35%, clinical factors including older age, CAD, and previous MI are associated with transmural LGE in the posterolateral wall, while CAD is associated with LGE. This data may have potential implications for planning ICD and CRT placement procedures.
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Therapies for Advanced Heart Failure Patients Ineligible for Heart Transplantation: Beyond Pharmacotherapy.
Can J Cardiol2020 Feb;36(2):234-243. doi: S0828-282X(19)31437-0.
Huitema Ashlay A, Harkness Karen, Malik Shiraz, Suskin Neville, McKelvie Robert S,
Abstract
Globally, there are ? 26 million people living with heart failure (HF), 50% of them with reduced ejection fraction, costing countries billions of dollars each year. Improvements in treatment of cardiovascular diseases, including advanced HF, have allowed an unprecedented number of patients to survive into old age. Despite these advances, patients with HF deteriorate and often require advanced therapies. As the proportion of elderly patients in the population increases, there will be an increasing number of patients to be evaluated for advanced therapies and an increasing number that do not qualify for, won't be considered for, or decline orthotopic heart transplantation. The purpose of this article is to review the benefits of palliative care (PC), exercise-based cardiac rehabilitation (ExCR), device therapy (cardiac resynchronization therapy and mitral clip), and mechanical circulatory support (MCS) in advanced HF patients who are transplant ineligible. PC interventions should be introduced early in the course of a patient's diagnosis to manage symptoms, address goals of care, and improve patient-centered outcomes. Further improvement in health-related quality of life as well as functional capacity can be achieved safely in patients with advanced HF through patient participation in ExCR. Device therapy and MCS can reduce HF hospitalizations and improve survival. In fact, early survival with MCS approaches that of heart transplantation. Despite their being transplant ineligible, there are a variety of treatment options available to patients to improve their quality of life, decrease hospitalizations, and potentially improve mortality.
Copyright © 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
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Association of Implantable Device Measured Physical Activity With Hospitalization for Heart Failure.
JACC Heart Fail2020 Feb;():. doi: S2213-1779(19)30853-4.
Kelly Jacob P, Ballew Nicholas G, Lin Li, Hammill Bradley G, Stivland Timothy M, Jones Paul W, Curtis Lesley H, Hernandez Adrian F, Greiner Melissa A, Atwater Brett D,
Abstract
OBJECTIVES:
Evaluate the association of physical activity (PA) level and longitudinal PA trajectory with a composite heart failure hospitalization and mortality endpoint over a 5-year follow-up period following implantation.
BACKGROUND:
Low device measured PA early after implantation of an implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy defibrillator (CRT-D) is associated with poor outcomes.
METHODS:
We linked daily PA data from the Boston Scientific ALTITUDE dataset of patients with ICD or CRT-D implantation to Medicare claims data. We used a joint model to investigate the association of the composite endpoint with 1) the time-varying point estimate of PA and 2) the time-varying trajectory/slope of PA during follow-up.
RESULTS:
Among 20,927 patients with median activity level 85 min/day, 14.1% and 49.6% experienced the composite endpoint at 1 and 5 years. Adjusted joint model results showed that there was a 1.13 (95% confidence interval: 1.12 to 1.13)-fold increase in the hazard of the composite endpoint for 75 min of daily PA relative to 85 min of PA; and a within-patient 10-min decrease in average daily PA over an 8-week period from 85 to 75 min was associated with a hazard ratio of 4.02 (95% confidence interval: 3.82 to 4.22) for the composite endpoint.
CONCLUSIONS:
Patients with large decreases in PA have significantly higher risk of experiencing heart failure hospitalization or death. PA data from implantable devices may identify patients before clinical decompensation.
Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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Synchronized Biventricular Heart Pacing in a Closed-chest Porcine Model based on Wirelessly Powered Leadless Pacemakers.
Sci Rep2020 Feb;10(1):2067. doi: 10.1038/s41598-020-59017-z.
Lyu Hongming, John Mathews, Burkland David, Greet Brian, Post Allison, Babakhani Aydin, Razavi Mehdi,
Abstract
About 30% of patients with impaired cardiac function have ventricular dyssynchrony and seek cardiac resynchronization therapy (CRT). In this study, we demonstrate synchronized biventricular (BiV) pacing in a leadless fashion by implementing miniaturized and wirelessly powered pacemakers. With their flexible form factors, two pacemakers were implanted epicardially on the right and left ventricles of a porcine model and were inductively powered at 13.56?MHz and 40.68?MHz industrial, scientific, and medical (ISM) bands, respectively. The power consumption of these pacemakers is reduced to µW-level by a novel integrated circuit design, which considerably extends the maximum operating distance. Leadless BiV pacing is demonstrated for the first time in both open-chest and closed-chest porcine settings. The clinical outcomes associated with different interventricular delays are verified through electrophysiologic and hemodynamic responses. The closed-chest pacing only requires the external source power of 0.3?W and 0.8?W at 13.56?MHz and 40.68?MHz, respectively, which leads to specific absorption rates (SARs) 2-3 orders of magnitude lower than the safety regulation limit. This work serves as a basis for future wirelessly powered leadless pacemakers that address various cardiac resynchronization challenges.
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Modeling defibrillation benefit for survival among cardiac resynchronization therapy defibrillator recipients.
Am Heart J2019 Dec;222():93-104. doi: S0002-8703(19)30360-6.
Bilchick Kenneth C, Wang Yongfei, Curtis Jeptha P, Cheng Alan, Dharmarajan Kumar, Shadman Ramin, Dardas Todd F, Anand Inder, Lund Lars H, Dahlström Ulf, Sartipy Ulrik, Maggioni Aldo, O'Connor Christopher, Levy Wayne C,
Abstract
BACKGROUND:
Patients with heart failure having a low expected probability of arrhythmic death may not benefit from implantable cardioverter defibrillators (ICDs).
OBJECTIVE:
The objective was to validate models to identify cardiac resynchronization therapy (CRT) candidates who may not require CRT devices with ICD functionality.
METHODS:
Heart failure (HF) patients with CRT-Ds and non-CRT ICDs from the National Cardiovascular Data Registry and others with no device from 3 separate registries and 3 heart failure trials were analyzed using multivariable Cox proportional hazards regression for survival with the Seattle Heart Failure Model (SHFM; estimates overall mortality) and the Seattle Proportional Risk Model (SPRM; estimates proportional risk of arrhythmic death).
RESULTS:
Among 60,185 patients (age 68.6?±?11.3 years, 31.9% female) meeting CRT-D criteria, 38,348 had CRT-Ds, 11,389 had non-CRT ICDs, and 10,448 had no device. CRT-D patients had a prominent adjusted survival benefit (HR 0.52, 95% CI 0.50-0.55, P?median had substantially more ICD-attributable benefit (absolute risk reduction of 2.6%/year combined; P?
CONCLUSIONS:
The SPRM and SHFM identified a quarter of real-world, primary prevention CRT-D patients with minimal benefit from ICD functionality. Further studies to evaluate CRT pacemakers in these low-risk CRT candidates are indicated.
Copyright © 2019 Elsevier Inc. All rights reserved.
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Acute redistribution of regional left ventricular work by cardiac resynchronization therapy determines long-term remodelling.
Eur Heart J Cardiovasc Imaging2020 Feb;():. doi: jeaa003.
Duchenne Jürgen, Aalen John M, Cvijic Marta, Larsen Camilla K, Galli Elena, Bézy Stéphanie, Beela Ahmed S, Ünlü Serkan, Pagourelias Efstathios D, Winter Stefan, Hopp Einar, Kongsgĺrd Erik, Donal Erwan, Fehske Wolfgang, Smiseth Otto A, Voigt Jens-Uwe,
Abstract
AIMS:
Investigating the acute impact of cardiac resynchronization therapy (CRT) on regional myocardial work distribution in the left ventricle (LV) and to which extent it is related to long-term reverse remodelling.
METHODS AND RESULTS:
One hundred and thirty heart failure patients, referred for CRT implantation, were recruited in our prospective multicentre study. Regional myocardial work was calculated from non-invasive segmental stress-strain loop area before and immediately after CRT. The magnitude of volumetric reverse remodelling was determined from the change in LV end-systolic volume, 11?±?2?months after implantation. CRT caused acute redistribution of myocardial work across the LV, with an increase in septal work, and decrease in LV lateral wall work (all P?
CONCLUSION:
The acute redistribution of regional myocardial work between the septal and lateral wall of the LV is an important determinant of reverse remodelling after CRT implantation. Our data suggest that the treatment of the loading imbalance should, therefore, be the main aim of CRT.
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.
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Early experience of Sacubitril-Valsartan in heart failure with reduced ejection fraction in real-world clinical setting.
ESC Heart Fail2020 Feb;():. doi: 10.1002/ehf2.12644.
Nordberg Backelin Charlotte, Fu Michael, Ljungman Charlotta,
Abstract
AIMS:
Sacubitril/Valsartan (Sac/Val) was proven more effective than enalapril for symptomatic patients with heart failure (HF) with reduced ejection fraction (HFrEF). This study aimed to investigate eligibility, titration, and tolerability for Sac/Val in a real-world clinical setting.
METHODS AND RESULTS:
This retrospective cohort study consists of two parts. In Part 1 (eligibility study), all patients discharged from Sahlgrenska University Hospital due to HF were consecutively included during 1 year. Data from the patients' medical records were collected. Patients were adjudicated to be eligible based on European Society of Cardiology (ESC) criteria for angiotensin receptor neprilysin inhibitor (ARNI) with the exception of N-terminal (NT)-proBNP levels. Patients who received <50% of target dose angiotensin-converting enzyme/angiotensin receptor blocker and otherwise fulfilled ESC criteria were adjudicated to be potentially eligible. In Part 2 (tolerability study), all patients receiving Sac/Val during the same period were included. Medical data regarding dose, titration, and adverse effects and events were registered. A total of 1355 patients (mean age 78 ± 13 years) were hospitalized for HF and 619 patients had an EF ?40%. Twenty percent were eligible for initiation of ARNI, and additionally 8% were potentially eligible. In all 95 patients (mean age 65 ± 12 years) were initiated with Sac/Val, which correlates to 13%. The patients who were initiated were younger (65 years), more often had dilated cardiomyopathy (31%), more often were on guideline-directed medical therapy, and had a higher frequency of cardiac resynchronization therapy and implantable cardioverter-defibrillator compared with the patients who did not receive Sac/Val. Of the initiated patients, 59% reached target dose of Sac/Val, and 15% discontinued due to adverse effects. The most common cause of discontinuation was benign gastrointestinal adverse effects, followed by elevated creatinine, malaise, and vertigo. Female gender [odds ratio (OR) 3.58; 95% CI 1.07-2.00; P = 0.038] and NT-proBNP ? median level (OR 0.48; 95% CI 0.26-0.90; P = 0.021) was associated with termination of the medication.
CONCLUSIONS:
Among HFrEF patients in this real-world cohort, 20% were eligible for ARNI; however, only 13% received the treatment. Sac/Val was well tolerated, but 41% of the patients did not reach target dose. How this affects outcome is not known and needs further investigation.
© 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.
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Relationship of soluble ST2 to pulmonary hypertension severity in patients undergoing cardiac resynchronization therapy.
J Thorac Dis2019 Dec;11(12):5362-5371. doi: 10.21037/jtd.2019.11.66.
Beaudoin Jonathan, Szymonifka Jackie, Lavender Zachary, Deańo Roderick C, Zhou Qing, Januzzi James L, Singh Jagmeet P, Truong Quynh A,
Abstract
Background:
Pulmonary hypertension (PH) is an adverse prognostic marker in patients undergoing cardiac resynchronization therapy (CRT). We sought to determine the relation of biomarkers of fibrosis [soluble ST2 (sST2), galectin-3], wall stretch [amino terminal pro-brain natriuretic peptide (NT-proBNP)], and necrosis [high-sensitivity troponin-I (hsTnI)] to PH severity in CRT patients.
Methods:
Biomarkers and right ventricular systolic pressure (RVSP) were measured at CRT implant and 6-month later (n=111). PH was categorized into 3 groups based on RVSP: no (<35 mmHg), mild-moderate (35-60 mmHg), and severe (>60 mmHg). Patients were categorized as progressors (worsened PH), persistent PH (no change) and regressors (improved PH). Endpoints were 6-month CRT response and 2-year major adverse cardiac event (MACE).
Results:
RVSP was associated with CRT nonresponse (P=0.02) and MACE (P=0.03). Severe PH patients had 5-fold increase risk for CRT nonresponse (OR 5.0, P=0.04) and MACE (HR 5.7, P=0.04) over non-PH patients. Progressors and persistent PH patients had >2-fold odds for CRT non-response (OR 2.8, P=0.45) and >11-fold increase in MACE compared to no PH patients or regressors (HR 11.6, P=0.02). Only NT-proBNP and sST2 were discernable between PH groups, with graded increase based on PH severity (both P?0.02), and lower values in regressors versus non-regressors (both P?0.01). Levels of sST2 decreased at 6 months in regressors (15 ng/mL, P=0.03) and increased slightly (3-8 ng/mL) in non-regressors, without difference for NT-proBNP (P=0.08).
Conclusions:
sST2 levels are related with PH severity in CRT patients. Serial sST2 changes after CRT implant suggests potential role to monitor PH after CRT.
2019 Journal of Thoracic Disease. All rights reserved.
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Correction to: CRT Survey II: a European Society of Cardiology (ESC) survey of cardiac resynchronization therapy-an Irish subset analysis.
Ir J Med Sci2020 Feb;():. doi: 10.1007/s11845-020-02193-8.
Ranganathan Deepti, Sharif Zain, Murphy Theodore, Mahon Nial, Sheahan Conor R, Normand Camilla, Linde Cecilia, Dickstein Kenneth, Sheahan Ricky,
Abstract
In the original version of this article, the author list contained a number of errors, namely a missing author name, and author names that had been merged incorrectly.
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Left ventricular response after cardiac resynchronization therapy is related to early left atrial volume reduction.
Korean J Intern Med2020 Feb;():. doi: 10.3904/kjim.2018.430.
Cho In-Jeong, Uhm Jae-Sun, Oh Jaewon, Nam Jong-Ho, Yu Hee Tae, Kim Taehoon, Joung Boyoung, Kang Seok-Min,
Abstract
Background/Aims:
The current study aimed to elucidate a time-course change in left atrial volume after cardiac resynchronization therapy (CRT) and to verify factors associated with left atrial volume reduction (LAVR) and its prognostic implications.
Methods:
The records of 97 patients were retrospectively reviewed after CRT. Echocardiographic data were analyzed at baseline before CRT, at early follow-up (FU) (? 1 year, median 6 months), and at late FU (median 30 months). Left ventricular volume response (LVVR) was defined as 15% reduction in left ventricular (LV) end-systolic volume (ESV). LAVR was classified into two groups by the median value at early FU: LAVR (? 7.5%) and no LAVR (< 7.5%).
Results:
LV ESV index continuously decreased from baseline to early FU and from early FU to late FU (106.1 ± 47.4 mL/m2 vs. 87.6 ± 51.6 mL/m2 vs. 72.5 ± 57.1 mL/m2). LA volume index decreased from baseline to early FU, but there were no reductions thereafter (51.8 ± 21.9 mL/m2 vs. 45.1 ± 19.6 mL/m2 vs. 44.9 ± 23.0 mL/m2). The only echocardiographic factor associated with LAVR was change in E velocity (odds ratio [OR], 1.04; p = 0.002). Early LAVR (OR, 10.05; p = 0.002) was an independent predictor for late LVVR.
Conclusions:
LAVR was related to reduction in E velocity, suggesting its relation with optimization of LV filling pressure. Early LAVR was a predictor for LVVR to CRT in long-term FU.
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Real-world behavior of CRT pacing using the AdaptivCRT algorithm on patient outcomes: effect on mortality and atrial fibrillation incidence.
J Cardiovasc Electrophysiol2020 Feb;():. doi: 10.1111/jce.14376.
Singh Jagmeet P, Cha Yong-Mei, Lunati Maurizio, Chung Eugene, Li Shelby, Smeets Pascal, O'Donnell David,
Abstract
BACKGROUND:
The AdaptivCRT (aCRT) algorithm continuously adjusts CRT according to intrinsic AV conduction, providing synchronized left-ventricular pacing in patients with normal PR interval and adaptive BiV pacing in patients with prolonged PR interval. Previous analyses demonstrated an association between aCRT and clinical benefit. We evaluated the incidence of patient mortality and AF with aCRT compared with standard CRT in a real-world population.
METHODS AND RESULTS:
Patients enrolled in the Medtronic Personalized CRT Registry and implanted with a CRT from 2013-2018 were divided into aCRT ON or standard CRT groups based upon device stored data. A frailty survival model was used to evaluate the potential survival benefit of aCRT, accounting for patient heterogeneity and center variability. Daily AF burden and first device detected AF episodes of various durations were recorded by the device during follow-up. A total of 1814 CRT patients with no reported long-standing AF history at implant were included. Mean follow-up time was 26.1±16.5 months and 1162 patients (64.1%) had aCRT ON. Patient survival probability at 36 months was 88.3% for aCRT ON and 83.7% for standard CRT (covariate-adjusted HR=0.71, 95% CI: 0.53-0.96, P=0.028). Mean AF burden during follow-up was consistently lower in aCRT ON patients compared to standard CRT. At 36 months, the probability of AF was lower in patients with aCRT ON, regardless of which AF definition threshold was applied (6 min-30 days, all P<0.001).
CONCLUSION:
Use of the AdaptivCRT algorithm was associated with improved patient survival and lower incidence of AF in a real-world, prospective, non-randomized registry. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
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Design and rationale of the Impact of MultiPoint pacing in CRT patients with reduced RV-to-LV delay (IMAGE-CRT) study.
J Cardiovasc Med (Hagerstown)2020 Mar;21(3):250-258. doi: 10.2459/JCM.0000000000000928.
Solimene Francesco, Nigro Gerardo, Canciello Michelangelo, Tavoletta Vincenzo, Shopova Gergana, Calvanese Raimondo, Rago Anna, La Rosa Concetto, Nappi Felice, Viscusi Miguel, Urraro Francesco, Manzo Gianluca, Gallo Paolo, Andriani Andrea, Rovaris Giovanni, Palmisano Pietro, Innocenti Sara, D'Onofrio Antonio,
Abstract
BACKGROUND:
Cardiac resynchronization therapy (CRT) is an established treatment in patients with heart failure and prolonged QRS duration. A biventricular device is implanted to achieve faster activation and more synchronous contraction of the ventricles. Despite the convincing effect of CRT, 30-40% of patients do not respond. We decided to investigate the role of multipoint pacing (MPP) in a selected group of patients with right ventricle (RV)-to-left ventricle (LV) intervals less than 80?ms that do not respond to traditional CRT.
METHODS:
We will enrol 248 patients in this patient-blinded, observational, clinical study aiming to investigate if MPP could decrease LV end-systolic volume (ESV) in patients with RV-to-LV interval less than 80?ms. MPP will be activated ON at implant in patients with RV-to-LV delay less than 80?ms and OFF in RV-to-LV at least 80?ms. At follow-up the activation of MPP will be related to CRT response. The primary study endpoint will be the responder rate at 6 months, defined as a decrease in LV ejection fraction, LV end-diastolic volume, LV end-systolic volume (LVESV) at least 15% from baseline. Secondary outcomes include 12 months relative percentage reduction in LVESV and a combined clinical outcome measure of response to CRT defined as the patient being alive, no hospitalization due to heart failure, and experiencing an improvement in New York Heart Association functional class (Composite-Score).
CONCLUSION:
Reducing the nonresponder rate continues to be an important goal for CRT.If an increase in reverse remodelling can be achieved by MPP, this study supports the conduct of larger trials investigating the role of MPP on clinical outcomes in selected patients treated, right now, only with traditional CRT.
TRIAL REGISTRATION:
ClinicalTrials.gov, NCT02713308. Registered on 18 March 2016.
Guarda su PubMed
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Cardiac resynchronization therapy as mechanical treatment: a triphasic response?
Eur Heart J Cardiovasc Imaging
