Daniel J Friedman1, Gaurav A Upadhyay2, Alefiyah Rajabali2, Robert K Altman3, Mary Orencole2, Kimberly A Parks4, Stephanie A Moore4, Mi Young Park5, Michael H Picard6, Jeremy N Ruskin2, Jagmeet P Singh2, E Kevin Heist7. 1. Division of Cardiology, Duke University Hospital, Durham, North Carolina. 2. Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts. 3. Al-Sabah Arrhythmia Institute, Mount Sinai St. Lukes Roosevelt Hospital, New York, New York. 4. Heart Failure and Cardiac Transplantation Unit, Massachusetts General Hospital, Boston Massachusetts. 5. Department of Cardiology, Hallym University Dongtan Sacred Hospital, Hwaseong, Republic of Korea. 6. Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Boston, Massachusetts. 7. Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: kheist@partners.org.
Abstract
BACKGROUND: Cardiac resynchronization therapy (CRT) nonresponders have poor outcomes. The significance of progressive ventricular dysfunction among nonresponders remains unclear. OBJECTIVE: We sought to define predictors of and clinical outcomes associated with progressive ventricular dysfunction despite CRT. METHODS: We conducted an analysis of 328 patients undergoing CRT with defibrillator for standard indications. On the basis of 6-month echocardiograms, we classified patients as responders (those with a ≥5% increase in ejection fraction) and progressors (those with a ≥5% decrease in ejection fraction), and all others were defined as nonprogressors. Coprimary end points were 3-year (1) heart failure, left ventricular assist device (LVAD), transplantation, or death and (2) ventricular tachycardia (VT) or ventricular fibrillation (VF). RESULTS: Multivariable predictors of progressive ventricular dysfunction were aldosterone antagonist use (hazard ratio [HR] 0.23; P = .008), prior valve surgery (HR 3.3; P = .005), and QRS duration (HR 0.98; P = .02). More favorable changes in ventricular function were associated with lower incidences of heart failure, LVAD, transplantation, or death (70% vs 54% vs 33%; P < .0001) and VT or VF (66% vs 38% vs 28%; P = .001) for progressors, nonprogressors, and responders, respectively. After multivariable adjustment, progressors remained at increased risk of heart failure, LVAD, transplantation, or death (HR 2.14; P = .0029) and VT or VF (HR 2.03; P = .046) as compared with nonprogressors. Responders were at decreased risk of heart failure, LVAD, transplantation, or death (HR 0.44; P < .0001) and VT or VF (0.51; P = .015) as compared with nonprogressors. CONCLUSION: Patients with progressive deterioration in ventricular function despite CRT represent a high-risk group of nonresponders at increased risk of worsened clinical outcomes.
BACKGROUND: Cardiac resynchronization therapy (CRT) nonresponders have poor outcomes. The significance of progressive ventricular dysfunction among nonresponders remains unclear. OBJECTIVE: We sought to define predictors of and clinical outcomes associated with progressive ventricular dysfunction despite CRT. METHODS: We conducted an analysis of 328 patients undergoing CRT with defibrillator for standard indications. On the basis of 6-month echocardiograms, we classified patients as responders (those with a ≥5% increase in ejection fraction) and progressors (those with a ≥5% decrease in ejection fraction), and all others were defined as nonprogressors. Coprimary end points were 3-year (1) heart failure, left ventricular assist device (LVAD), transplantation, or death and (2) ventricular tachycardia (VT) or ventricular fibrillation (VF). RESULTS: Multivariable predictors of progressive ventricular dysfunction were aldosterone antagonist use (hazard ratio [HR] 0.23; P = .008), prior valve surgery (HR 3.3; P = .005), and QRS duration (HR 0.98; P = .02). More favorable changes in ventricular function were associated with lower incidences of heart failure, LVAD, transplantation, or death (70% vs 54% vs 33%; P < .0001) and VT or VF (66% vs 38% vs 28%; P = .001) for progressors, nonprogressors, and responders, respectively. After multivariable adjustment, progressors remained at increased risk of heart failure, LVAD, transplantation, or death (HR 2.14; P = .0029) and VT or VF (HR 2.03; P = .046) as compared with nonprogressors. Responders were at decreased risk of heart failure, LVAD, transplantation, or death (HR 0.44; P < .0001) and VT or VF (0.51; P = .015) as compared with nonprogressors. CONCLUSION:Patients with progressive deterioration in ventricular function despite CRT represent a high-risk group of nonresponders at increased risk of worsened clinical outcomes.
Authors: C Sardu; M Santamaria; M R Rizzo; M Barbieri; M di Marino; G Paolisso; G Santulli; R Marfella Journal: Int J Clin Pract Date: 2016-06-13 Impact factor: 2.503
Authors: Szu-Yeu Hu; Enrico Santus; Alexander W Forsyth; Devvrat Malhotra; Josh Haimson; Neal A Chatterjee; Daniel B Kramer; Regina Barzilay; James A Tulsky; Charlotta Lindvall Journal: PLoS One Date: 2019-10-03 Impact factor: 3.240
Authors: Ahmed AlTurki; Pedro Y Lima; Martin L Bernier; Daniel Garcia; Alejandro Vidal; Bruno Toscani; Sergio Diaz; Mauricio Montemezzo; Alaa Al-Dossari; Tomy Hadjis; Jacqueline Joza; Vidal Essebag Journal: CJC Open Date: 2020-01-21