scholarly journals 073_16781-K3 NYHA Functional Class or Left Ventricle Ejection Fraction: Who Should we Rely on to Predict Mortality in Cardiac Resynchronization Therapy?

2017 ◽  
Vol 3 (10) ◽  
pp. S21
Author(s):  
R. Baggen Santos ◽  
R. Baggen Santos ◽  
M. Trepa ◽  
I. Silveira ◽  
M.J. Sousa ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Ejection Fraction ◽  
Cardiac Resynchronization Therapy ◽  
Functional Class ◽  
Left Ventricle Ejection Fraction ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Nyha Functional Class

Abstract 12722: Cardiac Resynchronization Therapy in Pacing Induced Cardiomyopathy: A Higher Right Ventricle Pacing Percentage Predicts Greater Improvement in Left Ventricle Ejection Fraction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Sean Lacy ◽  
Jonathan Chandler ◽  
NACHIKET MADHAV APTE ◽  
Seth Sheldon ◽  
Madhu Reddy ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Ejection Fraction ◽  
Cardiac Resynchronization Therapy ◽  
Left Ventricular ◽  
Left Ventricle Ejection Fraction ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Qrs Duration ◽  
Rv Pacing ◽  
The Impact

Introduction: Cardiac resynchronization therapy (CRT) upgrade is indicated for improvement of cardiac function in patients with chronic right ventricular (RV) pacing burden >40% and heart failure with reduced ejection fraction. It is uncertain whether the CRT response is different among patients with high (≥90%) versus intermediate (<90%) burden of baseline RV pacing. Hypothesis: To assess the impact of baseline RV pacing percent on ECG and echocardiographic response after CRT upgrade for pacing induced cardiomyopathy. Methods: We conducted a retrospective study of all CRT upgrades for pacing induced cardiomyopathy at our hospital from January 2017 to December 2018. Cohorts were grouped by RV pacing burden ≥90% or <90%. QRS duration, left ventricle ejection fraction (LVEF), and left ventricular internal dimension systolic (LVIDs) were assessed at baseline and 3-12 months post CRT upgrade. Results: We included 82 patients (age 74 ± 12 yr., 71% male) who underwent CRT upgrade for pacing induced cardiomyopathy. The RV pacing burden was ≥90% [median 99% (IQR 98-99%)] in 61 patients, and <90% [median 79% (IQR 69-88%)] in 21 patients. There was a trend towards greater reduction in QRS duration in the ≥90% RV pacing group (28 ± 29 ms vs. 22 ± 38 ms, p=0.5). Improvement in LVEF was greater in ≥90% vs. <90% RV pacing group (14.3 ± 10.1% vs. 6.3 ± 10.1%, p=0.003). The association persisted on multivariable adjustment for age, sex and baseline LVEF (p=0.004). There was a trend towards greater % reduction in LVIDs in the ≥90% vs. <90% RV pacing group (6.4 ± 15.5 % vs. 3.9 ± 14.3 %, p=0.5) [Figure]. Conclusions: A higher baseline RV pacing burden predicts a greater improvement in LVEF after CRT upgrade for pacing induced cardiomyopathy.

Abstract 1608: Posterior Shift of the Anterior Papillary Muscle is a Determinant of Improvement after Cardiac Resynchronization Therapy

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Tetsuya Hara ◽  
Kohei Yamashiro ◽  
Katsunori Okajima ◽  
Teishi Kajiya
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Brain Natriuretic Peptide ◽  
Papillary Muscle ◽  
Left Ventricular ◽  
Functional Class ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Nyha Functional Class ◽  
Anterior Papillary Muscle ◽  
Posterior Shift

Background : Cardiac resynchronization therapy (CRT) can improve heart failure symptoms and decrease mitral regurgitation (MR). Improved coordinated timing of mechanical activation of papillary muscle was reported to be a contributor to reduction of MR after CRT. Purpose : We tested the hypothesis that the anatomical location of anterior papillary muscle (A-PM) affects improvement of MR and other parameters after CRT. Methods : Twenty-three patients (age 69.8 ± 8.2 years, left ventricular ejection fraction (LVEF) 29.4 ± 6.9%, 16 male, 20 non-ischemic dilated cardiomyopathy, 3 previous myocardial infarcion) underwent both CRT and multi-detector computed tomography (MDCT) were studied. We measured the angle between the anterior edge of the left ventricular free wall and A-PM (Ang. PM) in cross sectional images of left ventricle obtained by MDCT. Patients were divided into 2 groups; 13 patients with severe A-PM displacement (Ang.PM >100 degree) and 10 patients with Ang.PM <100 degree. In both groups, parameters obtained by echocardiography, NYHA functional class, and brain natriuretic peptide before and 6 months after CRT were analyzed. Results : Mean Ang.PM was 106 ± 12.2 degree. LVEF and NYHA functional class were significantly improved after 6 months of CRT in both groups (p < 0.05, respectively). However, significant decreases of the proportion of grade 2– 4 MR, left ventricular end-systolic and end-diastolic dimensions, and brain natriuretic peptide level after 6 months of CRT were observed only in patients with severe A-PM dislocation (p = 0.02, p = 0.04, p = 0.03 respectively). Conclusion : Posterior shift of A-PM may have a potential to predict improvement after CRT.

Cathodic-anodal left ventricular stimulation during cardiac resynchronization therapy: haemodynamic evaluation and electrocardiographic analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Gravellone ◽  
G Dell' Era ◽  
F De Vecchi ◽  
E Boggio ◽  
E Prenna ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Arterial Pressure ◽  
Cardiac Resynchronization Therapy ◽  
Right Ventricle ◽  
Single Point ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Biventricular Stimulation ◽  
Qrs Duration

Abstract Background Cardiac resynchronization therapy (CRT) is an established treatment for heart failure with reduced ejection fraction (HFrEF). However, one third of patients are “non responders”. Cathodic-anodal (CA) left ventricle (LV) capture is a multisite pacing occurring during CRT using both bipolar and quadripolar LV lead. It allows depolarization to arise simultaneously from the cathode and the anode of the bipole located on the LV epicardium, activating a larger volume of myocardium than cathodal pacing alone, thus potentially improving electromechanical synchrony (figure 1). We have previously proven that CA-LV stimulation is feasible and similar to bicathodic multipoint pacing (MPP) in terms of QRS wavefront activation. Purpose We aimed to evaluate both the acute intraprocedural haemodynamic and electrical effects of CA biventricular stimulation (CA-BS), comparing it with right-ventricle only pacing (Right Ventricle-Stimulation: RV-S), single-point CRT (Single Point-Biventricular Stimulation: SP-BS) and multipoint bicathodic biventricular stimulation (Multi Point-Biventricular Stimulation:MP-BS) in de novo CRT implants. Methods Ten patients candidates to CRT (LV ejection fraction ≤35% and left bundle branch block) received a quadripolar LV lead. Four pacing configurations were tested: RV-S, SP-BS, MP-BS and CA-BS, where cathode and the anode were the same electrodes used as cathodes in MP-BS. QRS duration by 12-lead ECG was defined as the time from the earliest ventricular deflection until the return to the isoelectric line. Haemodynamic assessment by radial artery catheterization using Pressure Recording Analytical Method processed the following parameters: dP/dT max (mmHg/msec), systolic arterial pressure (aPsys, mmHg), diastolic arterial pressure (aPdia, mmHg), mean arterial pressure (aPmean, mmHg), Cardiac Index (CI, l/min/m2), Stroke Volume Index (SVI, ml/min/m2). Results dP/dT max and aPmean increased significantly from RV-S to SP-BS (mean dP/dT max 0,82±0,28 versus 0,87±0,29 mmHg/msec, p=0,02; mean aPmean 89±19 versus 93±20 mmHg, p=0,01), but not from RV-S to MP-BS. Comparing RV-S to CA-BS, only aPmean exhibited a significant increase (mean aPmean 89±19 versus 92±20 mmHg, p=0,01). There were no haemodynamic differences between SP-BS, MP-BS and CA-BS. QRS duration reduced significantly from RV-S (167±10 msec) to each biventricular stimulation (135±14 msec, p=0,0002 for SP-BS; 130±17 msec, p=0,0001 for MP-BS; 129±18 msec, p=0,0002 for CA-BS) and from SP-BS to MP-BS and CA-BS (p=0,03 for both), whereas there were no difference comparing MP-BS and CA-BS. Conclusions CA-LV stimulation is not superior to single-point CRT in terms of acute haemodynamic performance, whereas it reduces the duration of ventricular electrical activation, showing an electrohaemodynamic mismatch. Long-term studies are needed to evaluate if acute electrical benefits of CA stimulation can predict chronic benefits, in terms of reverse cardiac remodelling. Cathodic-anodal left ventricular capture Funding Acknowledgement Type of funding source: None

NISAR-F SCORE: a simple risk stratification tool for patients implanted with cardiac resynchronization therapy

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
J Correia ◽  
L Goncalves ◽  
I Pires ◽  
J Santos ◽  
V Neto ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Cardiac Resynchronization Therapy ◽  
Cox Regression ◽  
Nyha Class ◽  
Prognostic Score ◽  
Roc Curves ◽  
Cardiac Resynchronization ◽  
Class Iii ◽  
Resynchronization Therapy

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Individualized estimation of prognosis after cardiac resynchronization therapy (CRT) remains challenging. Outcomes in this group of patients are influenced by multiple factors and a comprehensive and customized approach to estimate prognosis after CRT is lacking Aims To develop and validate a simple prognostic score for patients implanted with CRT (NISAR-F score), based on readily available clinical and echocardiographic variables to predict the combined endpoints of death or hospitalization in 24 months. Methods A single-centre retrospective study was conducted with inclusion of all consecutive patients who underwent CRT implantation between 2012 and 2019. Follow-up started after CRT implantation and ended upon death, hospitalization or 24 months after study entry. Survival analysis was performed using a multivariate Cox regression model, in order to analyze the effect on survival /hospitalization in 24 months of the following factors: age, gender, NYHA Class III-IV, ischemic heart failure, type 2 diabetes, arterial hypertension, dyslipidemia and ejection fraction &lt; 21%. According to the analysis, points were attributed to each factor. Afterwards, the NISAR-F score was calculated for each patient, summing the points of each variable. The authors finally created ROC curves for the NISAR-F score to predict the occurrence of the combined endpoint in 2 groups of patients: CRT responders (ejection fraction increase of at least 10% after CRT implantation) and CRT non-responders. The statistical analysis was performed in SPSS. Results 102 patients were included in the study (75.4% male, mean age 68 ± 10.46 years). 10(9.8%) of the patients were re-hospitalized and 8 (7.8%) died during the 24-month follow-up.  After calculating NISAR-F score for each patient, area under ROC curves were obtained. The analysis of the ROC curves allows us to confirm the good performance of the score created [responders group (AUC 0.812) vs non-responders (AUC 0.721)]. Conclusion The NISAR-F score is a useful tool to predict the combined endpoint (mortality and hospitalization in 24 months) after CRT implantation, in both responders and non-responders, revealing good performance of this new and simple score based only on clinical and echocardiographic variables.

Abstract 2711: The Modification Of Collagen Type I Turnover Is Associated With Long-term Response To Cardiac Resynchronization Therapy

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Begoña Lopez-Salazar ◽  
Alfonso Macias ◽  
Juan Jose Gavira ◽  
Javier Diez-Martinez ◽  
Ignacio Garcia-Bolao
Keyword(s):  
Ejection Fraction ◽  
Cardiac Resynchronization Therapy ◽  
Collagen Type ◽  
Collagen Type I ◽  
Cardiac Resynchronization ◽  
Type I ◽  
Resynchronization Therapy ◽  
Carboxy Terminal ◽  
Term Response

We investigated whether modification of collagen type I turnover is related to the long-term response to cardiac resynchronization therapy (CRT). Methods and Results: Serum carboxy-terminal propeptide of procollagen type I or PICP (a marker of collagen type I synthesis), carboxy-terminal telopeptide of collagen type I or CITP (a marker of collagen type I degradation), matrix metalloproteinase (MMP)-1, -2, -9 and tissue inhibitor of MMP (TIMP)-1, were measured in 54 patients (35 responders) at baseline and after 1 year of CRT. At baseline, PICP and the ratio PICP: CITP were higher (p < 0.01) in responders than in nonresponders. At 1-year, both PICP (p < 0.005) and the ratio PICP:CITP (p < 0.05) decreased in responders, while increased in nonresponders (p < 0.005 and p < 0.05, respectively). MMP-1 (p < 0.05), MMP-9 (p < 0.005), and the ratio MMP-1:TIMP-1 (p < 0.01) increased, while TIMP-1 decreased (p < 0.005) in responders, but remained unchanged in nonresponders. The ratio PICP:CITP correlated inversely with ejection fraction (r = -0.501, p < 0.01) and directly with left ventricular end-diastolic diameter (r = 0.376, p < 0.05) in responders after CRT. Direct correlations were found between MMP-1, and -9 and ejection fraction (r = 0.315, p < 0.05, r = 0.516, p < 0.01) in responders after CRT. Conclusions The ability of CRT to modify collagen type I turnover (i.e. decreasing synthesis and increasing degradation) is associated with its long-term response.

Left ventricle and mitral valve reverse remodeling in response to cardiac resynchronization therapy in nonischemic cardiomyopathy

2020 ◽  
Vol 37 (10) ◽  
pp. 1557-1565
Author(s):  
Christos G. Mihos ◽  
Evin Yucel ◽  
Gaurav A. Upadhyay ◽  
Mary P. Orencole ◽  
Jagmeet P. Singh ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Left Ventricle ◽  
Cardiac Resynchronization Therapy ◽  
Cardiac Resynchronization ◽  
Reverse Remodeling ◽  
Nonischemic Cardiomyopathy ◽  
Resynchronization Therapy
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