Prognostic significance of cardiac sympathetic innervation and contractility in heart failure patients submitted to cardiac resynchronization therapy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Mishkina ◽  
K.V Zavadovsky ◽  
V.V Saushkin ◽  
D.I Lebedev ◽  
Y.U.B Lishmanov
Keyword(s):  
Heart Failure ◽  
Sympathetic Activity ◽  
Sympathetic Innervation ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Cardiac Sympathetic Activity ◽  
Cardiac Sympathetic Innervation ◽  
Heart Failure Patients ◽  
Lv Dyssynchrony ◽  
Crt Response

Abstract Introduction In chronic heart failure patients, cardiac resynchronization therapy (CRT) does not lead to the expected result in 30% of cases. There is a lack of prognostic data related to the cardiac sympathetic activity and contractility assessment in ischemic (IHF) and non-ischemic (CHF) heart failure patients. Purpose To assess the prognostic value of radionuclide cardiac sympathetic innervation and contractility assessment in IHF and NIHF patients submitted to CRT. Methods This study included 38 HF patients (24 male; mean age of 56±11 years), who were submitted to CRT: NYHA class II/III (n=10/28), mean QRS=159.3±17.9ms. The etiology of HF was ischemic in 16 patients and non-ischemic in 22 of them. Before CRT all patients underwent 123I-metaiodobenzylguanidine (123I-MIBG) imaging for cardiac sympathetic activity evaluating. The following indexes were estimated: early and delayed heart to mediastinum ratio (eH/M and dH/M), summed MIBG Score (eSMS and dSMS). Moreover all patients underwent gated myocardial perfusion scintigraphy with the assessments of LV dyssynchrony indexes: standard deviation (SD) and histogram bandwidth (HBW). In addition, all patients underwent gated blood-pool SPECT with both ventricles ejection fraction (EF) and stroke volume (SV) assessment. Results One year after CRT all patients were divided into two groups: responders (IHF group n=11; NIHF group n=15) and non-responders (IHF group n=5; NIHF group n=7). Among baseline scintigraphic parameters the following ones showed significant differences between responders vs. non-responders. In IHF patients - HBW: 162 (115.2–180) degree vs. 115.2 (79.2–136.8) degree, p<0.05; RV_EF: 54.5 (41–56)% vs. 44.5 (37–49.5)%, p<0.05; RV_SV: 80 (69–101)ml vs. 55.5 (50–72.5)ml, p<0.05. In group of NIHF patients responders and non-responders were significantly differed in the following preoperative parameters: eH/M: 2.27 (2.02–2.41) vs. 1.64 (1.32–2.16), p<0.05; dH/M: 2.18 (2.11–2.19) vs. 1.45 (1.23–1.61), p<0.05; eSMS: 7 (5–7) vs. 15.5 (10–28.5), p<0.05; dSMS: 10 (10–13) vs. 16.5 (15.5–29), p<0.05, SD: 54.3 (43–58) degree vs. 65 (62–66) degree, p<0.05; HBW: 179.5 (140–198) degree vs. 211 (208–213) degree, p<0.05. Univariate logistic regression in IHF patients showed that LV dyssynchrony indexes – SD (OR=1.55; 95% CI 1.09–2.2; p<0.5) and HBW (OR=1.13; 95% CI 1.02–1.24; p<0.5), as well as RV indexes – RV_EF (OR=1.11; 95% CI 1.001–1.23; p<0.5), RV_SV (OR=1.07; 95% CI 1.003–1.138; p<0.5) were predictors of CRT response. In the group of NIHF patients, dH/M (OR=1.47; 95% CI 1.08–2; p<0.5), SD (OR=0.83; 95% CI 0.73–0.95; p<0.5), HBW (OR=0.96; 95% CI 0.93–0.99; p<0.5) showed the predictive value in terms of CRT response. Conclusion(s) The positive response to CRT in IHF patients showed a link with LV dyssynchrony and preserved RV contractility. Whereas in NIHF patients the functional state of cardiac sympathetic activity, as well as LV dyssynchrony, were associated with CRT response. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Russian Foundation for Basic Research

scholarly journals The prognostic significance of cardiac sympathetic activity and dyssynchrony in cardiac resynchronization therapy in ischemic and non-ischemic heart failure patients

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A Mishkina ◽  
K Zavadovsky ◽  
V Saushkin ◽  
D Lebedev ◽  
Y Lishmanov
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Sympathetic Activity ◽  
Gated Spect ◽  
Prognostic Significance ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Cardiac Sympathetic Activity ◽  
Heart Failure Patients ◽  
Crt Response

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Russian Foundation for Basic Research Introduction Impaired cardiac sympathetic activity and contractility are associated with poor prognosis in patients with heart failure after cardiac resynchronization therapy (CRT). There are few prognostic data of the cardiac sympathetic activity and dyssynchrony in patients with chronic heart failure of various etiologies. Purpose To examine the prognostic significance of scintigraphic cardiac sympathetic activity and contractility in predicting the response to CRT and to assess the differences between patients with ischemic (IHF) and non-ischemic (NIHF) heart failure. Methods This study included 38 heart failure patients (24 male; mean age of 56 ± 11 years; 16 patients with ischemic etiology), who were submitted to CRT. Before CRT all patients underwent 123I-metaiodobenzylguanidine (123I-MIBG) imaging for cardiac sympathetic activity evaluating: early and delay heart to mediastinum ratio (eH/M and dH/M), summed MIBG Score (eSMS and dSMS). Moreover all patients underwent gated SPECT with the assessments of left ventricle dyssynchrony indexes: standard deviation (SD) and histogram bandwidth (HBW). In addition, all patients underwent gated blood-pool SPECT (GBPS) to assessed ejection fraction (EF) and stroke volume (SV) of both ventricles. Results One year after CRT response defined as LV ESV decreased by≥15% and/or LV EF increase by≥5%. Baseline cardiac sympathetic activity parameters showed significant differences between responders and non-responders only in NIHF patients: eH/M: 2.27 (2.02–2.41) vs. 1.64 (1.32–2.16); dH/M: 2.18 (2.11–2.19) vs. 1.45 (1.23 – 1.61); eSMS: 7 (5-7) vs. 15.5 (10–28.5); dSMS: 10 (10–13) vs. 16.5 (15.5–29). Significant differences in baseline LV dyssynchrony indexes between responders and non-responders were in patients of both group: in NIHF patients - SD: 54.3 (43–58) degree vs. 65 (62–66) degree; HBW: 179.5 (140–198) degree vs. 211 (208-213) degree, p < 0.054 in IHF patients - HBW: 162 (115.2–180) degree vs.  115.2 (79.2–136.8) degree. Contractility of RV was significantly differed between responders and non-responders in IHF patients: RV EF: 54.5 (41-56) % vs. 44.5 (37–49.5) %; RV SV: 80 (69-101) ml vs. 55.5 (50–72.5) ml. According to univariate logistic regression analyses in IHF patients LV dyssynchrony indexes – SD (OR = 1.55; 95% CI 1.09-2.2; p < 0.5) and HBW (OR = 1.13; 95% CI 1.02-1.24; p < 0.5), as well as RV indexes – RV EF (OR = 1.11; 95% CI 1.001-1.23; p < 0.5), RV SV (OR = 1.07; 95% CI 1.003-1.138; p < 0.5) were predictors of CRT response. In the group of NIHF patients, dH/M (OR = 1.47; 95% CI 1.08-2; p < 0.5), SD (OR = 0.83; 95% CI 0.73-0.95; p < 0.5), HBW (OR = 0.96; 95% CI 0.93-0.99; p < 0.5) showed the predictive value in terms of CRT response. Conclusion  Scintigraphic methods can be used to select patients for CRT. Cardiac 123I-MIBG scintigraphy and gated SPECT may be used for predicting CRT response in NIHF patients. Whereas in IHF patients ECG-gated SPECT and GBPS may be valuable for predicting the response to CRT.

Electrocardiographic Model to Predict Cardiac Resynchronization Therapy Response among Chronic Heart Failure Patients

2020 ◽  
Vol 103 (10) ◽  
pp. 1091-1098
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Guideline Recommendation ◽  
Current Guideline ◽  
Resynchronization Therapy ◽  
Heart Failure Patients ◽  
Crt Response

Background: Despite contemporary restrictive clinical and electrocardiographic selection criteria, up to one-third of chronic heart failure patients with implanted cardiac resynchronization therapy (CRT) are non-responders. Previous studies reported that some electrocardiographic patterns, such as the longer the intrinsicoid deflection (ID) in lead I, the higher the R wave amplitude in V₆, and other patterns may be helpful for CRT response prediction. Objective: To establish a simplified model using electrocardiographic parameters as predictors of CRT response among chronic heart failure patients. Materials and Methods: Eighty chronic heart failure patients meeting the current guideline recommendation for CRT implantation were enrolled in the present retrospective cohort study. The patients’ clinical and electrocardiographic parameters at the time of CRT implantation and during follow-up were analyzed. The response to CRT was evaluated after six months of implantation, defined as a decrease in the left ventricular end systolic volume (LVESV) of 15% or more or an increase in the left ventricular ejection fraction (LVEF) of 10% or more. Results: During a median follow-up period of 34 months, there were 45 (56.3%) responders. In multivariate analysis, the independent predictors for CRT response were the greater the reduction of the QRS complex duration after implantation (QRS post – QRS pre), the higher the time to ID in the lead I/QRS ratio (ID I/QRS), and the higher the difference in the amplitude of the R and S waves in lead V₁ and V₆ [(S1+R6) – (S6+R1)] (QRS post – QRS pre: adjusted odds ratio [OR] 0.97, 95% CI 0.94 to 0.99, p=0.004; ID I/QRS: OR 18.65, 95% CI 1.02 to 342.64, p=0.049; (S1+R6) – (S6+R1): OR 1.1, 95% CI 1.04 to 1.17, p=0.002). The new equation for calculating the predictive CRT response model, generated from multiple logistic regression analysis, was –3.414 – 0.035(QRS post – QRS pre) + 2.926(ID I/QRS) + 0.097[(S1+R6) – (S6+R1)]. The area under the receiver operating characteristic (ROC) curve for the new model for predicting CRT response was 0.853 (95% CI 0.767 to 0.939). A model score of more than 0.3 showed a sensitivity of 85.7% and specificity of 80% for the prediction of CRT response. Conclusion: The new electrocardiographic model achieved a high sensitivity and specificity for the prediction of CRT response among chronic heart failure patients, who met the current guideline recommendation for CRT implantation. Keywords: Cardiac resynchronization therapy, Electrocardiography, Heart failure, Responders, Model

scholarly journals Importance of systematic right ventricular assessment in cardiac resynchronization therapy candidates: a machine-learning approach

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
E Galli ◽  
V Le Rolle ◽  
OA Smiseth ◽  
J Duchenne ◽  
JM Aalen ◽  
...  
Keyword(s):  
Machine Learning ◽  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Right Ventricular ◽  
Systolic Heart Failure ◽  
Left Ventricular ◽  
Supervised Machine Learning ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Crt Response

Abstract Funding Acknowledgements Type of funding sources: None. Background Despite having all a systolic heart failure and broad QRS, patients proposed for cardiac resynchronization therapy (CRT) are highly heterogeneous and it remains extremely complicated to predict the impact of the device on left ventricular (LV) function and outcomes. Objectives We sought to evaluate the relative impact of clinical, electrocardiographic, and echocardiographic data on the left ventricular (LV) remodeling and prognosis of CRT-candidates by the application of machine learning (ML) approaches. Methods 193 patients with systolic heart failure undergoing CRT according to current recommendations were prospectively included in this multicentre study. We used a combination of the Boruta algorithm and random forest methods to identify features predicting both CRT volumetric response and prognosis (Figure 1). The model performance was tested by the area under the receiver operating curve (AUC). We also applied the K-medoid method to identify clusters of phenotypically-similar patients. Results From 28 clinical, electrocardiographic, and echocardiographic-derived variables, 16 features were predictive of CRT-response; 11 features were predictive of prognosis. Among the predictors of CRT-response, 7 variables (44%) pertained to right ventricular (RV) size or function. Tricuspid annular plane systolic excursion was the main feature associated with prognosis. The selected features were associated with a very good prediction of both CRT response (AUC 0.81, 95% CI: 0.74-0.87) and outcomes (AUC 0.84, 95% CI: 0.75-0.93) (Figure 1, Supervised Machine Learning Panel). An unsupervised ML approach allowed the identifications of two phenogroups of patients who differed significantly in clinical and parameters, biventricular size and RV function. The two phenogroups had significant different prognosis (HR 4.70, 95% CI: 2.1-10.0, p < 0.0001; log –rank p < 0.0001; Figure 1, Unsupervised Machine Learning Panel). Conclusions Machine learning can reliably identify clinical and echocardiographic features associated with CRT-response and prognosis. The evaluation of both RV-size and function parameters has pivotal importance for the risk stratification of CRT-candidates and should be systematically assessed in patients undergoing CRT. Abstract Figure 1

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