scholarly journals A prognostic nomogram for event-free survival in patients with atrial fibrillation before cardiac resynchronization therapy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Cai ◽  
W Hua ◽  
S.W Yang ◽  
N.X Zhang ◽  
Y.R Hu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
High Risk ◽  
Risk Stratification ◽  
Cardiac Resynchronization Therapy ◽  
Cardiac Resynchronization ◽  
Concordance Index ◽  
Resynchronization Therapy ◽  
Event Free Survival ◽  
Free Survival

Abstract Background Atrial fibrillation (AF), one of the most common comorbidities with heart failure (HF), is associated with worse prognosis in HF patients receiving cardiac resynchronization therapy (CRT). However, there is still no convenient tool to evaluate and identify patients with high risk of mortality and hospitalization due to heart failure in CRT candidates with AF. Methods We included 152 consecutive patients with AF for CRT in our hospital from January 2009 to July 2019. Multivariate Cox regression was applied to derive a nomogram, using multiple imputation for missing values and backward stepwise regression for variable selection. Results Five predictors were incorporated in the nomogram, including N-terminal pro brain natriuretic protein (NTproBNP) >1745pg/mL, history of syncope, previous pulmonary hypertension (PHP), moderate or severe tricuspid regurgitation (TR), thyroid stimulating hormone (TSH) >4mIU/L. Concordance index (0.70, 95% CI 0.62–0.77), corrected concordance index (0.67, 95% CI 0.59–0.74) and calibration curve showed optimal discrimination and calibration of the established nomogram. Significant difference of overall event-free survival was recognized by the nomogram-derived scores in patients with high risk (>50 points), intermediate risk (21–50 points) and low risk (0–20 points) before CRT. Conclusion Our nomogram may be an applicable tool for early risk stratification among CRT candidates with AF. Nomogram and risk stratification Funding Acknowledgement Type of funding source: None

scholarly journals Cardiac resynchronization therapy improves left atrial reservoir function through resynchronization of the left atrium in patients with heart failure

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
K Dokuni ◽  
K Matsumoto ◽  
K Tatsumi ◽  
A Shono ◽  
M Suzuki ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Cardiac Resynchronization ◽  
Qrs Complex ◽  
Resynchronization Therapy ◽  
Event Free Survival ◽  
Cardiac Events ◽  
Free Survival ◽  
Reservoir Function ◽  
Patients With Heart Failure

Abstract Funding Acknowledgements Type of funding sources: None. Background The structural remodeling of the left atrium (LA) has been proposed as an important determinant of adverse outcomes in patients with heart failure (HF). However, little is known about the potential impact of LA mechanical dyssynchrony on its reservoir function and the prognosis of patients with HF. In addition, it has not been fully investigated whether cardiac resynchronization therapy (CRT) is also beneficial to LA function. Purposes The purposes of this study were to test whether left ventricular (LV) dyssynchrony may negatively affect LA synchronicity and reservoir function, and to assess whether residual LA dyssynchrony after CRT affects the prognosis in patients with HF with reduced ejection fraction (HFrEF). Methods This study included total of 90 subjects: 40 HFrEF with a wide-QRS complex (≧130 ms), 28 HFrEF with a narrow-QRS, and 22 age- and sex-matched normal controls. LA global longitudinal strain (LA-GLS) and LA dyssynchrony were quantified using speckle-tracking strain analysis. LA dyssynchrony was defined as the maximal difference of time-to-peak strain (LA time-diff). All wide-QRS HFrEF received CRT, and event-free survival was tracked for 24 months. Results At baseline, HFrEF patients showed significant LA remodeling coupled with the reduced LA reservoir function, as evidenced by larger LA volume index (LAVi: 46 ± 16 vs. 30 ± 14 mL/m², P < 0.01) and smaller LA-GLS (13.0 ± 4.8 vs. 30.6 ± 10.7%, P < 0.01). Of note was that, not only LV dyssynchrony (381 ± 178 vs. 177 ± 62 ms, P < 0.01) but also LA dyssynchrony (298 ± 136 vs. 186 ± 78 ms, P < 0.01) were significantly larger in patients with HFrEF compared to normal subjects and this applied even more to patients with a wide-QRS complex. All patients with a wide-QRS complex underwent CRT, and only responders exhibited the significant decrease in LA time-diff (from 338 ± 123 to 245 ± 141 ms, P < 0.05) and increase in LA-GLS (from 11.9 ± 4.7 to 19.6 ± 10.1%, P < 0.05) in parallel with the reduction in LAVi (from 48 ± 17 to 37 ± 18 mL/m², P < 0.05) at 6 months after CRT. Receiver operating characteristic curve analysis identified the optimal cut-off value of LA time-diff at 6 months after CRT as 202 ms (P < 0.05) and that of LA-GLS as 14.6% (P < 0.05) for predicting adverse cardiac events. The patients whose LA time-diff reduced <202 ms after CRT showed significantly favorable event-free survival than the others. Similarly, the patients whose LA-GLS improved >14.6% after CRT exhibited significantly favorable event-free survival than the others (P < 0.05, respectively). Of note was that, when the patients were restricted to CRT responders only, those who showed LA time-diff less than 202 ms at 6 months after CRT almost never experienced cardiac events (P < 0.05). Conclusions The improved LV coordination by CRT also resulted in resynchronization of discoordinated LA wall motion and a consecutive improvement of LA reservoir function, which ultimately lead to the favorable outcome for HFrEF patients with wide-QRS complex. Abstract Figure.

Abstract 5895: The Impact of Response to Cardiac Resynchronization Therapy on Ventricular Arrhythmic Events

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Kenji Ando ◽  
Yoshimitsu Soga ◽  
Takeshi Arita ◽  
Shinichi Shirai ◽  
Masahiko Goya ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Nyha Class ◽  
Survival Rates ◽  
Cardiac Resynchronization ◽  
Rank Test ◽  
Resynchronization Therapy ◽  
Event Free Survival ◽  
Free Survival ◽  
The Impact

Background: It’s well known that cardiac resynchronization therapy (CRT) is effective to reduce heart failure hospitalization. However, the impact of response to CRT on ventricular arrhythmic events is not well established. Methods: We investigated 216 pts received CRT in two institutions (age 69.3+/−10.8 years, NYHA class 3.1+/−0.5, LVEF 25.8+/−7.4%, LVEDD 62.1+/−8.3mm, pre QRS duration 158+/−32ms, AF 19.4%, ischemic heart disease 33.3%, CRT-D 51.3%) and divided into two groups, Responders (n=145, 67.1%) and Non-responders (n=71, 32.9%). CRT responder was defined as improvement of LVEF > or =5%, or reduction of LVEDD > or = 5mm at 3–6 month echo data. Long-term ventricular arrhythmic events (ventricular tachycardia: VT, ventricular fibrillation: VF and sudden cardiac death: SCD) were obtained. Kaplan-Meier curve were draw and Long-Rank test was used to compare event rates of two groups. Results: Mean follow up periods was 19.3 +/−12.7 months. Event free survival rates from ventricular arrhythmic events (VT, VF and SCD) were all significantly higher in Responders compared to Non-responders (VT: 89.2% vs. 77.8% at 2 year, Log-rank p=0.031, VF: 99.2% vs. 89.9% at 2 year, Log-rank p=0.0031, SCD: 98.6% vs. 89.2% at 2 year, Log-rank p=0.0038) and event free survival rate from combined VT, VF and SCD was also significantly higher in Responders (87.8% vs. 76.5% at 2 year, Log-rank p=0.0013). Conclusion: Response to CRT seems to reduce not only heart failure events, but also ventricular arrhythmic events. Figure: Adverse events in new onset AF vs no AF

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