All-cause mortality and cardiac resynchronization therapy with or without defibrillation in primary prevention

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Bisson
Keyword(s):  
Primary Prevention ◽  
Cardiac Resynchronization Therapy ◽  
Ischemic Cardiomyopathy ◽  
Real Life ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Total Study Population ◽  
Life Study ◽  
All Cause Mortality ◽  
Study Population

Abstract Aims Cardiac resynchronization therapy with (CRTD) or without (CRTP) defibrillator is recommended in selected patient with systolic chronic heart failure and wide QRS. There is no guideline firmly indicating choice between CRTP and CRTD in primary prevention, particularly in older patients. Methods Based on the French administrative hospital-discharge database, information was collected from 2010 to 2017 for all patients implanted with CRTP or CRTD in primary prevention. Outcomes analyses were undertaken in the total study population and in propensity-matched samples. Results A total of 45,697 patients were analyzed (19,266 with CRTP and 26,431 with CRTD). The nationwide numbers of implantations increased between 2010 and 2017 (+29.6% for CRTD, +28.8% for CRTP). Proportion of CRTP implantation over CRTD remained similar over these years. During follow up (913 days, SD 841, median 701, IQR 151–1493), incidence rate (%patient/year) of all-cause mortality was higher in CRTP (11.6%) than in CRTD patients (6.8%) (Hazard Ratio [HR] 1.70, 95% CI 1.63–1.76, p<0.001). After propensity-matched analyses, mortality of patients over 75 years-old with non-ischemic cardiomyopathy (NICM) was not different with CRTP and CRTD (HR 0.93, 95% CI 0.80–1.09, p=0.39). CRTP patients under 75 yo with NICM had a higher mortality than CRTD patients (HR 1.22, 95% CI 1.08–1.37, p=0.01). Mortality rate was also higher with CRTP than with CRTD irrespectively of age in patients with ischemic cardiomyopathy (ICM) (<75 yo: HR 1.13, 95% CI 1.04–1.33, p<0.01; ≥75 yo: HR 1.22, 95% CI 1.08–1.37, p=0.01). Conclusion This real-life study gives up-to-date information about unselected patients implanted with CRTP and CRTD in primary prevention, and provides additional data which may help physicians choosing between CRTP and CRTD at the time of implantation. Benefit of CRTD seemed clear for all-cause mortality in patients with ICM and in patients with NICM under 75 yo. Patients over 75 yo with NICM seemed less likely to benefit from primary prevention CRTD implantation. Event free curves for mortality outcomes Funding Acknowledgement Type of funding source: None

Mortality and cardiac resynchronization therapy with or without defibrillation in primary prevention

EP Europace ◽  
2020 ◽  
Vol 22 (8) ◽  
pp. 1224-1233
Author(s):  
Matthieu Gras ◽  
Arnaud Bisson ◽  
Alexandre Bodin ◽  
Julien Herbert ◽  
Dominique Babuty ◽  
...  
Keyword(s):  
Primary Prevention ◽  
Cardiac Resynchronization Therapy ◽  
Real Life ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Total Study Population ◽  
Old Patients ◽  
Life Study ◽  
Ischaemic Cardiomyopathy ◽  
All Cause Mortality

Abstract Aims  Cardiac resynchronization therapy with (CRTD) or without (CRTP) defibrillator is recommended in selected patient with systolic chronic heart failure and wide QRS. There is no guideline firmly indicating choice between CRTP and CRTD in primary prevention, particularly in older patients. Methods and results  Based on the French administrative hospital-discharge database, information was collected from 2010 to 2017 for all patients implanted with CRTP or CRTD in primary prevention. Outcome analyses were undertaken in the total study population and in propensity-matched samples. During follow-up (913 days, SD 841, median 701, IQR 151–1493), 45 697 patients were analysed (CRTP 19 266 and CRTD 26 431). Incidence rate (%patient/year) of all-cause mortality was higher in CRTP patients (11.6%) than in CRTD patients (6.8%) [hazard ratio (HR) 1.70, 95% confidence interval (CI) 1.63–1.76, P < 0.001]. After propensity-matched analyses, mortality of patients over 75 years old with non-ischaemic cardiomyopathy (NICM) was not different with CRTP and CRTD (HR 0.93, 95% CI 0.80–1.09, P = 0.39). The CRTP patients under 75 years old with NICM had a higher mortality than CRTD patients (HR 1.22, 95% CI 1.03–1.45, P = 0.02). Mortality rate was also higher with CRTP than with CRTD irrespectively of age in patients with ischaemic cardiomyopathy (ICM) (<75 years old: HR 1.22, 95% CI 1.08–1.37, P = 0.01; ≥75 years old: HR 1.13, 95% CI 1.04–1.22, P = 0.003). Conclusion  In this real-life study, CRTD was associated with a significantly lower all-cause mortality than CRTP in patients with ICM and in patients with NICM under 75 years old. Patients over 75 years old with NICM did not have lower mortality with primary prevention CRTD implantation.

P1174Impact of sex-differences in long-term outcomes with cardiac resynchronization therapy: are women different?

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
Z L Moreno Weidmann ◽  
C Alonso-Martin ◽  
F Mendez-Zurita ◽  
E Rodriguez-Font ◽  
J Guerra-Ramos ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Ischemic Cardiomyopathy ◽  
Nyha Class ◽  
Real Life ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Resynchronization Therapy ◽  
The Moment

Abstract Introduction Women are frequently underrepresented in clinical trials for heart failure. Differences on cardiovascular background may imply differences on indications, device election and outcomes in patients receiving cardiac devices (CRT and ICD). We sought to compare sex-related differences in a real-life cohort. Methods We analyzed all subjects who underwent a cardiac resynchronization therapy (CRT) implantation (with or without ICD) between 2016 and 2019 in a single center, all of them followed by remote monitoring. Baseline characteristics and outcomes were compared according to gender. Response to resynchronization was defined as clinical improvement in NYHA class or an increase of > =10% in LVEF. Results A total of 430 devices (ICD or CRT) were implanted. 149 (35%) of them were CRTs: 116 (88%) CRT-D and 33 (22%) CRT-P. Of the whole cohort, 43 (29%) were women and the mean age was similar in both sex (70+/-9 years). Women had more likely non-ischemic cardiomyopathy (86% vs 49%, p < 0.01), higher proportion of NYHA class III-IV (26% vs 40%, p 0.04) and worse renal function (mean glomerular filtration 61ml/min vs 75ml/min, p 0.04), but tend to be less affected by atrial fibrillation (21% vs 40%, p 0.05). Left ventricular ejection fraction was similar at the moment of implantation among both sex (30+/-7%, p > 0.05) and no difference on optimal medical treatment was observed. Women trend to receive more frequently CRT-P than men (33% vs 18%, p 0.054). After a mean follow-up of 3 years, a four-fold higher response to CRT was observed in women (OR 4.0, 95% CI 2.0-10.7, p 0.002), after adjustment by the etiology of the myocardiopathy. No differences on all-cause mortality (6% in men vs 1% in women, p 0.2) or ventricular arrhythmias (10% in men vs 2% in women, p 0.3) were observed.  Conclusions in a real-life cohort, CRT implantation showed a sex-disparity: the proportion of women receiving a CRT was lower than in men, but a CRT without defibrillation was more frequently implanted in women, reflecting a higher prevalence of ischemic cardiomyopathy in men. The underlying myocardial substrate in women and a lower prevalence of AF may explain a more favorable response to CRT, despite more pronounced symptoms of heart failure at the moment of implantation.

Cardiac Resynchronization Therapy (CRT) with or without Defibrillation in Patients with Non-Ischemic Cardiomyopathy: A Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Divyang Patel ◽  
Anirudh Kumar ◽  
Eric Black-Maier ◽  
Rebecca L. Morgan ◽  
Kevin Trulock ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Resynchronization Therapy ◽  
Ischemic Cardiomyopathy ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Cochrane Review ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Medical Advance ◽  
All Cause Mortality

Background - Cardiac resynchronization therapy (CRT) represents a major medical advance in patients with heart failure (HF) with electrical dysschrony to improve symptoms, reduce hospitalization, and increase survival both in the presence and absence of implantable-cardioverter defibrillator (ICD) therapy. However, among CRT-eligible patients with non-ischemic cardiomyopathy (NICM), the benefit of defibrillator therapy in addition to CRT remains unclear. A systematic review and meta-analysis comparing outcomes of patients with NICM and HF who underwent CRT with ICD (CRT-D) vs. CRT only (CRT-P) was therefore performed. Methods - A literature search from inception through February 2020 was conducted in PubMed and Cochrane Review Databases for all studies reporting outcomes of CRT-D versus CRT-P in CRT-eligible patients with NICM. Studies reporting non-stratified outcomes including patients with ischemic cardiomyopathy were excluded. The primary end point of interest was all-cause mortality. A random effects model using hazards ratio (HR) was utilized to calculate a cumulative HR for all-cause mortality. The GRADE approach assessed the certainty of evidence across outcomes. Results - Of a total of 1,478 potential citations, the search yielded eight citations that met inclusion and exclusion criteria. There was one randomized controlled trial which included a sub-group of 645 CRT-eligible NICM patients (322 with CRT-D and 323 with CRT-P). Seven observational studies representing 9,944 CRT-eligible patients with NICM (6,865 CRT-D implantation and 3,079 with CRT-P) were included in a pooled meta-analysis. The cumulative adjusted HR for all-cause mortality for CRT-D versus CRT-P was 0.92 (95% CI; 0.83, 1.03); I 2 = 0 though with low certainty of evidence. There may be little difference in infection and cardiac mortality between CRT-D versus CRT-P devices (HR: 0.82; 95% CI: 0.29, 2.20 moderate certainty of evidence, and HR: 0.68; 95% CI: 0.37, 1.25, low certainty of evidence, respectively). Conclusions - In this meta-analysis, the addition of defibrillator therapy was not significantly associated with a reduction in all-cause mortality in CRT-eligible patients with NICM.

scholarly journals Physiological pacing to improve cardiac resynchronization therapy non-responder and a tryst with calcified septum—a case report

2021 ◽  
Vol 73 (1) ◽  
Author(s):  
Vanita Arora ◽  
Francesco Zanon ◽  
Viveka Kumar ◽  
Vivek Kumar ◽  
Pawan Suri
Keyword(s):  
Case Report ◽  
Cardiac Resynchronization Therapy ◽  
Ischemic Cardiomyopathy ◽  
Cardiac Resynchronization ◽  
Conduction Delay ◽  
Resynchronization Therapy ◽  
Intraventricular Conduction ◽  
Technological Approach ◽  
Intraventricular Septum ◽  
Intraventricular Conduction Delay

Abstract Background As per the literature, patients with intraventricular conduction delay (IVCD) do not respond well to cardiac resynchronization therapy (CRT) alone. They need advanced technological approach and out of the box thinking for a good response. Case Ours is a case of ischemic cardiomyopathy with wide QRS-IVCD, a non-responder to CRT. While planning for replacement of the device for early replacement indicator (ERI), we decided to do His-optimized CRT/left bundle optimized CRT (HOT-CRT/LOT-CRT) for the patient. Conclusion The challenges we faced with the present available hardware paved a way for insisting on the limitation of the available lumenless lead to penetrate calcified the septum and importance of the pre-procedure evaluation of intraventricular septum (IVS) for calcification by more than just echocardiography.

scholarly journals Exploring sex-specific patterns of mortality predictors among patients undergoing cardiac resynchronization therapy: a machine learning approach

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Tokodi ◽  
A Behon ◽  
E.D Merkel ◽  
A Kovacs ◽  
Z Toser ◽  
...  
Keyword(s):  
Machine Learning ◽  
Sex Differences ◽  
Cardiac Resynchronization Therapy ◽  
Cardiac Resynchronization ◽  
Funding Source ◽  
Resynchronization Therapy ◽  
Test Set ◽  
All Cause Mortality ◽  
Mortality Predictors

Abstract Background The relative importance of variables explaining sex differences in outcomes is scarcely explored in patients undergoing cardiac resynchronization therapy (CRT). Purpose We sought to implement and evaluate machine learning (ML) algorithms for the prediction of 1- and 3-year all-cause mortality in patients undergoing CRT implantation. We also aimed to assess the sex-specific differences and similarities in the predictors of mortality using ML approaches. Methods A retrospective registry of 2191 CRT patients (75% males) was used in the current analysis. ML models were implemented in 6 partially overlapping patient subsets (all patients, females or males with 1- or 3-year follow-up data available). Each cohort was randomly split into a training (80%) and a test set (20%). After hyperparameter tuning with 10-fold cross-validation in the training set, the best performing algorithm was also evaluated in the test set. Model discrimination was quantified using the area under the receiver-operating characteristic curves (AUC) and the associated 95% confidence intervals. The most important predictors were identified using the permutation feature importances method. Results Conditional inference random forest exhibited the best performance with AUCs of 0.728 [0.645–0.802] and 0.732 [0.681–0.784] for the prediction of 1- and 3-year mortality, respectively. Etiology of heart failure, NYHA class, left ventricular ejection fraction and QRS morphology had higher predictive power in females, whereas hemoglobin was less important than in males. The importance of atrial fibrillation and age increased, whereas the relevance of serum creatinine decreased from 1- to 3-year follow-up in both sexes. Conclusions Using advanced ML techniques in combination with easily obtainable clinical features, our models effectively predicted 1- and 3-year all-cause mortality in patients undergoing CRT implantation. The in-depth analysis of features has revealed marked sex differences in mortality predictors. These results support the use of ML-based approaches for the risk stratification of patients undergoing CRT implantation. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Research, Development and Innovation Office of Hungary

scholarly journals The use of mechanical dyssynchrony for predicting response to cardiac resynchronization therapy in patients with non-ischemic cardiomyopathy

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
V Saushkin ◽  
YV Varlamova ◽  
AI Mishkina ◽  
DI Lebedev ◽  
SV Popov ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Myocardial Perfusion ◽  
Cardiac Resynchronization Therapy ◽  
Ischemic Cardiomyopathy ◽  
Gated Spect ◽  
Mechanical Dyssynchrony ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Crt Response

Abstract Funding Acknowledgements Type of funding sources: None. Aim/Introduction: Assessment of mechanical dyssynchrony by myocardial perfusion gated-SPECT in patients with non-ischemic cardiomyopathy for predict response to cardiac resynchronization therapy (CRT). Materials and Methods  We examined 32 patients with non-ischemic cardiomyopathy before and six months after CRT.  Left ventricular mechanical dyssynchrony and contractility were assessed for all patients by myocardial perfusion gated-SPECT. The phase standard deviation (PSD), histogram bandwidth (HBW), phase histogram skewness (S) and phase histogram kurtosis (K) were used as an indicator of mechanical dyssynchrony for the both ventricles.  Results  Mechanical dyssynchrony of both ventricles before CRT was increased in all patients. Median value PSD 53°(41-61°), HBW 176°(136-202°), S 1,62(1,21-1,89), K 2,81(1,21-3,49). Six months after CRT 22(68%) respondents were identified. We divided the patients into two groups (responders and non-responders) and compared phase parameters. It was found that the PSD (44°(35-54°)) and HBW (158°(118-179°) in the responders were significantly lower than in the non-responders (PSD (68°(58-72°); HBW (205°(199-249°)). The value of phase histogram skewness and kurtosis in responders were significantly higher (Responders: S 1,77(1,62-2,02); K 3,03(2,60-3,58). Non-responders: S 1,21(0,93-1,31); K 1,21(0,19-1,46)).  We found that all four indicators of mechanical dyssynchrony can predict CRT response according to the results of univariate logistic regression analysis. Moreover, It was found that only phase histogram kurtosis (OR = 1.196, 95% CI 1.04-1.37) is an independent predictor of CRT response according to multivariate logistic regression. Conclusion  Radionuclide assessment of mechanical dyssynchrony may be the optimal diagnostic method for selecting patients with non-ischemic cardiomyopathy on CRT.

scholarly journals Response to cardiac resynchronization therapy in non‐ischemic cardiomyopathy is unrelated to medical therapy

2018 ◽  
Vol 42 (1) ◽  
pp. 143-150 ◽  
Author(s):  
Gregory Sinner ◽  
Hesham R. Omar ◽  
You W. Lin ◽  
Samy C. Elayi ◽  
Maya E. Guglin
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Medical Therapy ◽  
Ischemic Cardiomyopathy ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy

scholarly journals Outcomes of Cardiac Resynchronization Therapy in Patients with Hypothyroidism and Heart Failure

2020 ◽  
Author(s):  
MEI YANG ◽  
Xuping Li ◽  
John C. Morris III ◽  
Jinjun Liang ◽  
Abhishek J. Deshmukh ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Implantable Cardioverter Defibrillator ◽  
Hazard Ratio ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Therapy Outcomes ◽  
Implantable Cardioverter Defibrillator Therapy ◽  
Cardioverter Defibrillator ◽  
All Cause Mortality

Abstract Background Hypothyroidism is known to be associated with adverse clinical outcomes in heart failure. The association between hypothyroidism and cardiac resynchronization therapy outcomes in patients with severe heart failure is not clear. Methods The study included 1,316 patients who received cardiac resynchronization therapy between 2002 and 2015. Baseline demographics and cardiac resynchronization therapy outcomes, including left ventricular ejection fraction, New York Heart Association class, appropriate implantable cardioverter-defibrillator therapy, and all-cause mortality, were collected from the electronic health record. Results Of the study cohort, 350 patients (26.6%) were classified as the hypothyroidism group. The median duration of follow-up was 3.6 years (interquartile range, 1.7-6.2). Hypothyroidism was not associated with a higher risk of all-cause mortality in patients receiving CRT for heart failure. The risk of appropriate implantable cardioverter-defibrillator therapy significantly increased in association with increased baseline thyroid -stimulating hormone level in the entire cohort (hazard ratio, 1.23 per 5mIU/L increase; 95% CI, 1.01-1.5; P=0.04) as well as in the hypothyroid group (hazard ratio, 1.44 per 5mIU/L increase; 95% CI, 1.13-1.84; P=0.004). Conclusions CRT improves cardiac function in hypothyroid patients. The ventricular arrhythmic events requiring ICD therapies are associated with baseline TSH level, which might be considered as an important biomarker to stratify the risk of sudden death for patients with heart failure and hypothyroidism.

Sign in / Sign up

Export Citation Format

Share Document