scholarly journals Dynamic optimization of CRT pacing using a novel algorithm improves survival in a real-world cohort of patients

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M.R Gold ◽  
P Zimmerman ◽  
J.P Singh
Keyword(s):  
Real World ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
World Population ◽  
Block Group ◽  
Av Block ◽  
Private Company ◽  
Pr Interval ◽  
Block Figure

Abstract Background The AdaptivCRT (aCRT) algorithm continuously adjusts cardiac resynchronization therapy (CRT) according to intrinsic atrioventricular (AV) conduction status, providing synchronized left-ventricular pacing in patients (pts) with a normal PR interval and adaptive biventricular (BiV) pacing in pts with a prolonged PR interval. Prior secondary analyses of prospective trials demonstrated a reduction in mortality and atrial fibrillation incidence with aCRT. Objective To compare mortality in a large real-world population of pts with and without aCRT using electronic health record (EHR) data. Methods An Optum® de-identified EHR dataset and Medtronic CareLink device data were linked to identify pts (age>18 years) with a CRT implanted between 2014–2018 who survived ≥35 days post implant and with a documented baseline left ventricular ejection fraction (LVEF). Pts were grouped with aCRT set to either Adaptive BiV+LV (aCRT group) or standard CRT (control group). Two pt subgroups were identified: (i) pts with left bundle branch block (LBBB) and no AV block, (ii) pts with either no LBBB or with AV block. Kaplan-Meier curves and log-rank were used to estimate and compare survival between treatment and control groups in both the full cohort and subgroups. Multivariate Cox regression was used to estimate the aCRT treatment effect while controlling for baseline characteristics. Results Among 8624 patients implanted with a CRT device with EHR data available for a median of 23.5 months post implant [IQR: 12.6, 37.3], 3994 patients had the aCRT feature activated. Pts in the aCRT group were younger (median 69 [IQR:60, 76] vs 73 [IQR: 65, 79] years), more frequently female (35% vs 26%), and more frequently had LBBB (72% vs 51%); p's<0.001. Median QRS duration was 150ms (IQR: 133, 164) for the aCRT group and 152ms (IQR: 134, 172) for the control group (p<0.001). Median LVEF was 22% (IQR: 18, 30) for the aCRT group and 25% (IQR: 20, 30) for the control group (p<0.001). Through 60 months post implant, the overall mortality rate was 23.6% (95% CI: 20.7%-26.3%) for the aCRT group and 37.6% for the control group (95% CI: 34.9%-40.1%), p<0.001. Subgroup analysis demonstrated a significant reduction in mortality with aCRT in both pts with LBBB without AV block (Figure, left panel) and pts without LBBB and with AV block (Figure, right panel). After accounting for baseline differences, the reduction in mortality remained significant in the LBBB/no AV block group (HR: 0.54, 95% CI: 0.39–0.76, p<0.001) and trended toward significance in the no LBBB/with AV block group (HR: 0.89, 95% CI: 0.79–1.01; p=0.08). Conclusion In a large, real-world population of pts implanted with CRT devices, the AdaptivCRT algorithm was associated with significantly reduced mortality, with a greater reduction observed among pts with LBBB and without AV block. These results are being tested prospectively in the ongoing AdaptResponse multi-national, randomized clinical trial. FUNDunding Acknowledgement Type of funding sources: Private company. Main funding source(s): Medtronic, Inc. Cumulative probability of death by group

scholarly journals Novel antisense therapy targeting microRNA-132 in patients with heart failure

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
J Taubel ◽  
W Hauke ◽  
S Rump ◽  
J Viereck ◽  
S Batkai ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Fibrosis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Private Company ◽  
Ventricular Ejection Fraction ◽  
Pharmacodynamic Effects ◽  
Amino Terminal ◽  
Patients With Heart Failure

Abstract Background Cardiac microRNA-132-3p (miR-132) levels are increased in patients with heart failure (HF) and mechanistically drive cardiac remodelling processes. CDR132L, a specific antisense oligonucleotide, is a first-in-class miR-132 inhibitor that attenuates and even reverses HF in preclinical models. Purpose The aim of the current clinical Phase 1b study was to assess safety, pharmacokinetics, target engagement, and exploratory pharmacodynamic effects of CDR132L in patients on standard-of-care therapy for chronic ischaemic HF in a randomized, placebo-controlled, double-blind, dose-escalation study. Methods Patients had left ventricular ejection fraction between ≥30% and <50% or amino terminal fragment of pro-brain natriuretic peptide (NT-proBNP) >125 ng/L at screening. Twenty-eight patients were randomized to receive CDR132L (0.32, 1, 3, and 10 mg/kg body weight) or placebo (0.9% saline) in two intravenous infusions, 4 weeks apart in four cohorts of seven (five verum and two placebo) patients each. Results CDR132L was safe and well tolerated, without apparent dose-limiting toxicity. A pharmacokinetic/pharmacodynamic dose modelling approach suggested an effective dose level at ≥1 mg/kg CDR132L. CDR132L treatment resulted in a dose-dependent, sustained miR-132 reduction in plasma. Patients given CDR132L ≥1 mg/kg displayed median 23.3% NT-proBNP reduction, vs. 0.9% median increase in the control group. CDR132L treatment induced significant QRS narrowing and positive trends for cardiac fibrosis biomarkers. Conclusions This study is the first clinical trial of an antisense drug in HF patients. CDR132L was safe and well tolerated, confirmed linear plasma pharmacokinetics with no signs of accumulation, and suggests cardiac functional improvements. The indicative efficacy of this drug is very encouraging justifying additional clinical studies to confirm the beneficial CDR132L pharmacodynamic effects for the treatment of HF. FUNDunding Acknowledgement Type of funding sources: Private company. Main funding source(s): Cardior Pharmaceuticals GmbH

Dapagliflozin in a real-world population with chronic heart failure: how many would be eligible?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S.F.C Maltes ◽  
B.L Rocha ◽  
G.L Cunha ◽  
J.P Presume ◽  
L Campos ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Real World ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
World Population ◽  
Ventricular Ejection Fraction ◽  
Disease Modifying Drugs ◽  
Sodium Glucose Cotransporter ◽  
Patients With Heart Failure

Abstract Background In patients with heart failure (HF) and reduced left ventricle ejection fraction (LVEF), the sodium-glucose cotransporter inhibitor (iSGLT2) dapagliflozin has recently been shown to reduce the risk of worsening heart failure or death from cardiovascular causes in the DAPA-HF trial. Results of iSGLT2 in HF with preserved LVEF are awaited. Our goal was to investigate how many patients in a real-world setting would be eligible for dapagliflozin according to the DAPA-HF criteria. Methods This is a single-center retrospective study enrolling consecutive patients followed in an HF Clinic from 2013 to 2019. The key DAPA-HF inclusion criteria [i.e., Left Ventricular Ejection Fraction (LVEF) <40% and NT-proBNP >600pg/mL (or >900pg/ml if AF)] and exclusion criteria [estimated glomerular filtration rate (eGFR) <30ml/kg/1.73m2, systolic blood pressure (SBP) <95mmHg] were considered. Results Overall, 479 patients (mean age 75.7±12.8 years; 50.4% male; 78.8% with hypertension; 45.0% with an eGFR <60ml/min/1.73m2; 36.5% with type 2 diabetes mellitus; 33.5% ischaemic HF) were assessed. Of these, 155 (33.2%) patients had LVEF <40%. Patients had a mean SBP of 131±28 mmHg, a median eGFR of 48 (IQR 33–65) ml/min/m2 and a NT-proBNP of 2183 (IQR 1010–5310) pg/mL Overall, according to the DAPA-HF trial key criteria, 88 patients (18.3%) would be eligible for dapagliflozin. The remainder would be excluded due to a LVEF>40% (67.5%), eGFR <30 ml/min/1.73m2 (19.4%), NT-proBNP <600 pg/mL (or <900 pg/mL if AF) (16.7%) and/or SBP <90mmHg (2.1%) (figure 1). If we limit the analysis to those with a LVEF <40%, 56.7% would be eligible for dapagliflozin. The remainder would be excluded due to a eGFR <30ml/kg/1.73m2 (20%), NT-proBNP <600 pg/mL (or <900 pg/mL if AF) (16.1%) and/or SBP <90mmHg (8.4%) (figure 1). Conclusion Roughly one in every five patients in our real-world HF cohort would be eligible to start dapagliflozin according to the key criteria of the DAPA-HF trial. The main reason for non-eligibility was a LVEF >40%. These findings highlight the urgent need for disease-modifying drugs in mid-range and preserved LVEF. The results of ongoing iSGLT2 trials in these LVEF subgroups are eagerly awaited. Funding Acknowledgement Type of funding source: None

scholarly journals Improving atrioventricular coupling in heart failure patients with PR prolongation, the ReachPR Trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
F Salden ◽  
J.G Luermans ◽  
A.M.W Van Stipdonk ◽  
C.P Allaart ◽  
M Meine ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Funding Source ◽  
Stroke Work ◽  
Private Company ◽  
Pr Interval ◽  
Qrs Duration ◽  
Rv Pacing ◽  
Av Delay

Abstract Background PR prolongation is associated with poor hemodynamic performance and may contribute to heart failure (HF). There is some evidence that in HF patients, normalization of atrioventricular (AV) coupling can attenuate HF. Purpose To investigate acute hemodynamic effects of restoration of AV coupling by atrio-biventricular (BiV) pacing in patients with HF and PR prolongation, but without evident ventricular dyssynchrony. Methods Nineteen patients underwent BiV pacemaker implantation. An invasive hemodynamic pacing protocol was performed during BiV and right ventricular (RV) pacing with four paced AV delays (100, 75, 50 and 25% of patient's PR interval during baseline AAI pacing). All patients had symptomatic HF, left ventricular ejection fraction (LVEF) <35% and PR interval ≥230 ms, without evident prolonged QRS duration >150 ms or left bundle branch block. Acute hemodynamic response was assessed by invasive left ventricular (LV) stroke work measurements (conductance catheter technique). Results At baseline, PR interval was 255±22 ms, QRS duration 122±19 ms and LVEF 29±6%. Reducing AV delay to 50% of patient's intrinsic PR interval by BiV pacing resulted in a median 25% increase (p<0.05) in LV stroke work relative to baseline (figure, left panel). This increase in LV stroke work was mainly determined by an increase in LV stroke volume (figure, right panel). In contrast to BiV pacing, reducing AV delay by RV pacing did not improve LV stroke work (figure, left panel). Conclusion In patients with HF and PR prolongation, BiV pacing can be used to improve AV coupling that leads to hemodynamic improvement. These results suggest that BiV pacing may also be beneficial in this subset of HF patients that are currently not indicated for CRT. ReachPR Trial Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Abbott funded a part of this study.

Abstract 250: Role of First Degree Atrioventricular Block and Long Term Mortality in U.S. Veterans With Atherothrombotic Risk Factors

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Amish Patel ◽  
Jonathan Pollock ◽  
Edward Sam Roberto ◽  
Thein Tun Aung ◽  
Ronald Markert ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Common Finding ◽  
Av Block ◽  
Pr Interval ◽  
History Of ◽  
Long Term Mortality

Background: First-degree atrioventricular (AV) block [PR interval exceeding 200 milliseconds (ms)] on a 12-lead electrocardiogram is a common finding. Previous studies suggested that first-degree AVB has a benign prognosis, but more recent reports suggest that first-degree AVB may be associated with adverse outcomes. We investigated the relationship between PR interval and long term morality in U.S. Veterans with atherothrombotic risk factors. Methods: We retrospectively collected and analyzed data from a Veterans Affairs (VA) medical center for consecutive patients (October 2001 to January 2005) who presented for coronary angiography. Results: Of 1193 charts, 1082 had a PR interval reading recorded (mean = 172.5±30.5 ms; median = 168 ms [range 59-334]). Mean follow-up period was 103±52 months. Mean age was 63.2±10.8 years with 98% male. Mean body mass index was 30.0±5.9. The prevalence of selected comorbidities was: hypertension (88%), hyperlipidemia (79%), obstructive coronary artery disease (73%), diabetes mellitus (45%), smoker (39%), history of peripheral vascular disease (17%), and history of cerebrovascular accident (8%). Mean left ventricular ejection fraction was 47%±13%. Eighty-two percent were on beta-blockers (BB), and 25% were on calcium channel blockers (CCB) while intraventricular conduction delay was seen in 6%. In a comparison of patients with PR interval ≤200 ms (n=936) vs. >200 ms (n=146), long term mortality was higher with PR interval >200 ms (58.2% vs. 44.4%, p=0.002). Mortality rate was also higher with patients on BB or CCB vs. not on either (49.8% vs 39.7%, p=0.024). While PR interval was a significant univariate predictor of mortality, it was not significant when adjusted for the covariates listed above [not including BB and CCB] (odds ratio = 1.08 [95% Cl = 0.70 to 1.66], p = 0.73). Conclusion: In this study of US Veterans with atherothrombotic risk factors, the long term mortality rate was higher with first-degree AV block. PR interval has prognostic value within this specific cohort.

Prognostic role of results of dynamic capnography in integral assessment of parameters of respiratory system in 6-minute walk test in patients with chronic heart failure

2020 ◽  
Vol 28 (3) ◽  
pp. 290-299
Author(s):  
Kira A. Ageeva ◽  
Evgenii V. Filippov
Keyword(s):  
Respiratory System ◽  
Prognostic Significance ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Walk Test ◽  
Ventricular Ejection Fraction ◽  
6Mwt Distance ◽  
6 Minute Walk Test ◽  
Minute Walk

Aim. To study the prognostic value of the results of dynamic capnography in the complex assessment of parameters of the respiratory system in 6-minute walk test in patients with chronic heart failure (CHF). Materials and Methods. 73 Patients were examined: the group of study included 48 patients with IIA or IIB stage CHF (mean age 57.94.6 years, 23 men), the control group included 25 practically healthy volunteers (mean age 47.63.5 years, 9 men). The patients were conducted complex determination of parameters of the respiratory system: clinical scaling before and after 6-minute walk test (6MWT), instrumental examinations including spirometry, capnography and pulse oximetry before, during and after physical activity. The analysis of survival was conducted on the basis of the dynamic follow-up of patients within 5 years (60 months). Results. In the analysis of parameters of dyspnea at rest, all the parameters were higher in the group of patients with CHF (р0.05). The distance walked by the patients with CHF in 6 minutes was 488.2390.84 m, which was significantly less than in the control group (815.6053.89 m, р=0.009). Dyspnea as the cause of stoppage/slowing down of walking in 6MWT, was also more often recorded in patients with CHF (93.83.0% and 48.05.1%, р=0.049). Besides, in 6MWT the patients noted: weakness in legs (50.15.0% in the group of CHF and 40.05.0% in the control group, р=0.014), palpitation (29.04.6% and 20.04.1%, respectively, р=0.004). Worsening of dyspnea parameters in 6MWT was more evident in patients with CHF than in the control group (р0.01). In the CHF group, hypocapnic type of ventilation was revealed in 6MWT, analysis of РЕТСО2 trend graphs revealed a wave-like increase in the parameters, the so called periodic breathing (PB). CO2 trend was recorded in CHF group in 58.31.0% of cases (the difference with the control group with р=0.046), the trend of heart rate in 18.80.3% of cases (р=0.027). Cox proportional hazards regression analysis of mortality in patients with CHF showed a prognostic significance of a complex model comprising the following parameters of a patient: body mass index (р=0.005), left ventricular end-diastolic dimension (р=0.034), left ventricular end-systolic dimension (р=0.002), left ventricular ejection fraction (р=0.041), 6MWT distance (р=0.004), desaturation (р=0.009), and the presence of signs of PB during 6MWT (р=0.005). Model coefficients were statistically significant at р0.0001. Conclusions. Dynamic capnography and pulse oximetry allow to identify signs of PB in patients with CHF during 6MWT which may deepen a complex assessment of parameters of the cardio-respiratory system in patients with CHF in order to determine tolerance to physical exercise as well as the effectiveness of the conducted treatment. Complex assessment of survival of patients with CHF showed prognostic significance of the following parameters of a patient: body mass index, left ventricular end-diastolic dimension, left ventricular end-systolic dimension, left ventricular ejection fraction, 6MWT distance, desaturation, PB during 6MWT.

STUDY THE CHANGES IN MORPHOLOGY AND LEFT VENTRICULAR FUNCTION IN OVERWEIGHT-OBESE CHILDREN 5-15 YEARS OLD WHO VISITED CHILDREN'S HOSPITAL IN CAN THO

2011 ◽  
pp. 36-42
Author(s):  
Hung Viet Bui ◽  
Thi Cu Nguyen
Keyword(s):  
Left Ventricular Function ◽  
Ventricular Function ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Obese Children ◽  
Ventricular Ejection Fraction ◽  
Children's Hospital ◽  
Number Of Patients ◽  
Children’S Hospital

Objective: In Vietnam, obesity is increasing particularly in many large cities. Adult cardiovascular diseases are often derived from cardiovascular disorders during the children period. The implementation of early measures to prevent atherosclerosis, such as weight control, better lipid control will reduce the cardiovascular complications, such as hypertension (HTA), coronary heart diseases and some other diseases. Materials and Methods: Overweight - obese children from 5 to 15 years old who visited the Children's Hospital in Can Tho from May 2009 to May 2010. Total number of patients were chosen as 50 children. Method: Descriptive cross-sectional. Children in the study underwent Doppler ultrasound exam to evaluate cardiac morphology and cardiac function. Results: There were increases in left ventricular systolic diameter, left ventricular diastolic diameter, LV mass in overweight-obese children in the study compared with controls at all ages (p <0.05 ). Left ventricular ejection fraction in overweight-obese children in the study was lower than the control group at all ages (p> 0.05). The average rate of left ventricular shortening of overweight-obese children in the study was 34.8 ± 4.5(%). There was no difference in the rate of shortening of the left ventricle in overweight-obese children in the study compared with controls (p>0.05). There was no relationship between variation in morphology and left ventricular function with the degree of overweight-obesity in this study. Conclusion: The study showed that disturbances in morphology and left ventricular function in overweight-obese children but did not find a strong association with the disorder degree of overweight-obesity.

scholarly journals Review of Irish patients meeting ST elevation criteria during the COVID-19 pandemic

Open Heart ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. e001716
Author(s):  
Luke Byrne ◽  
Roisin Gardiner ◽  
Patrick Devitt ◽  
Caleb Powell ◽  
Richard Armstrong ◽  
...  
Keyword(s):  
Public Health ◽  
Public Perception ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Ventricular Ejection Fraction ◽  
St Elevation ◽  
The Impact ◽  
Transfer Times

IntroductionThe COVID-19 pandemic has seen the introduction of important public health measures to minimise the spread of the virus. We aim to identify the impact government restrictions and hospital-based infection control procedures on ST elevation myocardial infarction (STEMI) care during the COVID-19 pandemic.MethodsPatients meeting ST elevation criteria and undergoing primary percutaneous coronary intervention from 27 March 2020, the day initial national lockdown measures were announced in Ireland, were included in the study. Patients presenting after the lockdown period, from 18 May to 31 June 2020, were also examined. Time from symptom onset to first medical contact (FMC), transfer time and time of wire cross was noted. Additionally, patient characteristics, left ventricular ejection fraction, mortality and biochemical parameters were documented. Outcomes and characteristics were compared against a control group of patients meeting ST elevation criteria during the month of January.ResultsA total of 42 patients presented with STEMI during the lockdown period. A significant increase in total ischaemic time (TIT) was noted versus controls (8.81 hours (±16.4) vs 2.99 hours (±1.39), p=0.03), with increases driven largely by delays in seeking FMC (7.13 hours (±16.4) vs 1.98 hours (±1.46), p=0.049). TIT remained significantly elevated during the postlockdown period (6.1 hours (±5.3), p=0.05), however, an improvement in patient delays was seen versus the control group (3.99 hours (±4.5), p=0.06). There was no difference seen in transfer times and door to wire cross time during lockdown, however, a significant increase in transfer times was seen postlockdown versus controls (1.81 hours (±1.0) vs 1.1 hours (±0.87), p=0.004).ConclusionA significant increase in TIT was seen during the lockdown period driven mainly by patient factors highlighting the significance of public health messages on public perception. Additionally, a significant delay in transfer times to our centre was seen postlockdown.

scholarly journals Evaluation of Galectin-3 Plasma Concentration in Adolescents with Ventricular Arrhythmia

2021 ◽  
Vol 18 (5) ◽  
pp. 2410
Author(s):  
Radosław Pietrzak ◽  
Tomasz M. Książczyk ◽  
Elżbieta Górska ◽  
Łukasz A. Małek ◽  
Bożena Werner
Keyword(s):  
Plasma Concentration ◽  
Ventricular Arrhythmia ◽  
Linear Regression Analysis ◽  
Holter Monitoring ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Healthy Children ◽  
Ventricular Ejection Fraction ◽  
Galectin 3

Galectin-3 (G3) is a biomarker known as an inflammatory state exponent. The aim of this paper was to analyze the G3 in adolescents with ventricular arrhythmia (VES) in order to evaluate its impact on myocardial tissue preservation. The study group (SG) consisted of 25 VES adolescents. The control group (CG) was 21 healthy children. G3 was assessed in the SG and CG. In the SG electrocardiography, Holter monitoring, echocardiography and CMR were performed. The G3 in SG was 13.45 ± 11.4 ng/mL and in CG 7.2 ± 2.0 ng/mL, p < 0.001. Moderate positive correlation between the G3 and z-score of the left ventricular diameter (r = 0.47, p = 0.041) and moderate negative correlation between the G3 and the left ventricular ejection fraction in cardiac magnetic resonance (CMR EF) (−0.49, p = 0.032) were found. According to the multiple linear regression analysis, CMR EF and VES were independent predictors for G3 elevation. Conclusion: Galectin-3 plasma concentration is elevated and correlates with the chosen left ventricular dysfunction parameters in adolescents suffering from ventricular arrhythmia. Further investigation is necessary to establish if elevated G3 is a useful biomarker for screening young individuals with ventricular arrhythmia who are at risk of structural cardiovascular pathology.

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