P709Improvement in endothelial function and arterial elastic properties facilitates response to cardiac resynchronization therapy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
N D Karamichalakis ◽  
I Ikonomidis ◽  
J Parissis ◽  
P Simitsis ◽  
S Xydonas ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Endothelial Function ◽  
Cardiac Resynchronization Therapy ◽  
Elastic Properties ◽  
Global Longitudinal Strain ◽  
Endothelial Glycocalyx ◽  
Cardiac Resynchronization ◽  
P Value ◽  
Resynchronization Therapy

Abstract Background Cardiac resynchronization therapy (CRT) is a well-established therapy in heart failure (HF) patients with prolonged QRS. In HF patients, reduced nitric oxide availability and increased oxidative stress promote endothelial dysfunction (ED) and arterial stiffness. Purpose To investigate the pathophysiologic changes in endothelium and arterial elastic properties in CRT patients and their correlation to therapy. Methods We studied 32 HF patients before and 3 months after CRT implantation. In each visit we performed a 12-lead ECG and assessed markers of endothelial function. Specifically, we examined flow-mediated dilatation of the brachial artery (FMD), carotid to femoral pulse wave velocity (cfPWV), as well as the layer of endothelial glycocalyx using the Perfused Boundary Region (PBR) of the sublingual microvessel range: 5–25 microns. We also evaluated left ventricle ejection fraction (LVEF), left ventricle (LV) global longitudinal strain (GLS) and arterial elastance (Ea) to ventricular elastance (Ees) ratio (Ea/Ees) by echocardiography. Results 32 HF CRT patients, at age 65.5 (±10.9) years, with reduced LVEF (baseline LVEF: 27±7%, LVESV: 151±42 ml, GLS: 6.47±2.89%) were followed-up for a median of 115 days (IQR: 36). During follow up, all markers of ED demonstrated significant change: FMD was increased by 4.37±3.34% (p<0.001), cfPWV and PBR 5–25 were reduced by 1.10±1.56 (p=0.003) and 0.13±0.25 microns (p=0.028) respectively. LVEF was significantly increased (mean change: 7.50±4.77%) and LVESV was significantly reduced (mean change: −26.91±17.20 ml). 16 of 32 patients were responders (LVESV change ≥15% compared to baseline). Among the changes of the examined markers during follow-up, response to CRT correlated with the change of FMD (OR: 3.10, 95% CI: 1.47–15.51, p=0.039) and change of Ea/Ees (OR: 0.000, 95% CI: 0.000–0.061, p=0,0239). Effect of change in measurements during follow-up on response to CRT Measurement OR (95% CI) Main effect p-value FMD change 3.100 (1.470–15.513) 0.0397 cfPWV change 0.669 (0.295–1.354) 0.0622 PBR 5–25 change 1.773 (0.008–455.458) 0.828 Ea/Ees change 0.000 (0.000–0.061) 0.0239 Conclusion Improvement in endothelial function and arterial elastic properties evaluated by FMD and Ea/Ees respectively are related with effective CRT.

scholarly journals 414 Ventricular-arterial interaction predicts response to cardiac resynchronization therapy: a link with improvement of endothelial function and arterial elastic properties

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
N Karamichalakis ◽  
I Ikonomidis ◽  
J Parissis ◽  
P Simitsis ◽  
S Xydonas ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Endothelial Function ◽  
Cardiac Resynchronization Therapy ◽  
Vascular Function ◽  
Global Longitudinal Strain ◽  
Endothelial Glycocalyx ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
The Impact

Abstract Background Endothelial dysfunction (ED) is a hall mark of chronic heart failure and has been linked to disease progression, hospitalizations and mortality. Purpose to evaluate the impact of cardiac resynchronization therapy (CRT) in ED and to determine predictors of response to CRT Methods CRT recipients from 19/07/2016 until 19/10/2018 were studied at baseline and 3 months after. In each visit we evaluated a 12 lead ECG, carotid to femoral pulse wave velocity (cfPWV), flow-mediated dilatation of the brachial artery (FMD), left ventricle ejection fraction (LVEF) and left ventricle (LV) global longitudinal strain (GLS). We evaluated arterial elastance (Ea) to ventricular elastance (Ees) ratio (Ea/Ees) by echocardiography and the ratio of cfPWV to GLS, as valid markers of ventricular-arterial interaction. We also assessed the layer of endothelial glycocalyx by measurement of Perfused Boundary Region (PBR) of the sublingual microvessel range:5-25 microns. Results 32 patients with a mean age 65.5 (±10.9) years and severe LV systolic dysfunction were enrolled. During follow-up, LVEF, GLS, LVESV and all ED markers exhibited significant improvement (table 1). 23 patients were responders. Among the baseline vascular function markers, only the ratio cfPWV/GLS predicted response to CRT (OR: 0.245, 95%CI: 0.042-0.759, p = 0.044).Threshold analysis showed that the best threshold of cfPWV/GLS for response to CRT was 2.75 (specificity: 0.67%, sensitivity: 0.94%). Conclusions After 3 months of CRT, endothelial function, arterial elasticity and ventricular arterial interaction are improved. The baseline ratio cfPWV/GLS, a novel marker of ventricular arterial interaction, can be applied to predict response to CRT. table 1 Baseline Follow-up Change Measurement mean (sd) mean (sd) mean (sd) p-value SBP (mmHg) 126 (19) 128 (16) 2.18 (11.98) 0,465 DBP (mmHg) 79 (9) 80 (9) 1.06 (8.58) 0,618 LVEF (%) 27 (7) 35 (9) 7.50 (4.77) &lt;0.001 LVESV (mL) 151 (42) 120 (46) -26.91 (17.20) &lt;0.001 GLS (%) 6.47 (2.89) 9.33 (4.18) 2.85 (2.28) &lt;0.001 FMD (%) 5.88 (2.79) 10.25 (3.67) 4.37 (3.34) &lt;0.001 Ea/Ees 2.81 (1.10) 2.04 (0.99) -0.77 (0.47) &lt;0.001 cfPWV 11.11 (2.61) 10.01 (2.45) -1.10 (1.56) 0,003 PBR 5-25(microns) 2.26 (0.20) 2.14 (0.24) -0.13 (0.25) 0,028 cfPWV/GLS 2.18 (1.46) 1.45 (1.11) -0.73 (0.55) &lt;0.001 Measurements at baseline, follow-up and their change during study Abstract 414 Figure. picture 1

Abstract 14303: Low Global Longitudinal Strain in Ischemic Cardiomyopathy Patients at Baseline is Associated With Ventricular Arrhythmias After Cardiac Resynchronization Therapy

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Bhupendar Tayal ◽  
Antonia Delgado-Montero ◽  
Akiko Goda ◽  
Samir Saba ◽  
Niels Risum ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Ventricular Arrhythmias ◽  
Ischemic Cardiomyopathy ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Increased Risk ◽  
Prognostic Implications

Introduction: Heart failure (HF) patients have an increased risk for ventricular arrhythmias (VA) and in particular patients with ischemic cardiomyopathy (ICM) have a worse prognosis after cardiac resynchronization therapy with defibrillator (CRT-D) compared with non-ischemic patients. Hypothesis: We hypothesize that global longitudinal strain (GLS) at baseline has the ability to identify ICM patients at higher risk for VA after CRT-D. Methods: We prospectively studied 175 consecutive HF patients implanted with CRT-D from a single center. All of them had class II-IV HF symptoms, LV ejection fraction (≤35%), QRS≥120 ms. GLS was measured from the three standard apical views and presented as absolute values. Outcome event was defined as VA (anti-tachycardia pacing or appropriate shock) after CRT in the first 2 years of follow-up. Results: Of 175 patients aged 65±11 years, 135 (77%) were male and 115 (66%) had ICM. They suffered 34 (19%) VA events over 2 years. Mean GLS of the population was 8.1±3.0. GLS (< 6.5%) was associated with VA events after CRT-D with a sensitivity of 70% and specificity of 56%. A cutoff of GLS<6.5% was associated with greater VA events in the ICM patients with HR 2.92 (95% confidence interval 1.48 to 5.77, p=0.002). A similar significant association of GLS was not seen in the non ICM patients (p=0.12). Conclusions: Low GLS (<6.5% in absolute values) in ICM patients is associated with increased risk for VA after CRT-D and might represent more extensive myocardial scarring and has prognostic implications.

scholarly journals 553 Acute re-distribution of regional left ventricular work by cardiac resynchronization therapy determines long-term remodelling

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
J Duchenne ◽  
J M Aalen ◽  
M Cvijic ◽  
C K Larsen ◽  
E Galli ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Cardiac Resynchronization Therapy ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Multivariate Linear Regression Analysis ◽  
Resynchronization Therapy ◽  
Work Distribution ◽  
Reverse Remodelling

Abstract Background In patients with dilated cardiomyopathy and left bundle branch block (LBBB), different regions of the left ventricle (LV) have been shown to perform different amounts of work. In this study, we investigate the acute impact of cardiac resynchronization therapy (CRT) on regional LV work distribution and its relation to long-term reverse-remodelling. Methods We recruited 140 heart failure patients, referred for CRT. Regional myocardial work was calculated from non-invasive echocardiographic segmental stress-strain-loop-area before and immediately after CRT. The magnitude of volumetric reverse-remodelling was determined from the change in LV end-systolic volume (ESV), 11 ± 3 months after implantation. Characteristics of patients with the lowest and highest quartile of LV ESV reverse remodelling (LV ESV reduction of less than 10% and LV ESV reduction of more than -48%) were compared. Results Before CRT, myocardial work showed significant differences among the walls of the LV (Figure A). CRT caused an acute re-distribution of myocardial work, on average with most increase in the septum and most decrease laterally (all walls p &lt; 0.05) and lead to a homogeneous work distribution (Figure B). The acute change in the difference between lateral and septal wall work (Δ Lateral-to-septal work) correlated significantly with LV ESV reverse-remodelling (r = 0.63, p &lt; 0.0001). The smallest changes in work were seen in the patients with the least LV ESV reverse remodelling (Figure C, red markers), while patients with the most LV ESV reverse remodelling showed the largest changes in work (Figure C, green markers). In multivariate linear regression analysis, including conventional parameters such as pre-implant QRS duration, LV ejection fraction, LV end-diastolic volume and global longitudinal strain, the re-distribution of work across the septal and lateral walls appeared as the strongest determinant of volumetric reverse-remodelling after CRT (R²=0.393, p &lt; 0.0001). Conclusions The acute re-distribution of regional myocardial work between the septal and lateral wall of the left ventricle is an important determinant of long term reverse-remodelling after CRT-implantation. Our data suggest that modification of regional loading is the mode of action of CRT treatment. Abstract 553 Figure.

P1240Is resynchronization therapy really efficient in laminopathy?

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Burdeau ◽  
G Viart ◽  
E Gandjbakhch ◽  
A Savoure ◽  
B Godin ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Heart Transplantation ◽  
Nyha Class ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
P Value ◽  
Resynchronization Therapy ◽  
Ventricular Ejection Fraction

Abstract Introduction Laminopathy (LMNA) is a group of rare disease caused by a mutation of lamin A/C genes. Heart transplantation (HT) is often required. Cardiac resynchronization therapy (CRT) may be an option to postpone HT. Purpose To describe characteristics and outcome of LMNA patients receiving CRT. Methods All consecutive LMNA patients implanted with a CRT device for conventional indications were included in the study. Clinical and echocardiographic (TTE) data were collected during the follow-up period. Results From 2002 to 2017, 68 LMNA patients had CRT implantation. Despite CRT, 30/68 patients (44%) had HT. Population divided into two groups according to response to CRT. Patients were considered without benefit (WHOB-CRT group) if they experienced severe events (inscription on heart transplantation list or death) within two years after CRT implantation. Other patients were in the WB-CRT group. TTE and clinical parameters are described in Table 1. Table 1 Parameters WB-CRT (n=33) WHOB-CRT (n=35) P-value At implantation   Age (years) 52.3±9.7 50.6±9.5 0.27   Women 9 (27%) 13 (37%) 0.45   NYHA class 2.7±0.6 2.8±0.7 0.45   LVEF (%) 33.2±8.8 31.3±7 0.64   LVEDD (mm) 60±6.9 60±6.9 0.96   TAPSE (mm) 23±3.7 14±4.8 0.002 At last follow up   NYHA class 2.2±0.6 2.9±0.7 <0.001   LVEF (%) 36.4±11 27±9 <0.001   LVEDD (mm) 59±5.5 59±7.7 0.98   TAPSE (mm) 19.9±5.5 12.3±3.3 0.003 Left ventricular ejection fraction (LVEF); Left ventricular end diastolic diameter (LVEDD); Tricuspid annular plane systolic excursion (TAPSE). Conclusion Cardiac resynchronization therapy is less efficient in LMNA patients. An impaired right ventricular stroke function seems to be the only predictive factor leading to poor response to CRT.

scholarly journals DYNAMICS OF MECHANICAL DYSSYNCHRONY IN PATIENTS WITH SUPERRESPONSE TO CARDIAC RESYNCHRONISATION THERAPY WITH A LONG-TERM FOLLOW-UP

2018 ◽  
Vol 33 (2) ◽  
pp. 42-50
Author(s):  
N. E. Shirokov ◽  
V. A. Kuznetsov ◽  
A. M. Soldatova ◽  
S. M. Diachkov ◽  
D. V. Krinochkin
Keyword(s):  
Heart Failure ◽  
Left Ventricle ◽  
Cardiac Resynchronization Therapy ◽  
Mechanical Dyssynchrony ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Therapy Effect ◽  
Long Term Follow Up ◽  
Baseline Values

Aim. The aim is to assess clinical features of organism and morpho-functional properties of heart and to study the dynamics of mechanical dyssynchrony in patients with congestive heart failure and superresponse to cardiac resynchronization therapy.Material and Methods. 72 patients were examined (mean age 54.3±8.9 years) at baseline and during follow-up visits: 10.5±3.7 months, 52.0±21.4 months. Patients were divided into groups: I group (n=31) with decrease of left ventricle endsystolic volume ≥30% (superresponders) and II group (n=41) — decrease of left ventricle endsystolic volume <30% (nonsuperresponders).Results. At baseline there were differences in the presence of myocardial infarction (22.5% in I group vs 46.3% in II group; p=0.038), the groups were comparable in severity of electrical and mechanical dyssynchrony. Left ventricle pre-ejection period in I group was statistically significantly decreased at both control visits, in group II there was no significant change. Right ventricular pre-ejection period significantly increased only in I group at the second control visit compared to baseline values. The mechanical interventricular delay significantly decreased in I group at both control visits compared to baseline values, in II group only at first control visit. The Intraventricular dyssynchrony assessed by tissue doppler imaging significantly decreased in both groups compared to baseline values. The survival rate in I group was 87.1%, in group II was 65.9% (Log-Rank test p=0.038).Discussion. Based on the results of the subanalysis of the Echo-CRT study, it was shown that a decrease in mechanical dyssynchrony in patients with cardiac resynchronization therapy is associated with a lower incidence of hospitalization due to heart failure or death. Persistent or worsening dyssynchrony according to echocardiography may be a marker of a severity of the disease in patients with congestive heart failure and has a prognostic value. It is important to note that in our study the described facts confirm the preservation of cardiac resynchronization therapy effect with long follow-up in superresponders and limited cardiac resynchronization therapy effect with short follow-up in nonsuperresponders.Conclusion. Superresponse is associated with a decrease of mechanical dyssynchrony with a long-term follow-up also with a higher survival rate.

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

Fragmented QRS, a predictor of clinical events in patients on cardiac resynchronization therapy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Martinez Milla ◽  
C Garcia-Talavera ◽  
B Arroyo ◽  
A Camblor ◽  
A Garcia-Ropero ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Cardiovascular Events ◽  
Hospital Admissions ◽  
Multivariate Logistic Regression Analysis ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Coronary Syndrome ◽  
Clinical Events ◽  
Increased Risk

Abstract Introduction Cardiac resynchronization therapy with defrilator (CRT-D) has been shown to reduce mortality in HFrEF. The width and morphology of the QRS are essential when deciding on the implantation of these devices. QRS fragmentation (fQRS) has been shown to be a good predictor of cardiovascular events in certain patients, but its role in patients with CRT-D has not been studied. The aim of this study is to determine whether the presence of a fQRS at the time of CRT-D implantation can predict clinical events. Methods All patients who underwent CRT-D implantation from 2010 to 2017 were included. Patients' ECG were evaluated at the time of implantation, and the incidence of clinical events during follow-up was also assessed. fQRS was defined as the presence of an RSR' pattern with a notch in the R wave or in the ascending or descending branch of the S wave in two continuous leads on the ECG. Results We studied 131 patients (mean age 73 years, 76.5% male). The mean follow-up period was 37±26 months. No difference in baseline characteristics was found (Table 1); the proportion of fQRS was 48.9%. 25 patients (19.1%) had hospital admissions secondary to cardiovascular causes (heart failure, arrhythmic events, acute coronary syndrome, and death from other causes). We performed a multivariate logistic regression analysis aiming at an association between the presence of fQRS and the increased risk of hospital admissions due to cardiovascular causes OR 2.92 (95% CI: 1.04–8.21, P=0.04). Conclusion The presence of a fQRS at the time of implantation of a CRT-D is an independent predictor of hospital admissions due to cardiovascular causes. Therefore this could be a useful marker to identify the population at high risk of cardiovascular events, for this we consider necessary to conduct future studies and thus assess the value of the fQRS for the selection of patients requiring closer monitoring thus avoiding further hospital admissions. Funding Acknowledgement Type of funding source: None

The distribution of ICD therapy by extent of response to cardiac resynchronization therapy; results of long term clinical follow up

2013 ◽  
Vol 34 (suppl 1) ◽  
pp. P3161-P3161
Author(s):  
A. C. Van Der Heijden ◽  
U. Hoke ◽  
C. J. W. Borleffs ◽  
J. Thijssen ◽  
J. B. Van Rees ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Icd Therapy
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