P1169Cardiac resynchronization theraphy. Long term benefit

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
N Galizio ◽  
M Peltzer ◽  
A Tronconi ◽  
G Carnero ◽  
M Mysuta ◽  
...  
Keyword(s):  
Remote Monitoring ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Multicenter Studies ◽  
Study Population ◽  
Receptor Blockers ◽  
M 31 ◽  
Term Benefit

Abstract Introduction The benefit of cardiac resynchronization therapy (CRT) in patients (pts) with left ventricular dysfunction is mainly evaluated in multicenter studies with a follow up of 6, 12 or 24 months (m). Objectives To describe the response of pts implanted with a CRT-D/P, from a single center prospective registry, at 12, 24, 36 and 48 m. Methods Between june 2009 and june 2018, 381 pts implanted with CRT-D/P were followed at 12, 24, 36 and 48 m. Indications were performed according to international guidelines. Primary prevention: 335 pts (88%). The A-V and V-V delay were programmed according the results of Cardiac Doppler after implantation and when it was necesary. All pts had an out patient control and 10% remote monitoring control. The pts were considered Responders: decrease ≥ 1 FC NYHA or increase LVEF ≥ 5% (absolute), Super-Responders: increase LVEF ≥ 10% (absolute) and with LVEF normalization: LVEF ≥ 50%. Baseline characteristics: Age 64 ± 11 years, men 268 p (70%), ischemic cardiomyopathy 144 pts (38%), nonischemic cardiomyopathy 237 (62%), FC II-III NYHA 341 p (90%), LBBB 246 p (72%), mean QRSd 165 ± 27ms, mean LVDD 68 ± 10mm, mean LVSD 56 ± 12mm, and mean LVEF 24 ± 9%. Pts were on β-blockers (93%), ACEi/ARBs (90%), mineral receptor blockers (83%) and diuretics (73%). Results Responders: 227/276 pts (82%) at 12 m, 184/224 pts (82%) at 24 m, 141/180 p (78%) at 36 m and 112/137 (82%) at 48 m. Super-Responders: 92/186 pts (49%) at 12 m, 92/172 pts (53%) at 24 m, 71/128 (55%) at 36 m and 66/116 (57%) at 48 m. LVEF normalization: 22/186 pts (12%) at 12 m, 31/172 pts (18%) at 24 m, 24/128 pts (19%) at 36 m and 23/116 pts (20%) at 48 m. Conclusion In our study population, pts with CRT-D/P implanted according an appropriate indication, programming and follow up, with in-office and/or remote monitoring control, showed an elevated percentage of Responders, Super-Responders and LVEF normalization. The benefit was sustained or even incresed over time.

scholarly journals Long-term single-centre large volume experience with transseptal endocardial left ventricular lead implantation

EP Europace ◽  
2019 ◽  
Vol 21 (8) ◽  
pp. 1237-1245 ◽  
Author(s):  
László Gellér ◽  
Zoltán Salló ◽  
Levente Molnár ◽  
Tamás Tahin ◽  
Emin Evren Özcan ◽  
...  
Keyword(s):  
Femoral Vein ◽  
Anticoagulation Therapy ◽  
Heart Association ◽  
Left Ventricular ◽  
Left Ventricular Lead ◽  
Cardiac Resynchronization ◽  
Single Centre ◽  
Ventricular Lead

Abstract Aims The aim of our study was to investigate the long-term efficacy and safety of transseptal endocardial left ventricular lead implantation (TELVLI). Methods and results Transseptal endocardial left ventricular lead implantation was performed in 54 patients (44 men, median age 69, New York Heart Association III–IV stage) between 2007 and 2017 in a single centre. In 36 cases, the transseptal puncture (TP) was performed via the femoral vein, and in 18 cases, the TP and also the left ventricular (LV) lead placement were performed via the subclavian vein. An electrophysiological deflectable catheter was used to reach the LV wall through the dilated TP hole. The LV lead implantation was successful in all patients. A total of 54 patients were followed up for a median of 29 months [interquartile range (IQR) 8–40 months], the maximum follow-up time was 94 months. Significant improvement in the LV ejection fraction was observed at the 3-month visit, from the median of 27% (IQR 25–34%) to 33% (IQR 32–44%), P < 0.05. Early lead dislocation was observed in three cases (5%), reposition was performed using the original puncture site in all. The patients were maintained on anticoagulation therapy with a target international normalized ratio between 2.5 and 3.5. Four thromboembolic events were noticed during follow-up. A total of 27 patients died, with a median survival of 15 months (IQR 6–40). Conclusion The TELVLI is an effective approach for cardiac resynchronization therapy (CRT) however it is associated with a substantial thromboembolic risk (7%).

Abstract 13444: Complete Left-Sided Reverse Remodeling in Cardiac Resynchronization Therapy and Clinical Implications: a MADIT-CRT Long-term Follow-up Sub-study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Andrew M Mathias ◽  
Scott D Solomon ◽  
Arthur J Moss ◽  
Dorit Knappe ◽  
Anne-Catherine Pouleur ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Lower Risk ◽  
Left Atrial ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Long Term Follow Up ◽  
Median Change

Background: Left ventricular and left atrial remodeling (defined as a reduction in left ventricular end-systolic volume [LVESV] and left atrial volume [LAV] respectively) have both been shown to be associated with better clinical outcome in patients with cardiac resynchronization therapy (CRT). However, a portion of CRT patients exhibit discordant remodeling (e.g. improvement in LVESV but not in LAV or vice versa). Whether combined assessment of LA and LV remodeling predicts clinical outcome is unknown. Objectives: We aimed to evaluate the predictive value of a combined assessment of LAV and LVESV change in CRT patients with left bundle branch block (LBBB) enrolled in MADIT-CRT. We hypothesized that combined assessment better predicts outcome than LAV or LVESV reduction alone. Methods: The study population comprised 533 CRT-D LBBB patients assigned to lesser remodeling (below median LAV and LVESV change), discordant remodeling (above median change in only LAV or LVESV), or complete left-sided remodeling (above median change in both LAV and LVESV). The end point was heart failure (HF) during follow-up. Results: At 1-year follow-up, 206 patients had lesser remodeling, 115 had discordant remodeling and 212 had complete left-sided remodeling. Patients with complete left-sided remodeling had less HF than those with discordant remodeling or lesser remodeling (Figure, p=0.002). Multivariate analysis confirmed that complete left-sided remodeling is associated with lower risk of HF than discordant remodeling and discordant remodeling is better than lesser remodeling (HR=0.62 per each group, 95% CI: 0.44-0.86, p = 0.004). Conclusions: A combined assessment of LAV and LVESV reduction predicts HF in CRT patients with LBBB. Patients with complete left-sided remodeling had a significantly lower risk of HF during long-term follow-up.

Abstract WMP43: The Natural History of Vertebral Artery Origin Stenosis and Long-term Survival

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Matthew Thompson ◽  
Mohammad Issa ◽  
Marc Lazzaro ◽  
Osama Zaidat
Keyword(s):  
Vertebral Artery ◽  
Multicenter Studies ◽  
Term Survival ◽  
Control Subjects ◽  
Kaplan Meier ◽  
Long Term Follow Up ◽  
History Of ◽  
Study Population

Methods: We retrospectively reviewed clinical data on patients admitted at a single institution for possible stroke between 2004 and 2007, and selected subjects who underwent angiography of the neck. We classified subjects as having vertebral artery origin stenosis (VAOS) by ‘moderate’ to ‘severe’ (≥50%) occlusion. Age, sex, and race-matched control subjects were selected from our study population as having no evidence of VAOS on angiography. Long-term follow-up data was collected and death certificates were searched for comparison among cases and controls. A Kaplan-Meier curve was plotted based on time to event (stroke or death). Results: The proportion of subjects that were found to have VAOS was 58 per 358 cases, or 16.2%. Four subjects were excluded because of stenting, so a total of 54 cases and 54 matched controls were included for long-term follow-up analysis. In our study population, we calculated the relative risk of having a stroke or dying in patients with VAOS to be 6.0 times that of patients without VAOS ( p <0.02). The observed 5-year survival for patients with VAOS was 67% (36/54) compared to 89% (48/54) in control subjects ( p <0.01). Conclusions: Patients with vertebral artery origin stenosis are at a significantly higher risk of having a stroke or dying. Subsequent prospective, multicenter studies are needed to validate our results.

Left ventricular volumes at baseline and outcome in heart failure patients undergoing cardiac resynchronization therapy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Kostyukevich ◽  
P Van Der Bijl ◽  
B Mertens ◽  
M Vo ◽  
N.A Marsan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Filtration Rate ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
End Point ◽  
Lv Volumes ◽  
Long Term Prognosis

Abstract Background Studies evaluating the relationship between baseline left ventricular (LV) volumes and long-term prognosis in heart failure (HF) patients undergoing cardiac resynchronization therapy (CRT) are lacking. Purpose To evaluate the association of LV end-systolic and end-diastolic volumes (ESV and EDV) with long-term prognosis in patients with HF treated with CRT. Methods Patients from an ongoing institutional HF registry who received CRT according to contemporary guidelines were included. All patients underwent standard transthoracic echocardiography. LV volumes were measured using the biplane method during off-line analysis. Primary end-point included all-cause mortality, implantation of left ventricular assist device or heart transplantation, which were assessed according to the national death registry and case records. Results In total, 1165 patients with feasible LV volume assessment were included (mean age 67±10 years; 74.8% males; 55.3% with non-ischemic aetiology of HF). After a median follow-up of 75 (40; 123) months, the primary end-point occurred in 708 (60.8%) patients. Median baseline LV ESV was 151 (108; 198) ml and EDV was 202 (156; 258) ml. All patients were divided into quartiles according to the baseline EDV and ESV: those with larger volumes were significantly younger, more frequently male and had longer QRS durations (p&lt;0.001). Heart failure aetiology, glomerular filtration rate, quality of life and 6-minute walking test distance did not differ significantly between the groups (p&gt;0.05). To investigate the association between long-term prognosis and baseline LV volumes (EDV and ESV), a Cox proportional hazards model was constructed with variables known to influence the mortality of HF patients (age, gender, aetiology, QRS duration, and estimated glomerular filtration rate). When separately included in a multivariate analysis, baseline LV ESV and LV EDV were both independently associated with the primary end-point (p&lt;0.001). To demonstrate hazard change across the range of LV ESV and EDV as continuous variables, an adjusted (for covariates influencing HF mortality) spline curve was drawn, showing an increased mortality risk when the baseline LV ESV and EDV are larger than 100 ml and 200 ml, respectively (Figure). Conclusion LV volumes before CRT implantation are independently associated with prognosis during long-term follow-up. Our findings indicate the importance of taking baseline LV remodelling into consideration to identify patients at high mortality risk after CRT implantation. Funding Acknowledgement Type of funding source: Public grant(s) – EU funding. Main funding source(s): The author acknowledges funding received from the European Society of Cardiology in form of an ESC Training Grant

P1171Optimal fusion vs. biventricular pacing in cardiac resynchronization therapy: long-term results of 540 consecutive patients

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
D A Radu ◽  
C N Iorgulescu ◽  
S N Bogdan ◽  
A I Deaconu ◽  
A Nastasa ◽  
...  
Keyword(s):  
Biventricular Pacing ◽  
Statistical Significance ◽  
Left Ventricular ◽  
Long Term Results ◽  
Cardiac Resynchronization ◽  
P Value ◽  
Data Set ◽  
P Values

Abstract Background Right ventricular (RV) stimulation induces supplemental dyssynchrony in case of left bundle branch block (LBBB) patients. Isolated left ventricular (LV) pacing has been proven superior to biventricular pacing (BiV) in terms of acute hemodynamic response. Purpose We sought to determine whether an optimised isolated LV pacing algorithm called "optimal fusion" (OFu) produces better and sustainable effects when compared to BiV in the long term. Methods 540/760 (reasonable data collection) consecutive patients implanted with CRT in CEHB were analysed. The follow-up included 7 hospital visits for each patient (between baseline and 3 years). Demographics, risk factors, usual serum levels, pre-procedural planning factors, clinical, ECG, TTE and biochemical markers were recorded. Statistical analysis was performed using software. Data were reported as either p-values from crosstabs (discrete) or mean differences, p-values and confidence intervals from t-tests (continuous). A p-value of .05 was chosen for statistical significance (SS). Results The overall group consisted of 51% OFu (275) and the rest BiV patients. Subjects in OFu were younger (-4.379 ys; &lt;.001; (-7.028;-1.729)), more often females (40.9 vs. 24.9%; &lt;.002), more obese (40.1 vs. 29.6%; &lt;0.40) and had more structural disease other than ischaemic scar burden (10.8 vs. 2.7%; &lt;.005). Procedures in OFu were mainly "de novo" (93 vs. 73.4%; &lt;.000), more often CRT-Ds (58.2 vs. 42.9%; &lt;.005) and more frequently in sinus rhythm (99.4 vs. 62.3%; &lt;.000) and with typical LBBB (77.2 vs. 45%; &lt;.000). Baseline PR interval was shorter in OFu (-32.20 msec; &lt;.033; (-61.58;-2.58)). Notably, OFu patients started from a lower EF (-3.29%; &lt;.001; (-5.156;-1.441)), had more dyssynchrony as evaluated by Pitzalis’ index (34.32 msec; &lt;.017; (6.132;62.522)) and poorer initial mechanical performance by dP/dt (-104.83 mm Hg/sec; &lt;.012; (-185.301;-24.366)). There was no SS difference in clinical parameters at 3 years. Mean EF was higher in OFu (38.59 vs. 34.82%; NS; (4.183;-4.755)) while both EDVs (170.40 vs. 161.40 ml; NS; (-82.40;100.40)) and ESVs (115.36 vs. 102.67 ml; NS; (-82.65;108.03)) were lower. When looking at absolute Δs, OFu performed much better in the long term: EF (+15.81 vs. +8.86%; NS; (-17.06877;3.17710)), EDV (-46.07 vs. – 10.1 ml; NS; (-19.88;102.60)) and ESV (-55.91 vs. -17.46 ml; NS; (-39.88;124.71)). The cumulated super-responder/responder (SR/R) percentage at 1 year was much higher in OFu (83.43 vs. 57.75; &lt;.040). Conclusions The benefit of OFu is definitely sustainable in the long term. Structural response is constantly superior with OFu when compared to BiV although the current data set did not yield SS when comparing absolute means. However, parameter Δs are clearly in favor of OFu which produced a SS higher cumulated rate of SR/Rs over 3 years of follow-up.

Abstract 14884: Patients with Renal Impairment Derive Long-Term Benefit from Cardiac Resynchronization Therapy: Results from the MADIT-CRT Long-Term Follow-Up

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Usama Daimee ◽  
Arthur Moss ◽  
Ilan Goldenberg ◽  
Scott Solomon ◽  
Scott McNitt ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Cardiac Resynchronization ◽  
Risk Of Death ◽  
Mild Heart Failure ◽  
All Cause Mortality ◽  
Long Term Follow Up ◽  
Term Benefit

Background: Whether patients with renal impairment experience benefit from cardiac resynchronization therapy plus an implantable cardioverter-defibrillator (CRT-ICD) during long-term follow-up is unknown. Hypothesis: We assessed the hypothesis that baseline renal function affects long-term risk of all-cause mortality and heart-failure events (HFEs) as well as benefit derived from CRT-ICD. Methods: We evaluated the impact of renal function in 1274 patients with mild heart failure and left-bundle branch block enrolled in MADIT-CRT. Patients with BUN>70 mg/dl or creatinine>3.0 mg/dl were excluded from the trial. Two subgroups were created based on the estimated glomerular filtration rate (GFR): GFR<60 and GFR≥60 ml/min/1.73 m2. Patients were studied over a follow-up period of 7 years for the end points of all-cause mortality and HFEs. Results: There were 413 patients with baseline GFR<60 ml/min/1.73 m2 (mean 48.1±8.3). Relative to those with GFR≥60 ml/min/1.73 m2 (mean 79.6±16.0), the low-GFR patients experienced greater risk of death (HR=2.14, 95% CI: 1.57-2.91, p<0.0001) and HFEs (HR= 1.31, 95% CI: 1.02-1.69, p=0.03). In both GFR groups, CRT-ICD relative to ICD alone was associated with significantly lower risk of death (GFR<60: HR=0.63, 95% CI: 0.42-0.94, p=0.024, absolute risk reduction [ARR]=12%; GFR≥60: HR=0.65, 95% CI: 0.42-0.99, p=0.049, ARR=8%) [Figure]. Similarly, there was significant reduction in the risk of HFEs (GFR<60: HR=0.36, 95% CI: 0.25-0.53, p<0.0001, ARR=27%; GFR≥60: HR= 0.42, 95% CI: 0.31-0.57, p<0.0001, ARR=17%). Conclusion: In conclusion, in mild heart failure patients, moderate renal dysfunction is associated with higher risk of all-cause mortality and HFEs relative to mildly impaired-to-normal renal function. While patients in both groups derive long-term benefit from CRT-ICD with similar relative reductions in all-cause mortality and HFEs, the greater absolute benefit occurs in patients with moderate renal disease.

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