scholarly journals Body composition in heart failure and the impact of cardiac resynchronisation therapy: a proof-of-concept study

Open Heart ◽  
2020 ◽  
Vol 7 (1) ◽  
pp. e001105
Author(s):  
Christopher J McAloon ◽  
Samantha Hyndman ◽  
Valerie Ansell ◽  
Paul O'Hare ◽  
Harpal Randeva ◽  
...  
Keyword(s):  
Heart Failure ◽  
Fat Mass ◽  
Cardiac Resynchronisation Therapy ◽  
Left Ventricular ◽  
Left Ventricular Geometry ◽  
Proof Of Concept ◽  
Ventricular Geometry ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy ◽  
The Impact

AimsBody composition (BC) is known to alter in heart failure. Cardiac resynchronisation therapy (CRT) improves left ventricular geometry but the impact on BC is unknown. Our aim was to evaluate BC in these patients before and after CRT implantation.MethodsProspective proof-of-concept pilot study of heart failure patients undergoing CRT between September 2014 and December 2015. Assessments performed pre-CRT and post-CRT (6 weeks and 6 months) were: BC parameters (using air-displacement plethysmography), New York Heart Failure classification for assessing symptom severity, echocardiography to assess left ventricular geometry, electrocardiography, Minnesota Heart Failure Questionnaire and N-terminal probrain natriuretic peptide (NT-pro-BNP). Repeated measures analysis of variance was performed to assess relative change over time and potential correlations.ResultsTwenty-five patients were recruited; mean-age (±SD) was 73.4±10.0 years, 23 males, 18 CRT defibrillators (remainder CRT pacemakers), 16 had ischaemic aetiology, 6 diabetics, 17 with left bundle-branch morphology on ECG and 10 had atrial fibrillation. Significant inverse correlations were observed in the first 6 weeks following CRT between fat mass and left ventricular end-diastolic volume (r=−0.69, p<0.01) and NT-pro-BNP and fat mass (r=0.41, p=0.05). No significant differences were noted over 6 months. There was an observed trend towards reduced fat mass in the first 6 weeks post-CRT implant driven by non-responders. There was no significant difference between responders and non-responders in BC over 6 months.ConclusionThis is the first study to observe interplay between BC and cardiac geometry/function following CRT; a trend in overall fat mass reduction was noted following CRT and merits further study.

Cardiac Resynchronisation Therapy – Evolving Strategies to Enhance Response

2010 ◽  
Vol 6 (1) ◽  
pp. 83
Author(s):  
Jagmeet P Singh ◽  
Keyword(s):  
Heart Failure ◽  
Systolic Heart Failure ◽  
Cardiac Resynchronisation Therapy ◽  
Left Ventricular ◽  
Patient Specific ◽  
Cardiac Resynchronisation ◽  
Clinical Benefits ◽  
Pacing Lead ◽  
Resynchronisation Therapy ◽  
Physiological Impact

Cardiac resynchronisation therapy (CRT) has gained widespread acceptance as a safe and effective therapeutic strategy for congestive heart failure (CHF) refractory to optimal medical therapy. The use of implantable devices has substantially altered the natural history of systolic heart failure. These devices exert their physiological impact through ventricular remodelling, associated with a reduction in left ventricular (LV) volumes and an improvement in ejection fraction (EF). Several prospective randomised studies have shown that this in turn translates into long-term clinical benefits such as improved quality of life, increased functional capacity and reduction in hospitalisation for heart failure and overall mortality. Despite these obvious benefits, there remain more than a few unresolved concerns, the most important being that up to one-third of patients treated with CRT do not derive any detectable benefit. There are several determinants of successful delivery and response to CRT, including selecting the appropriate patient, patient-specific optimal LV pacing lead placement and appropriate post-implant device care and follow-up. This article highlights the importance of collectively working on all of these aspects of CRT to enhance and maximise response.

Emerging Cardiac Resynchronisation Therapy Indications

2011 ◽  
Vol 7 (1) ◽  
pp. 29
Author(s):  
Charlotte Eitel ◽  
Gerhard Hindricks ◽  
Christopher Piorkowski ◽  
◽  
◽  
...  
Keyword(s):  
Heart Failure ◽  
Systolic Heart Failure ◽  
Cardiac Resynchronisation Therapy ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Current Evidence ◽  
Class Iii ◽  
Ventricular Ejection Fraction ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy

Cardiac resynchronisation therapy (CRT) is an efficacious and cost-effective therapy in patients with highly symptomatic systolic heart failure and delayed ventricular conduction. Current guidelines recommend CRT as a class I indication for patients with sinus rhythm, New York Heart Association (NYHA) functional class III or ambulatory class IV, a QRS duration ≥120ms, and left ventricular ejection fraction (LVEF) ≤35%, despite optimal pharmacological therapy. Recent trials resulted in an extension of current recommendations to patients with mild heart failure, patients with atrial fibrillation, and patients with an indication for permanent right ventricular pacing with the aim of morbidity reduction. The effectiveness of CRT in patients with narrow QRS, patients with end-stage heart failure and cardiogenic shock, and patients with an LVEF >35% still needs to be proved. This article reviews current evidence and clinical applications of CRT in heart failure and provides an outlook on future developments.

scholarly journals Scar burden is an independent and incremental predictor of cardiac resynchronisation therapy response

Open Heart ◽  
2019 ◽  
Vol 6 (2) ◽  
pp. e001067 ◽  
Author(s):  
Serge C Harb ◽  
Saleem Toro ◽  
Jennifer A Bullen ◽  
Nancy A Obuchowski ◽  
Bo Xu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Characteristic Curve ◽  
Cardiac Resynchronisation Therapy ◽  
Left Ventricular ◽  
Lv Function ◽  
Prognostic Impact ◽  
Clinical Events ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy ◽  
Heart Failure Admission

ObjectiveDetermine the prognostic impact of scar quantification (scar %) by cardiac magnetic resonance (CMR) in predicting heart failure admission, death and left ventricular (LV) function improvement following cardiac resynchronisation therapy (CRT), after controlling for the presence of left bundle branch block (LBBB), QRS duration (QRSd) and LV lead tip location and polarity.MethodsConsecutive patients who underwent CMR between 2002 and 2014 followed by CRT were included. The primary endpoint was death or heart failure admission. The secondary endpoint was change in ejection fraction (EF) ≥3 months after CRT. Cox proportional hazards, linear regression models and change in the area under the receiver operating characteristic curve (AUC) were used.ResultsA total of 84 patients were included (63% male, 51% with ischaemic cardiomyopathy). After adjusting for clinical factors, presence of LBBB and QRSd and LV lead tip location and polarity, greater scar % remained associated with a higher risk for clinical events (HR=1.06; 95% CI 1.02 to 1.10; p<0.001) and a smaller improvement in EF (slope: −0.61%; 95% CI −0.93% to 0.29%; p<0.001). When adding scar % to QRSd and LBBB, there was significant improvement in predicting clinical events at 3 years (AUC increased to 0.831 from 0.638; p=0.027) and EF increase ≥10% (AUC 0.869 from 0.662; p=0.007).ConclusionScar quantification by CMR has an incremental value in predicting response to CRT, in terms of heart failure admission, death and EF improvement, independent of the presence of LBBB, QRSd, LV lead tip location and polarity.

scholarly journals Update on Cardiac Resynchronisation Therapy for Heart Failure

2014 ◽  
Vol 9 (2) ◽  
pp. 100
Author(s):  
David D Daly ◽  
Michael R Gold ◽  
◽  
Keyword(s):  
Heart Failure ◽  
Systolic Dysfunction ◽  
Systolic Heart Failure ◽  
Cardiac Resynchronisation Therapy ◽  
Left Ventricular ◽  
Conduction Delay ◽  
Lead Placement ◽  
Mild Heart Failure ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy

Cardiac resynchronisation therapy (CRT) is well accepted therapy for the treatment of symptomatic systolic heart failure in defined patient subgroups. Large clinical trials over the past 20 years have shown that patients with a left ventricular (LV) systolic dysfunction and interventricular conduction delay benefit from this therapy. Recent advances in this field include the expansion indications for CRT to patients with mild heart failure and to those with a mildly depressed ejection fraction that require frequent right ventricular pacing. In addition, although CRT guidelines have included indications in atrial fibrillation, it is now clear that this is most effective when pacing is utilised nearly 100 % of the time, often requiring atrioventricular (AV) junction ablation. Strategies for optimising LV lead placement based on identifying late mechanical contraction or electrical delay are promising for maximising CRT response. Finally, the role of routine AV delay optimisation is no longer recommended based on the results of multicentre trials.

scholarly journals Cardiac Resynchronisation Therapy and Heart Failure: Persepctive from 5P Medicine

2015 ◽  
Vol 1 (1) ◽  
pp. 35 ◽  
Author(s):  
Fang Fang ◽  
Zhou Yu Jie ◽  
Luo Xiu Xia ◽  
Liu Ming ◽  
Ma Zhan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronisation Therapy ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Patients With Heart Failure ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy ◽  
Qrs Duration

Chronic heart failure is still a major challenge for healthcare. Currently, cardiac resynchronisation therapy (CRT) has been incorporated into the updated guideline for patients with heart failure, left ventricular ejection fraction ≤35 % and prolonged QRS duration. With 20 years of development, the concept of ‘from bench to bedside’ has been illustrated in the field of CRT. Given the fact that the indications of CRT keep evolving, the role of CRT is not limited to the curative method for heart failure. We therefore summarise with the perspective of 5P medicine – preventive, personalised, predictive, participatory, promotive, to review the benefit of CRT in the prevention of heart failure in those with conventional pacemaker indications, the individualised assessment of patient’s selection, the predictor of responders of CRT, and the obstacles hindering the more application of CRT and the future development of this device therapy.

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