scholarly journals A Novel Risk Model of Mortality and Hospitalization of Cardiac Resynchronization Therapy in Patients with Non-ischemic Cardiomyopathy: the Alpha-score

2019 ◽  
Author(s):  
Shengwen Yang ◽  
Zhimin Liu ◽  
Yiran Hu ◽  
Ran Jing ◽  
Wei Hua
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Ischemic Cardiomyopathy ◽  
Risk Model ◽  
Nyha Class ◽  
High Sensitivity ◽  
Cardiac Resynchronization ◽  
Reverse Remodeling ◽  
Resynchronization Therapy ◽  
Heart Failure Hospitalization

Abstract Background Non-ischemic cardiomyopathy (NICM) has been associated with a better LV reverse remodeling response and better clinical outcomes after cardiac resynchronization therapy (CRT). The aims of our study were to identify the predictors of mortality and heart failure hospitalization in patients treated with CRT and design a risk score for prognosis. Methods A cohort of 422 consecutive NICM patients with CRT was retrospectively enrolled between January 2010 and December 2017. The primary endpoint was all-cause mortality and the secondary endpoint was heart failure hospitalization. Results In a multivariate analysis the predictors of all-cause death were left atrial diameter [Hazard ratio (HR): 1.056, 95% confidence interval (CI): 1.020-1.093, P=0.002], non-left bundle branch block (HR: 1.793, 95% CI: 1.131-2.844, P =0.013), high sensitivity C-reactive protein (HR: 1.081, 95% CI: 1.029-1.134 P= 0.002), and N-terminal pro-B-type natriuretic peptide per 100 pg/ml (HR: 1.018, 95% CI: 1.007-1.030, P =0.002), NYHA IV (HR: 1.018, 95% CI: 1.007-1.030, P =0.002). The Alpha-score (Atrial diameter, non-LBBB, ProBNP, Hs-CRP, NYHA class IV) was derived from each independent risk factor. The novel score had better calibration (Hosmer-Lemeshow test, P >0.05) and discrimination for both all cause-death and heart transplantation [c-statistics: 0.749 (95% CI: 0.694-0.804), P <0.001] or heart failure hospitalization [c-statistics: 0.692 (95% CI: 0.639-0.745), P <0.001]. Conclusion The Alpha-score may enable better discrimination and accurate prediction of long-term outcomes among NICM patients with CRT.

scholarly journals A Novel Risk Model for Mortality and Hospitalization following Cardiac Resynchronization Therapy in Patients with Non-ischemic Cardiomyopathy: The Alpha-score

2019 ◽  
Author(s):  
Shengwen Yang ◽  
Zhimin Liu ◽  
Yiran Hu ◽  
Ran Jing ◽  
Wei Hua
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Ischemic Cardiomyopathy ◽  
Risk Model ◽  
Heart Association ◽  
Cardiac Resynchronization ◽  
Reverse Remodeling ◽  
Resynchronization Therapy ◽  
Heart Failure Hospitalization ◽  
Class Iv

Abstract Background: Non-ischemic cardiomyopathy (NICM) has been associated with a better left ventricle reverse remodeling response and improved clinical outcomes after cardiac resynchronization therapy (CRT). The aims of our study were to identify the predictors of mortality and heart failure hospitalization in patients treated with CRT and design a risk score for prognosis. Methods: A cohort of 422 consecutive NICM patients with CRT was retrospectively enrolled between January 2010 and December 2017. The primary endpoint was all-cause mortality and heart transplantation. Results: In a multivariate analysis, the predictors of all-cause death were left atrial diameter [Hazard ratio (HR): 1.056, 95% confidence interval (CI): 1.020-1.093, P=0.002]; non-left bundle branch block [HR: 1.793, 95% CI: 1.131-2.844, P =0.013]; high sensitivity C-reactive protein [HR: 1.081, 95% CI: 1.029-1.134 P= 0.002]; and N-terminal pro-B-type natriuretic peptide [HR: 1.018, 95% CI: 1.007-1.030, P =0.002]; and New York Heart Association class IV [HR: 1.018, 95% CI: 1.007-1.030, P =0.002]. The Alpha-score ( A trial diameter, non- L BBB, P ro-BNP, H s-CRP, NYH A class IV) was derived from each independent risk factor. The novel score had good calibration (Hosmer-Lemeshow test, P >0.05) and discrimination for both primary endpoints [c-statistics: 0.749 (95% CI: 0.694-0.804), P <0.001] or heart failure hospitalization [c-statistics: 0.692 (95% CI: 0.639-0.745), P <0.001]. Conclusion: The Alpha-score may enable improved discrimination and accurate prediction of long-term outcomes among NICM patients with CRT.

scholarly journals A Novel Risk Model for Mortality and Hospitalization following Cardiac Resynchronization Therapy in Patients with Non-ischemic Cardiomyopathy: The Alpha-score

2020 ◽  
Author(s):  
Shengwen Yang ◽  
Zhimin Liu ◽  
Yiran Hu ◽  
Ran Jing ◽  
Wei Hua
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Ischemic Cardiomyopathy ◽  
Risk Model ◽  
Heart Association ◽  
Cardiac Resynchronization ◽  
Reverse Remodeling ◽  
Resynchronization Therapy ◽  
Heart Failure Hospitalization ◽  
Class Iv

Abstract Background: Non-ischemic cardiomyopathy (NICM) has been associated with a better left ventricle reverse remodeling response and improved clinical outcomes after cardiac resynchronization therapy (CRT). The aims of our study were to identify the predictors of mortality and heart failure hospitalization in patients treated with CRT and design a risk score for prognosis. Methods: A cohort of 422 consecutive NICM patients with CRT was retrospectively enrolled between January 2010 and December 2017. The primary endpoint was all-cause mortality and heart transplantation. Results: In a multivariate analysis, the predictors of all-cause death were left atrial diameter [Hazard ratio (HR): 1.056, 95% confidence interval (CI): 1.020-1.093, P=0.002]; non-left bundle branch block [HR: 1.793, 95% CI: 1.131-2.844, P =0.013]; high sensitivity C-reactive protein [HR: 1.081, 95% CI: 1.029-1.134 P= 0.002]; and N-terminal pro-B-type natriuretic peptide [HR: 1.018, 95% CI: 1.007-1.030, P =0.002]; and New York Heart Association class IV [HR: 1.018, 95% CI: 1.007-1.030, P =0.002]. The Alpha-score ( A trial diameter, non- L BBB, P ro-BNP, H s-CRP, NYH A class IV) was derived from each independent risk factor. The novel score had good calibration (Hosmer-Lemeshow test, P >0.05) and discrimination for both primary endpoints [c-statistics: 0.749 (95% CI: 0.694-0.804), P <0.001] or heart failure hospitalization [c-statistics: 0.692 (95% CI: 0.639-0.745), P <0.001]. Conclusion: The Alpha-score may enable improved discrimination and accurate prediction of long-term outcomes among NICM patients with CRT.

scholarly journals A Novel Risk Model for Mortality and Hospitalization following Cardiac Resynchronization Therapy in Patients with Non-ischemic Cardiomyopathy: The Alpha-score

2020 ◽  
Author(s):  
Shengwen Yang ◽  
Zhimin Liu ◽  
Yiran Hu ◽  
Ran Jing ◽  
Min Gu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Ischemic Cardiomyopathy ◽  
Risk Model ◽  
Heart Association ◽  
Cardiac Resynchronization ◽  
Reverse Remodeling ◽  
Resynchronization Therapy ◽  
Heart Failure Hospitalization ◽  
Class Iv

Abstract Background: Non-ischemic cardiomyopathy (NICM) has been associated with a better left ventricle reverse remodeling response and improved clinical outcomes after cardiac resynchronization therapy (CRT). The aims of our study were to identify the predictors of mortality and heart failure hospitalization in patients treated with CRT and design a risk score for prognosis. Methods: A cohort of 422 consecutive NICM patients with CRT was retrospectively enrolled between January 2010 and December 2017. The primary endpoint was all-cause mortality and heart transplantation. Results: In a multivariate analysis, the predictors of all-cause death were left atrial diameter [Hazard ratio (HR): 1.056, 95% confidence interval (CI): 1.020-1.093, P=0.002]; non-left bundle branch block [HR: 1.793, 95% CI: 1.131-2.844, P =0.013]; high sensitivity C-reactive protein [HR: 1.081, 95% CI: 1.029-1.134 P= 0.002]; and N-terminal pro-B-type natriuretic peptide [HR: 1.018, 95% CI: 1.007-1.030, P =0.002]; and New York Heart Association class IV [HR: 1.018, 95% CI: 1.007-1.030, P =0.002]. The Alpha-score ( A trial diameter, non- L BBB, P ro-BNP, H s-CRP, NYH A class IV) was derived from each independent risk factor. The novel score had good calibration (Hosmer-Lemeshow, P >0.05) and discrimination for both primary endpoints [c-statistics: 0.749 (95% CI: 0.694-0.804), P <0.001] or heart failure hospitalization [c-statistics: 0.692 (95% CI: 0.639-0.745), P <0.001]. Conclusion: The Alpha-score may enable improved discrimination and accurate prediction of long-term outcomes among NICM patients with CRT.

Abstract 259: The Role of Gender in Cardiac Resynchronization Therapy Response in Patients with Optimal Anatomical and Electrical Left Ventricular Lead Location.

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Abhishek Bose ◽  
Jagdesh Kandala ◽  
Jagmeet P Singh
Keyword(s):  
Heart Failure ◽  
Gender Differences ◽  
Cardiac Resynchronization Therapy ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Reverse Remodeling ◽  
Resynchronization Therapy ◽  
Heart Failure Hospitalization ◽  
Lead Location

Background: While optimal left ventricular (LV) lead location and the female sex are known to predict a favorable response to cardiac resynchronization therapy (CRT), the role of gender differences affecting CRT outcomes in patients with optimal LV lead location remains uncertain. Methods: We analyzed a prospective cohort of 180 CRT patients. Anatomical lead location was confirmed by coronary venograms and chest radiographs. LV lead electrical delay (LVLED) was measured from QRS onset on surface ECG to the first sensed signal of the LV lead, and standardized based on native QRS width. Echocardiographic response was evaluated at baseline and 6 months. Time to first heart failure hospitalization or death was assessed over 3 years. Results: 100 patients (Age 68.2 ± 12.3 years; Baseline LVEF 23.2 ± 6.8 %, NYHA 3.0 ± 0.3) with optimal LV lead location defined as ‘long’ LVLED (LVLED>50%) with non-apical and anterolateral, lateral or posterolateral lead position were selected from the original cohort. They were further divided into the female (n=26) and male (n=74) groups. Baseline clinical characteristics were similar between groups except for a higher incidence of ischemic cardiomyopathy in males (72.4% vs. 47.1%, p=0.01) and longer QRS duration in females (171.3 ± 29.9 vs. 153.6 ± 26.9, p=0.008). Baseline echocardiographic characteristics revealed a smaller LV internal dimension in systole (LVIDs) and diastole (LVIDd) in females (51.7 ± 10.2 vs. 57.1 ± 8.9, p=0.02; 58.5% ± 10.1 vs. 64.5 ± 8.3, p=0.007 respectively). Survival with respect to first heart failure hospitalization (Figure 1A) and a composite of mortality and heart failure (Figure 1B) were comparable. Echocardiographic response, defined as an increase in mean LVEF by 10% was significant in females (+11.6 ± 11.0 % vs. +5.3 ± 9.0 %, p=0.01). Conclusion: In CRT patients with optimal lead location, females have superior outcomes with respect to reverse remodeling but gender differences donot appear to predict clinical outcomes.

P3807Impact of unipolar vs bipolar left ventricular pacing using a quadripolar lead on heart failure hospitalization in patients undergoing cardiac resynchronization therapy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Mittal ◽  
T Stivland ◽  
N Wold ◽  
E Hammill ◽  
K M Stein
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Nyha Class ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Study Cohort ◽  
Resynchronization Therapy ◽  
Heart Failure Hospitalization ◽  
Lead Location

Abstract Background Unipolar (uni) pacing from a bipolar left ventricular (LV) pacing lead in cardiac resynchronization therapy (CRT) patients (pts) has been associated with worse outcomes than bipolar (bi) pacing (MADIT CRT and ALTITUDE analyses). However, it is unknown whether the same is true with quadripolar LV pacing leads. Purpose To determine whether there is a difference in heart failure hospitalization (HFH) following CRT implantation in pts undergoing uni vs. bi LV pacing. Methods All pts enrolled in the NAVIGATE study were implanted with a CRT-D (RESONATE, Boston Scientific) using a quadripolar LV lead (ACUITY X4 Spiral Long, Spiral Short, or Straight). Pts were followed, and data collected on HFH and mortality. Vectors were programmed at the discretion of the implanter. Outcomes were adjusted for age, gender, NYHA class, ischemic etiology, conduction disorder pattern, EF, LV lead location, and LV lead shape. Results The study cohort included 2080 pts; 1781 pts had bi and 299 pts had uni LV pacing. Bi LV had higher % female, NYHA II/III, non-ischemic, LBBB, spiral shape, lateral and apical locations. During follow-up, the adjusted likelihood of HFH was significantly lower in pts undergoing bi LV pacing (HR 0.75, 0.58–0.97, p=0.027, Figure). Mortality was similar between the two groups. Conclusions In this large prospective study, uni LV pacing was associated with significantly greater likelihood of need for HFH during a 4-year follow-up period. These data suggest that routine programming in a bi configuration may be better for post-CRT pts. However, further study is needed to confirm causality and mechanism of this finding.

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 &gt; =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 &lt; 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 &gt; 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.

scholarly journals Analysis of Risk Factors for Acute Heart Failure in Patients with Dilated Cardiomyopathy and Persistent Severe Functional Mitral Regurgitation Despite Cardiac Resynchronization Therapy

2020 ◽  
pp. 35-39
Author(s):  
R. V. Buriak ◽  
K. V. Rudenko ◽  
O. A. Krykunov
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Mitral Regurgitation ◽  
Cardiac Resynchronization Therapy ◽  
Dilated Cardiomyopathy ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Functional Mitral Regurgitation ◽  
Reverse Remodeling ◽  
Resynchronization Therapy

Congestive heart failure resulting from non-ischemic dilated cardiomyopathy (DCM) with secondary functional mitral regurgitation (FMR) is associated with poor prognosis. Medical treatment results in a 1-year survival of 52% to 87% and a 5-year survival of 22% to 54%, with highest survivals observed in more recent years, probably reflecting improvements in medical therapy. Non-surgical interventions involve cardiac resynchronization therapy. In addition to medical treatment, cardiac resynchronization therapy (CRT) should be considered in patients with New York Heart Association (NYHA) class II– IV HF, left ventricular ejection fraction (LVEF) =35%, normal sinus rhythm and left bundle branch block with QRS >150 ms. In these patients, CRT can also facilitate left ventricular (LV) reverse remodeling and reduce associated FMR. The aim of this study was to investigate the features of symptomatology and to analyze the risk factors for acute heart failure (AHF) in patients with DCM and persistent severe functional mitral regurgitation despite CRT and optimal guideline-directed medical therapy (GDMT). Materials and methods. After providing informed consent, 144 patients with severe FMR were involved in the study. Concomitant tricuspid valve regurgitation was registered in 142 (98.6%) cases. The median LVEF was 27.0 (23.0-31.6)%. 40 (27.8%) patients had a permanent form of atrial fibrillation, and 24 (16.7%) patients had a first-degree atrioventricular node block. The median NT-proBNP was 2600 (2133-3200) pg/ml, indicating the presence of severe chronic heart failure. Results. The median term after CRT device implantation was 36 (3.5-60) months. A comparative analysis between DCM patients with and without CRT revealed statistically significant differences between clinical characteristics, namely: age (p=0.020), lower heart rate (p=0.004), lower hemoglobin (p=0.017), higher erythrocyte sedimentation rate (ESR) (p=0.000) and more frequent AHF at the hospital stage (p=0.030). The incidence of AHF at the hospital stage was 13.8% in patients with CRT and 3.5% in those without CRT. The calculated odds ratio of AHF was 4.44 (95% confidence interval (CI) 1.039-18.971), and the relative risk of AHF was 3.966 (95% CI 1.054-14.915). Discussion. FMR has been reported to persist in about 20% to 25% of CRT patients and, in an additional 10% to 15%, it may actually worsen after CRT. In this subset of CRT non-responders, reduced reverse remodeling, increased morbidity, and increased mortality have been reported compared with CRT patients in whom FMR was significantly reduced or abolished. Conclusions. The results of our study demonstrate that severe functional mitral regurgitation despite cardiac resynchronization therapy in patients with dilated cardiomyopathy is a significant risk factor for AHF and subsequent hospitalizations for heart failure.

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