Predictors of clinical outcomes after cardiac resynchronization therapy in patients ≥75 years

Abstract Background: Cardiac resynchronization therapy benefit has been proved in selected patients with heart failure and reduced ejection fraction. Older patients have been underrepresented in CRT trials. This study was conducted to determine whether predictive factors of cardiac resynchronization therapy outcomes may differ in patients older and younger than 75 years. Methods: Consecutive patients who received cardiac resynchronization therapy device between 2013 and 2016 in our center were retrospectively included. The primary endpoint was cardiac resynchronization therapy effectiveness defined as combination of survival for one year with no heart failure hospitalization and improvement by one or more NYHA classes. Secondary endpoints were mortality, complications, and device therapies. Results: Among the 243 patients included, 102 were ≥75 years. Cardiac resynchronization therapy effectiveness was observed in 70 patients (50%) <75 years and in 48 patients (47%) ≥75 years (p=0.69). NYHA class ≥III (OR=6.02; CI95% [1.33-18.77], p=0.002) was a predictive factor of cardiac resynchronization therapy effectiveness only in ≥75 years group, while in <75 years group atrial fibrillation was independently negatively associated with primary endpoint (OR=0.28; CI95% [0.13-0.62], p=0.001). One-year mortality rate was 14% with no difference between age groups. Rescue cardiac resynchronization therapy and atrial fibrillation were independent predictive factors for mortality in both age groups. Eighty-two complications occurred in 45 patients (19%) with no difference between groups. Defibrillator use and QRS duration were independent predictive factors for complications in both age groups. There was no difference considering device therapies. Conclusion: At one-year, cardiac resynchronization therapy response is not compromised by patients age. In older patients, highly symptomatic individuals with NYHA class ≥III have better outcomes after cardiac resynchronization therapy. KEY WORDS: Resynchronization therapy; heart failure; aged; treatment outcome

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Predictors of clinical outcomes after cardiac resynchronization therapy in patients ≥75 years of age: a retrospective cohort study

10.21203/rs.2.11022/v3 ◽

2019 ◽

Author(s):

Laure Champ-Rigot ◽

Anne-Laure Cornille ◽

Pierre Ollitrault ◽

Arnaud Pellissier ◽

Mathieu Chequel ◽

...

Keyword(s):

Heart Failure ◽

Cardiac Resynchronization Therapy ◽

Predictive Factors ◽

Nyha Class ◽

Age Groups ◽

Cardiac Resynchronization ◽

Class Iii ◽

Resynchronization Therapy ◽

Therapy Effectiveness ◽

One Year

Abstract Background: Cardiac resynchronization therapy has been shown to benefit selected patients with heart failure and reduced ejection fraction. Older patients have been underrepresented in randomized trials. This study was conducted to determine whether predictive factors for cardiac resynchronization therapy outcomes differ in patients older and younger than 75 years of age. Methods: Consecutive patients who received a cardiac resynchronization device cardiac resynchronization therapy between 2013 and 2016 in our center were retrospectively included in this cohort study. The primary endpoint was cardiac resynchronization therapy effectiveness, which was defined as survival for one year with both no heart failure hospitalization and improvement by one or more NYHA class. The secondary endpoints were mortality, complications, and device therapies. Results: Among the 243 patients included, 102 were ≥75 years old. Cardiac resynchronization therapy effectiveness was observed in 70 patients (50%) <75 years old and in 48 patients (47%) ≥75 years old (p=0.69). NYHA class ≥III (OR=6.02; CI95% [1.33-18.77], p=0.002) was a predictive factor for cardiac resynchronization therapy effectiveness only in the ≥75-year-old group, while atrial fibrillation was independently negatively associated with the primary endpoint in the <75-year-old group (OR=0.28; CI95% [0.13-0.62], p=0.001). The one-year mortality rate was 14%, with no difference between age groups. Rescue cardiac resynchronization therapy and atrial fibrillation were independent predictive factors for mortality in both age groups. Eighty-two complications occurred in 45 patients (19%), with no difference between groups. Defibrillator use and QRS duration were independent predictive factors for complications in both age groups. There was no difference between groups considering device therapies. Conclusion: At one year, cardiac resynchronization therapy response is not compromised by patient age. In older patients, highly symptomatic individuals with NYHA class ≥III have better outcomes after cardiac resynchronization therapy. KEYWORDS: Resynchronization therapy; heart failure; aged; treatment outcome

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Predictors of clinical outcomes after cardiac resynchronization therapy in patients ≥75 years of age: a retrospective cohort study

BMC Geriatrics ◽

10.1186/s12877-019-1351-4 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Laure Champ-Rigot ◽

Anne-Laure Cornille ◽

Pierre Ollitrault ◽

Arnaud Pellissier ◽

Mathieu Chequel ◽

...

Keyword(s):

Cardiac Resynchronization Therapy ◽

Predictive Factors ◽

Older Patients ◽

Nyha Class ◽

Age Groups ◽

Cardiac Resynchronization ◽

Class Iii ◽

Resynchronization Therapy ◽

Therapy Effectiveness ◽

One Year

Abstract Background Cardiac resynchronization therapy has been shown to benefit selected patients with heart failure and reduced ejection fraction. Older patients have been underrepresented in randomized trials. This study was conducted to determine whether predictive factors for cardiac resynchronization therapy outcomes differ in patients older and younger than 75 years of age. Methods Consecutive patients who received a cardiac resynchronization device cardiac resynchronization therapy between 2013 and 2016 in our center were retrospectively included in this cohort study. The primary endpoint was cardiac resynchronization therapy effectiveness, which was defined as survival for one year with both no heart failure hospitalization and improvement by one or more NYHA class. The secondary endpoints were mortality, complications, and device therapies. Results Among the 243 patients included, 102 were ≥ 75 years old. Cardiac resynchronization therapy effectiveness was observed in 70 patients (50%) < 75 years old and in 48 patients (47%) ≥75 years old (p = 0.69). NYHA class ≥III (OR = 6.02; CI95% [1.33–18.77], p = 0.002) was a predictive factor for cardiac resynchronization therapy effectiveness only in the ≥75-year-old group, while atrial fibrillation was independently negatively associated with the primary endpoint in the < 75-year-old group (OR = 0.28; CI95% [0.13–0.62], p = 0.001). The one-year mortality rate was 14%, with no difference between age groups. Rescue cardiac resynchronization therapy and atrial fibrillation were independent predictive factors for mortality in both age groups. Eighty-two complications occurred in 45 patients (19%), with no difference between groups. Defibrillator use and QRS duration were independent predictive factors for complications in both age groups. There was no difference between groups considering device therapies. Conclusion At one year, cardiac resynchronization therapy response is not compromised by patient age. In older patients, highly symptomatic individuals with NYHA class ≥III have better outcomes after cardiac resynchronization therapy.

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Predictors of clinical outcomes after cardiac resynchronization therapy in patients ≥75 years of age: a retrospective cohort study

10.21203/rs.2.11022/v2 ◽

2019 ◽

Author(s):

Laure Champ-Rigot ◽

Anne-Laure Cornille ◽

Pierre Ollitrault ◽

Arnaud Pellissier ◽

Mathieu Chequel ◽

...

Keyword(s):

Cardiac Resynchronization Therapy ◽

Predictive Factors ◽

Older Patients ◽

Nyha Class ◽

Age Groups ◽

Cardiac Resynchronization ◽

Class Iii ◽

Resynchronization Therapy ◽

Therapy Effectiveness ◽

One Year

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2177Cardiac resynchronization therapy in patients greater than 75 years of age - results from the European Society of Cardiology Survey II with 11 088 patients

European Heart Journal ◽

10.1093/eurheartj/ehz748.0096 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

C Normand ◽

K Dickstein ◽

C Linde

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Adverse Events ◽

Cardiac Resynchronization Therapy ◽

European Society ◽

Nyha Class ◽

Cardiac Resynchronization ◽

Class Iii ◽

Resynchronization Therapy ◽

European Society Of Cardiology

Abstract Background Cardiac Resynchronization Therapy (CRT) reduces morbidity and mortality in selected patients with heart failure (HF) and electrical dyssynchrony. The median age for patients included in the CRT landmark trials ranged from 62–68 years, therefore limited trial evidence exists on CRT in patients ≥75 years of age. Purpose To assess similarities and differences in patient demographics and implantation practice in different age groups implanted with a CRT device. Methods Between 2015 and 2017, two European Society of Cardiology (ESC) associations, European Heath Rhythm Society and the Heart Failure Association, conducted the CRT Survey II, a survey of CRT implantations in 11,088 patients in 42 ESC member states. Results In our survey 32% of patients included were ≥75 years of age. These patients were more frequently in NYHA Class III or IV, had more comorbidity (including hypertension, atrial fibrillation, anaemia and renal dysfunction) and had significantly higher NT-pro BNP levels than younger patients. Slightly fewer patients ≥75 years of age had LBBB but all groups had the same median QRS duration. Despite substantially more patients ≥75 years of age having HF of ischaemic aetiology compared with those <65 year of age, far fewer patients in oldest age group category were implanted with a CRT-defibrillator (CRT-D) compared with those in the youngest group. CRT Survey II Patients by Age Categories Demographics Age <65 years Age 65–74 years Age ≥75 years N 3478 (32%) 4025 (36%) 3536 (32%) NYHA class III & IV 52% 59% 66%* Ischaemic HF aetiology 33% 49% 50%* Atrial fibrillation 17% 27% 33* NT proBNP (pg/ml, median, IQR) 1651 (670, 3811) 2319 (1070, 5169) 3510 (1647, 7631)* CRT-D 81% 76% 52%* Peri-procedural complications 5% 6% 6% Adverse Events during hospitalization 4% 5% 5% CRT-D, Cardiac resynchronization therapy – defibrillator; HF, heart failure; IQR, interquartile range. *Differences between groups is significant with p<0.001. Conclusions Patients ≥75 years of age had greater comorbidity and experienced more symptoms from their heart failure. However, they did not suffer more complications or adverse events during the index hospitalization, suggesting that CRT may safely be offered to elderly patients. Acknowledgement/Funding The work was supported by EHRA, the HFA, Biotronik, Boston Scientific, Medtronic, Sorin, St. Jude, Abbott, Bayer, Bristol-Myers Squibb and Servier

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NISAR-F SCORE: a simple risk stratification tool for patients implanted with cardiac resynchronization therapy

EP Europace ◽

10.1093/europace/euab116.457 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

J Correia ◽

L Goncalves ◽

I Pires ◽

J Santos ◽

V Neto ◽

...

Keyword(s):

Ejection Fraction ◽

Cardiac Resynchronization Therapy ◽

Cox Regression ◽

Nyha Class ◽

Prognostic Score ◽

Roc Curves ◽

Cardiac Resynchronization ◽

Class Iii ◽

Resynchronization Therapy

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Individualized estimation of prognosis after cardiac resynchronization therapy (CRT) remains challenging. Outcomes in this group of patients are influenced by multiple factors and a comprehensive and customized approach to estimate prognosis after CRT is lacking Aims To develop and validate a simple prognostic score for patients implanted with CRT (NISAR-F score), based on readily available clinical and echocardiographic variables to predict the combined endpoints of death or hospitalization in 24 months. Methods A single-centre retrospective study was conducted with inclusion of all consecutive patients who underwent CRT implantation between 2012 and 2019. Follow-up started after CRT implantation and ended upon death, hospitalization or 24 months after study entry. Survival analysis was performed using a multivariate Cox regression model, in order to analyze the effect on survival /hospitalization in 24 months of the following factors: age, gender, NYHA Class III-IV, ischemic heart failure, type 2 diabetes, arterial hypertension, dyslipidemia and ejection fraction < 21%. According to the analysis, points were attributed to each factor. Afterwards, the NISAR-F score was calculated for each patient, summing the points of each variable. The authors finally created ROC curves for the NISAR-F score to predict the occurrence of the combined endpoint in 2 groups of patients: CRT responders (ejection fraction increase of at least 10% after CRT implantation) and CRT non-responders. The statistical analysis was performed in SPSS. Results 102 patients were included in the study (75.4% male, mean age 68 ± 10.46 years). 10(9.8%) of the patients were re-hospitalized and 8 (7.8%) died during the 24-month follow-up. After calculating NISAR-F score for each patient, area under ROC curves were obtained. The analysis of the ROC curves allows us to confirm the good performance of the score created [responders group (AUC 0.812) vs non-responders (AUC 0.721)]. Conclusion The NISAR-F score is a useful tool to predict the combined endpoint (mortality and hospitalization in 24 months) after CRT implantation, in both responders and non-responders, revealing good performance of this new and simple score based only on clinical and echocardiographic variables.

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P5680One-year outcomes of heart failure patients undergoing cardiac resynchronization therapy using adaptivCRT algorithm

European Heart Journal ◽

10.1093/eurheartj/ehz746.0622 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

S Briongos Figuero ◽

A Estevez ◽

M L Perez ◽

J B Martinez-Ferrer ◽

L Alvarez-Costa ◽

...

Keyword(s):

Heart Failure ◽

Cardiac Resynchronization Therapy ◽

Real Life ◽

Left Ventricular ◽

Cardiac Resynchronization ◽

Ventricular Pacing ◽

Class Iii ◽

Resynchronization Therapy ◽

Risk Of Death

Abstract Background Adaptive cardiac resynchronization therapy (aCRT) algorithm provides synchronized left ventricular (LV) only pacing and ambulatory optimization of the intrinsic atrioventricular and interventricular conduction intervals. Studies reporting morbidity and mortality outcomes of aCRT carriers in daily clinical practice are lacking. Purpose To determine in a real-life setting, whether 1-year outcomes were different among CRT carriers undergoing aCRT pacing and those under conventional biventricular (biV) pacing. Methods Symptomatic heart failure (HF) patients with sinus rhythm undergoing first CRT-defibrillator implant were selected from the UMBRELLA nationwide registry (2012–2017). The primary endpoint was the composite of all-cause mortality or HF hospitalization at 12-month follow-up. HF admission was defined as hospitalization due to symptoms requiring intravenous diuretic treatment. Primary healthcare records were used to prospectively collect all data. Results Two hundred and six patients were collected (66.1±8.7 years; 73.3% male). Eighty-seven out of 206 patients were implanted with an aCRT capable device, but this algorithm was activated at implant and remained enabled at 1-year in 59 patients (aCRT group). The other 147 patients composed the non-aCRT group. At implant left bundle branch block was present in 93% of patients, 69.6% of population was in functional class III or IV and mean left ventricle ejection fraction was of 26.5±5.6%. Non-ischemic cardiomyopathy was present in 63.1% of patients and optimal medical treatment was achieved in majority of population (92% of patients with beta-blockers; angiotensin-converting enzyme inhibitorsor angiotensin II receptor blockersin 89%). The percentage of ventricular pacing through 12 months was 96.1±9.4% in non-aCRT patients and 97.5±2.7% in aCRT patients (p=0.261). In aCRT patients, LV-only pacing accounted for a mean of 53.3±37.6% of all ventricular pacing. After 12-month follow-up period, 25 patients (12.1%) met the primary composite endpoint of death or HF hospitalization. Nine patients died and nineteen patients were admitted due to worsening HF. There was no difference in the risk of all-cause death or HF hospitalization between aCRT and non-aCRT patients (10.2% vs. 12.9% respectively; OR=0.76, CI: 0.29–2.01, p=0.585) Conclusions In this contemporary cohort of HF patients undergoing CRT with high percentages of ventricular pacing, clinical performance of aCRT algorithm was adequate. The risk of death or HF hospitalization was low and no differences were observed at one-year follow-up. Future randomized studies will clarify the role of this algorithm in CRT carriers. Acknowledgement/Funding None

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Remote Hemodynamic‐Guided Therapy of Patients With Recurrent Heart Failure Following Cardiac Resynchronization Therapy

Journal of the American Heart Association ◽

10.1161/jaha.120.017619 ◽

2021 ◽

Author(s):

Niraj Varma ◽

Robert C. Bourge ◽

Lynne Warner Stevenson ◽

Maria Rosa Costanzo ◽

David Shavelle ◽

...

Keyword(s):

Heart Failure ◽

New York ◽

Cardiac Resynchronization Therapy ◽

Area Under The Curve ◽

Heart Association ◽

Cardiac Resynchronization ◽

Class Iii ◽

Resynchronization Therapy ◽

Heart Failure Questionnaire ◽

New York Heart Association

Background Patients with recurring heart failure (HF) following cardiac resynchronization therapy fare poorly. Their management is undecided. We tested remote hemodynamic‐guided pharmacotherapy. Methods and Results We evaluated cardiac resynchronization therapy subjects included in the CHAMPION (CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in New York Heart Association Class III Heart Failure Patients) trial, which randomized patients with persistent New York Heart Association Class III symptoms and ≥1 HF hospitalization in the previous 12 months to remotely managed pulmonary artery (PA) pressure‐guided management (treatment) or usual HF care (control). Diuretics and/or vasodilators were adjusted conventionally in control and included remote PA pressure information in treatment. Annualized HF hospitalization rates, changes in PA pressures over time (analyzed by area under the curve), changes in medications, and quality of life (Minnesota Living with Heart Failure Questionnaire scores) were assessed. Patients who had cardiac resynchronization therapy (n=190, median implant duration 755 days) at enrollment had poor hemodynamic function (cardiac index 2.00±0.59 L/min per m 2 ), high comorbidity burden (67% had secondary pulmonary hypertension, 61% had estimated glomerular filtration rate <60 mL/min per 1.73 m 2 ), and poor Minnesota Living with Heart Failure Questionnaire scores (57±24). During 18 months randomized follow‐up, HF hospitalizations were 30% lower in treatment (n=91, 62 events, 0.46 events/patient‐year) versus control patients (n=99, 93 events, 0.68 events/patient‐year) (hazard ratio, 0.70; 95% CI, 0.51–0.96; P =0.028). Treatment patients had more medication up‐/down‐titrations (847 versus 346 in control, P <0.001), mean PA pressure reduction (area under the curve −413.2±123.5 versus 60.1±88.0 in control, P =0.002), and quality of life improvement (Minnesota Living with Heart Failure Questionnaire decreased −13.5±23 versus −4.9±24.8 in control, P =0.006). Conclusions Remote hemodynamic‐guided adjustment of medical therapies decreased PA pressures and the burden of HF symptoms and hospitalizations in patients with recurring Class III HF and hospitalizations, beyond the effect of cardiac resynchronization therapy. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT00531661.

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Prediction of 5-year survival in patients with heart failure and implanted cardiac resynchronization therapy devices

Russian Journal of Cardiology ◽

10.15829/1560-4071-2021-4409 ◽

2021 ◽

Vol 26 (6) ◽

pp. 4409

Author(s):

A. M. Soldatova ◽

V. A. Kuznetsov ◽

E. A. Gorbatenko ◽

T. N. Enina ◽

L. M. Malishevsky

Keyword(s):

Heart Failure ◽

Survival Rate ◽

Cardiac Resynchronization Therapy ◽

Nyha Class ◽

Training Sample ◽

Left Ventricular ◽

Cardiac Resynchronization ◽

Left Ventricular Ejection ◽

Resynchronization Therapy ◽

Patients With Heart Failure

Aim. Based on clinical parameters and diagnostic investigations, to create a complex model of personalized selection of patients with heart failure (HF) for cardiac resynchronization therapy (CRT). To establish the diagnostic value of the created model in predicting 5-year survival.Material and methods. The study included 141 patients with HF (men, 77,3%; women, 22,7%). The mean age of patients at the time of implantation was 60,0 [53,0; 66,0] years. All patients had New York Heart Association (NYHA) class II-IV HF, left ventricular ejection fraction (LVEF) ≤35%, and QRS ≥130 ms. Patients were randomly divided into training (n=95) and test (n=36) samples, which were comparable in main clinical and functional characteristics.Results. The index included parameters that had a significant relationship with 5-year survival according to the Cox regression: male sex, prior myocardial infarction, hypertension, QRS <150 ms, no left bundle branch block, PR ≥200 ms with sinus rhythm/absence of radiofrequency ablation in atrial fibrillation, NYHA class III, IV HF, LVEF <30%, left ventricular end-diastolic volume ≥235,0 ml, NT-proBNP ≥2692,0 ng/ml. All variables were scored based on the в-coefficients. In the training sample, a value ≥45 points demonstrated a sensitivity of 82,4% and a specificity of 67,2% in predicting 5-year survival (AUC, 0,873; p<0,001). The index use on the test sample showed comparable results (AUC, 0,718; p=0,020; sensitivity — 71,4%, specificity — 62,5%). Also, in the training sample, the index ≥45 points was associated with1-year survival (sensitivity — 84,6%, specificity — 58,1%, AUC, 0,811; p<0,001).Conclusion. An index of personalized selection for CRT has been created, which makes it possible to accurately predict the 5-year survival rate, as well as the 1-year survival rate, regardless of the current selection criteria.

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