scholarly journals Beta Blockers Up-Titration in Patients with Heart Failure Reduced Ejection Fraction and Cardiac Resynchronization Therapy, a Single Center Study

2019 ◽  
Vol 7 (6) ◽  
pp. 71
Author(s):  
Daniele Masarone ◽  
Marina Verrengia ◽  
Ernesto Ammendola ◽  
Rita Gravino ◽  
Fabio Valente ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cardiac Resynchronization Therapy ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
Β Blockers ◽  
Group 2 ◽  
Group 1

Clinical trials have shown the benefits of β-blockers therapy in patients with heart failure reduced ejection fraction. These benefits include improved survival and a reduced need for hospitalization. Cardiac resynchronization therapy has emerged as an essential device-based therapy for symptomatic patients with heart failure reduced ejection fraction despite optimal pharmacologic treatment. The extent to which β-blockers are being utilized in patients receiving cardiac resynchronization therapy is not well known. In this study, we evaluate the possibility of increasing β-blockers doses in an unselected cohort of heart failure reduced ejection patients after cardiac resynchronization therapy capable defibrillator system implantation and the correlation between β-blockers treatments and clinical outcome. Methods and results: Patients with heart failure reduced ejection fraction in β-blockers therapy that underwent cardiac resynchronization therapy capable defibrillator system implantation between July 2008, and December 2016 were enrolled in the study. The β-blockers dose was determined at the time of discharge and during follow-up. Cardiovascular mortality, hospitalization for worsening heart failure or arrhythmic storm and appropriate intervention of the device, were recorded. The study cohort included 480 patients, 289 patients (60.3%) had β-blockers doses equal to the dose before CRT (Group 1), 191 patients (39.7%) had higher β-blockers doses than those before the CRT implant (Group 2). Comparing the two groups, Group 2 have lower cardiovascular mortality, heart failure-related hospitalization, and arrhythmic events than Group 1. Conclusion: After initiating CRT, β-blockers could be safely up-titrated at higher doses with the reduction in mortality, heart failure-related hospitalization, and arrhythmic events.

scholarly journals Implantable Cardioverter-Defibrillators and Cardiac Resynchronization Therapy in the Treatment of Heart Failure with Reduced Ejection Fraction

2017 ◽  
Vol 10 ◽  
Author(s):  
Ilaria Spoletini ◽  
Andrew Coats
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cardiac Resynchronization Therapy ◽  
Cardiac Resynchronization ◽  
Implantable Cardioverter Defibrillators ◽  
Resynchronization Therapy ◽  
Device Therapy ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
Cardioverter Defibrillators

It has been long acknowledged that electrical-conduction disturbances may be both a cause of heart failure and a consequence of it. In fact, many patients with heart failure have an asynchronous contraction pattern of the heart muscle that further reduces the heart ability to pump blood. Electrical disturbances may therefore result in progressive left ventricular dysfunction, due to the added effects of HF-related electrical dyssynchrony. For this reason, device therapy may play a key role in the management of patients with heart failure and reduced ejection fraction (HFrEF). In particular, Implantable Cardioverter- Defibrillators (ICD) and Cardiac Resynchronization Therapy (CRT) may improve ejection fraction by reestablishing mechanical synchrony, possibly reversing symptoms and signs of heart failure, in addition to the more obvious role of ICD in terminating ventricular arrhythmias that threaten sudden death. Recommendations on device therapy from the current guidelines on heart failure management put out by the ESC/HFA in 2016 update our understanding of the evidence base for the use of ICD and CRT in HFrEF. We review these recommendations and the evidence behind them.

scholarly journals Cardiac resynchronization therapy with or without defibrillator in patients with heart failure

EP Europace ◽  
2021 ◽  
Author(s):  
Benedikt Schrage ◽  
Lars H Lund ◽  
Michael Melin ◽  
Lina Benson ◽  
Alicia Uijl ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cardiac Resynchronization Therapy ◽  
Outpatient Clinic ◽  
Cox Regression ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
All Cause Mortality

Abstract Aims Randomized data on the efficacy/safety of cardiac resynchronization therapy with vs. without defibrillator (CRT-D,-P) in heart failure with reduced ejection fraction (HFrEF) are scarce. We aimed to evaluate survival associated with use of CRT-D vs. CRT-P in a contemporary cohort with HFrEF. Methods and results Patients from Swedish HF Registry treated with CRT-D/CRT-P and fulfilling criteria for primary prevention defibrillator use were included. Logistic regression was used to evaluate predictors of CRT-D non-use. All-cause mortality was compared in CRT-D vs. CRT-P by Cox regression in a 1 : 1 propensity-score-matched cohort. Of 1988 patients with CRT, 1108 (56%) had CRT-D and 880 (44%) CRT-P. Older age, higher ejection fraction (EF), female sex, and the lack of referral to HF nurse-led outpatient clinic were major determinants of CRT-D non-use. After matching, 645 CRT-D patients were compared with 645 with CRT-P. The CRT-D use was associated with lower 1- and 3-year all-cause mortality [hazard ratio (HR):0.76, 95% confidence interval (CI):0.58–0.98; HR: 0.82, 95% CI: 0.68–0.99, respectively]. Results were consistent in all pre-specified subgroups except for CRT-D use being associated with lower 3-year mortality in patients with an EF < 30% but not in those with an EF ≥ 30% (HR: 0.73, 95% CI: 0.59–0.89 and HR: 1.24, 95% CI: 0.83–1.85, respectively; P-interaction = 0.02). Conclusion In a contemporary HFrEF cohort, CRT-D was associated with lower mortality compared with CRT-P. The CRT-D use was less likely in older patients, females, and in patients not referred to HF nurse-led outpatient clinic. Our findings support the use of CRT-D vs. CRT-P in HFrEF, in particular with severely reduced EF.

1409Use of phenomapping to determine response of treatment by sacubitril/valsartan in patients with heart failure with reduced ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Godet ◽  
O Raitiere ◽  
H Chopra ◽  
P Guignant ◽  
C Fauvel ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Heat Map ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Background Treatment by sacubitril/valsartan decreases mortality, improves KCCQ score and ejection fraction in patients with heart failure with reduced ejection fraction (HF REF), but there is currently no data to predict response to treatment. Purpose The purpose of our work was to assess whether unbiased clustering analysis, using dense phenotypic data, could identify phenotypically distinct HF-REF subtypes with good or no response after 6 months of sacubitril/valsartan administration. Methods A total of 78 patients in NYHA functional class 2–3 and treated by ACE inhibitor or AAR2, were prospectively assigned to equimolar sacubitril/valsartan replacement. We collected demographic, clinical, biological and imaging continuous variables. Phenotypic domains were imputed with 5 eigenvectors for missing value, then filtered if the Pearson correlation coefficient was >0.6 and standardized to mean±SD of 0±1. Thereafter, we used agglomerative hierarchical clustering for grouping phenotypic variables and patients, then generate a heat map (figure 1). Subsequently, participants were categorized using Penalized Model-Based Clustering. P<0,05 was considered significant. Results Mean age was 60.4±13.4 yo and 79.0% patients were males. Mean ejection fraction was 29.3±7.0%. Overall, 16 phenotypic domains were isolated (figure 1) and 3 phenogroups were identified (Table 1). Phenogroup 1 was remarkable by isolated left ventricular involvement (LVTDD 64.3±5.9mm vs 73.9±8.7 in group 2 and 63.8±5.7 in group3, p<0.001) with moderate diastolic dysfunction (DD), no mitral regurgitation (MR) and no pulmonary hypertension (PH). Phenogroups 2 and 3 corresponded to patients with severe PH (TRMV: 2.93±0.47m/s in group 2 and 3.15±0.61m/s in groupe 3 vs 2.16±0.32m/s in group 1), related to severe DD (phenogroup 2) or MR (phenogroup 3). In both phenogroups, the left atrium was significantly enlarged and the right ventricle was remodeled, compared with phenogroup 1. Despite more severe remodeling and more compromised hemodynamic in phenogroups 2 and 3, the echocardiographic response to sacubitril/valsartan was comparable in all groups with similar improvement of EF and reduction of cardiac chambers dimensions (response of treatment, defined by improvement of FE +15% and/or decreased of indexed left ventricule diastolic volume −15% = group 2: 22 (76%); group 3: 18 (60%); group 1: 9 (50%); p=0.17; OR group 2 vs 1: OR=3.14; IC95% [0.9–11.03]; p=0.074; OR group 3 vs 1: OR=1.5; IC95% [0.46–4.87]; p=0.5)). The clinical response was even better in phenogroups 2 and 3 (Group 2: 19 (66%); group 3: 21 (78%) vs group 1: 9 (50%); p=0.05). Heat map Conclusion HF-REF patients with severe diastolic dysfunction, significant mitral regurgitation and elevated pulmonary hypertension by echocardiographic had similar reverse remodeling but better clinical improvement than patients with isolated left ventricular systolic dysfunction.

scholarly journals Modulation of Heart Contractility

2019 ◽  
Vol 32 (2) ◽  
pp. 108-117
Author(s):  
Tiago Luiz Silvestrini ◽  
Rafael de March Ronsoni ◽  
Celso Salgado
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cardiac Resynchronization Therapy ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Patients With Heart Failure ◽  
Electric Therapy ◽  
Heart Contractility ◽  
Low Ejection Fraction ◽  
Conventional Pacemakers

Patients with heart failure (HF) are being benefi ted by electric therapy through conventional pacemakers when associated to bradycardia and cardiac resynchronization therapy or with low ejection fraction and presence of QRS longer than 150 ms, mainly in the presence of left branch block. Other groups of patients with HF present limitations regarding electrotherapy. However, an old concept has gained space in the treatment of patients who are outside the national and international guidelines for electrotherapy in HF: the modulation of heart contractility. This article has the purpose of presenting a review of already produced scientifi c evidence regarding this new modality for HF treatment

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