scholarly journals Possible genetic implications in the response to cardiac resynchronisation therapy in a patient affected by heart failure

2011 ◽  
Vol 5 (2) ◽  
pp. 61-68
Author(s):  
Natalia Pezzali ◽  
Marco Metra ◽  
Livio Dei Cas
Keyword(s):  
Heart Failure ◽  
Left Ventricular Systolic Dysfunction ◽  
Cardiac Resynchronisation Therapy ◽  
Left Ventricular ◽  
Idiopathic Dilated Cardiomyopathy ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy

This report presents a case of a patient with idiopathic dilated cardiomyopathy and severe left ventricular systolic dysfunction who underwent cardiac resynchronisation therapy (CRT). During the follow-up a progressive increase in left ventricular ejection fraction was observed, as well as clinical improvement. No cardiovascular events occurred during the follow-up, except for appropriate Implantable Cardioverter Defibrillator (ICD) bursts for fast ventricular tachycardia. Genotyping for adrenoceptor gene polymorphisms detected that the patient was Glu27Glu homozygous carrier. There’s a large interindividual variability in response to CRT. Despite attempts to identify factors having an impact on this therapy, only QRS duration is accepted according to guidelines. Beta-adrenoceptors polymorphisms, modulating sympathetic drive in heart failure and left ventricular remodelling, may have a role in identifying patients with a better response to CRT, in order to target and individualise the patients’ treatment.

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 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.

scholarly journals Characterisation of circulating biomarkers before and after cardiac resynchronisation therapy and their role in predicting CRT response: the COVERT-HF study

Open Heart ◽  
2018 ◽  
Vol 5 (2) ◽  
pp. e000899 ◽  
Author(s):  
Christopher J McAloon ◽  
Temo Barwari ◽  
Jimiao Hu ◽  
Thomas Hamborg ◽  
Alan Nevill ◽  
...  
Keyword(s):  
Heart Failure ◽  
Functional Response ◽  
Cardiac Resynchronisation Therapy ◽  
Left Ventricular ◽  
Collagen I ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Cardiac Resynchronisation ◽  
Before And After ◽  
Resynchronisation Therapy

AimsCardiac resynchronisation therapy (CRT) is effective treatment for selected patients with heart failure (HF) but has ~30% non-response rate. We evaluated whether specific biomarkers can predict outcome.MethodsA prospective single-centre pilot study of consecutive unselected patients undergoing CRT for HF between November 2013 and December 2015 evaluating cardiac extracellular matrix biomarkers and micro-ribonucleic acid (miRNA) expression before and after CRT assessing ability to predict functional response and survival. Each underwent three assessments (pre-implant, 6  weeks and 6  months postimplant) including: New York Heart Association (NYHA) class, echocardiography, electrocardiography, 6  min walk test (6MWT), Minnesota Living with Heart Failure Questionnaire (MLHFQ) and N-terminal pro-brain natriuretic peptide (NT-pro-BNP). Plasma markers of cardiac fibrosis assessed were: N-terminal pro-peptides of collagen I and III, collagen I C-terminal telopeptides (CTx) and matrix metalloproteinases (MMP-2 and MMP-9) as well as a panel of miRNAs (miRNA-21, miRNA-30d, miRNA-122, miRNA-133a, miRNA-210 and miRNA-486).ResultsA total of 52 patients were recruited; mean age (±SD) was 72.4±9.4 years; male=43 (82.7%), ischaemic aetiology=30 (57.7%), mean QRS duration=166.4±23.5  ms, left bundle branch block (LBBB) morphology = 39 (75.0%), mean NYHA=2.7±0.6, 6MWT=238.8±130.6  m, MLHFQ=46.4±21.3  and left ventricular ejection fraction (LVEF)=24.3%±8.0%. Mean follow-up=1.7±0.3  and 5.8±0.7 months. There were 27 (55.1%) functional responders (3 no definable 6-month response; 2 missed assessments and 1 long-term lead displacement). No marker predicted response, however, CTx and LBBB trended most towards predicting functional response.ConclusionNo specific biomarkers reached significance for predicting functional response to CRT. CTx showed a trend towards predicting response and warrants further study.Trial registration numberNCT02541773.

scholarly journals Left ventricular ejection fraction as an imaging biomarker to guide cardiac resynchronisation therapy in heart failure patients: a multimodal comparison of 2D and 3D echocardiography and CMR

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
S Lam ◽  
MS Nazir ◽  
B Campbell ◽  
M Yazdani ◽  
G Carr-White ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cardiac Resynchronisation Therapy ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
King's College ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy ◽  
2D And 3D

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): The authors acknowledge financial support from the Department of Health through the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre award to Guy’s & St Thomas’ NHS Foundation Trust in partnership with King’s College London and King’s College Hospital NHS Foundation Trust and by the NIHR MedTech Co-operative for Cardiovascular Disease at Guy’s and St Thomas’ NHS Foundation Trust. This work was supported by the Wellcome/EPSRC Centre for Medical Engineering [WT 203148/Z/16/Z]. MSN was funded by a clinical lectureship awarded by the NIHR. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, the DoH, EPSRC, MRC or the Wellcome Trust. Introduction – Imaging derived left ventricular ejection fraction (LVEF) has an important role to guide initiation of medical therapy and device insertion in patients with heart failure and reduced ejection fraction (HFrEF). Previous studies have reported the correlation and agreement of LVEF in various patient populations, but sparse evidence exists on patients with heart failure referred for Cardiac Resynchronisation Therapy (CRT) using 2D and 3D echocardiography (2DE & 3DE) and cardiovascular magnetic resonance (CMR). Objectives – To determine the correlation and agreement of LVEF as determined by 2DE, 3DE and CMR in a cohort of HF patients referred for assessment of CRT. Methods – Patients with suspected HFrEF referred for assessment for CRT therapy were included in this single centre study. Patients underwent 2DE, 3DE and CMR to derive LVEF, LVESV and LVEDV. Correlation was determined with Pearson’s correlation, agreement with Bland-Altman analysis and Cohen’s kappa analysis for agreement using a dichotomous cut off of LVEF ≤35% as a threshold for CRT insertion (Ponikowski, 2016). Results - 55 patients (mean age 71 ± 9.2, 76% male) were included. The mean LVEF for 2DE, 3DE, CMR and were 32.4 ± 8.6, 32.1 ± 9.6 and 30.3 ± 9.5 respectively. CMR had a significantly lower LVEF compared to 2DE (p = 0.03). There was good correlation between 3DE & CMR and 2DE & CMR, and excellent correlation between 3DE and 2DE for LVEF (Table 1). There was for trend for CMR to underestimate LVEF compared to 2DE and 3DE, with small biases although wide limits of agreement (Figure 1). There was excellent correlation of LVEDV and LVESV across all 3 techniques. CMR underestimated volumes compared to 2DE and 3DE with large biases and wide LOA. The kappa coefficient agreement at threshold level for CRT insertion (LVEF ≤35%) was fair for 3DE and CMR (0.379, p = 0.004) and 2DE and CMR (0.462, p = 0.001), and moderate for 3DE and 2DE (0.575, p ≤ 0.001). Conclusion – Whilst LVEF is not the only indicator to guide CRT insertion, it remains an important imaging parameter for clinical decision making. We observed large biases in left ventricular volumes between 2D, 3D and CMR. However, whilst the overall bias in LVEF is small, the wide limits of agreement (LOA) observed may represent an area of clinical uncertainty, which may impact on the dichotomous imaging threshold for CRT insertion. Comparison of indices between modalities LVEF Correlation (r) LVEF Bias & LOA (%±SD) EDV Correlation (r) EDV Bias & LOA (mL ± SD) ESV Correlation (r) ESV Bias & LOA (mL ± SD) 3DE vs CMR 0.676 (p < 0.001) +1.75 ± 15.4 0.896 (p < 0.001) -82.16 ± 42.8 0.937 (p < 0.001) -61.3 ± 34.9 3DE vs 2DE 0.872 (p < 0.001) +0.48 ± 4.5 0.909 (p < 0.001) -10.31 ± 28.3 0.936 (p < 0.001) -8.42 ± 20.5 2DE vs CMR 0.675 (p < 0.001) +2.35 ± 14.6 0.876 (p < 0.001) -67.35 ± 36.3 0.898 (p < 0.001) -51.42 ± 30.1 Abstract Figure. Bland-Altman Plot LVEF by 3DE & CMR

Rapidly progressive heart failure after dual-chamber pacemaker implantation

2021 ◽  
Vol 14 (10) ◽  
pp. e245006
Author(s):  
Claire Seydoux ◽  
Philipp Suter ◽  
Denis Graf ◽  
Hari Vivekanantham
Keyword(s):  
Heart Failure ◽  
De Novo ◽  
Pacemaker Implantation ◽  
Cardiac Resynchronisation Therapy ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Dual Chamber ◽  
Ventricular Ejection Fraction ◽  
Device Implantation ◽  
Resynchronisation Therapy

Pacing-induced cardiomyopathy (PICM) consists of heart failure (HF) associated with a drop in the left ventricular ejection fraction (LVEF) in the setting of high-burden right ventricular pacing, with presentation that may range from subclinical to severe. Time to manifestation can go from weeks to years after device implantation. Treatment typically consists in an upgrade to a cardiac resynchronisation therapy (CRT) or His bundle pacing (HisP). Several risk factors for PICM have been described and should be considered before pacemaker (PM) implantation, as thorough patient selection for de novo CRT or HisP, may preclude its manifestation. We present the case of an 82-year-old patient presenting with acute congestive HF and new severely reduced LVEF, 30 days following dual chamber PM implantation for high-grade atrioventricular block. Treatment with HF medication and upgrade to a CRT permitted rapid resolution of the symptoms and normalisation of the LVEF at 1-month follow-up.

scholarly journals Initial experience, feasibility and safety of permanent left bundle branch pacing: results from a prospective single-centre study

2021 ◽  
Author(s):  
L. M. Rademakers ◽  
J. L. P. M. van den Broek ◽  
M. Op ’t Hof ◽  
F. A. Bracke
Keyword(s):  
Sinus Node ◽  
High Volume ◽  
Cardiac Resynchronisation Therapy ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Success Rates ◽  
Ventricular Ejection Fraction ◽  
Resynchronisation Therapy ◽  
Qrs Duration

Abstract Background Left bundle branch (LBB) pacing is a novel pacing technique which may serve as an alternative to both right ventricular pacing for symptomatic bradycardia and cardiac resynchronisation therapy (CRT). A substantial amount of data is reported by relatively few, highly experienced centres. This study describes the first experience of LBB pacing in a high-volume device centre. Methods Success rates (i.e. the ability to achieve LBB pacing), electrophysiological parameters and complications at implant and up to 6 months of follow-up were prospectively assessed in 100 consecutive patients referred for various pacing indications. Results The mean age was 71 ± 11 years and 65% were male. Primary pacing indication was atrioventricular (AV) block in 40%, CRT in 42%, and sinus node dysfunction or refractory atrial fibrillation prior to AV node ablation in 9% each. Baseline left ventricular ejection fraction was < 50% in 57% of patients, mean baseline QRS duration 145 ± 34 ms. Overall LBB pacing was successful in 83 of 100 (83%) patients but tended to be lower in patients with CRT pacing indication (69%, p = ns). Mean left ventricular activation time (LVAT) during LBB pacing was 81 ms and paced QRS duration was 120 ± 19 ms. LBB capture threshold and R‑wave sense at implant was 0.74 ± 0.4 mV at 0.4 ms and 11.9 ± 5.9 V and remained stable at 6‑month follow-up. No complications occurred during implant or follow-up. Conclusion LBB pacing for bradycardia pacing and resynchronisation therapy can be easily adopted by experienced implanters, with favourable success rates and safety profile.

Cardiac resynchronisation therapy in anthracycline-induced cardiomyopathy

Heart ◽  
2021 ◽  
pp. heartjnl-2020-318333
Author(s):  
Divyang Patel ◽  
Anirudh Kumar ◽  
Laurie Ann Moennich ◽  
Kevin Trulock ◽  
David M Nemer ◽  
...  
Keyword(s):  
Cardiac Resynchronisation Therapy ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Term Survival ◽  
Ventricular Ejection Fraction ◽  
Lv Dysfunction ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy

IntroductionChemotherapy-induced cardiomyopathy has been increasingly recognised as patients are living longer with more effective treatments for their malignancies. Anthracyclines are known to cause left ventricular (LV) dysfunction. While heart failure medications are frequently used, some patients may need consideration for device-based therapies such as cardiac resynchronisation therapy (CRT). However, the role of CRT in anthracycline-induced cardiomyopathy (AIC) is not well understood.MethodsWe performed a retrospective review of all patients undergoing CRT implantation at our centre from 2003 to 2019 with a diagnosis of AIC. The LV remodelling and survival outcomes of this population were obtained and then compared with consecutive patients with other aetiologies of non-ischaemic cardiomyopathy (NICM).ResultsA total of 34 patients underwent CRT implantation with a diagnosis of AIC with a mean age of 60.5±12.7 years, left ventricular ejection fraction (LVEF) of 21.7%±7.4%, and 11.3±7.5 years and 10.2±7.4 years from cancer diagnosis and last anthracycline exposure, respectively. At 9.6±8.1 months after CRT implantation, there was an increase of LVEF from 21.8%±7.6% to 30.4%±13.0% (p<0.001). Patients whose LVEF increased by at least 10% post-CRT implant (42.5% of cohort) survived significantly longer than patients who failed to improve their LVEF by that amount (p=0.01). A propensity matched analysis between patients with AIC and 369 consecutive patients with other aetiologies of NICM who underwent CRT implantation during the same period revealed no significant differences in improvement in LVEF or long-term survival.ConclusionsPatients with AIC undergo LV remodelling with CRT at rates similar to other aetiologies of NICM. Furthermore, AIC post-CRT responders have a favourable long-term mortality compared with non-responders.

scholarly journals Multi-polar stimulation of the left ventricle during cardio-resynchronisation therapy in patients with congestive heart failure: Randomised pilot study outcomes from parallel groups

2020 ◽  
Vol 24 (1) ◽  
pp. 54
Author(s):  
A. V. Ponomarenko ◽  
I. L. Mikheenko ◽  
E. A. Morzhanayev ◽  
A. G. Filippenko ◽  
D. V. Losik ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Cardiac Resynchronisation ◽  
Bipolar Stimulation ◽  
Resynchronisation Therapy ◽  
Stimulation Group ◽  
Observation Period ◽  
Stimulation Of

<p><strong>Background.</strong> Cardiac resynchronisation therapy (CRT) has been used for the treatment of patients with congestive heart failure (CHF) and wide QRS complexes for more than ten years. Nevertheless, the percentage of patients unresponsive to this therapy is 30%. There is recent evidence for increased responder proportions to treatments with multipolar pacing of the left ventricle (LV) in CRT. Accordingly, the aim of this study is to evaluate the effectiveness of multi-polar pacing of LV in patients with CHF and indications for CRT.</p><p><strong>Methods.</strong> Sixty-two patients [42 men, mean age 62.5 (58–68) years] with CHF and indications for CRT (for example patients with symptomatic heart failure and QRS duration ≥130 ms with left bundle branch block and left ventricular ejection fraction ≤ 35%) were included in this prospective, pilot, randomised study. Patients were implanted with cardiac resynchronisation devices with multi-polar electrodes. After implantation, patients were randomised into two groups according to the programming of the LV stimulation vector: true bipolar stimulation (group 1, stimulation vector LVring-LVtip, n = 31) and extended-bipolar LV stimulation (group 2, standard programming LV ring to RV, n = 31). The main objective of the study was to assess the effects of true bipolar stimulation on the increase of the number of CRT responders. Responders were defined as patients with a 15% decrease in the left ventricular end systolic volume compared with the initial characteristics as detected by echocardiography. Secondary points included changes in a) left ventricular ejection fraction (LVEF), b) 6-min walk test dynamics, and c) brain natriuretic peptide. The observation period was 12 months.</p><p><strong>Results.</strong> The LV electrode was implanted in the anterior (6%), antero-lateral (8%), lateral (18%), posterior (2%), or postero-lateral (66%) branches of the coronary sinus, and the average LV stimulation threshold was 1.7 ± 1.1 V. No intra-operative complications were detected. Four patients (6.5%) underwent LV electrode re-positioning on the second day after surgery owing to diaphragmatic nerve stimulation. At the end of the observation period, the average threshold used for LV stimulation of patients in the true bi-polar stimulation group with the LVring-LVtip vector was 1.9 ± 1.5 V compared with 1.6 ± 1.3 V in the case of the extended-bipolar LV stimulation group (p = 0.88). The number of responders in the true bipolar stimulation group was 25 (80.6%) compared with 21 (67.7%) patients in the extended-bipolar LV stimulation group (p = 0.38). LVEF significantly increased in both groups compared with pre-operative values without significant differences between the groups (29.4 vs. 36.5, p &lt; 0.001 in the extended bipolar LV stimulation group; 28.0 vs. 34.9, p &lt; 0.001 in the true bi-polar stimulation group, p = 0.86 between groups). The distance covered during the 6-min walk test significantly increased in both groups compared with pre-operative values in the absence of a significant difference between the groups (p = 0.92). The decreased levels of the cerebral natriuretic peptide were 60.3 ± 42.3 pg/ml and 56.6 ± 38.5 pg/ml in the extended and true bipolar stimulation groups, respectively (p = 0.95). </p><p><strong>Conclusion.</strong> Based on the results of this pilot study, the choice of a vector for true bipolar LV stimulation demonstrated its advantage and tendency to increase the number of responders in subjects with implanted CRT devices. Subsequent multi-centre randomised trials will help determine the role of true bipolar LV stimulation and extended-bipolar stimulation from different regions of the LV to increase the response to CRT.</p><p><br />Received 24 December 2019. Revised 18 January 2020. Accepted 20 January 2020.</p><p><strong>Funding:</strong> The work is supported by a grant of the President of the Russian Federation No. МД-2893.2018.7.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />Conception and study design: A.B. Romanov<br />Data collection and analysis: A.V. Ponomarenko, I.L. Mikheenko, E.A. Morzhanayev, A.G. Filippenko, R.E. Zhizhov, I.S. Peregudov<br />Statistical analysis: A.B. Romanov, I.L. Mikheenko<br />Drafting the article: A.V. Ponomarenko, I.L. Mikheenko, E.A. Morzhanayev<br />Critical revision of the article: A.B. Romanov, D.V. Losik, I.L. Mikheenko, A.V. Ponomarenko, V.V. Shabanov, S.N. Artemenko <br />Final approval of the version to be published: A.V. Ponomarenko, I.L. Mikheenko, E.A. Morzhanayev, A.G. Filippenko, D.V. Losik, V.V. Shabanov, I.S. Peregudov, R.E. Zhizhov, A.B. Romanov, S.N. Artemenko</p>

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