Left Ventricular End-Systolic Volume Can Predict 1-Year Hierarchical Clinical Composite End Point in Patients with Cardiac Resynchronization Therapy

Uhm, Jae Sun; Oh, Jaewon; Cho, In Jeong; Park, Minsu; Kim, In Soo; Jin, Moo-Nyun; Bae, Han Joon; Yu, Hee Tae; Kim, Tae Hoon; Pak, Hui Nam; Lee, Moon Hyoung; Joung, Boyoung; Kang, Seok Min

doi:10.3349/ymj.2019.60.1.48

Cited by 8 publications

(9 citation statements)

References 22 publications

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“…In reimbursement criteria of Korea, most of patients who are indicated for CRT implantation were also indicated for ICD implantation. Thus CRT-D has been used overwhelmingly over CRT-P in Korea 33)34). The ratio of CRT-P and CRT-D in the present study was 1:2.7 in 2009 then increased to 1:13.3 in 2016.…”

Section: Discussionmentioning

confidence: 44%

Temporal Trends of Cardiac Implantable Electronic Device Implantations: a Nationwide Population-based Study

Lee

Choi

et al. 2019

Korean Circ J

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Background and Objectives Implantation of cardiac implantable electronic devices (CIED), including permanent pacemakers (PM), implantable cardioverter-defibrillators (ICD), and cardiac resynchronization therapy (CRT) devices, has increased significantly over the past several years. However, limited data exists regarding temporal trends of CIED implantations in Asian population. This study aimed to investigate temporal trends of CIED treatment in Korea. Methods Using the National Health Insurance Service database of the entire Korean adult population, temporal trends of CIED procedures between 2009 and 2016 were evaluated. Additionally, temporal changes in the prevalence of patients' comorbidities were evaluated. Results A total of 35,421 CIED procedures (new implantations: 27,771, replacements: 7,650) were performed during the study period. The mean age of new CIED recipients and the prevalence of comorbidities, including hypertension, diabetes mellitus, heart failure, stroke, and atrial fibrillation, increased substantially with time. Compared to 2009, the number of new implantations of PM, ICD, and CRT devices increased by 2.0 (1,977 to 3,910), 3.6 (230 to 822), and 4.9 (44 to 217) times in 2016, respectively. The annual new implantation rate of CIED also increased accordingly (5.1 to 9.3 for PM, 0.6 to 1.9 for ICD, and 0.1 to 0.5 for CRT devices, per 100,000 persons). Conclusions The number of CIED implantation increased substantially from 2009 to 2016 in Korea. Also, the patients with CIED have been changed to be older and have more comorbidities. Therefore, the burden of health care cost in patients with CIED would be expected to increase in the future.

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Section: Discussionmentioning

confidence: 44%

Temporal Trends of Cardiac Implantable Electronic Device Implantations: a Nationwide Population-based Study

Lee

Choi

et al. 2019

Korean Circ J

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“…CRT response definition by markers of LV reverse remodeling following device implantation is widely used, and a more than 15% reduction in LV end-systolic volume (ΔESV < –15%) is the most widely accepted criterion (Park et al, 2012 ). In consistency with that, an optimal cutoff value for ΔESV was defined at 13.5% (sensitivity = 0.719, specificity = 0.719) for a 1-Year hierarchical clinical composite end point in patients who underwent CRT (Uhm et al, 2019 ). Our earlier 278 patients' study by Chumarnaya et al ( 2021 ) revealed a 9% cutoff value for ESV reduction for responders.…”

Section: Discussionmentioning

confidence: 99%

Machine Learning Prediction of Cardiac Resynchronisation Therapy Response From Combination of Clinical and Model-Driven Data

et al. 2021

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Background: Up to 30–50% of chronic heart failure patients who underwent cardiac resynchronization therapy (CRT) do not respond to the treatment. Therefore, patient stratification for CRT and optimization of CRT device settings remain a challenge.Objective: The main goal of our study is to develop a predictive model of CRT outcome using a combination of clinical data recorded in patients before CRT and simulations of the response to biventricular (BiV) pacing in personalized computational models of the cardiac electrophysiology.Materials and Methods: Retrospective data from 57 patients who underwent CRT device implantation was utilized. Positive response to CRT was defined by a 10% increase in the left ventricular ejection fraction in a year after implantation. For each patient, an anatomical model of the heart and torso was reconstructed from MRI and CT images and tailored to ECG recorded in the participant. The models were used to compute ventricular activation time, ECG duration and electrical dyssynchrony indices during intrinsic rhythm and BiV pacing from the sites of implanted leads. For building a predictive model of CRT response, we used clinical data recorded before CRT device implantation together with model-derived biomarkers of ventricular excitation in the left bundle branch block mode of activation and under BiV stimulation. Several Machine Learning (ML) classifiers and feature selection algorithms were tested on the hybrid dataset, and the quality of predictors was assessed using the area under receiver operating curve (ROC AUC). The classifiers on the hybrid data were compared with ML models built on clinical data only.Results: The best ML classifier utilizing a hybrid set of clinical and model-driven data demonstrated ROC AUC of 0.82, an accuracy of 0.82, sensitivity of 0.85, and specificity of 0.78, improving quality over that of ML predictors built on clinical data from much larger datasets by more than 0.1. Distance from the LV pacing site to the post-infarction zone and ventricular activation characteristics under BiV pacing were shown as the most relevant model-driven features for CRT response classification.Conclusion: Our results suggest that combination of clinical and model-driven data increases the accuracy of classification models for CRT outcomes.

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“…CRT interrogation and optimization based on intracardiac electrogram were performed at every visit to achieve optimal biventricular pacing rate. CRT response was defined as a decrease in the LV end‐systolic volume > 15% on echocardiography 6 months after CRT implantation 5 . Patients defined as non‐responders were analysed and followed up using the same methods.…”

Section: Methodsmentioning

confidence: 99%

The role of sacubitril/valsartan in the management of cardiac resynchronization therapy non‐responders: a retrospective analysis

Park

et al. 2020

ESC Heart Failure

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Aims Optimal medical therapy after cardiac resynchronization therapy (CRT) implantation is important in heart failure (HF) with reduced ejection fraction (HFrEF) patients. Although sacubitril/valsartan (SV) is a mainstay in the treatment of HFrEF, its efficacy in the management of CRT non-responders has not been emphasized. We aimed to investigate the efficacy of SV in CRT non-responders. Methods and results We analysed 175 HFrEF patients who received CRT implantation between January 2010 and January 2019. CRT responder was defined as a decrease in left ventricular (LV) end-systolic volume > 15% on echocardiography 6 months after implantation. Medical records were retrospectively reviewed. Patients underwent follow-up for HF rehospitalization, heart transplantation (HT), implantation of a LV assistant device (LVAD), cardiac death, and all-cause death. Among the study population, 164 patients were evaluated for CRT response; 54 (33%) were CRT non-responders. Four patients (6%) who received SV before CRT implantation were excluded, leaving 50 patients for analysis. Twenty-two non-responders (44%) received SV. There was no significant difference in baseline characteristics between SV users and non-users (n = 28). During follow-up, SV users had significantly lower incidence of all-cause death [1 (5%) vs. 10 (36%), P = 0.022] and tended to have lower HF rehospitalization [6 (27%) vs. 16 (57%), P = 0.068] and cardiac death (including HT and LVAD implant) [2 (9%) vs. 10 (36%), P = 0.064]. Kaplan-Meier survival analysis revealed that SV use was associated with a lower risk of cardiac death (including HT and LVAD implant) (log-rank P = 0.029). Conclusions SV treatment was related to a lower incidence of cardiac death including HT and LVAD implant in CRT nonresponders. The optimization of HF management, including SV, should be considered in CRT non-responders.

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Left Ventricular End-Systolic Volume Can Predict 1-Year Hierarchical Clinical Composite End Point in Patients with Cardiac Resynchronization Therapy

Cited by 8 publications

References 22 publications

Temporal Trends of Cardiac Implantable Electronic Device Implantations: a Nationwide Population-based Study

Temporal Trends of Cardiac Implantable Electronic Device Implantations: a Nationwide Population-based Study

Machine Learning Prediction of Cardiac Resynchronisation Therapy Response From Combination of Clinical and Model-Driven Data

The role of sacubitril/valsartan in the management of cardiac resynchronization therapy non‐responders: a retrospective analysis

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