Long-term survival following upgrade compared with <i>de novo</i> cardiac resynchronization therapy implantation: a single-centre, high-volume experience

Schwertner, Walter Richárd; Behon, A; Merkel, Eperke Dóra; Tokodi, Márton; Kovács, Attila; Zima, Endre; Osztheimer, István; Molnár, Levente; Király, Ákos; Papp, Roland; Gellér, László; Kuthi, L; Veres, B; Kosztin, Annamária; Merkely, Béla

doi:10.1093/europace/euab059

Cited by 10 publications

(15 citation statements)

References 19 publications

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“…HFrecEF is a recently classified group of heart failure patients; therefore, there are limited data on their survival directly compared with HFmrEF-HFpEF patients. According to our results, systolic heart failure patients who are expecting the most beneficial outcome after a positive response to CRT have similar medium-term all-cause mortality risks to HFpEF-HFmrEF patients [ 18 , 19 , 20 , 21 ]. In addition, the presence of anemia significantly worsened the outcome of patients regardless of heart failure etiology.…”

Section: Discussionmentioning

confidence: 90%

“…We also selected an HFrecEF cohort from our retrospective cardiac resynchronization therapy (CRT) database, which comprised 2524 patients who underwent CRT implantation in our center between 2005 and 2018, with patients’ characteristics that were previously published in detail [ 18 , 19 , 20 , 21 ]. Patients were considered for device implantation as per the current guidelines: symptomatic (NYHA II-IVa) HF patients with reduced EF (LVEF < 35%), and wide QRS (>130 ms) despite the optimal medical treatment.…”

Section: Methodsmentioning

confidence: 99%

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The Prognostic Value of Anemia in Patients with Preserved, Mildly Reduced and Recovered Ejection Fraction

et al. 2022

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Data on the relevance of anemia in heart failure (HF) patients with an ejection fraction (EF) > 40% by subgroup—preserved (HFpEF), mildly reduced (HFmrEF) and the newly defined recovered EF (HFrecEF)—are scarce. Patients with HF symptoms, elevated NT-proBNP, EF ≥ 40% and structural abnormalities were registered in the HFpEF-HFmrEF database. We described the outcome of our HFpEF-HFmrEF cohort by the presence of anemia. Additionally, HFrecEF patients were also selected from HFrEF patients who underwent resynchronization and, as responders, reached 40% EF. Using propensity score matching (PSM), 75 pairs from the HFpEF-HFmrEF and HFrecEF groups were matched by their clinical features. After PMS, we compared the survival of the HFpEF-HFmrEF and HFrecEF groups. Log-rank, uni-and multivariate regression analyses were performed. From 375 HFpEF-HFmrEF patients, 42 (11%) died during the median follow-up time of 1.4 years. Anemia (HR 2.77; 95%CI 1.47–5.23; p < 0.01) was one of the strongest mortality predictors, which was also confirmed by the multivariate analysis (aHR 2.33; 95%CI 1.21–4.52; p = 0.01). Through PSM, the outcomes for HFpEF-HFmrEF and HFrecEF patients with anemia were poor, exhibiting no significant difference. In HFpEF-HFmrEF, anemia was an independent mortality predictor. Its presence multiplied the mortality risk in those with EF ≥ 40%, regardless of HF etiology.

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Section: Discussionmentioning

confidence: 90%

Section: Methodsmentioning

confidence: 99%

The Prognostic Value of Anemia in Patients with Preserved, Mildly Reduced and Recovered Ejection Fraction

et al. 2022

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“…For those patients, it is not well known which therapeutic strategy should come first, corticosteroids therapy or an upgrade to CRT therapy from a pacemaker or ICD. Generally, the clinical response and long‐term survival have been less favorable in patients undergoing CRT upgrades than de novo implantations 8 . However, the pathophysiology of CS greatly differs from that of other cardiomyopathies, and corticosteroid therapy would have a potential to affect the clinical response and long‐term prognosis.…”

Section: Introductionmentioning

confidence: 99%

“…Generally, the clinical response and long‐term survival have been less favorable in patients undergoing CRT upgrades than de novo implantations. 8 However, the pathophysiology of CS greatly differs from that of other cardiomyopathies, and corticosteroid therapy would have a potential to affect the clinical response and long‐term prognosis. Thus, in the present study, we investigated the echocardiographic response and long‐term prognosis in patients with non‐ischemic cardiomyopathy (NICM) who underwent CRT upgrade therapy and analyzed the impact of the timing of the initiation of the corticosteroid therapy on the clinical outcomes in patients with CS.…”

Section: Introductionmentioning

confidence: 99%

Impact of corticosteroid use on the clinical response and prognosis in patients with cardiac sarcoidosis who underwent an upgrade to cardiac resynchronization therapy

Suzuki

Takami

Fukuzawa

et al. 2022

Journal of Arrhythmia

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Background: Corticosteroids are widely used in patients with cardiac sarcoidosis (CS). In addition, upgrading to cardiac resynchronization therapy (CRT) is sometimes needed. This study aimed to investigate the impact of corticosteroid use on the clinical outcomes following CRT upgrades.Methods: A total of 48 consecutive patients with non-ischemic cardiomyopathies who underwent CRT upgrades were retrospectively reviewed and divided into three groups: group 1 included CS patients taking corticosteroids before the CRT upgrade (n = 7), group 2, CS patients not taking corticosteroids before the CRT upgrade (n = 10), and group 3, non-CS patients (n = 31). The echocardiographic response, heart failure hospitalizations, and cardiovascular deaths were evaluated. Results:The baseline characteristics during CRT upgrades exhibited no significant differences in the echocardiographic data between the three groups. After the CRT upgrade, responses regarding the ejection fraction (EF) and end-systolic volume (ESV) were significantly lower in CS patients than non-CS patients (ΔEF: group 1, 6.7% vs. group 2, 7.7% vs. group 3, 13.6%; p = .039, ΔESV: 3.0 ml vs. -12.7 ml vs. -37.2 ml; p = .008). The rate of an echocardiographic response was lowest in group 1 (29%). There were, however, no significant differences in the cumulative freedom from a composite outcome among the three groups (p = .19). No cardiovascular deaths occurred in group 1. Conclusion:The echocardiographic response to an upgrade to CRT and the long-term prognosis in patients with CS should be carefully evaluated because of the complex etiologies and impact of immunosuppressive therapy.

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“…A substantial proportion of patients with HFrEF (perhaps up to 30% [ 7 ]) who have narrow QRS develop progression of QRS width despite medical therapy [ 8 ]. This often occurs within the lifetime of the original device; more than one quarter of all CRT procedures are device upgrades [ 8 ], and almost 60% of all secondary procedures were upgrades to CRT [ 9 ], most commonly from single or dual chamber ICDs. However, predictors of progression and how these are associated with changes in clinical status have been incompletely explored.…”

Section: Introductionmentioning

confidence: 99%

Clinical implications and risk factors for QRS prolongation over time in heart failure patients

et al. 2022

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Background QRS prolongation is an established prognostic marker in heart failure (HF). In contrast, the role of QRS width progression over time has been incompletely explored. The current study investigates the role of QRS width progression over time on clinical status and identifies underlying predictors. Methods Datasets of ≥ 2 consecutive visits from 100 attendees to our HF clinic between April and August 2021 were analysed for changes in QRS complex duration. Results In total 240 datasets were stratified into tertiles based on change in QRS duration (mm/month) (1st tertile: − 1.65 [1.50] ‘regression’; 2nd tertile 0.03 [0.19] ‘stable’, 3rd tertile 3.57 [10.11] ‘progression’). The incidence of the combined endpoint HF hospitalisation and worsening of symptomatic heart failure was significantly higher in the group with QRS width progression (3rd tertile) compared with the stable group (2nd tertile; log-rank test: p = 0.013). These patients were characterised by higher plasma NT-pro-BNP levels (p = 0.008) and higher heart rate (p = 0.007). A spline-based prediction model identified patients at risk of QRS width progression when NT-pro-BNP and heartrate were > 837 pg/ml and > 83/bpm, respectively. These markers were independent of guideline-directed medical HF therapy. Patients beyond both thresholds had a 14-fold increased risk of QRS width progression compared to those with neither or either alone (HR: 14.2 [95% 6.9 – 53.6]; p < 0.0001, p for interaction = 0.016). Conclusions This pilot study demonstrates that QRS width progression is associated with clinical deterioration of HF. NTproBNP plasma levels and heart rate indicate patients at risk QRS width progression, independently of HF therapy. Graphic abstract

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Long-term survival following upgrade compared with de novo cardiac resynchronization therapy implantation: a single-centre, high-volume experience

Cited by 10 publications

References 19 publications

The Prognostic Value of Anemia in Patients with Preserved, Mildly Reduced and Recovered Ejection Fraction

The Prognostic Value of Anemia in Patients with Preserved, Mildly Reduced and Recovered Ejection Fraction

Impact of corticosteroid use on the clinical response and prognosis in patients with cardiac sarcoidosis who underwent an upgrade to cardiac resynchronization therapy

Clinical implications and risk factors for QRS prolongation over time in heart failure patients

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