New‐onset left bundle branch block‐associated idiopathic nonischemic cardiomyopathy and time from diagnosis to cardiac resynchronization therapy: The NEOLITH II study

Wang, Norman C.; Li, Jack Z.; Adelstein, Evan; Althouse, Andrew D.; Sharbaugh, Michael S.; Jain, Sandeep; Mendenhall, G. Stuart; Shalaby, Alaa; Voigt, Andrew; Saba, Samir

doi:10.1111/pace.13264

Cited by 32 publications

(35 citation statements)

References 45 publications

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“…The NEOLITH II study was a retrospective cohort study conducted at the University of Pittsburgh Medical Center (Wang, Li, et al, 2018). Subjects implanted with CRT devices between January 1998 and April 2016 were identified from a prospectively maintained database.…”

Section: Study Population and Designmentioning

confidence: 99%

“…Cardiovascular medications received at the time of CRT implant and CRT characteristics are listed in Table 2. Additional information on medical therapy has been previously published (Wang, Li, et al, 2018). Transvenous LV lead placement was achieved in 120 (97.6%) subjects and 3 (2.4%) received epicardial leads.…”

Section: Re Sultsmentioning

confidence: 99%

“…There was no core laboratory for LVEF measurements. Underlying differences may have existed between men and women despite stringent selection criteria for LBBB-associated idiopathic cardiomyopathy in the NEOLITH II study (Wang, Li, et al, 2018). These may be related to genetic and/or other pathophysiologic processes (Eisenberg, Di Palo, & Piña, 2018;Japp, Gulati, Cook, Cowie, & Prasad, 2016…”

Section: Study Strengths and Limitationsmentioning

confidence: 99%

“…The NEw-Onset LBBB-Associated Idiopathic Nonischemic CardiomyopaTHy (NEOLITH) II study was conducted in CRT recipients with LBBB at the time of initial diagnosis of idiopathic NICM (Wang, Li, et al, 2018). In this substudy, we sought to address the hypothesis that clinical outcomes after CRT implantation would differ between women and men.…”

Section: Introductionmentioning

confidence: 99%

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Sex‐specific clinical outcomes after cardiac resynchronization therapy in left bundle branch block‐associated idiopathic nonischemic cardiomyopathy: A NEOLITH II substudy

Wang

Mezu-Chukwu

Adelstein

et al. 2019

Noninvasive Electrocardiol

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Background: Sex differences in clinical outcomes for left bundle branch block (LBBB)associated idiopathic nonischemic cardiomyopathy (NICM) after cardiac resynchronization therapy (CRT) are not well described. Methods: A retrospective cohort study at an academic medical center included subjects with LBBB-associated idiopathic NICM who received CRT. Cox regression analyses estimated the hazard ratios (HRs) between sex and clinical outcomes. Results: In 123 total subjects (mean age 62 years, mean initial left ventricular ejection fraction 22.8%, 76% New York Heart Association class III, and 98% CRT-defibrillators), 55 (45%) were men and 68 (55%) were women. The median follow-up time after CRT was 72.4 months. Similar risk for adverse clinical events (heart failure hospitalization, appropriate implantable cardioverter-defibrillator shock, appropriate antitachycardia pacing therapy, ventricular assist device implantation, heart transplantation, and death) was observed between men and women (HR, 1.20; 95% confidence interval [CI] 0.57-2.51; p = 0.63). This persisted in multivariable analyses. Men and women had similar risk for all-cause mortality in univariable analysis, but men had higher risk in the final multivariable model that adjusted for age at diagnosis, QRS duration, and left ventricular end-diastolic dimension index (HR, 4.55; 95% CI, 1.26-16.39; p = 0.02). The estimated 5-year mortality was 9.5% for men and 6.9% for women. Conclusions: In LBBB-associated idiopathic NICM, men have higher risk for all-cause mortality after CRT when compared to women. K E Y W O R D S cardiac resynchronization therapy, clinical outcomes, left bundle branch block, nonischemic cardiomyopathy, sex-specific How to cite this article: Wang NC, Mezu-Chukwu U, Adelstein EC, et al. Sex-specific clinical outcomes after cardiac resynchronization therapy in left bundle branch block-associated idiopathic nonischemic cardiomyopathy: A

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Section: Study Population and Designmentioning

confidence: 99%

Section: Re Sultsmentioning

confidence: 99%

Section: Study Strengths and Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Sex‐specific clinical outcomes after cardiac resynchronization therapy in left bundle branch block‐associated idiopathic nonischemic cardiomyopathy: A NEOLITH II substudy

Wang

Mezu-Chukwu

Adelstein

et al. 2019

Noninvasive Electrocardiol

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“…HBP has been successfully performed in a variety of conditions, including pacing‐induced cardiomyopathy and congenital heart disease with heart block 13–16 . While studies have revealed the benefit of conventional BiV‐CRT in LBBB, no investigation on the effects of HBP‐CRT on LBBB‐mediated cardiomyopathy have been completed 7,12,17 . We studied the effect of HBP‐CRT on the New York Heart Association (NYHA) functional status, left ventricular ejection fraction (LVEF), and echocardiographic parameters in individuals with LBBB‐mediated cardiomyopathy.…”

Section: Introductionmentioning

confidence: 99%

His‐bundle pacing: A novel treatment for left bundle branch block‐mediated cardiomyopathy

Singh

Devabhaktuni²,

Ezzeddine

et al. 2020

Cardiovasc electrophysiol

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Background: Chronic left bundle branch block (LBBB) can lead to LBBB-mediated cardiomyopathy from left ventricular dysynchrony. His-bundle pacing (HBP) results in direct electrical synchrony using the native His-Purkinje system, providing a novel treatment for this cardiomyopathy. Objective: To assess the feasibility of HBP for cardiac resynchronization therapy (CRT) in LBBB-mediated cardiomyopathy patients. Methods: Retrospective database review was conducted on patients who underwent CRT by the HBP capable provider at Indiana University Health and Eskenazi Hospital from August 2015 to August 2017. A subset of patients who met the predefined syndrome criteria of LBBB-mediated cardiomyopathy who underwent HBP were identified. Clinical, echocardiographic, and electrocardiographic variables were extracted at baseline and follow-up. Results: Nine patients had cardiomyopathy and LBBB. Among those two were lost to follow-up. Seven patients were included in the analysis. The average time from device implantation to the last follow-up was 14.5 months. Left ventricular ejection fraction improved on average from 25% to 50% (p = .0001). The left ventricular endsystolic dimension decreased from 47 to 37 mm (p = .003) and the left ventricular end-diastolic dimension decreased from 55 to 48 mm (p = .03). QRS duration with HBP-CRT decreased from 152 to 115 ms. New York Heart Association classification improved from an average of 2.7-2. Conclusion: HBP is a viable technique for pursuing CRT in patients with LBBBmediated cardiomyopathy.

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Prognostic value of reverse remodelling criteria in heart failure with reduced or mid‐range ejection fraction

et al. 2021

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Aims Reverse remodelling (RR) is the recovery from left ventricular (LV) dilatation and dysfunction. Many arbitrary criteria for RR have been proposed. We searched the criteria with the strongest prognostic yield for the hard endpoint of cardiovascular death. Methods and resultsWe performed a systematic literature search of diagnostic criteria for RR. We evaluated their prognostic significance in a cohort of 927 patients with LV ejection fraction (LVEF) < 50% undergoing two echocardiograms within 12 ± 2 months. These patients were followed for a median of 2.8 years (interquartile interval 1.3-4.9) after the second echocardiogram, recording 123 cardiovascular deaths. Two prognostic models were defined. Model 1 included age, LVEF, N-terminal pro-B-type natriuretic peptide, ischaemic aetiology, cardiac resynchronization therapy, estimated glomerular filtration rate, New York Heart Association, and LV end-systolic volume (LVESV) index, and Model 2 the validated Cardiac and Comorbid Conditions Heart Failure score. We identified 25 criteria for RR, the most used being LVESV reduction ≥15% (12 studies out of 42). In the whole cohort, two criteria proved particularly effective in risk reclassification over Model 1 and Model 2. These criteria were (i) LVEF increase >10 U and (ii) LVEF increase ≥1 category [severe (LVEF ≤ 30%), moderate (LVEF 31-40%), mild LV dysfunction (LVEF 41-55%), and normal LV function (LVEF ≥ 56%)]. The same two criteria yielded independent prognostic significance and improved risk reclassification even in patients with more severe systolic dysfunction, namely, those with LVEF < 40% or LVEF ≤ 35%. Furthermore, LVEF increase >10 U and LVEF increase ≥1 category displayed a greater prognostic value than LVESV reduction ≥15%, both in the whole cohort and in the subgroups with LVEF < 40% or LVEF ≤ 35%. For example, LVEF increase >10 U independently predicted cardiovascular death over Model 1 and LVESV reduction ≥15% (hazard ratio 0.40, 95% confidence interval 0.18-0.90, P = 0.026), while LVESV reduction ≥15% did not independently predict cardiovascular death (P = 0.112). Conclusions Left ventricular ejection fraction increase >10 U and LVEF increase ≥1 category are stronger predictors of cardiovascular death than the most commonly used criterion for RR, namely, LVESV reduction ≥15%.

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New‐onset left bundle branch block‐associated idiopathic nonischemic cardiomyopathy and time from diagnosis to cardiac resynchronization therapy: The NEOLITH II study

Abstract: In LBBB-associated idiopathic NICM, earlier CRT implantation was associated with more favorable cardiac remodeling. Delaying CRT may miss a critical period to halt and reverse progressive myocardial damage.

Cited by 32 publications

References 45 publications

Sex‐specific clinical outcomes after cardiac resynchronization therapy in left bundle branch block‐associated idiopathic nonischemic cardiomyopathy: A NEOLITH II substudy

Sex‐specific clinical outcomes after cardiac resynchronization therapy in left bundle branch block‐associated idiopathic nonischemic cardiomyopathy: A NEOLITH II substudy

His‐bundle pacing: A novel treatment for left bundle branch block‐mediated cardiomyopathy

Prognostic value of reverse remodelling criteria in heart failure with reduced or mid‐range ejection fraction

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