Prognostication of Poor Survival After Cardiac Resynchronization Therapy

Abstract

Background and Objectives: Cardiac resynchronization therapy (CRT) is a successful treatment option for appropriately selected patients. However, one–third of recipients do not experience any positive outcome or their condition even declines. We aimed to assess preimplantation factors associated with worse survival after the CRT. Materials and Methods: This was a retrospective unicenter trial. The study cohort included 183 consecutive CRT-treated patients. Baseline demographic, clinical, electrocardiographic, and echocardiographic characteristics were analyzed. Results: After the median follow-up of 15.6 months (9.3–26.3), 20 patients had died (11%). In multivariate Cox regression analysis, ischemic origin of heart failure (HF) was a significant predictor of poor survival (adjusted hazard ratio (aHR) 15.235, 95% confidence interval (CI) (1.999–116.1), p = 0.009). In univariate Cox regression, tricuspid annular plane systolic excursion (TAPSE) <15.5 mm (sensitivity 0.824, specificity 0.526; HR 5.019, 95% CI (1.436–17.539), p = 0.012), post-implantation prescribed antiplatelet agents (HR 2.569, 95% CI (1.060–6.226), p = 0.037), statins (HR 2.983, 95% CI (1.146–7.764), p = 0.025), and nitrates (HR 3.694, 95% CI (1.342–10.171), p = 0.011) appeared to be related with adverse outcome. Conclusions: ischemic etiology of HF is a significant factor associated with worse survival after the CRT. Decreased TAPSE is also related to poor survival.

Independent and Joint Association of Statin Therapy with Adverse Outcomes in Heart Failure Patients with Atrial Fibrillation Treated with Cardiac Resynchronization Therapy

“…Buber et al 12 found that statin use significantly reduced the risk of fatal ventricular tachycardia in patients with CRT (HR, 0.23; 95% CI, 0.13–0.40). Nevertheless, Bašinskas et al 13 reported that statin use was associated with unfavorable outcomes in patients with CRT (HR 2.98, 95% CI, 1.15–7.77). Therefore, there is no consensus in previous studies regarding the prognostic impact of statin use in cardiac patients, which may be attributed to differences in study design, race, statin type, and other confounding factors.…”

“… 11 , 12 However, a recent study found that statin use was associated with poorer survival in patients with CRT. 13 Therefore, the evidence on the impact of statin use in CRT patients is limited and inconsistent. Of note, patients with AF may be more likely to use statins than those free of AF due to AF-related comorbidities, including coronary artery disease (CAD), stroke, and hyperlipidemia.…”

A Simple Predictive Marker in Cardiac Resynchronization Therapy Recipients: Prominent S-Wave in Right Precordial Leads

“…Cumulative incidence of clinical events was stratified by the cutoff of independent variables and compared between the two groups using a log-rank test. Univariate and multivariate Cox proportional hazard ratio regression analyses were performed to investigate the impact of ECG parameters on clinical outcomes, which were adjusted for other considerable variables, including age, male sex, ischemic etiology, left ventricular ejection fraction, the serum levels of B-type natriuretic peptide, and LBBB [ 2 , 17 , 18 ].…”

Ischemic Etiology and Clinical Outcomes Following Cardiac Resynchronization Therapy

“…Dear Editor, Basinskas and colleagues demonstrated that the ischemic etiology of heart failure was an independent predictor of mortality following cardiac resynchronization therapy [1]. Given the cost-effectiveness and urgency of heart failure, optimal patient selection for cardiac resynchronization therapy should be essential [2].…”