The magnitude of reverse remodelling irrespective of aetiology predicts outcome of heart failure patients treated with cardiac resynchronization therapy

Biase, Luigi Di; Auricchio, Angelo; Sorgente, Antonio; Civello, Kenneth C.; Klersy, Catherine; Faletra, Francesco F.; Riedlbauchová, Lucie; Patel, Dimpi; Arruda, Mauricio; Schweikert, Robert A.; Martin, David O.; Saliba, Walid; Moccetti, Tiziano; Wilkoff, Bruce L.; Natale, Andrea

doi:10.1093/eurheartj/ehn221

Cited by 43 publications

(37 citation statements)

References 14 publications

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“…The improvement and the degree of improvement in LVEF after CRT present good correlation with the improvement in clinical outcome of patients undergoing CRT. According to Di Biase et al 21 , an increase of six points or more in LVEF at three months after CRT presents a rate around 66% of eventfree within five years of follow up.…”

Section: Discussionmentioning

confidence: 97%

Comparação entre a ecocardiografia 2D e 3D na avaliação do remodelamento reverso após a TRC

Hotta

Filho

Mady

et al. 2011

Arq. Bras. Cardiol.

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Section: Discussionmentioning

confidence: 97%

Comparação entre a ecocardiografia 2D e 3D na avaliação do remodelamento reverso após a TRC

Hotta

Filho

Mady

et al. 2011

Arq. Bras. Cardiol.

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“…57 In line with these results, Di Biase et al found that female gender was an independent predictor of favourable left ventricular reverse remodelling following CRT, analysing data from a prospective registry of 398 consecutive patients (25 % female) undergoing CRT. 58 In the recent Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy (MADIT-CRT), CRT plus ICD was demonstrated superior to ICD alone in reducing the risk of heart failure in a population of patients with dilated cardiomyopathy, a New York Heart Association (NYHA) functional class of I or II, and prolonged QRS duration. 59 Remarkably, a pre-specified sub-analysis confirmed that females treated with CRT plus ICD had a greater reduction in the 59 In a subsequent analysis, the authors reported that women had consistently greater improvements in reverse cardiac remodelling with cardiac resynchronisation therapy defibrillator (CRT-D) therapy than did men.…”

Section: Cardiac Resynchronisation Therapymentioning

confidence: 99%

Outcomes in Women Undergoing Electrophysiological Procedures

Biase

Basile

Al‐Ahmad

2013

Arrhythmia &Amp; Electrophysiology Review

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The number of invasive electrophysiological procedures is steadily increasing in Western countries, as the age of the population increases and technologies advance. In recent years, gender-related differences in cardiac rhythm disorders have been increasingly appreciated, which can potentially have a great impact on the outcomes of invasive electrophysiological procedures. Among supraventricular arrhythmias, women have a higher incidence of atrioventricular nodal re-entrant tachycardia and a significantly lower incidence of atrioventricular re-entrant tachycardia compared with males, and present to ablation procedures later and after having failed more antiarrhythmic drugs. The results of catheter ablation of atrial fibrillation in women have been reported worse than in men. This finding is possibly due to a later referral of females to ablation procedures, who present older and with a higher incidence of long-standing persistent atrial fibrillation. With regard to cardiac device implantation procedures, a smaller survival benefit from prophylactic implantable cardioverter defibrillator (ICD) implantation has been shown in women, essentially due to gender-specific differences in the clinical course of patients with severe left ventricular dysfunction, with women dying predominantly from non-arrhythmic causes. On the other side, the clinical outcome of cardiac resynchronisation therapy seems to be more favourable in women, who experience a greater degree of reverse left ventricular remodelling and a striking decrease of heart failure events or mortality after biventricular pacing. This review will summarise the available evidence on gender-related differences in outcomes of invasive electrophysiological procedures.

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“…EF response to CRT was defined as an absolute increase of LVEF ≥5% (EF units). [15][16][17] The principal outcome variable was the combined end point of death, heart transplantation, or LV assist device (LVAD) implantation. This combined end point was predetermined because only patients with HF who are clinically considered end stage undergo transplantation or LVAD implantation at our institution.…”

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confidence: 99%

Mechanistic Features Associated With Improvement in Mitral Regurgitation After Cardiac Resynchronization Therapy and Their Relation to Long-Term Patient Outcome

Onishi

Marek

et al. 2013

Circ: Heart Failure

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Background-Mechanisms of mitral regurgitation (MR) reduction with cardiac resynchronization therapy (CRT) are complex, and their association with long-term outcome is unclear. We sought to elucidate mechanistic features of reduction in MR with CRT, which impact long-term patient survival. Methods and Results-A prospective longitudinal study of 277 patients with heart failure with QRS width ≥120 ms and ejection fraction ≤35% for CRT was performed. Quantitative echocardiography, including dyssynchrony analysis, was performed at baseline. MR was quantified by color Doppler before and 6 months after CRT. Predefined end points of death, transplant, or left ventricular assist device were tracked during 4 years. There were 114 (48%) patients with CRT with significant MR (≥moderate) at baseline; of whom 48 (42%) patients had MR improvement, and 24 (19%) patients had MR worsening after CRT. The 66 events (47 deaths, 10 transplantations, and 9 left ventricular assist devices) were strongly associated with significant MR after CRT (hazard ratio, 3.58; 95% confidence interval, 2.18-5.87; P<0.0001). Three echocardiographic features were independently associated with amelioration of significant MR after CRT by multivariable analysis: anteroseptal to posterior wall radial strain dyssynchrony >200 ms, lack of severe left ventricular dilatation (end-systolic dimension index <29 mm/m 2 ), and lack of echocardiographic scar at papillary muscle insertion sites (all P<0.05) and, when combined, were additively associated with long-term survival (P=0.0001). Conclusions-Significant MR after CRT was strongly associated with less favorable long-term survival. Echocardiographic mechanistic features were identified that were associated with improvement in MR after CRT and favorable long-term survival. to body surface area. 8 Assessment for myocardial scar focused on the papillary muscle insertion sites using a wall motion score index where akinesis or dyskinesis and a reduction in end-diastolic wall thickness ≤0.6 cm were consistent with scar as suggested by the American Society of Echocardiography and European Association of Echocardiography. 8,9 Specifically, the wall motion score index at the level of the papillary muscle attachment site was determined from the corresponding 8 LV segments as previously reported. 10,11 Figure 1. Study patient flowchart. A flowchart of consecutive patients referred for cardiac resynchronization therapy (CRT) who were included in this study. The prevalence of significant mitral regurgitation (MR) before and after CRT is shown. Quantification of MR SeverityColor Doppler quantification of MR was based on the guidelines of the American Society of Echocardiography and European Society of Cardiology 11,12 using a multiparametric approach. A Nyquist limit of 40 to 60 cm/s and a color gain were used to optimize color Doppler jet visualization. Vena contracta width was measured as the narrowest portion of the MR color Doppler jet from zoomed optimized views. The ratio of the jet area to the left atrium area was m...

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The magnitude of reverse remodelling irrespective of aetiology predicts outcome of heart failure patients treated with cardiac resynchronization therapy

Abstract: Reverse remodelling measured by LVEF after 3 months is a good predictor of long-term outcome. Patients with an increase in LVEF >or=6 points have an excellent event-free survival approaching 66% at 5 years of follow-up.

Cited by 43 publications

References 14 publications

Comparação entre a ecocardiografia 2D e 3D na avaliação do remodelamento reverso após a TRC

Comparação entre a ecocardiografia 2D e 3D na avaliação do remodelamento reverso após a TRC

Outcomes in Women Undergoing Electrophysiological Procedures

Mechanistic Features Associated With Improvement in Mitral Regurgitation After Cardiac Resynchronization Therapy and Their Relation to Long-Term Patient Outcome

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