Long-Term Effect of Different Optimizing Methods for Cardiac Resynchronization Therapy in Patients with Heart Failure: A Randomized and Controlled Pilot Study

Cardiology ◽  
2019 ◽  
Vol 142 (3) ◽  
pp. 158-166
Author(s):  
Yu  Zhang ◽  
Qiang  Xing ◽  
Jiang-Hua Zhang ◽  
Wei-Feng  Jiang ◽  
Mu  Qin ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Left Ventricular ◽  
Term Effect ◽  
The Other ◽  
Nominal Group ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Long Term Effect

Aim: During cardiac resynchronization therapy (CRT), optimized programming of the atrioventricular (AV) delay and ventricular-to-ventricular (VV) interval can lead to improved hemodynamics, symptomatic response, and left ventricular systolic function. Currently, however, there is no recommendation for the best optimization method. This study aimed to compare the long-term clinical outcomes of 4 different CRT optimization methods. Methods: One hundred and twenty-four consecutive CRT patients with severe heart failure and left bundle-branch block configuration were randomly assigned into four groups to undergo AV/VV delay optimization through echocardiogram (ECHO; n = 30), electrocardiogram (ECG; n = 32), QuickOpt algorithm (n = 28), and nominal AV/VV (n = 36) groups. Patients were followed up and underwent examinations, including New York Heart Association (NYHA) cardiac functional classification, 6-min walking distance (6MWD), and echocardiography, at 6, 12, 24, 36, and 48 months, respectively. The patients’ survival and clinical outcomes were compared among the four groups. Results: Kaplan-Meier survival analyses showed that the median survival was the same in the 4 groups: ECHO, 43 months; ECG, 44 months; QuickOpt, 44 months, and nominal, 41 months. At the 6-month follow-up, the reduction in left ventricular end diastolic diameter (LVEDD) was significantly less in the nominal group (–1.91 ± 2.58 mm) than that in the other three groups (ECHO: –3.70 ± 2.78 mm, p = 0.012; ECG: –3.53 ± 3.14 mm, p = 0.020; QuickOpt: –3.46 ± 2.65 mm, p = 0.032); 6MWD was significantly shorter in the nominal group (87.88 ± 34.76 m) than that in the other three groups (ECHO: 120.63 ± 56.93 m, p = 0.006; ECG: 114.97 ± 54.95 m, p = 0.020; QuickOpt: 114.57 ± 35.41 m, p = 0.027). Left ventricular ejection fraction (LVEF) significantly increased in ECHO (7.23 ± 2.76%, p = 0.010), ECG (8.50 ± 3.17%, p < 0.001), and QuickOpt (8.39 ± 2.90%, p < 0.001) compared with the nominal group (5.35 ± 2.59%). There were no significant differences among the groups in the aforementioned parameters at 24, 36, and 48 months, respectively. Conclusion: While LVEDD, LVEF, 6MWD, and NYHA were significantly improved in ECHO, ECG, and QuickOpt at 6 months, there were no significant improvements in any of the groups at 12, 24, and 48 months. These findings suggested that the long-term effect of the four CRT methods for heart failure was not significantly different.

Predicting Long-term Effect of Cardiac Resynchronization Therapy

2007 ◽  
Vol 13 (6) ◽  
pp. S61
Author(s):  
Azusa Furugen ◽  
Naoki Matsuda ◽  
Tsuyoshi Shiga ◽  
Kyomi Tanimoto ◽  
Naoko Ishizuka ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Term Effect ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Long Term Effect

scholarly journals Usefulness of Biomarkers for Predicting Response to Cardiac Resynchronization Therapy

2020 ◽  
Vol 16 (2) ◽  
pp. 132-140
Author(s):  
Mohammad H. Asgardoon ◽  
Ali Vasheghani-Farahani ◽  
Alborz Sherafati
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Natriuretic Peptides ◽  
Inflammatory Markers ◽  
Ventricular Remodeling ◽  
Clinical Symptoms ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy

: Cardiac Resynchronization Therapy (CRT) is an effective treatment strategy for heart failure. It significantly improves clinical symptoms and decreases mortality and long-term morbidity. However, some patients do not respond properly to this treatment. In this review, the role of different biomarkers in predicting response to CRT is discussed. Some biomarkers, including natriuretic peptides and inflammatory markers have promising results but further trials are needed for more evaluation. Methods: All the studies reporting the extent of biomarkers for predicting the response to cardiac resynchronization therapy were included in this study. For studies using the same database, the ones with a higher number of cases and more complete data were included. Conclusions were drawn from relevant randomized controlled clinical trials and meta-analyses about CRT implantation and its associated alterations in biomarker levels. Cardiac Resynchronization in Heart Failure (CARE-HF) study was the first and the largest study on patients with CRT with the longest followup, which showed a significant correlation between BNP levels and long-term CRT outcome. CRP has been demonstrated to be a mediator of inflammation and a marker indicating the presence of an inflammatory process. Conclusion: Natriuretic peptides, including BNP, markers of collagen synthesis like PINP, inflammatory markers, especially CRP, gal-3, and CT-apelin yield promising results in left ventricular remodeling and their relationship with response to CRT implantation is seen. Although more research is needed in this area as little information is available for baseline and preprocedural measurements, so that it would be easy to choose appropriate candidates for CRT implantation.

scholarly journals Prognostic value of galectin-3 and right ventricular function for long-term mortality in heart failure patients treated with cardiac resynchronization therapy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Beata Zaborska ◽  
Ewa Pilichowska-Paszkiet ◽  
Ewa Makowska ◽  
Grażyna Sygitowicz ◽  
Tomasz Słomski ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Right Ventricular ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
All Cause Mortality ◽  
Galectin 3 ◽  
Rv Function

AbstractRecently, associations between the biomarker galectin-3 and numerous pathological processes involved in heart failure (HF) and right ventricular (RV) function have been observed. We aimed to assess the long-term prognostic ability of galectin-3 and RV function parameters for all-cause mortality in HF patients treated with cardiac resynchronization therapy (CRT). We prospectively studied 63 symptomatic HF patients with a left ventricular (LV) ejection fraction (EF) ≤ 35%. The median serum galectin-3 concentration was 13.4 ng/mL (IQR 11.05, 17.15). A detailed assessment of LV and RV geometry and function was performed with echocardiography. CRT defibrillator implantation was achieved in all patients without major complications. The follow-up lasted 5 years. In the multivariable Cox regression model, independent predictors for all-cause mortality were log baseline galectin-3 and baseline RV function expressed as tricuspid annular plane systolic excursion with HR 2.96 (p = 0.037) and HR 0.88 (p = 0.023), respectively. Analysis of subgroups defined by galectin-3 concentration and CRT response showed that patients with high baseline galectin-3 concentrations and a lack of response to CRT had a significantly lower probability of survival. In our patient cohort, the baseline galectin-3 concentration and RV function were independent predictors of long-term all-cause mortality in HFrEF patients following CRT implantation.

COST-EFFECTIVENESS OF CARDIAC RESYNCHRONIZATION THERAPY: PERSPECTIVE FROM ARGENTINA

2012 ◽  
Vol 28 (4) ◽  
pp. 429-435 ◽  
Author(s):  
Rosana Poggio ◽  
Federico Augustovsky ◽  
Joaquín Caporale ◽  
Vilma Irazola ◽  
Santiago Miriuka
Keyword(s):  
Heart Failure ◽  
Cost Effectiveness ◽  
Cardiac Resynchronization Therapy ◽  
Cost Effective ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Resynchronization Therapy ◽  
Long Term Treatment

Objectives: Cardiac resynchronization therapy (CRT) has recently been shown to reduce both mid-term and long-term mortality in patients with mild heart failure. Although proven effective, it is unclear whether CRT is cost-effective in low and middle-income countries (LMIC). Therefore, we set out to analyze the cost-effectiveness of CRT in Argentina in patients with New York Heart Association (NYHA) functional class (FC) I or II heart failure (HF). We chose to compare patients receiving optimal medical treatment (OMT) and CRT with those patients receiving only OMT.Methods: We constructed a Markov model with a cohort simulation, and a life-time horizon to assess costs, life-years, and quality-adjusted life-year (QALY) gained as a result of treatment with both CRT and OMT from an Argentine third party payer perspective. We included patients who met the following criteria: left ventricular ejection fraction (LVEF) ≤ 40 percent, sinus rhythm with a QRS ≥ 120 msec, and NYHA FC I-II HF. The results were expressed as cost per life-year and QALY gained in international dollars (ID$) for the year 2009.Results: For the base case analysis performed, we started at a fixed age of 65. After applying a 3 percent annual discount rate, the incremental cost-effectiveness ratio (ICER) was 38.005 ID$ per year of life gained and 34.185 ID$ per QALY gained.Conclusions: Long-term treatment with CRT appears to be cost-effective in Argentina compared with patients treated solely with OMT. Similar analysis should be performed to determine if this treatment option is cost-effective in other LMIC.

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