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Atrioventricular delay programming and the benefit of cardiac resynchronization therapy in MADIT-CRT.

https://arctichealth.org/en/permalink/ahliterature113570
Source
Heart Rhythm. 2013 Aug;10(8):1136-43
Publication Type
Article
Date
Aug-2013
Author
Andrew Brenyo
Valentina Kutyifa
Arthur J Moss
Andrew Mathias
Alon Barsheshet
Anne-Catherine Pouleur
Dorit Knappe
Scott McNitt
Bronislava Polonsky
David T Huang
Scott D Solomon
Wojciech Zareba
Ilan Goldenberg
Author Affiliation
Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA. Andrew_Brenyo@urmc.rochester.edu
Source
Heart Rhythm. 2013 Aug;10(8):1136-43
Date
Aug-2013
Language
English
Publication Type
Article
Keywords
Aged
Bundle-Branch Block - physiopathology - therapy - ultrasonography
Canada
Cardiac Resynchronization Therapy - adverse effects - methods - mortality
Echocardiography
Europe
Female
Heart Failure - physiopathology - ultrasonography
Humans
Male
Middle Aged
Multivariate Analysis
Survival Analysis
Treatment Outcome
United States
Abstract
The optimal atrioventricular pacing delay (AVD) in cardiac resynchronization therapy (CRT) remains to be determined.
To determine whether programming CRT devices to short AVD (S-AVD) will improve clinical response secondary to greater reductions in dyssynchrony.
The study population comprised 1235 patients with left bundle branch block enrolled in Multicenter Automatic Defibrillator Implantation Trial in Cardiac Resynchronization Therapy (MADIT-CRT). We assessed the relationship between AVD and outcomes. Patients programmed to S-AVD (median value of
Notes
Comment In: Heart Rhythm. 2013 Aug;10(8):1144-523665386
PubMed ID
23712031 View in PubMed
Less detail

Brain natriuretic peptide and cardiac resynchronization therapy in patients with mildly symptomatic heart failure.

https://arctichealth.org/en/permalink/ahliterature112755
Source
Circ Heart Fail. 2013 Sep 1;6(5):998-1004
Publication Type
Article
Date
Sep-1-2013
Author
Andrew Brenyo
Alon Barsheshet
Mohan Rao
David T Huang
Wojciech Zareba
Scott McNitt
W Jackson Hall
Derick R Peterson
Scott D Solomon
Arthur J Moss
Ilan Goldenberg
Author Affiliation
Division of Cardiology, and the Department of Biostatistics, University of Rochester Medical Center, Rochester, NY; and the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA.
Source
Circ Heart Fail. 2013 Sep 1;6(5):998-1004
Date
Sep-1-2013
Language
English
Publication Type
Article
Keywords
Aged
Biological Markers - blood
Canada
Cardiac Resynchronization Therapy - adverse effects - mortality
Cardiac Resynchronization Therapy Devices
Chi-Square Distribution
Defibrillators, Implantable
Electric Countershock - adverse effects - instrumentation - mortality
Europe
Female
Heart Failure - blood - diagnosis - mortality - therapy
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Multicenter Studies as Topic
Multivariate Analysis
Natriuretic Peptide, Brain - blood
Proportional Hazards Models
Randomized Controlled Trials as Topic
Retrospective Studies
Risk factors
Severity of Illness Index
Time Factors
Treatment Outcome
United States
Up-Regulation
Abstract
There are limited data on the prognostic implications of brain natriuretic peptide (BNP) assessment in patients with mildly symptomatic heart failure (HF) who receive cardiac resynchronization therapy with a defibrillator (CRT-D).
The effect of elevated baseline and 1-year BNP levels (dichotomized at the upper tertile BNP of 120 pg/mL) on the risk of HF or death was assessed among the cohort of 1197 patients with baseline BNP data enrolled in MADIT (Multicenter Automated Defibrillator Implantation Trial)-CRT. Elevated baseline BNP was associated with a significant 68% (P=0.007) and 58% (P=0.02) increase in the risk of HF or death among MADIT-CRT patients allocated to CRT-D and implantable cardioverter defibrillator-only therapy, respectively. At 1 year of follow-up, patients allocated to CRT-D displayed significantly greater reductions in BNP (26% reduction) levels compared with implantable cardioverter defibrillator-only patients (8% increase; P=0.005). Patients with CRT-D in whom 1-year BNP levels were reduced or remained low experienced a significantly lower risk of subsequent HF or death as compared with patients in whom 1-year BNP levels were high. Similarly, the echocardiographic response to CRT-D was highest among those who maintained low BNP levels or in whom BNP level at 1-year was reduced.
Our findings suggest that assessment of baseline and follow-up BNP provides important prognostic implications in patients with mildly symptomatic HF who receive CRT.
PubMed ID
23801020 View in PubMed
Less detail

Clinical significance of ventricular tachyarrhythmias in patients treated with CRT-D.

https://arctichealth.org/en/permalink/ahliterature114195
Source
Heart Rhythm. 2013 Jul;10(7):943-50
Publication Type
Article
Date
Jul-2013
Author
Valentina Kutyifa
Helmut U Klein
Paul J Wang
Scott McNitt
Bronislava Polonsky
Endre Zima
Bela Merkely
Arthur J Moss
Wojciech Zareba
Author Affiliation
University of Rochester Medical Center, Rochester, New York 14642, USA. Valentina.Kutyifa@heart. roehester.edu
Source
Heart Rhythm. 2013 Jul;10(7):943-50
Date
Jul-2013
Language
English
Publication Type
Article
Keywords
Aged
Canada - epidemiology
Defibrillators, Implantable
Disease Progression
Electrocardiography
Europe - epidemiology
Female
Follow-Up Studies
Heart Failure - epidemiology - etiology - prevention & control
Heart rate
Humans
Incidence
Male
Middle Aged
Prospective Studies
Survival Rate - trends
Tachycardia, Ventricular - complications - physiopathology - therapy
Treatment Outcome
United States - epidemiology
Abstract
Data on the outcome of cardiac resynchronization therapy with defibrillator (CRT-D) in patients developing ventricular arrhythmias are limited.
To evaluate the prognostic value of ventricular tachycardia (VT) or ventricular fibrillation (VF) episodes by heart rate in patients enrolled in the Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy trial.
Slow VT was defined as VTs with heart rate 250 beats/min) were considered as a combined category. Primary end point was heart failure (HF) or death. Secondary end point included all-cause mortality.
There were 228 (12.7%) patients with slow VT and 198 (11.1%) with fast VT/VF. In time-dependent analysis, slow VT was associated with an increased risk of HF/death in CRT-D patients with left branch bundle block (LBBB; hazard ratio [HR] 3.19; 95% confidence interval [CI] 1.83-5.55; P
Notes
Comment In: Heart Rhythm. 2013 Jul;10(7):951-223624159
PubMed ID
23639624 View in PubMed
Less detail

Dyssynchrony and the risk of ventricular arrhythmias.

https://arctichealth.org/en/permalink/ahliterature114795
Source
JACC Cardiovasc Imaging. 2013 Apr;6(4):432-44
Publication Type
Article
Date
Apr-2013
Author
Valentina Kutyifa
Anne-Catherine Pouleur
Dorit Knappe
Amin Al-Ahmad
Michal Gibinski
Paul J Wang
Scott McNitt
Bela Merkely
Ilan Goldenberg
Scott D Solomon
Arthur J Moss
Wojciech Zareba
Author Affiliation
University of Rochester Medical Center, Rochester, New York, USA. valentina.kutyifa@heart.rochester.edu
Source
JACC Cardiovasc Imaging. 2013 Apr;6(4):432-44
Date
Apr-2013
Language
English
Publication Type
Article
Keywords
Aged
Bundle-Branch Block - etiology - physiopathology
Canada
Cardiac Resynchronization Therapy
Cardiac Resynchronization Therapy Devices
Chi-Square Distribution
Defibrillators, Implantable
Electric Countershock - instrumentation
Europe
Female
Heart Failure - etiology - physiopathology - therapy
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Multivariate Analysis
Proportional Hazards Models
Prospective Studies
Risk assessment
Risk factors
Tachycardia, Ventricular - etiology - mortality - physiopathology - prevention & control
Time Factors
Treatment Outcome
United States
Ventricular Dysfunction, Left - complications - mortality - physiopathology - therapy - ultrasonography
Ventricular Fibrillation - etiology - mortality - physiopathology - prevention & control
Ventricular Function, Left
Abstract
The aim of our study was to evaluate the relationship between left ventricular (LV) dyssynchrony and the risk of ventricular tachycardia (VT) or ventricular fibrillation (VF) in patients enrolled in the MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy) trial.
Intraventricular mechanical dyssynchrony might be an important factor in ventricular arrhythmogenesis by enhancing electrical heterogeneity in heart failure patients. The effects of dyssynchrony have not yet been evaluated in a large cohort of implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy with defibrillator (CRT-D) patients.
LV dyssynchrony was measured at baseline and at 12-months by speckle-tracking echocardiography, defined as the standard deviation of time to peak systolic strain in 12 LV myocardial segments. The endpoint was the first VT/VF/death or VT/VF. LV dyssynchrony was evaluated in 764 left bundle branch block (LBBB) patients and in 312 non-LBBB patients.
Baseline LV dyssynchrony was not predictive of VT/VF/death or VT/VF in LBBB or non-LBBB patients in either treatment arm. In CRT-D patients with LBBB, improvement in LV dyssynchrony over a year was associated with significantly lower incidence of VT/VF/death (p
Notes
Comment In: JACC Cardiovasc Imaging. 2013 Apr;6(4):445-723579011
PubMed ID
23579010 View in PubMed
Less detail

Dyssynchrony, contractile function, and response to cardiac resynchronization therapy.

https://arctichealth.org/en/permalink/ahliterature134292
Source
Circ Heart Fail. 2011 Jul;4(4):433-40
Publication Type
Article
Date
Jul-2011
Author
Dorit Knappe
Anne-Catherine Pouleur
Amil M Shah
Susan Cheng
Hajime Uno
W Jackson Hall
Mikhail Bourgoun
Elyse Foster
Wojciech Zareba
Ilan Goldenberg
Scott McNitt
Marc A Pfeffer
Arthur J Moss
Scott D Solomon
Author Affiliation
Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA 02115, USA.
Source
Circ Heart Fail. 2011 Jul;4(4):433-40
Date
Jul-2011
Language
English
Publication Type
Article
Keywords
Aged
Canada
Cardiac Resynchronization Therapy
Defibrillators, Implantable
Echocardiography
Electrocardiography
Europe
Female
Heart Failure - physiopathology - therapy
Humans
Male
Middle Aged
Myocardial Contraction - physiology
Retrospective Studies
Stroke Volume - physiology
Treatment Outcome
United States
Ventricular Dysfunction, Left - physiopathology
Abstract
Despite benefits of cardiac resynchronization therapy (CRT) in patients with severe but less symptomatic heart failure, approximately 30% of patients do not fully respond to treatment. We hypothesized that a combined assessment of left ventricular (LV) dyssynchrony and contractile function by strain-based imaging would identify patients who would most benefit from CRT.
We studied 1077 patients with New York Heart Association class I/II, LV ejection fraction =30% and QRS width =130 ms enrolled in the Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy trial with sufficient echocardiographic image quality for cardiac deformation analysis (implantable cardioverter-defibrillator [ICD], n=416; CRT, n=661). Patients were assigned to CRT plus an ICD or to ICD alone in 3:2 random assignment. We assessed the degree to which baseline echocardiographic assessments of dyssynchrony, measured as the standard deviation of time-to-peak transverse strain over 12 segments, contractile function, measured as global longitudinal strain, or both predicted the effect of treatment on the primary outcome of death or heart failure. With 213 primary events occurring over a mean of 2.4 years, the benefit of CRT plus an ICD relative to ICD alone was greatest in patients with mild to moderate dyssynchrony (time-to-peak transverse strain standard deviation, 142 to 230 ms) and greater baseline contractile function (global longitudinal strain =-8.7%). Overall, those patients with mild to moderate dyssynchrony and those with best contractile function at baseline demonstrated the greatest benefit from CRT (adjusted hazards ratio, 0.20; 95% confidence interval, 0.09 to 0.44). Dyssynchrony and global longitudinal strain predicted response to CRT independent of each other, QRS width, LV ejection fraction, and presence versus absence of left bundle-branch block, although the observed benefit remained greatest in patients with left bundle-branch block.
Both mechanical dyssynchrony and contractile function are important independent correlates of benefit from CRT.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00180271.
PubMed ID
21602574 View in PubMed
Less detail

Predictors of spontaneous reverse remodeling in mild heart failure patients with left ventricular dysfunction.

https://arctichealth.org/en/permalink/ahliterature256757
Source
Circ Heart Fail. 2014 Jul;7(4):565-72
Publication Type
Article
Date
Jul-2014
Author
Andrew Brenyo
Alon Barsheshet
Valentina Kutyifa
Anne-Christine Ruwald
Mohan Rao
Wojciech Zareba
Anne-Catherine Pouleur
Dorit Knappe
Scott D Solomon
Scott McNitt
David T Huang
Arthur J Moss
Ilan Goldenberg
Author Affiliation
From the Cardiology Division of the Department of Medicine, University of Rochester Medical Center, NY (A. Brenyo, V.K., A.-C.R., M.R., W.Z., D.T.H., A.J.M., I.G., S.M.); Department of Cardiology, Greenville University Health System, SC (A. Brenyo); Department of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.-C.P., D.K., S.D.S.); Cardiology Department, Rabin Medical Center, Petah Tikva, Israel (A. Barsheshet); and Department of Cardiology, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel (A. Barsheshet).
Source
Circ Heart Fail. 2014 Jul;7(4):565-72
Date
Jul-2014
Language
English
Publication Type
Article
Keywords
Aged
Canada - epidemiology
Defibrillators, Implantable
Echocardiography
Europe - epidemiology
Female
Heart Failure - mortality - physiopathology - therapy
Heart Ventricles - physiopathology - ultrasonography
Humans
Male
Middle Aged
Prognosis
Risk factors
Stroke Volume - physiology
Survival Rate - trends
United States - epidemiology
Ventricular Dysfunction, Left - mortality - physiopathology - therapy
Ventricular Remodeling
Abstract
There are limited data regarding factors associated with spontaneous left ventricular reverse remodeling (S-LVRR) among mildly symptomatic heart failure (HF) patients and its prognostic implications on clinical outcomes.
Best subsets logistic regression analysis was used to identify factors associated with S-LVRR (defined as =15% reduction in left ventricular end-systolic volume at 1-year of follow-up) among 612 patients treated with internal cardioverter defibrillator-only therapy in Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT) and to create a score for the prediction of S-LVRR. Cox proportional hazards regression modeling was used to assess the clinical outcome of all internal cardioverter defibrillator-only patients (n=714) with a high S-LVRR score. S-LVRR occurred in 25% of internal cardioverter defibrillator-only patients. Predictors of S-LVRR included systolic blood pressure=140 mm Hg, serum creatinine
PubMed ID
24786217 View in PubMed
Less detail

QRS axis and the benefit of cardiac resynchronization therapy in patients with mildly symptomatic heart failure enrolled in MADIT-CRT.

https://arctichealth.org/en/permalink/ahliterature117916
Source
J Cardiovasc Electrophysiol. 2013 Apr;24(4):442-8
Publication Type
Article
Date
Apr-2013
Author
Andrew Brenyo
Mohan Rao
Alon Barsheshet
David Cannom
Aurelio Quesada
Scott McNitt
David T Huang
Arthur J Moss
Wojciech Zareba
Author Affiliation
Cardiology Division of the Department of Medicine, University of Rochester Medical Center, Rochester, New York 14642, USA. Andrew_Brenyo@urmc.rochester.edu
Source
J Cardiovasc Electrophysiol. 2013 Apr;24(4):442-8
Date
Apr-2013
Language
English
Publication Type
Article
Keywords
Action Potentials
Aged
Bundle-Branch Block - diagnosis - etiology - mortality - physiopathology - therapy
Canada
Cardiac Resynchronization Therapy - adverse effects - mortality
Cardiac Resynchronization Therapy Devices
Chi-Square Distribution
Electrocardiography
Europe
Female
Heart Conduction System - physiopathology
Heart Failure - complications - diagnosis - mortality - physiopathology - therapy
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Multivariate Analysis
Patient Selection
Proportional Hazards Models
Risk assessment
Risk factors
Severity of Illness Index
Stroke Volume
Time Factors
Treatment Outcome
United States
Ventricular Function, Left
Ventricular Remodeling
Abstract
Mildly symptomatic heart failure (HF) patients derive substantial clinical benefit from cardiac resynchronization therapy with defibrillator (CRT-D) as shown in MADIT-CRT. The presence of QRS axis deviation may influence response to CRT-D. The objective of this study was to determine whether QRS axis deviation will be associated with differential benefit from CRT-D.
Baseline electrocardiograms of 1,820 patients from MADIT-CRT were evaluated for left axis deviation (LAD: quantitative QRS axis -30 to -90) or right axis deviation (RAD: QRS axis 90-180) in left bundle branch block (LBBB), right bundle branch block (RBBB), and nonspecific interventricular conduction delay QRS morphologies. The primary endpoints were the first occurrence of a HF event or death and the separate occurrence of all-cause mortality as in MADIT-CRT.
Among LBBB patients, those with LAD had a higher risk of primary events at 2 years than non-LAD patients (20% vs 16%; P = 0.024). The same was observed among RBBB patients (20% vs 10%; P = 0.05) but not in IVCD patients (22% vs 23%; P = NS). RAD did not convey any increased risk of the primary combined endpoint in any QRS morphology subgroup. When analyzing the benefit of CRT-D in the non-LBBB subgroups, there was no significant difference in hazard ratios for CRT-D versus ICD for either LAD or RAD. However, LBBB patients without LAD showed a trend toward greater benefit from CRT therapy than LBBB patients with LAD (HR for no LAD: 0.37, 95% CI: 0.26-0.53 and with LAD: 0.54, 95% CI: 0.36-0.79; P value for interaction = 0.18).
LAD in non-LBBB patients (RBBB or IVCD) is not associated with an increased benefit from CRT. In LBBB patients, those without LAD seem to benefit more from CRT-D than those with LAD.
PubMed ID
23252875 View in PubMed
Less detail

7 records – page 1 of 1.