Heart Failure Etiology in Patients Undergoing Cardiac Resynchronization Therapy: Is It Relevant?
Background: Cardiac resynchronization therapy (CRT) is an established treatment for heart failure with reduced ejection fraction (HfrEF). Etiology may influence the outcome of patients undergoing CRT. Objective: to evaluate whether etiology (ischemic vs non-ischemic) influences the response to CRT a...
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Bucharest College of Physicians
2021-06-01
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| Series: | Modern Medicine |
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| Online Access: | https://medicinamoderna.ro/wp-content/uploads/2021/06/Heart-Failure-Etiology-in-Patients-Undergoing-Cardiac-Resynchronization-Therapy.pdf |
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| author | Silvia DEACONU Alexandru DEACONU Alina SCARLATESCU Ioana PETRE Sebastian ONCIUL Aura VIJIAC Amalia PETRE Gabriela MARASCU Corneliu IORGULESCU Andrei Dan RADU Stefan BOGDAN Radu VATASESCU Maria DOROBANTU |
| author_facet | Silvia DEACONU Alexandru DEACONU Alina SCARLATESCU Ioana PETRE Sebastian ONCIUL Aura VIJIAC Amalia PETRE Gabriela MARASCU Corneliu IORGULESCU Andrei Dan RADU Stefan BOGDAN Radu VATASESCU Maria DOROBANTU |
| author_sort | Silvia DEACONU |
| collection | DOAJ |
| description | Background: Cardiac resynchronization therapy (CRT) is an established treatment for heart failure with reduced ejection fraction (HfrEF). Etiology may influence the outcome of patients undergoing CRT. Objective: to evaluate whether etiology (ischemic vs non-ischemic) influences the response to CRT and overall outcome. Methods: Our study included HFrEF patients undergoing CRT between January 2017-November 2019. We assessed right ventricle (RV) and left ventricle (LV) function using transthoracic echocardiography at baseline and one year after CRT. The response to CRT was defined by a decrease of more than 15% of left ventricle systolic volume. Patients were divided in two groups: ischemic and non-ischemic based on personal history. Adverse events (HF related hospitalizations and deaths) were tracked for 33± 12.8 months. Results: 52 patients undergoing CRT were included (64±13.5 years, 55.7% male, 70% non-ischemic etiology) The two groups were similar considering LV systolic baseline parameters and volumes. Ischemic etiology was associated with non-LBBB morphology on ECG (p=0.03), a more severe LV diastolic dysfunction using E/e ratio (p<0.05), and a more severe RV dysfunction using TAPSE (p=0.008) and RV fractional area change (FAC) (p<0.05). There was no significant difference in CRT response between ischemic and non-ischemic etiology. 14 (26.9%) patients had events (10 hospitalizations and 4 deaths) with a higher prevalence in the ischemic group (58.33% vs 25%, p=0.01). Univariate Cox regression analysis reported a higher risk of cardiovascular events for ischemic etiology (HR 2.4, 95% CI [0.8-8.1], p <0.05). In our cohort there was no significant difference in use of an implantable cardioverter-defibrillator in addition to CRT between ischemic and non-ischemic group (64.2% respectively 63.3%, p =0.3). Conclusion: Our study shows that ischemic and nonischemic HF patients had similar response to CRT. However, ischemic etiology was associated with a higher risk ofadverse cardiovascular events and a worse RV systolic dysfunction at baseline. |
| format | Article |
| id | doaj-art-3966dfe8ea4b452aa074ba5cf7360e02 |
| institution | DOAJ |
| issn | 1223-0472 2360-2473 |
| language | English |
| publishDate | 2021-06-01 |
| publisher | Bucharest College of Physicians |
| record_format | Article |
| series | Modern Medicine |
| spelling | doaj-art-3966dfe8ea4b452aa074ba5cf7360e022025-08-20T03:09:59ZengBucharest College of PhysiciansModern Medicine1223-04722360-24732021-06-01282153159https://doi.org/10.31689/rmm.2021.28.2.153Heart Failure Etiology in Patients Undergoing Cardiac Resynchronization Therapy: Is It Relevant?Silvia DEACONU0https://orcid.org/0000-0002-0935-138XAlexandru DEACONU1https://orcid.org/0000-0002-5455-9753Alina SCARLATESCU2Ioana PETRE3Sebastian ONCIUL4https://orcid.org/0000-0002-1729-0126Aura VIJIAC5Amalia PETRE6Gabriela MARASCU7https://orcid.org/0000-0002-6778-7747Corneliu IORGULESCUAndrei Dan RADU8Stefan BOGDAN9https://orcid.org/0000-0001-9593-951XRadu VATASESCU10https://orcid.org/0000-0001-7163-8528Maria DOROBANTU11https://orcid.org/0000-0003-1940-5262„Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania„Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania„Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania„Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania„Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania„Carol Davila” University of Medicine and Pharmacy, Bucharest, RomaniaDepartment of Cardiology, Emergency Clinical Hospital, Bucharest, Romania„Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania„Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania„Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania„Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania„Carol Davila” University of Medicine and Pharmacy, Bucharest, RomaniaBackground: Cardiac resynchronization therapy (CRT) is an established treatment for heart failure with reduced ejection fraction (HfrEF). Etiology may influence the outcome of patients undergoing CRT. Objective: to evaluate whether etiology (ischemic vs non-ischemic) influences the response to CRT and overall outcome. Methods: Our study included HFrEF patients undergoing CRT between January 2017-November 2019. We assessed right ventricle (RV) and left ventricle (LV) function using transthoracic echocardiography at baseline and one year after CRT. The response to CRT was defined by a decrease of more than 15% of left ventricle systolic volume. Patients were divided in two groups: ischemic and non-ischemic based on personal history. Adverse events (HF related hospitalizations and deaths) were tracked for 33± 12.8 months. Results: 52 patients undergoing CRT were included (64±13.5 years, 55.7% male, 70% non-ischemic etiology) The two groups were similar considering LV systolic baseline parameters and volumes. Ischemic etiology was associated with non-LBBB morphology on ECG (p=0.03), a more severe LV diastolic dysfunction using E/e ratio (p<0.05), and a more severe RV dysfunction using TAPSE (p=0.008) and RV fractional area change (FAC) (p<0.05). There was no significant difference in CRT response between ischemic and non-ischemic etiology. 14 (26.9%) patients had events (10 hospitalizations and 4 deaths) with a higher prevalence in the ischemic group (58.33% vs 25%, p=0.01). Univariate Cox regression analysis reported a higher risk of cardiovascular events for ischemic etiology (HR 2.4, 95% CI [0.8-8.1], p <0.05). In our cohort there was no significant difference in use of an implantable cardioverter-defibrillator in addition to CRT between ischemic and non-ischemic group (64.2% respectively 63.3%, p =0.3). Conclusion: Our study shows that ischemic and nonischemic HF patients had similar response to CRT. However, ischemic etiology was associated with a higher risk ofadverse cardiovascular events and a worse RV systolic dysfunction at baseline.https://medicinamoderna.ro/wp-content/uploads/2021/06/Heart-Failure-Etiology-in-Patients-Undergoing-Cardiac-Resynchronization-Therapy.pdfcardiac resynchronization therapyheart failure etiologyright ventricle dysfunctiontapseheart failure with reduced ejection fraction |
| spellingShingle | Silvia DEACONU Alexandru DEACONU Alina SCARLATESCU Ioana PETRE Sebastian ONCIUL Aura VIJIAC Amalia PETRE Gabriela MARASCU Corneliu IORGULESCU Andrei Dan RADU Stefan BOGDAN Radu VATASESCU Maria DOROBANTU Heart Failure Etiology in Patients Undergoing Cardiac Resynchronization Therapy: Is It Relevant? Modern Medicine cardiac resynchronization therapy heart failure etiology right ventricle dysfunction tapse heart failure with reduced ejection fraction |
| title | Heart Failure Etiology in Patients Undergoing Cardiac Resynchronization Therapy: Is It Relevant? |
| title_full | Heart Failure Etiology in Patients Undergoing Cardiac Resynchronization Therapy: Is It Relevant? |
| title_fullStr | Heart Failure Etiology in Patients Undergoing Cardiac Resynchronization Therapy: Is It Relevant? |
| title_full_unstemmed | Heart Failure Etiology in Patients Undergoing Cardiac Resynchronization Therapy: Is It Relevant? |
| title_short | Heart Failure Etiology in Patients Undergoing Cardiac Resynchronization Therapy: Is It Relevant? |
| title_sort | heart failure etiology in patients undergoing cardiac resynchronization therapy is it relevant |
| topic | cardiac resynchronization therapy heart failure etiology right ventricle dysfunction tapse heart failure with reduced ejection fraction |
| url | https://medicinamoderna.ro/wp-content/uploads/2021/06/Heart-Failure-Etiology-in-Patients-Undergoing-Cardiac-Resynchronization-Therapy.pdf |
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