Outcomes of cardiac resynchronization therapy (CRT) in cardiac sarcoidosis patients with a range of ejection fractions
Abstract Aims In cardiac sarcoidosis (CS) patients, the benefit of cardiac resynchronization therapy (CRT) remains unclear. We sought to assess the short‐term and long‐term effects of CRT in CS patients with a range of left ventricular (LV) ejection fractions (LVEFs). Methods Consecutive CS patients...
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| Format: | Article |
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Wiley
2025-02-01
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| Series: | ESC Heart Failure |
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| Online Access: | https://doi.org/10.1002/ehf2.15113 |
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| author | Alexander Liu Raheel Ahmed Mansimran Singh Dulay Joseph Okafor Alessia Azzu Kamleshun Ramphul Rui Shi Gerald Ballo John Arun Baksi Kshama Wechalekar Rajdeep Khattar Peter Collins Athol Umfrey Wells Vasilis Kouranos Rakesh Sharma |
| author_facet | Alexander Liu Raheel Ahmed Mansimran Singh Dulay Joseph Okafor Alessia Azzu Kamleshun Ramphul Rui Shi Gerald Ballo John Arun Baksi Kshama Wechalekar Rajdeep Khattar Peter Collins Athol Umfrey Wells Vasilis Kouranos Rakesh Sharma |
| author_sort | Alexander Liu |
| collection | DOAJ |
| description | Abstract Aims In cardiac sarcoidosis (CS) patients, the benefit of cardiac resynchronization therapy (CRT) remains unclear. We sought to assess the short‐term and long‐term effects of CRT in CS patients with a range of left ventricular (LV) ejection fractions (LVEFs). Methods Consecutive CS patients with heart failure with reduced ejection fraction (HFrEF; LVEF ≤ 40%), mildly reduced ejection fraction (HFmrEF; LVEF 41%–49%) and preserved ejection fraction (HFpEF; LVEF ≥ 50) treated with CRT under the care of a tertiary UK centre between 2008 and 2023 were reviewed. CRT response was defined by >5% improvement in serial LVEF. The primary endpoint was a composite of all‐cause mortality, cardiac transplantation or unplanned hospitalization for decompensated heart failure. The secondary endpoint included ventricular arrhythmic events. Results Of the 100 patients enrolled (age 58 ± 10 years; 71% male), 63 had HFrEF, 17 had HFmrEF and 20 had HFpEF. After short‐term follow‐up (9.8 ± 5.4 months), HFrEF patients demonstrated significant LVEF response (P < 0.01). On Kaplan–Meier analysis (follow‐up 38 ± 32 months), HFrEF non‐responders had significantly worse event‐free survival compared with HFrEF responders for the primary (P < 0.001) and secondary (P = 0.001) endpoints. Despite short‐term LV function improvement, CRT responders still had worse event‐free survival compared with HFmrEF/HFpEF patients for the primary endpoint (P < 0.001). On multivariable Cox analysis, age [hazard ratio (HR) 1.05, 95% confidence interval (CI) 1.01–1.10, P = 0.008] and HFrEF CRT non‐response (HR 12.33, 95% CI 2.45–61.87, P = 0.002) were associated with the primary endpoint. Conclusions In CS patients with HFrEF, CRT response is associated with a better long‐term prognosis than non‐response. However, HFrEF CRT responders still have worse long‐term prognosis than HFmrEF/HFpEF patients. |
| format | Article |
| id | doaj-art-81f2ec5bdf704e70bb782001b70d861c |
| institution | OA Journals |
| issn | 2055-5822 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj-art-81f2ec5bdf704e70bb782001b70d861c2025-08-20T02:16:22ZengWileyESC Heart Failure2055-58222025-02-0112159260210.1002/ehf2.15113Outcomes of cardiac resynchronization therapy (CRT) in cardiac sarcoidosis patients with a range of ejection fractionsAlexander Liu0Raheel Ahmed1Mansimran Singh Dulay2Joseph Okafor3Alessia Azzu4Kamleshun Ramphul5Rui Shi6Gerald Ballo7John Arun Baksi8Kshama Wechalekar9Rajdeep Khattar10Peter Collins11Athol Umfrey Wells12Vasilis Kouranos13Rakesh Sharma14Royal Brompton and Harefield Hospitals, part of Guy's and St Thomas' NHS Foundation Trust London UKRoyal Brompton and Harefield Hospitals, part of Guy's and St Thomas' NHS Foundation Trust London UKRoyal Brompton and Harefield Hospitals, part of Guy's and St Thomas' NHS Foundation Trust London UKRoyal Brompton and Harefield Hospitals, part of Guy's and St Thomas' NHS Foundation Trust London UKRoyal Brompton and Harefield Hospitals, part of Guy's and St Thomas' NHS Foundation Trust London UKIndependent Researcher Triolet MauritiusRoyal Brompton and Harefield Hospitals, part of Guy's and St Thomas' NHS Foundation Trust London UKRoyal Brompton and Harefield Hospitals, part of Guy's and St Thomas' NHS Foundation Trust London UKRoyal Brompton and Harefield Hospitals, part of Guy's and St Thomas' NHS Foundation Trust London UKRoyal Brompton and Harefield Hospitals, part of Guy's and St Thomas' NHS Foundation Trust London UKRoyal Brompton and Harefield Hospitals, part of Guy's and St Thomas' NHS Foundation Trust London UKRoyal Brompton and Harefield Hospitals, part of Guy's and St Thomas' NHS Foundation Trust London UKRoyal Brompton and Harefield Hospitals, part of Guy's and St Thomas' NHS Foundation Trust London UKRoyal Brompton and Harefield Hospitals, part of Guy's and St Thomas' NHS Foundation Trust London UKRoyal Brompton and Harefield Hospitals, part of Guy's and St Thomas' NHS Foundation Trust London UKAbstract Aims In cardiac sarcoidosis (CS) patients, the benefit of cardiac resynchronization therapy (CRT) remains unclear. We sought to assess the short‐term and long‐term effects of CRT in CS patients with a range of left ventricular (LV) ejection fractions (LVEFs). Methods Consecutive CS patients with heart failure with reduced ejection fraction (HFrEF; LVEF ≤ 40%), mildly reduced ejection fraction (HFmrEF; LVEF 41%–49%) and preserved ejection fraction (HFpEF; LVEF ≥ 50) treated with CRT under the care of a tertiary UK centre between 2008 and 2023 were reviewed. CRT response was defined by >5% improvement in serial LVEF. The primary endpoint was a composite of all‐cause mortality, cardiac transplantation or unplanned hospitalization for decompensated heart failure. The secondary endpoint included ventricular arrhythmic events. Results Of the 100 patients enrolled (age 58 ± 10 years; 71% male), 63 had HFrEF, 17 had HFmrEF and 20 had HFpEF. After short‐term follow‐up (9.8 ± 5.4 months), HFrEF patients demonstrated significant LVEF response (P < 0.01). On Kaplan–Meier analysis (follow‐up 38 ± 32 months), HFrEF non‐responders had significantly worse event‐free survival compared with HFrEF responders for the primary (P < 0.001) and secondary (P = 0.001) endpoints. Despite short‐term LV function improvement, CRT responders still had worse event‐free survival compared with HFmrEF/HFpEF patients for the primary endpoint (P < 0.001). On multivariable Cox analysis, age [hazard ratio (HR) 1.05, 95% confidence interval (CI) 1.01–1.10, P = 0.008] and HFrEF CRT non‐response (HR 12.33, 95% CI 2.45–61.87, P = 0.002) were associated with the primary endpoint. Conclusions In CS patients with HFrEF, CRT response is associated with a better long‐term prognosis than non‐response. However, HFrEF CRT responders still have worse long‐term prognosis than HFmrEF/HFpEF patients.https://doi.org/10.1002/ehf2.15113cardiac resynchronization therapycardiac sarcoidosisoutcomes |
| spellingShingle | Alexander Liu Raheel Ahmed Mansimran Singh Dulay Joseph Okafor Alessia Azzu Kamleshun Ramphul Rui Shi Gerald Ballo John Arun Baksi Kshama Wechalekar Rajdeep Khattar Peter Collins Athol Umfrey Wells Vasilis Kouranos Rakesh Sharma Outcomes of cardiac resynchronization therapy (CRT) in cardiac sarcoidosis patients with a range of ejection fractions ESC Heart Failure cardiac resynchronization therapy cardiac sarcoidosis outcomes |
| title | Outcomes of cardiac resynchronization therapy (CRT) in cardiac sarcoidosis patients with a range of ejection fractions |
| title_full | Outcomes of cardiac resynchronization therapy (CRT) in cardiac sarcoidosis patients with a range of ejection fractions |
| title_fullStr | Outcomes of cardiac resynchronization therapy (CRT) in cardiac sarcoidosis patients with a range of ejection fractions |
| title_full_unstemmed | Outcomes of cardiac resynchronization therapy (CRT) in cardiac sarcoidosis patients with a range of ejection fractions |
| title_short | Outcomes of cardiac resynchronization therapy (CRT) in cardiac sarcoidosis patients with a range of ejection fractions |
| title_sort | outcomes of cardiac resynchronization therapy crt in cardiac sarcoidosis patients with a range of ejection fractions |
| topic | cardiac resynchronization therapy cardiac sarcoidosis outcomes |
| url | https://doi.org/10.1002/ehf2.15113 |
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