Cardiac resynchronisation therapy in patients with congestive heart failure: whether we should expect for an "early" response?

Кузнецов, В. А.; Солдатова, А. М.; Krinochkin, Dmitriy; Enina, T. N.

doi:10.18087/rhfj.2017.3.2341

Cited by 10 publications

(8 citation statements)

References 21 publications

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“…5). При использовании параметров, которые получены при имплантации ИЭУ, качество прогноза в первый год улучшилось, точность клас- [11], которые показали, что наибольшее число респондеров и все супер-респондеры появляются в отдаленном послеоперационном периоде. Более того, пациенты, демонстрирующие быстрый ответ на СРТ в раннем постоперационном периоде до 3 мес., имели меньшую выживаемость в сроке до 5 лет после начала СРТ [11].…”

Section: информационные модели прогноза эффективности сртunclassified

Evaluation of the long-term effectiveness of cardiac resynchronization therapy

et al. 2021

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Aim. To determine quantitative criteria for assessing the therapeutic benefits and the most informative time frames after cardiac resynchronization therapy (CRT) to assess its long-term effectiveness (1, 2, 3 years of follow-up) based on retrospective analysis. To assess the CRT effectiveness, parameters of left ventricular (LV) reverse remodeling and signs characterizing the clinical CRT response were considered.Material and methods. This single-center, retrospective, non-randomized study included data from 278 patients with implanted CRT devices. Quantitative criteria for assessing CRT effectiveness were determined using a two-step cluster analysis of patients 1, 2, and 3 years after CRT by LV reverse remodeling parameters.Results. In the dataset with satisfactory division accuracy, after the first year, two clusters were identified, which are conventionally named as “non-responders” and “responders”. Two and three years after therapy, patients were classified into three clusters: “non-responders”, “responders” and “super-responders”. For the obtained clusters, we found cutoff values for LV reverse remodeling parameters, which can be used as criteria for response to therapy.The study identified the most informative time frames for assessing the postoperative CRT effectiveness 1, 2, 3 years after the surgery. At the same time, the clinical response to therapy is manifested earlier in comparison with the reverse LV remodeling.Despite the high divisibility of patients into responders and non-responders, predictive models of CRT effectiveness created using the available data from standard diagnostic protocols for heart failure patients have insufficient accuracy to be used for making decisions on therapy appropriateness. This circumstance indicates the need to receive additional data to improve the forecasting quality.Conclusion. The study revealed a period for assessing the clinical response and changes in LV reverse remodeling after CRT surgery, which is important for the optimal choice of postoperative therapy. It has been shown that in most cases, one year after surgery is sufficient to assess the clinical response, and the process of LV reverse remodeling can last up to two years on average.When assessing the CRT effectiveness by reverse remodeling, along with a change in LV end-systolic volume (ESV), it is necessary to take into account LV end-diastolic volume (EDV) changes. The change in LV ejection fraction showed a significantly lower value among the analyzed parameters in assessing the CRT effectiveness. Based on the cluster classification of patients, a dividing rule was established for responders and non-responders in the first and second years after surgery with an accuracy of 97%: a decrease in LV ESV and EDV by 9% or more compared to preoperative values.

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Section: информационные модели прогноза эффективности сртunclassified

Evaluation of the long-term effectiveness of cardiac resynchronization therapy

et al. 2021

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“…Ранее нами было показано, что у ряда пациентов в течение первого года наблюдения отсутствует положительная динамика КСОЛЖ. Однако, в более поздние сроки эти пациенты чаще становятся суперрес пондерами (снижение КСОЛЖ>30%) [12]. Результаты этого исследования вновь подтвердили значимо больший срок лучшего ответа на СРТ в группе респондеров в сравнении с нереспондерами.…”

Section: обсуждение полученных результатовunclassified

Multimarker approach for assessing efficiency of cardiac resynchronization therapy in patients with sinus rhythm

Кузнецов

Enina

Солдатова

et al. 2020

Vestnik aritmologii

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Purpose: to design mathematical model, that can predict positive response to cardiac resynchronization therapy (CRT) in patients with congestive heart failure (CHF) and sinus rhythm, according to complex analysis of neurohumoral and immune activation biomarkers, fibrosis, renal dysfunction, echocardiography.Material and methods: parameters of echocardiography, plasma levels of NT-proBNP, interleukins-1β, 6, 10, tumor necrosis factor α, С-reactive protein (СRP), matrix metalloproteinase-9 (ММР-9), tissue inhibitors of metalloproteinase 1 and 4, cystatin С (CYSTATIN) were studied in 40 CHF patients with sinus rhythm (65% coronary artery disease patients, 75% males, mean age 54.8±10.6 years old) during the period of maximum decrease of left ventricular end-systolic volume (LVESV) (mean duration 27.5 [11.1; 46.3] months). Responders (decrease in LVESV ≥15%) and non-responders (decrease in LVESV ˂15%) were identified.Results: the number of responders was 26 (65%). Initial set of variables included: age, left ventricular ejection fraction (EF), systolic pressure in the pulmonary artery, right ventricle size and NT-proBNP, СRP, ММР-9, CYSTATIN. According to logistic regression analysis, a model was created: F=3.231 + 0.344 х EF - 3.479 x CYSTATIN - 0.039 х ММР-9 - 0.638 х CRР. Prediction of response to CRT (P) was carried out using the equation: Р=1/(1+е(-F)); a less than 0.696 p-value was associated with membership of non-responders group; p-value greater than or equaled to 0.696 was associated with group of responders. The specificity of the model was 92.9%, sensitivity - 83.3%, AUC=0.952 (р˂0.001).Conclusions: the proposed model, based on assessment of left ventricular EF and laboratory data, that reflect key mechanisms of development and progression of CHF - immune inflammation, fibrosis, renal dysfunction, suggests a possible response to CRT.

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“…Kardiologiia. 2019;59(4S): [21][22][23][24][25][26][27][28][29][30][31][32] Summary Purpose. To assess and to compare the ventricular myocardium activation pattern obtained by non-invasive epi-and endocardial mapping (NIEEM), as well as electrocardiographic (ECG) variants of left bundle branch block (LBBB) and to estimate the value of these data for the success of cardiac resynchronization therapy (CRT).…”

Section: оригинальные статьи § введениеmentioning

confidence: 99%

“…Кроме того, размер и дизайн исследования не позволяют определить прогностическое значение параметров электрической диссинхронии миокарда при оценке таких конечных точек, как смертность и частота госпитализаций. В данной работе период наблюдения составил 6 месяцев, в то время как есть данные, что у части пациентов обратное ремоделирование происходит в более поздние сроки [25].…”

Section: ограничения исследованияunclassified

Assessment of myocardial electrical dissynchrony by noninvasive activation mapping and its role in achieving the success of cardiac resynchronization

et al. 2019

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Purpose. To assess and to compare the ventricular myocardium activation patern obtained by non-invasive epi- and endocardial mapping (NIEEM), as well as electrocardiographic (ECG) variants of lef bundle branch block (LBBB) and to estimate the value of these data for the success of cardiac resynchronization therapy (CRT).Materials and methods. Te study included 23 patients (mean age 59,6±9,9 years) with LBBB, QRS duration ≥ 130 ms, lef ventricular ejection fraction (LVEF) ≤ 35%, heart failure (HF) NYHA II-IV despite optimal pharmacological therapy during 3 month. All patients had undergone CRT-D implantation. Depending on presence or absence of LBBB ECG-criteria, proposed by Strauss D.G. et. al, patients were divided into 2 groups: 1group - strict LBBB, proposed by Strauss D.G. et. al. (n=14) and 2 group – other ECG morphologies of LBBB (n=9). NIEEM by the Amycard 01C system with an analysis of epi- and endocardial ventricular electrical activation was performed in all patients and 5 healthy volunteers (mean age 29±1,0years). Response to CRT was estimated by echo and was defned as decrease in lef ventricular (LV) end-systolic volume by > 15% afer 6 months of follow-up.Results. LBBB ECG-criteria, proposed by Strauss D.G. et. al, was detected in 14 patients (61% of all included). According to the results of NIEEM, these patients had more pronounced ventricular electrical uncoupling (VEU) (р=0,002). Most ofen the line of block was detected in the anteroseptal or posterolateral region of the LV. Te zone of late LV activation, which is the most optimal position for the LV pacing electrode, was located in the basal and middle segments of the lateral and posterior walls. Afer 6 months of CRT 15 patients (65%) were included in the "response" group, the remaining 8 patients (35%) formed the "non-response" group according to echo criteria. In the "response" group the morphology of the QRS complex more frequently met the criteria, proposed by Strauss D.G. et al, than other ECG variants of LBBB (12 vs. 3 respectively, p = 0.023). Initially, VEU was more pronounced in the "response" group (VEU 55 [51, 64] ms in the "response" group vs 22 [8, 38] ms in the "non-response" group).Сonclusions. LBBB ECG criteria, proposed by Strauss D.G., identify patients with delayed transseptal interventricular conduction due to complete LBBB, what is a good target for CPT. Identifcation of individual ventricular activation properties may help to reveal responders to CRT in patients with LBBB.

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Cardiac resynchronisation therapy in patients with congestive heart failure: whether we should expect for an "early" response?

Cited by 10 publications

References 21 publications

Evaluation of the long-term effectiveness of cardiac resynchronization therapy

Evaluation of the long-term effectiveness of cardiac resynchronization therapy

Multimarker approach for assessing efficiency of cardiac resynchronization therapy in patients with sinus rhythm

Assessment of myocardial electrical dissynchrony by noninvasive activation mapping and its role in achieving the success of cardiac resynchronization

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