Cardiac Resynchronization in Chronic Heart Failure

Abraham, William T.; Fisher, Westby G.; Smith, Andrew L.; Delurgio, David B.; León, Angel R.; Loh, Evan; Kocovic, Dusan Z.; Packer, Milton; Clavell, Alfredo L.; Hayes, David L.; Ellestad, Myrvin H.; Trupp, Robin J.; Underwood, Jackie; Pickering, Faith; Truex, C. R.; McAtee, Peggy; Messenger, John C.

doi:10.1056/nejmoa013168

Cited by 4,348 publications

(2,566 citation statements)

References 35 publications

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“…The lack of statistically significant improvement in VO 2 max was similar to the results of some previously reported CRT studies19, 20 although CRT has also been shown to improve VO 2 max 2. In addition, there was a significant reduction in the plasma concentrations of N‐terminal proBNP, a similar finding to the CARE‐HF trial 2. In this regard, a post hoc analysis of the MADIT‐CRT trial21 found that reduction in BNP following CRT was associated with significant decrease in hospitalized heart failure and mortality.…”

Section: Discussionsupporting

confidence: 89%

“…Therefore, we have a cohort in whom there was effective mechanical cardiac resynchronization; otherwise, it would have been futile for us to proceed with the pursuit of understanding of any further mechanistic effect of CRT. The lack of statistically significant improvement in VO 2 max was similar to the results of some previously reported CRT studies19, 20 although CRT has also been shown to improve VO 2 max 2. In addition, there was a significant reduction in the plasma concentrations of N‐terminal proBNP, a similar finding to the CARE‐HF trial 2.…”

Section: Discussionsupporting

confidence: 86%

“…Over the last two decades, as a result of several landmark trials demonstrating mortality and morbidity benefits with cardiac resynchronization therapy (CRT) with or without defibrillation insertion,1, 2, 3 CRT has become a standard of care in select patients with systolic heart failure and concomitant left ventricular dyssynchrony. Substantial limitations of CRT include not only the 30–40% of recipients classified as ‘non‐responders’2 but also significant heterogeneity in the commonly used criteria of response and poor agreement between these different clinical and echocardiographic parameters of response 4.…”

Section: Introductionmentioning

confidence: 99%

“…Substantial limitations of CRT include not only the 30–40% of recipients classified as ‘non‐responders’2 but also significant heterogeneity in the commonly used criteria of response and poor agreement between these different clinical and echocardiographic parameters of response 4. There has been considerable interest in understanding the mechanisms underlying benefits associated with CRT and specifically whether these arise purely from mechanical correction of dyssynchrony.…”

Section: Introductionmentioning

confidence: 99%

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Does cardiac resynchronization therapy restore peripheral circulatory homeostasis?

et al. 2017

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AimsTo evaluate whether peripheral circulatory ‘remodelling’ as measured by changes in vascular compliance and in markers of nitric oxide signalling contributes to patient response to cardiac resynchronization therapy (CRT).Methods and resultsEffects of CRT were evaluated in 33 patients pre‐procedure and 6 months post‐procedure. Peak oxygen consumption, 6 min walk distance, New York Heart Association class, and quality of life score were evaluated. Augmentation index and its interactions with nitric oxide (NO) were evaluated by applanation tonometry. Platelet NO responsiveness and content of thioredoxin‐interacting protein were assessed. Plasma concentrations of N‐terminal proBNP, asymmetric and symmetric dimethylarginine (SDMA), high sensitivity C‐reactive protein, catecholamines, and matrix metalloproteinases‐2 and ‐9 were assessed. Despite significant improvement in 6 min walk distance (P = 0.005), New York Heart Association class (P < 0.001), quality of life (P = 0.001), and all echocardiographic parameters post‐CRT, there were no significant changes in augmentation index measurements, thioredoxin‐interacting protein content, and platelet NO response. Significant falls in N‐terminal proBNP (P = 0.008) and SDMA (P = 0.013; independent of renal function) occurred. Falls in SDMA predicted reduction in high‐sensitivity C‐reactive protein (P = 0.04) and increases in peak oxygen consumption (P = 0.04). There were no correlations between changes in echocardiographic parameters and those in vascular function.ConclusionsThese data suggest that the beneficial effects of CRT over 6 months are independent of any change in peripheral NO‐related signalling. However, there is evidence that suppression of inflammation occurs, and its magnitude predicts extent of clinical improvement.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Does cardiac resynchronization therapy restore peripheral circulatory homeostasis?

et al. 2017

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“…Cardiac resynchronization therapy (CRT) is recommended by current guidelines for the treatment of patients with symptomatic heart failure (HF), impaired left ventricular (LV) systolic function, and an electrocardiogram (ECG) which displays evidence of electrical dyssynchrony,1, 2 with established effects on morbidity and mortality 3, 4. However, in spite of the overall beneficial effects of CRT, no early clinical improvement is observed in approximately 30% of CRT recipients 3, 5…”

Section: Introductionmentioning

confidence: 99%

Rationale and design of the AdaptResponse trial: a prospective randomized study of cardiac resynchronization therapy with preferential adaptive left ventricular‐only pacing

Filippatos

Birnie

Gold

et al. 2017

European J of Heart Fail

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The AdaptResponse trial is designed to test the hypothesis that preferential adaptive left ventricular‐only pacing with the AdaptivCRT® algorithm reduces the incidence of the combined endpoint of all‐cause mortality and intervention for heart failure (HF) decompensation, compared with conventional cardiac resynchronization therapy (CRT), among patients with a CRT indication, left bundle branch block (LBBB) and normal atrioventricular (AV) conduction. The AdaptResponse study is a prospective, randomized, controlled, single‐blinded, multicentre, clinical trial (ClinicalTrials.gov Identifier: NCT02205359), conducted at up to 200 centres worldwide. Following enrolment and baseline assessment, eligible subjects will be implanted with a CRT system containing the AdaptivCRT algorithm, and randomized in a 1:1 fashion to either a treatment (‘AdaptivCRT’) or control (‘Conventional CRT’) group. The study is designed to observe a primary endpoint in 1100 patients (‘event‐driven’) and approximately 3000 patients will be randomized. The primary endpoint is the composite of all‐cause mortality and intervention for HF decompensation; secondary endpoints include all‐cause mortality, intervention for HF decompensation, clinical composite score (CCS) at 6 months, atrial fibrillation, quality of life measured by the Kansas City Cardiomyopathy Questionnaire (KCCQ), health outcome measured by the EQ‐5D instrument, all‐cause readmission after a HF admission, and cost‐effectiveness. The AdaptResponse clinical trial is powered to assess clinical endpoints and is expected to provide definitive evidence on the incremental utility of AdaptivCRT‐enhanced CRT systems.

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Integrating Palliative Care Into Heart Failure Care

Hauptman¹,

Havranek²

2005

Arch Intern Med

132

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Heart failure is a condition for which both palliative care and hospice care can be appropriate. The disease's increasing prevalence and predilection for elderly patients with significant comorbidity underscore the need to integrate these modes of care with the acute care approach that has dominated heart failure treatment. We propose integration of a palliative care approach early in the course of heart failure treatment and a tiered process for selecting patients for hospice care. A transition of the focus to palliative care rather than mortality reduction should occur over time, when clinical status deteriorates and advanced therapeutic options become inappropriate or ineffective. Failure to respond to the need for palliative care puts at risk the mandate to treat the patient with heart failure during the entire course of illness.

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Cardiac Resynchronization in Chronic Heart Failure

Abstract: Cardiac resynchronization results in significant clinical improvement in patients who have moderate-to-severe heart failure and an intraventricular conduction delay.

Cited by 4,348 publications

References 35 publications

Does cardiac resynchronization therapy restore peripheral circulatory homeostasis?

Does cardiac resynchronization therapy restore peripheral circulatory homeostasis?

Rationale and design of the AdaptResponse trial: a prospective randomized study of cardiac resynchronization therapy with preferential adaptive left ventricular‐only pacing

Integrating Palliative Care Into Heart Failure Care

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