Impact of Myocardial Viability and Left Ventricular Lead Location on Clinical Outcome in Cardiac Resynchronization Therapy Recipients with Ischemic Cardiomyopathy

Bose, Abhishek; Kandala, Jagdesh; Upadhyay, Gaurav A.; Riedl, Lindsay; Ahmado, Imad; Padmanabhan, Ram; Gewirtz, Henry; Mulligan, Lawrence J.; Singh, Jagmeet P.

doi:10.1111/jce.12348

Cited by 35 publications

(40 citation statements)

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“…There is considerable heterogeneity within patients, based on the presence of ventricular scar or fibrosis, extent of cardiac dilatation, electrical activation within the heart, along with a myriad of anatomical variations in the location of the atrial and ventricular leads 21 , 22 . Such a variance between patients emphasizes the need for a patient-centric approach to program the AV and VV timings, to help maximize cardiac synchrony and the consequent increase in cardiac contractility 7 .…”

Section: Discussionmentioning

confidence: 99%

Contractility sensor-guided optimization of cardiac resynchronization therapy: results from the RESPOND-CRT trial

Brugada¹,

Delnoy²,

Brachmann³

et al. 2016

Eur Heart J

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AimsAlthough cardiac resynchronization therapy (CRT) is effective in patients with systolic heart failure (HF) and a wide QRS interval, a substantial proportion of patients remain non-responsive. The SonR contractility sensor embedded in the right atrial lead enables individualized automatic optimization of the atrioventricular (AV) and interventricular (VV) timings. The RESPOND-CRT study investigated the safety and efficacy of the contractility sensor system in HF patients undergoing CRT.Methods and resultsRESPOND-CRT was a prospective, randomized, double-blinded, multicentre, non-inferiority trial. Patients were randomized (2:1, respectively) to receive weekly, automatic CRT optimization with SonR vs. an Echo-guided optimization of AV and VV timings. The primary efficacy endpoint was the rate of clinical responders (patients alive, without adjudicated HF-related events, with improvement in New York Heart Association class or quality of life), at 12 months. The study randomized 998 patients. Responder rates were 75.0% in the SonR arm and 70.4% in the Echo arm (mean difference, 4.6%; 95% CI, −1.4% to 10.6%; P < 0.001 for non-inferiority margin −10.0%) (Table 2). At an overall mean follow-up of 548 ± 190 days SonR was associated with a 35% risk reduction in HF hospitalization (hazard ratio, 0.65; 95% CI, 0.46–0.92; log-rank P = 0.01).ConclusionAutomatic AV and VV optimization using the contractility sensor was safe and as effective as Echo-guided AV and VV optimization in increasing response to CRT.ClinicalTrials.gov numberNCT01534234

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Section: Discussionmentioning

confidence: 99%

Contractility sensor-guided optimization of cardiac resynchronization therapy: results from the RESPOND-CRT trial

Brugada¹,

Delnoy²,

Brachmann³

et al. 2016

Eur Heart J

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“…Some studies showed that CRT can produce reserved remodeling, which is defined as a reduction in LV end-systolic volume at 6 months after CRT (Table 2; Russo et al, 2013). Although there are still not enough studies to evaluate the impact of CRT on myocardial fibrosis, Bose et al and Ypenburg et al reported that the extent of scar tissue and viable myocardium were directly related to the response of CRT (Ypenburg et al, 2007; Bose et al, 2014). Furthermore, Leong et al reported that the extent of myocardial fibrosis is independently associated with the lack of response to medical therapies in a new presentation of DCM (Leong et al, 2012).…”

Section: Treatmentsmentioning

confidence: 99%

Current Understanding of the Pathophysiology of Myocardial Fibrosis and Its Quantitative Assessment in Heart Failure

et al. 2017

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Myocardial fibrosis is an important part of cardiac remodeling that leads to heart failure and death. Myocardial fibrosis results from increased myofibroblast activity and excessive extracellular matrix deposition. Various cells and molecules are involved in this process, providing targets for potential drug therapies. Currently, the main detection methods of myocardial fibrosis rely on serum markers, cardiac magnetic resonance imaging, and endomyocardial biopsy. This review summarizes our current knowledge regarding the pathophysiology, quantitative assessment, and novel therapeutic strategies of myocardial fibrosis.

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“…So we did not have the chance to make comparisons between the two groups. Patients who have scar tissue in the region of the LV pacing site generally fails to show favorable response to CRT (Adelstein et al, 2011;Bose et al, 2014;Cochet et al, 2013) However, assessment of scar tissue at the pacing site was not performed in the current study. Most studies so far have used LVESV change at 6 months as an endpoint.…”

Section: Discussionmentioning

confidence: 99%

Coronary sinus lead delay index for optimization of coronary sinus lead placement

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et al. 2017

Noninvasive Electrocardiol

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Impact of Myocardial Viability and Left Ventricular Lead Location on Clinical Outcome in Cardiac Resynchronization Therapy Recipients with Ischemic Cardiomyopathy

Abstract: In CRT recipients with ICM, scar and reversible ischemia in or adjacent to LV pacing site were independent predictors of HF hospitalization and death.

Cited by 35 publications

References 30 publications

Contractility sensor-guided optimization of cardiac resynchronization therapy: results from the RESPOND-CRT trial

Contractility sensor-guided optimization of cardiac resynchronization therapy: results from the RESPOND-CRT trial

Current Understanding of the Pathophysiology of Myocardial Fibrosis and Its Quantitative Assessment in Heart Failure

Coronary sinus lead delay index for optimization of coronary sinus lead placement

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