Prognostic significance of beta-blocker up-titration in conjunction with cardiac resynchronization therapy in heart failure management

Nabeta, Takeru; Inomata, Takayuki; Iida, Yuichiro; Ikeda, Yuki; Iwamoto-Ishida, Miwa; Ishii, Shunsuke; Naruke, Tsuguo; Mizutani, Tomohiro; Shinagawa, Hisahito; Koitabashi, Toshimi; Takeuchi, Ichiro; Ako, Junya

doi:10.1007/s00380-015-0711-z

Cited by 11 publications

(8 citation statements)

References 39 publications

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“…Longer period of hospitalization, lower SBP at admission, higher BNP, lower CCr and % β-blockers were also associated with 2-year mortality, as shown in Table 3 , and these associations were consistent with previous reports [ 7 , 8 , 15 , 21 , 22 ]. Thus, the results indicated that the patients in this study did not represent any specific patient group.…”

Section: Discussionsupporting

confidence: 91%

The Change in Body Weight During Hospitalization Predicts Mortality in Patients With Acute Decompensated Heart Failure

et al. 2017

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BackgroundIn our experience, the change in body weight (BW) during hospitalization varies greatly in patients with acute decompensated heart failure (HF). Since the clinical significance of a change in BW is not clear, we investigated whether a change in BW could predict mortality.MethodsWe retrospectively enrolled 130 patients (72 males; aged 68 ± 10 years) who were hospitalized due to acute decompensated HF and followed for 2 years after discharge. The change in the BW index during hospitalization (ΔBWI) was calculated as (BW at hospital admission minus BW at hospital discharge)/body surface area at hospital discharge.ResultsThe patients were divided into quartiles according to ΔBWI, and the 2-year mortality rates in the quartiles with the lowest, second, third and highest ΔBWI were 18.8%, 12.1%, 3.1% and 9.1%, respectively. In a multivariate Cox proportional hazards analysis after adjusting for variables with a P value less than 0.05, ΔBWI was independently associated with 2-year mortality (P = 0.0002), and the quartile with the lowest ΔBWI had a higher relative risk (RR) for 2-year mortality than the quartile with the highest ΔBWI (RR: 7.46, 95% confidence interval: 1.03 - 53.99, P = 0.04).ConclusionIn conclusion, ΔBWI was significantly associated with 2-year mortality after discharge, which indicates that ΔBWI might be a simple predictor of prognosis in acute decompensated HF.

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Section: Discussionsupporting

confidence: 91%

The Change in Body Weight During Hospitalization Predicts Mortality in Patients With Acute Decompensated Heart Failure

et al. 2017

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“…Therefore, the discrepancy of therapeutic effect between high and low pacing proportion group could be attributed to high His-Purkinje system pacing proportion itself. Previous studies demonstrated that increasing the dose of β-blockers was an independent factor to improve the prognosis of HF patients treated with CRT 17 . In the present study, β-blockers dosage (59.9±52.1mg daily) in high pacing proportion group was significantly lower than that (120.6±68.5mg daily) in low pacing proportion group (P = 0.018), indicating that the clinical benefits of patients in high pacing proportion group were further ascribed to the higher pacing proportion.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic Effect of His-Purkinje System Pacing Proportion on Persistent Atrial Fibrillation Patients With Heart Failure

Tong

Sun

2021

Preprint

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Background His-Purkinje system pacing(HPSP) combined with atrioventricular node (AVN) ablation is an effective therapy for atrial fibrillation (AF) patients with heart failure (HF).However, AVN ablation is accompanied with some limitations and disadvantages. HPSP combined with β -blocker reduces inherent heart rate and increases pacing ratio, which may be an alternative to HPSP combined with AVN ablation. This study was to assess the therapeutic effect of different His-Purkinje system pacing proportions on AF patients with HF. Methods The study enrolled 30 consecutive persistent AF patients with HF who underwent HPSP. Heart rate was controlled by medical therapy. New York Heart Association (NYHA) classification, serum NT-proBNP concentration, echocardiographic parameters were assessed at each follow-up. Results The best cut-off value of pacing proportion to predict MACE by ROC analysis was 71%. In high pacing proportion group, there were significant improvements of NYHA classification, NT-proBNP concentration, LVEF and LVEDD from the baseline in wide QRS complex patients and HFrEF patients, and there were significant improvements in NYHA classification, NT-proBNP concentration from baseline in narrow QRS complex patients and HFpEF patients, moderate but no significant improvements of LVEF and LVEDD were observed in those patients groups. In low pacing proportion group, there were no significant improvements of NT-proBNP concentration, LVEDD or LVEF regardless of baseline QRS duration or LVEF (P > 0.05). Conclusion High pacing proportion of HPSP has a beneficial effect on the prognosis of persistent AF patients with heart failure.

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“…Moreover, a combination of early coadministration of BB–ivabradine for patients with acute HF with reduced ejection fraction showed 1-year improvement in LV systolic function 24. Nevertheless, recent data have highlighted that uptitration of HF medication is still a major drawback in real-world practice, and several studies have shown a general effort toward optimization of therapy after CRT with important benefits in reducing HF hospitalization and increasing survival, with a special focus on BB uptitration as an independent predictor of improved HF prognosis 25–28. Although such medications as ACE inhibitors/ARBs, loop diuretics, and antialdosteronics are of utmost importance in HF patients and changes pertaining to these drugs were also performed in our cohort during follow-up according to functional status and clinical/paraclinical variables, this study aimed to assess the importance of BB/ivabradine therapy and CRT-device reprogramming after systematic ET in maintaining constant CRT fusion pacing, which has proven to be a real need in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

<p>Exercise test is essential in LV-only fusion CRT pacing without right ventricle lead</p>

Văcărescu¹,

Cozma²,

Petrescu³

et al. 2019

CIA

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Purpose: Left ventricle (LV)-only pacing is non-inferior to biventricular pacing but permanent fusion pacing is needed to ensure cardiac resynchronization therapy (CRT) responsiveness. The role of systematic exercise testing (ET) in these patients has not been established. This study was designed to assess clinical and therapeutic implications (device programming/drugs) of systematic ET in patients requiring fusion-pacing CRT without an right ventricle (RV) lead. Methods: Consecutive patients with a right atrium/LV-only dual-chamber (DDD) pacing system were included. Prospective data were obtained: device interrogation, ET, and echocardiography at every 6-month follow-up visit. CRT assessment during ET included maximal heart rate, beat-to-beat echocardiography analysis of LV fusion pacing, LV loss of capture, and improvement in exercise capacity. If LV loss of capture or unsatisfactory LV fusion pacing occurred, reprogramming was individualized for each patient and ET redone. Results: A total of 55 patients (29 male) aged 62±11 years were included. During follow-up (39±18 months), a total of 235 ETs were performed, with mean exercise load 6.4±1.3 metabolic equivalents of task (118±35 W, maximal heart rate 119±17 beats/min). Twenty patients (36%) had inadequate pacing or loss of LV capture during ET, due to exceeding the maximum tracking rate (11%), chronotropic incompetence (7%), and LV pacing outside the fusion-pacing band (18%), caused by physiological shortening of the PR interval or exagerated LV preexcitation during maximum exercise. Post-ET CRT-device optimization included reprogramming of rate-adaptive atrioventricular interval (total decrease 23±8 ms), individualized programming of maximum tracking rate, or rate-response function. Drug optimization was performed in 32% of patients, and ET redone in 36%. Conclusion: In one of three ETs, an intervention in device and medication optimization was done to ensure a better outcome. Routine ET should be a standard approach to maximize fusion-pacing CRT response during follow-up.

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Prognostic significance of beta-blocker up-titration in conjunction with cardiac resynchronization therapy in heart failure management

Cited by 11 publications

References 39 publications

The Change in Body Weight During Hospitalization Predicts Mortality in Patients With Acute Decompensated Heart Failure

The Change in Body Weight During Hospitalization Predicts Mortality in Patients With Acute Decompensated Heart Failure

Therapeutic Effect of His-Purkinje System Pacing Proportion on Persistent Atrial Fibrillation Patients With Heart Failure

<p>Exercise test is essential in LV-only fusion CRT pacing without right ventricle lead</p>

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