What Happens to Non-Responders in Cardiac Resynchronization Therapy?

Detalhes bibliográficos
Autor(a) principal: Rio, P
Data de Publicação: 2017
Outros Autores: Oliveira, MM, Cunha, PS, Nogueira da Silva, M, Branco, LM, Galrinho, A, Soares, R, Feliciano, J, Pimenta, R, Cruz Ferreira, R
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: http://hdl.handle.net/10400.17/2839
Resumo: INTRODUCTION AND OBJECTIVES: Left ventricular reverse remodeling (LVRR) is strongly related to the long-term prognosis of patients undergoing cardiac resynchronization therapy (CRT). The aim of this study was to assess the long-term clinical outcome of patients without LVRR at six months after CRT implantation and to determine the prognostic impact of clinical response in this population. METHODS: We analyzed 178 consecutive patients who underwent successful CRT device implantation (age 64±11 years; 69% male; 89% in New York Heart Association [NYHA] functional class III; 35% with ischemic cardiomyopathy). Clinical status and echocardiographic parameters were determined before and six months after CRT implantation. We identified those without criteria for LVRR (≥10% increase in left ventricular ejection fraction with ≥15% reduction in left ventricular end-systolic diameter compared to baseline). Clinical responders were defined by a sustained improvement of at least one NYHA functional class. RESULTS: At six-month assessment after CRT, 109 (61%) patients showed LVRR. During a mean follow-up of 56±21 months, 47 (26%) patients died, with higher mortality in the group without LVRR (36% vs. 20%, p=0.023). Clinical response was greater in patients with LVRR (88% vs. 55%, p<0.001). In patients without LVRR, clinical response to CRT was the strongest independent predictor of survival (hazard ratio: 0.120; 95% confidence interval: 0.039-0.366; p<0.001). CONCLUSION: Although patients without LVRR six months after CRT implantation had a worse prognosis, with higher all-cause mortality, clinical response can be an independent predictor of survival in this population.
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spelling What Happens to Non-Responders in Cardiac Resynchronization Therapy?O Que Acontece aos Não Respondedores na Terapia de Ressincronização Cardíaca?HSM CARCardiac Resynchronization TherapyDefibrillators, ImplantableHeart Failure/therapyRetrospective StudiesTime FactorsTreatment FailureINTRODUCTION AND OBJECTIVES: Left ventricular reverse remodeling (LVRR) is strongly related to the long-term prognosis of patients undergoing cardiac resynchronization therapy (CRT). The aim of this study was to assess the long-term clinical outcome of patients without LVRR at six months after CRT implantation and to determine the prognostic impact of clinical response in this population. METHODS: We analyzed 178 consecutive patients who underwent successful CRT device implantation (age 64±11 years; 69% male; 89% in New York Heart Association [NYHA] functional class III; 35% with ischemic cardiomyopathy). Clinical status and echocardiographic parameters were determined before and six months after CRT implantation. We identified those without criteria for LVRR (≥10% increase in left ventricular ejection fraction with ≥15% reduction in left ventricular end-systolic diameter compared to baseline). Clinical responders were defined by a sustained improvement of at least one NYHA functional class. RESULTS: At six-month assessment after CRT, 109 (61%) patients showed LVRR. During a mean follow-up of 56±21 months, 47 (26%) patients died, with higher mortality in the group without LVRR (36% vs. 20%, p=0.023). Clinical response was greater in patients with LVRR (88% vs. 55%, p<0.001). In patients without LVRR, clinical response to CRT was the strongest independent predictor of survival (hazard ratio: 0.120; 95% confidence interval: 0.039-0.366; p<0.001). CONCLUSION: Although patients without LVRR six months after CRT implantation had a worse prognosis, with higher all-cause mortality, clinical response can be an independent predictor of survival in this population.Elsevier EspañaRepositório do Centro Hospitalar Universitário de Lisboa Central, EPERio, POliveira, MMCunha, PSNogueira da Silva, MBranco, LMGalrinho, ASoares, RFeliciano, JPimenta, RCruz Ferreira, R2018-01-09T15:53:45Z2017-122017-12-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10400.17/2839engRev Port Cardiol. 2017 Dec;36(12):885-89210.1016/j.repc.2017.02.017info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-03-10T09:39:52Zoai:repositorio.chlc.min-saude.pt:10400.17/2839Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T17:20:10.396993Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv What Happens to Non-Responders in Cardiac Resynchronization Therapy?
O Que Acontece aos Não Respondedores na Terapia de Ressincronização Cardíaca?
title What Happens to Non-Responders in Cardiac Resynchronization Therapy?
spellingShingle What Happens to Non-Responders in Cardiac Resynchronization Therapy?
Rio, P
HSM CAR
Cardiac Resynchronization Therapy
Defibrillators, Implantable
Heart Failure/therapy
Retrospective Studies
Time Factors
Treatment Failure
title_short What Happens to Non-Responders in Cardiac Resynchronization Therapy?
title_full What Happens to Non-Responders in Cardiac Resynchronization Therapy?
title_fullStr What Happens to Non-Responders in Cardiac Resynchronization Therapy?
title_full_unstemmed What Happens to Non-Responders in Cardiac Resynchronization Therapy?
title_sort What Happens to Non-Responders in Cardiac Resynchronization Therapy?
author Rio, P
author_facet Rio, P
Oliveira, MM
Cunha, PS
Nogueira da Silva, M
Branco, LM
Galrinho, A
Soares, R
Feliciano, J
Pimenta, R
Cruz Ferreira, R
author_role author
author2 Oliveira, MM
Cunha, PS
Nogueira da Silva, M
Branco, LM
Galrinho, A
Soares, R
Feliciano, J
Pimenta, R
Cruz Ferreira, R
author2_role author
author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Repositório do Centro Hospitalar Universitário de Lisboa Central, EPE
dc.contributor.author.fl_str_mv Rio, P
Oliveira, MM
Cunha, PS
Nogueira da Silva, M
Branco, LM
Galrinho, A
Soares, R
Feliciano, J
Pimenta, R
Cruz Ferreira, R
dc.subject.por.fl_str_mv HSM CAR
Cardiac Resynchronization Therapy
Defibrillators, Implantable
Heart Failure/therapy
Retrospective Studies
Time Factors
Treatment Failure
topic HSM CAR
Cardiac Resynchronization Therapy
Defibrillators, Implantable
Heart Failure/therapy
Retrospective Studies
Time Factors
Treatment Failure
description INTRODUCTION AND OBJECTIVES: Left ventricular reverse remodeling (LVRR) is strongly related to the long-term prognosis of patients undergoing cardiac resynchronization therapy (CRT). The aim of this study was to assess the long-term clinical outcome of patients without LVRR at six months after CRT implantation and to determine the prognostic impact of clinical response in this population. METHODS: We analyzed 178 consecutive patients who underwent successful CRT device implantation (age 64±11 years; 69% male; 89% in New York Heart Association [NYHA] functional class III; 35% with ischemic cardiomyopathy). Clinical status and echocardiographic parameters were determined before and six months after CRT implantation. We identified those without criteria for LVRR (≥10% increase in left ventricular ejection fraction with ≥15% reduction in left ventricular end-systolic diameter compared to baseline). Clinical responders were defined by a sustained improvement of at least one NYHA functional class. RESULTS: At six-month assessment after CRT, 109 (61%) patients showed LVRR. During a mean follow-up of 56±21 months, 47 (26%) patients died, with higher mortality in the group without LVRR (36% vs. 20%, p=0.023). Clinical response was greater in patients with LVRR (88% vs. 55%, p<0.001). In patients without LVRR, clinical response to CRT was the strongest independent predictor of survival (hazard ratio: 0.120; 95% confidence interval: 0.039-0.366; p<0.001). CONCLUSION: Although patients without LVRR six months after CRT implantation had a worse prognosis, with higher all-cause mortality, clinical response can be an independent predictor of survival in this population.
publishDate 2017
dc.date.none.fl_str_mv 2017-12
2017-12-01T00:00:00Z
2018-01-09T15:53:45Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://hdl.handle.net/10400.17/2839
url http://hdl.handle.net/10400.17/2839
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv Rev Port Cardiol. 2017 Dec;36(12):885-892
10.1016/j.repc.2017.02.017
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Elsevier España
publisher.none.fl_str_mv Elsevier España
dc.source.none.fl_str_mv reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
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instname_str Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
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reponame_str Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
collection Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
repository.name.fl_str_mv Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
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