Echocardiographic Predictors of Worse Outcome After Cardiac Resynchronization Therapy
Autor(a) principal: | |
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Data de Publicação: | 2015 |
Outros Autores: | , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Arquivos Brasileiros de Cardiologia (Online) |
Texto Completo: | http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2015002500552 |
Resumo: | Abstract Background: Cardiac resynchronization therapy (CRT) is the recommended treatment by leading global guidelines. However, 30%-40% of selected patients are non-responders. Objective: To develop an echocardiographic model to predict cardiac death or transplantation (Tx) 1 year after CRT. Method: Observational, prospective study, with the inclusion of 116 patients, aged 64.89 ± 11.18 years, 69.8% male, 68,1% in NYHA FC III and 31,9% in FC IV, 71.55% with left bundle-branch block, and median ejection fraction (EF) of 29%. Evaluations were made in the pre‑implantation period and 6-12 months after that, and correlated with cardiac mortality/Tx at the end of follow-up. Cox and logistic regression analyses were performed with ROC and Kaplan-Meier curves. The model was internally validated by bootstrapping. Results: There were 29 (25%) deaths/Tx during follow-up of 34.09 ± 17.9 months. Cardiac mortality/Tx was 16.3%. In the multivariate Cox model, EF < 30%, grade III/IV diastolic dysfunction and grade III mitral regurgitation at 6‑12 months were independently related to increased cardiac mortality or Tx, with hazard ratios of 3.1, 4.63 and 7.11, respectively. The area under the ROC curve was 0.78. Conclusion: EF lower than 30%, severe diastolic dysfunction and severe mitral regurgitation indicate poor prognosis 1 year after CRT. The combination of two of those variables indicate the need for other treatment options. |
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Arquivos Brasileiros de Cardiologia (Online) |
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Echocardiographic Predictors of Worse Outcome After Cardiac Resynchronization TherapyHeart Failure/ mortalityEchocardiographyPacemaker, ArtificialCardiac Resynchronization TherapyRisk FactorsAbstract Background: Cardiac resynchronization therapy (CRT) is the recommended treatment by leading global guidelines. However, 30%-40% of selected patients are non-responders. Objective: To develop an echocardiographic model to predict cardiac death or transplantation (Tx) 1 year after CRT. Method: Observational, prospective study, with the inclusion of 116 patients, aged 64.89 ± 11.18 years, 69.8% male, 68,1% in NYHA FC III and 31,9% in FC IV, 71.55% with left bundle-branch block, and median ejection fraction (EF) of 29%. Evaluations were made in the pre‑implantation period and 6-12 months after that, and correlated with cardiac mortality/Tx at the end of follow-up. Cox and logistic regression analyses were performed with ROC and Kaplan-Meier curves. The model was internally validated by bootstrapping. Results: There were 29 (25%) deaths/Tx during follow-up of 34.09 ± 17.9 months. Cardiac mortality/Tx was 16.3%. In the multivariate Cox model, EF < 30%, grade III/IV diastolic dysfunction and grade III mitral regurgitation at 6‑12 months were independently related to increased cardiac mortality or Tx, with hazard ratios of 3.1, 4.63 and 7.11, respectively. The area under the ROC curve was 0.78. Conclusion: EF lower than 30%, severe diastolic dysfunction and severe mitral regurgitation indicate poor prognosis 1 year after CRT. The combination of two of those variables indicate the need for other treatment options.Sociedade Brasileira de Cardiologia - SBC2015-12-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2015002500552Arquivos Brasileiros de Cardiologia v.105 n.6 2015reponame:Arquivos Brasileiros de Cardiologia (Online)instname:Sociedade Brasileira de Cardiologia (SBC)instacron:SBC10.5935/abc.20150108info:eu-repo/semantics/openAccessRocha,Eduardo ArraisPereira,Francisca Tatiana MoreiraAbreu,José SebastiãoLima,José Wellington O.Monteiro,Marcelo de Paula M.Rocha Neto,Almino CavalcanteQuidute,Ana Rosa PintoGoés,Camilla Viana A.Rodrigues Sobrinho,Carlos Roberto MartinsScanavacca,Maurício Ibrahimeng2016-01-06T00:00:00Zoai:scielo:S0066-782X2015002500552Revistahttp://www.arquivosonline.com.br/https://old.scielo.br/oai/scielo-oai.php||arquivos@cardiol.br1678-41700066-782Xopendoar:2016-01-06T00:00Arquivos Brasileiros de Cardiologia (Online) - Sociedade Brasileira de Cardiologia (SBC)false |
dc.title.none.fl_str_mv |
Echocardiographic Predictors of Worse Outcome After Cardiac Resynchronization Therapy |
title |
Echocardiographic Predictors of Worse Outcome After Cardiac Resynchronization Therapy |
spellingShingle |
Echocardiographic Predictors of Worse Outcome After Cardiac Resynchronization Therapy Rocha,Eduardo Arrais Heart Failure/ mortality Echocardiography Pacemaker, Artificial Cardiac Resynchronization Therapy Risk Factors |
title_short |
Echocardiographic Predictors of Worse Outcome After Cardiac Resynchronization Therapy |
title_full |
Echocardiographic Predictors of Worse Outcome After Cardiac Resynchronization Therapy |
title_fullStr |
Echocardiographic Predictors of Worse Outcome After Cardiac Resynchronization Therapy |
title_full_unstemmed |
Echocardiographic Predictors of Worse Outcome After Cardiac Resynchronization Therapy |
title_sort |
Echocardiographic Predictors of Worse Outcome After Cardiac Resynchronization Therapy |
author |
Rocha,Eduardo Arrais |
author_facet |
Rocha,Eduardo Arrais Pereira,Francisca Tatiana Moreira Abreu,José Sebastião Lima,José Wellington O. Monteiro,Marcelo de Paula M. Rocha Neto,Almino Cavalcante Quidute,Ana Rosa Pinto Goés,Camilla Viana A. Rodrigues Sobrinho,Carlos Roberto Martins Scanavacca,Maurício Ibrahim |
author_role |
author |
author2 |
Pereira,Francisca Tatiana Moreira Abreu,José Sebastião Lima,José Wellington O. Monteiro,Marcelo de Paula M. Rocha Neto,Almino Cavalcante Quidute,Ana Rosa Pinto Goés,Camilla Viana A. Rodrigues Sobrinho,Carlos Roberto Martins Scanavacca,Maurício Ibrahim |
author2_role |
author author author author author author author author author |
dc.contributor.author.fl_str_mv |
Rocha,Eduardo Arrais Pereira,Francisca Tatiana Moreira Abreu,José Sebastião Lima,José Wellington O. Monteiro,Marcelo de Paula M. Rocha Neto,Almino Cavalcante Quidute,Ana Rosa Pinto Goés,Camilla Viana A. Rodrigues Sobrinho,Carlos Roberto Martins Scanavacca,Maurício Ibrahim |
dc.subject.por.fl_str_mv |
Heart Failure/ mortality Echocardiography Pacemaker, Artificial Cardiac Resynchronization Therapy Risk Factors |
topic |
Heart Failure/ mortality Echocardiography Pacemaker, Artificial Cardiac Resynchronization Therapy Risk Factors |
description |
Abstract Background: Cardiac resynchronization therapy (CRT) is the recommended treatment by leading global guidelines. However, 30%-40% of selected patients are non-responders. Objective: To develop an echocardiographic model to predict cardiac death or transplantation (Tx) 1 year after CRT. Method: Observational, prospective study, with the inclusion of 116 patients, aged 64.89 ± 11.18 years, 69.8% male, 68,1% in NYHA FC III and 31,9% in FC IV, 71.55% with left bundle-branch block, and median ejection fraction (EF) of 29%. Evaluations were made in the pre‑implantation period and 6-12 months after that, and correlated with cardiac mortality/Tx at the end of follow-up. Cox and logistic regression analyses were performed with ROC and Kaplan-Meier curves. The model was internally validated by bootstrapping. Results: There were 29 (25%) deaths/Tx during follow-up of 34.09 ± 17.9 months. Cardiac mortality/Tx was 16.3%. In the multivariate Cox model, EF < 30%, grade III/IV diastolic dysfunction and grade III mitral regurgitation at 6‑12 months were independently related to increased cardiac mortality or Tx, with hazard ratios of 3.1, 4.63 and 7.11, respectively. The area under the ROC curve was 0.78. Conclusion: EF lower than 30%, severe diastolic dysfunction and severe mitral regurgitation indicate poor prognosis 1 year after CRT. The combination of two of those variables indicate the need for other treatment options. |
publishDate |
2015 |
dc.date.none.fl_str_mv |
2015-12-01 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2015002500552 |
url |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2015002500552 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
10.5935/abc.20150108 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
text/html |
dc.publisher.none.fl_str_mv |
Sociedade Brasileira de Cardiologia - SBC |
publisher.none.fl_str_mv |
Sociedade Brasileira de Cardiologia - SBC |
dc.source.none.fl_str_mv |
Arquivos Brasileiros de Cardiologia v.105 n.6 2015 reponame:Arquivos Brasileiros de Cardiologia (Online) instname:Sociedade Brasileira de Cardiologia (SBC) instacron:SBC |
instname_str |
Sociedade Brasileira de Cardiologia (SBC) |
instacron_str |
SBC |
institution |
SBC |
reponame_str |
Arquivos Brasileiros de Cardiologia (Online) |
collection |
Arquivos Brasileiros de Cardiologia (Online) |
repository.name.fl_str_mv |
Arquivos Brasileiros de Cardiologia (Online) - Sociedade Brasileira de Cardiologia (SBC) |
repository.mail.fl_str_mv |
||arquivos@cardiol.br |
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1752126565710299136 |