Echocardiographic Predictors of Worse Outcome After Cardiac Resynchronization Therapy
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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Sociedade Brasileira de Cardiologia - SBC
2015
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oai:scielo:S0066-782X20150025005522016-01-06Echocardiographic Predictors of Worse Outcome After Cardiac Resynchronization TherapyRocha,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 Ibrahim Heart Failure/ mortality Echocardiography Pacemaker, Artificial Cardiac Resynchronization Therapy Risk Factors 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.info:eu-repo/semantics/openAccessSociedade Brasileira de Cardiologia - SBCArquivos Brasileiros de Cardiologia v.105 n.6 20152015-12-01info:eu-repo/semantics/articletext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2015002500552en10.5935/abc.20150108 |
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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 |
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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 Echocardiographic Predictors of Worse Outcome After Cardiac Resynchronization Therapy |
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_sort |
Rocha,Eduardo Arrais |
title |
Echocardiographic Predictors of Worse Outcome After Cardiac Resynchronization Therapy |
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 |
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. |
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Sociedade Brasileira de Cardiologia - SBC |
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2015 |
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http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2015002500552 |
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