Cardiac resynchronization therapy : advances in optimal patient selection

Despite the impressive results of cardiac resynchronization theraphy (CRT) in recent large randomized trials a consistent number of patients fails to improve following CRT implantation when the established CRT selection criteria (NYHA class III-IV heart failure, LV ejection fraction __35 % and QRS duration > 120 ms) were applied. For example, close analysis of the data from the MIRACLE trial revealed that 32% of patients did not improve or even worsened in NYHA class after 6 months of CRT. The presence of clinical non-responders to CRT has now been confirmed in several other studies and is usually around 30%. In addition, if response to CRT is defined using more objective parameters such absence of LV reverse remodeling or lack of improvement in LV ejection fraction on echocardiography at mid-term follow-up the number of non-responders is usually between 40-50%. In view of the unnecessary procedure risks and health care expenses in patients without response to CRT the percentage of non-responders among patients selected according to the current selection criteria is unacceptably high and should be reduced. Aim of the thesis: The relatively high number of patients without benefit from CRT (referred to as non-responders) indicates the need for refinement of the current selection criteria in order to 1] better identify those patients with the highest likelihood of response to CRT and 2] avoid device implantations in patients that are unlikely to respond to CRT. The aim of the current thesis was to improve and refine the current CRT selection criteria through the evaluation of the mechanismus underlying (non-) response to CRT.UBL - phd migration 201

Data on sex differences in one-year outcomes of out-of-hospital cardiac arrest patients without ST-segment elevation

Sex differences in out-of-hospital cardiac arrest (OHCA) patients are increasingly recognized. Although it has been found that post-resuscitated women are less likely to have significant coronary artery disease (CAD) than men, data on follow-up in these patients are limited. Data for this data in brief article was obtained as a part of the randomized controlled Coronary Angiography after Cardiac Arrest without ST-segment elevation (COACT) trial. The data supplements the manuscript “Sex differences in out-of-hospital cardiac arrest patients without ST-segment elevation: A COACT trial substudy” were it was found that women were less likely to have significant CAD including chronic total occlusions, and had worse survival when CAD was present. The dataset presented in this paper describes sex differences on interventions, implantable-cardioverter defibrillator (ICD) shocks and hospitalizations due to heart failure during one-year follow-up in patients successfully resuscitated after OHCA. Data was derived through a telephone interview at one year with the patient or general practitioner. Patients in this randomized dataset reflects a homogenous study population, which can be valuable to further build on research regarding long-term sex differences and to further improve cardiac care

Cardiac resynchronization therapy : advances in optimal patient selection

Despite the impressive results of cardiac resynchronization theraphy (CRT) in recent large randomized trials a consistent number of patients fails to improve following CRT implantation when the established CRT selection criteria (NYHA class III-IV heart failure, LV ejection fraction __35 % and QRS duration > 120 ms) were applied. For example, close analysis of the data from the MIRACLE trial revealed that 32% of patients did not improve or even worsened in NYHA class after 6 months of CRT. The presence of clinical non-responders to CRT has now been confirmed in several other studies and is usually around 30%. In addition, if response to CRT is defined using more objective parameters such absence of LV reverse remodeling or lack of improvement in LV ejection fraction on echocardiography at mid-term follow-up the number of non-responders is usually between 40-50%. In view of the unnecessary procedure risks and health care expenses in patients without response to CRT the percentage of non-responders among patients selected according to the current selection criteria is unacceptably high and should be reduced. Aim of the thesis: The relatively high number of patients without benefit from CRT (referred to as non-responders) indicates the need for refinement of the current selection criteria in order to 1] better identify those patients with the highest likelihood of response to CRT and 2] avoid device implantations in patients that are unlikely to respond to CRT. The aim of the current thesis was to improve and refine the current CRT selection criteria through the evaluation of the mechanismus underlying (non-) response to CRT

Obstruction of distal left anterior descending artery by the right ventricular lead of an implantable cardiac defibrillator

Cardiolog

Cardiac resynchronization therapy in patients with a narrow QRS

Although cardiac resynchronization therapy (CRT) is indicated in patients with moderate to severe heart failure with a wide QRS complex (> 120 ms), current guidelines exclude many heart failure patients with a narrow QRS. Detecting mechanical dyssynchrony on echocardiography has become a promising tool in selecting patients with a narrow QRS who may respond to CRT. Several small single-center studies identified patients with a narrow QRS (using echocardiography-based dyssynchrony criteria) who responded favorably to CRT; however, the results of two recent pilot studies remain elusive. The results of the RethinQ study do not provide necessary evidence for making clinical treatment decisions in this population. The lack of definitive evidence is the strongest rationale for conducting an adequately powered, long-term, end point-driven, randomized controlled trial to investigate whether CRT therapy can improve morbidity and mortality outcomes in heart failure patients with a narrow QRS. Such a trial, the EchoCRT trial, has recently been launched