Long term results of cardiac resynchronisation therapy for patients with severe heart failure

Česká verzia

Authors: A. Bulava ^1,2; J. Lukl ¹; M. Hutyra ¹; D. Marek ¹
Authors place of work: I. interní klinika Lékařské fakulty UP a FN Olomouc, přednosta prof. MUDr. Jan Lukl, CSc. ¹; Kardiocentrum Nemocnice České Budějovice, a. s., ředitel MUDr. Ladislav Pešl ²
Published in the journal: Vnitř Lék 2007; 53(11): 1153-1163
Category: Original Contributions

Summary

Introduction:
Cardiac resynchronisation therapy (CRT) has been shown to be a highly effective treatment strategy for patients with severe chronic heart failure (ChHF).

Objective of study:
To determine the clinical response of patients to CRT, to measure morbidity and mortality for this population of patients, to determine causes and predictors of death. To test whether the parameters of tissue Doppler echocardiography are able to predict response to CRT.

Patients and methods:
Before and after implantation of the CRT and 12 months later, echocardiograph tests were carried out and relevant clinical data was recorded during the monitoring of patients.

Results:
102 patients (71 men, 31 women) with an average age of 71 ± 9 years took part in the study. 68% patients had cardiac ischemia, 29% had idiopathic dilated cardiomyopathy. 75% patients were in functional class NYHA III, 25% NYHA IV. After a monitoring period of 711 ± 329 days, 26 patients had died and 35 patients had been hospitalised. 34% of all hospitalisations were for acute exacerbation of ChHF. Patients with initial functional classification NYHA IV had a higher mortality rate in years one and two than patients in class NYHA III. The proportion of clinical responders was 64% after 12 months of CRT. In 58% of patients, a year of CRT produced a relative increase in the ejection fraction of the left ventricle (EF LV) of ≥ 30%. 1/3 of patients had EF LV ? 45% with minimal symptoms of ChHF. The following were found to predict reverse remodelling of the left ventricle: less advanced state of the basic illness (EFLV >23%, left ventricular end-diastolic diameter < 65 mm, left ventricular enddiastolic volume < 160 ml and left ventricular end-systolic volume < 120 ml) and interventricular mechanical delay > 45 ms.

Conclusion:
CRT is a safe method with a high success rate. There continues to be a problem with identifying responders. Symptoms of less advanced heart disease and interventricular delay were identified as sensitive predictors of the response to treatment.

Key words:
biventricular stimulation – cardiac resynchronisation therapy – tissue Dopplerometry – left ventricular reverse remodelling – responder prediction

Zdroje

1. Abraham WT, Fisher WG, Smith AL et al. Cardiac resynchronization in chronic heart failure. N Engl J Med 2002; 346: 1845-1853.

2. Abraham WT, Hayes DL. Cardiac resynchronization therapy for heart failure. Circulation 2003; 108: 2596-2603.

3. Achilli A, Peraldo C, Sassara M et al. Prediction of Response to Cardiac Resynchronization Therapy: The Selection of Candidates for CRT (SCART) Study. Pacing Clin Electrophysiol 2006; 29(Suppl 2): S11-S19.

4. Alonso C, Leclercq C, D’Allonnes FR et al. Six year experience of transvenous left ventricular lead implantation for permanent biventricular pacing in patients with advanced heart failure: Technical aspects. Heart 2001; 86: 405-410.

5. Auricchio A, Abraham WT. Cardiac resynchronization therapy: current state of the art: cost versus benefit. Circulation 2004; 109: 300-307.

6. Bax JJ, Bleeker GB, Marwick TH et al. Left ventricular dyssynchrony predicts response and prognosis after cardiac resynchronization therapy. J Am Coll Cardiol 2004; 44: 1834-1840.

7. Bax JJ, Marwick TH, Molhoek SG et al. Left ventricular dyssynchrony predicts benefit of cardiac resynchronization therapy in patients with end-stage heart failure before pacemaker implantation. Am J Cardiol 2003; 92: 1238-1240.

8. Bristow MR, Saxon LA, Boehmer J et al. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 2004; 350: 2140-2150.

9. Bulava A, Lukl J. Five-year experience with transvenous electrode implantation for biventricular pacing in patients with chronic heart failure. Bratislavské lekárské listy 2007; 108: 21-22.

10. Cazeau S, Leclercq C, Lavergne T et al. Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. N Engl J Med 2001; 344: 873-880.

11. Cleland JG, Coletta AP, Lammiman M et al. Clinical trials update from the European Society of Cardiology meeting 2005: CARE-HF extension study, ESSENTIAL, CIBIS-III, S-ICD, ISSUE-2, STRIDE-2, SOFA, IMAGINE, PREAMI, SIRIUS-II and ACTIVE. Eur J Heart Fail 2005; 7: 1070-1075.

12. Cleland JG, Daubert JC, Erdmann E et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med 2005; 352: 1539-1549.

13. Diaz-Infante E, Mont L, Leal J et al. Predictors of lack of response to resynchronization therapy. Am J Cardiol 2005; 95: 1436-1440.

14. Hunt SA, Abraham WT, Chin MH et al. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation 2005; 112: e154-e235.

15. Kautzner J, Riedlbauchova L. Biventricular cardiac pacing. Vnitř Lék 2003; 49: 734-739.

16. Notabartolo D, Merlino JD, Smith AL et al. Usefulness of the peak velocity difference by tissue Doppler imaging technique as an effective predictor of response to cardiac resynchronization therapy. Am J Cardiol 2004; 94: 817-820.

17. Packer M. Proposal for a new clinical end point to evaluate the efficacy of drugs and devices in the treatment of chronic heart failure. J Card Fail 2001; 7: 176-182.

18. Penicka M, Bartunek J, De Bruyne B et al. Improvement of left ventricular function after cardiac resynchronization therapy is predicted by tissue Doppler imaging echocardiography. Circulation 2004; 109: 978-983.

19. Pitzalis MV, Iacoviello M, Romito R et al. Cardiac resynchronization therapy tailored by echocardiographic evaluation of ventricular asynchrony. J Am Coll Cardiol 2002; 40: 1615-1622.

20. Quinones MA, Otto CM, Stoddard M et al. Recommendations for quantification of Doppler echocardiography: a report from the Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. J Am Soc Echocardiogr 2002; 15: 167-184.

21. Táborský M, Kautzner J, Bytešník J et al. Zásady pro implantace kardiostimulátorů a implantabilních kardioverterů-defibrilátorů. Cor Vasa 2005; 47: 59-68.

22. Tei C, Ling LH, Hodge DO et al. New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function - a study in normals and dilated cardiomyopathy. J Cardiol 1995; 26: 357-366.

23. Toussaint JF, Lavergne T, Kerrou K et al. Basal asynchrony and resynchronization with biventricular pacing predict long-term improvement of LV function in heart failure patients. Pacing Clin Electrophysiol 2003; 26: 1815-1823.

24. White HD, Norris RM, Brown MA et al. Left ventricular end-systolic volume as the major determinant of survival after recovery from myocardial infarction. Circulation 1987; 76: 44-51.

25. Yu CM, Abraham WT, Bax J et al. Predictors of response to cardiac resynchronization therapy (PROSPECT) - study design. Am Heart J 2005; 149: 600-605.

26. Yu CM, Chau E, Sanderson JE et al. Tissue Doppler echocardiographic evidence of reverse remodeling and improved synchronicity by simultaneously delaying regional contraction after biventricular pacing therapy in heart failure. Circulation 2002; 105: 438-445.

27. Yu CM, Fung JW, Zhang Q et al. Tissue Doppler imaging is superior to strain rate imaging and postsystolic shortening on the prediction of reverse remodeling in both ischemic and nonischemic heart failure after cardiac resynchronization therapy. Circulation 2004; 110: 66-73.

28. Yu CM, Fung WH, Lin H et al. Predictors of left ventricular reverse remodeling after cardiac resynchronization therapy for heart failure secondary to idiopathic dilated or ischemic cardiomyopathy. Am J Cardiol 2003; 91: 684-688.

29. Yu CM, Lin H, Zhang Q et al. High prevalence of left ventricular systolic and diastolic asynchrony in patients with congestive heart failure and normal QRS duration. Heart 2003; 89: 54-60.

30. Yu CM, Zhang Q, Chan YS et al. Tissue Doppler velocity is superior to displacement and strain mapping in predicting left ventricular reverse remodelling response after cardiac resynchronisation therapy. Heart 2006; 92: 1452-1456.