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Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
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Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing

Published on: December 11, 2017

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Prognostic implications of staging cardiac remodeling in patients undergoing cardiac resynchronization therapy

Jan Stassen1, Mand Khidir2, Xavier Galloo3

  • 1Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, the Netherlands; Department of Cardiology, Jessa Hospital Hasselt, Stadsomvaart 11, 3500 Hasselt, Belgium.

International Journal of Cardiology
|February 21, 2022
PubMed

Insights

Cardiac resynchronization therapy (CRT) candidates with advanced cardiac remodeling, particularly pulmonary hypertension and right ventricular dysfunction, face higher mortality. Early risk stratification using a novel staging system is crucial for better patient outcomes.

Area of Science:

  • Cardiology
  • Medical Devices
  • Heart Failure Management

Background:

  • Cardiac resynchronization therapy (CRT) candidates often exhibit significant mitral/tricuspid regurgitation, pulmonary hypertension, and right ventricular dysfunction before device implantation.
  • Assessing the extent of cardiac remodeling prior to CRT is critical for understanding patient prognosis.

Purpose of the Study:

  • To investigate the prognostic value of a novel cardiac staging system based on pre-implantation cardiac remodeling.
  • To improve risk-stratification for patients undergoing CRT.

Main Methods:

  • A registry of 844 CRT recipients was analyzed.
  • Patients were categorized into four groups based on the extent of cardiac remodeling (left ventricular dysfunction, left atrial dilatation/mitral regurgitation, pulmonary hypertension/tricuspid regurgitation, right ventricular systolic impairment).
  • All-cause mortality was tracked over a median follow-up of 95 months.

Main Results:

  • Patients in groups 2, 3, and 4 demonstrated significantly higher mortality rates compared to group 1.
  • Groups 3 (pulmonary hypertension/tricuspid regurgitation) and 4 (right ventricular systolic impairment) were independently associated with increased all-cause mortality on multivariable analysis.
  • A substantial proportion of patients (45%) presented with right ventricular systolic impairment (group 4).

Conclusions:

  • The majority of CRT candidates present with extensive cardiac remodeling upon referral.
  • The novel cardiac staging system effectively improves risk-stratification for CRT candidates.
  • Early referral for CRT is essential, particularly for patients with advanced remodeling and right ventricular dysfunction.
Abstract

Keywords:
Cardiac remodelingCardiac resynchronization therapyHeart failure with reduced ejection fractionMortality

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