Cardiac Resynchronization Therapy - Risk Stratification and Long-Term Outcome

Christian Reitan

Cardiac Resynchronization Therapy - Risk Stratification and Long-Term Outcome

Christian Reitan

Cardiology

Research output: Thesis › Doctoral Thesis (compilation)

551 Downloads (Pure)

Abstract

Heart failure is a condition that will affect 2-3% of the population. Around one third of the patients have a decreased LVEF and a widened QRS complex as a sign of ventricular dyssynchrony. CRT has emerged as a treatment that reduces morbidity, mortality and improve functional status in this population. However, a substantial amount of treated patients do not respond satisfactory after implantation. This thesis sought to assess characteristics and factors associated with long term mortality and outcome in a cohort of CRT patients.

The thesis includes four papers:

Paper I assessed the association between early subjective response after implantation and long term outcome in CRT-P patients. We found that those who exhibited a self-assessed positive therapy response after 1-2 months had a significantly better survival rate compared with those who did not.

The second paper investigated long term mortality in CRT-P and primary prophylactic CRT-D patients. Patients with CRT-D had better crude survival rates than those with CRT-P. However, the CRT-P group was older and had more comorbidities. CRT-D was not significantly associated with better survival when adjusting for confounders, as compared to CRT-P.

The third paper assessed a method of estimating myocardial scar burden from a standard 12-lead ECG (Selvester QRS score) in patients with Left Bundle Branch Block. 401 patients were assessed and divided into a high-score and a low-score group. The group with high Selvester QRS score was found to have a worse survival rate compared to the group of patients with lower scores.

The last paper found that the CHA2DS2-VASc score, which is commonly used for stroke risk estimation in atrial fibrillation patients, was associated with long term mortality and a composite endpoint of mortality or hospitalization for heart failure in a CRT population. When comparing CHA2DS2-VASc to other, CRT-specific scores, it performed approximately as well in predicting mortality and the composite endpoint.

Original language	English
Qualification	Doctor
Awarding Institution	Department of Clinical Sciences, Lund
Supervisors/Advisors	Borgquist, Rasmus, Supervisor Platonov, Pyotr, Assistant supervisor
Award date	2018 Sept 7
Place of Publication	Lund
Publisher	Lund University: Faculty of Medicine
ISBN (Print)	978-91-7619-667-0
Publication status	Published - 2018

Bibliographical note

Defence details
Date: 2018-09-07
Time: 13:00
Place: Segerfalksalen, BMC A10, Sölvegatan 17 i Lund
External reviewer(s)
Name: Birgersdotter-Green, Ulrika
Title: professor
Affiliation: University of California, San Diego

Subject classification (UKÄ)

Cardiac and Cardiovascular Systems

Free keywords

Cardiac Resynchronization Therapy
heart Failure
Device therapy
long-term outcome

Access to Document

KappaReitanFinal published version, 4.55 MB

3 Article

Semi-automated QRS score as a predictor of survival in CRT treated patients with strict left bundle branch block
Reitan, C., Chaudhry, U., Atwater, B., Jacobsson, J., Couderc, J. P., Xia, X., Carlson, J., Platonov, P. G. & Borgquist, R., 2018 Mar, In: Journal of Electrocardiology. 51, 2, p. 282-287
Research output: Contribution to journal › Article › peer-review
Long-term Results of Cardiac Resynchronization Therapy; A Comparison Between CRT-Pacemakers Versus Primary Prophylactic CRT-Defibrillators.
Reitan, C., Chaudhry, U., Bakos, Z., Brandt, J., Wang, L., Platonov, P. & Borgquist, R., 2015, In: PACE. 38, 6, p. 758-767
Research output: Contribution to journal › Article › peer-review
Patient-assessed short-term positive response to cardiac resynchronization therapy is an independent predictor of long-term mortality.
Reitan, C., Bakos, Z., Platonov, P., Höijer, C. J., Brandt, J., Wang, L. & Borgquist, R., 2014, In: Europace. 16, 11, p. 1603-1609
Research output: Contribution to journal › Article › peer-review

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Cite this

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title = "Cardiac Resynchronization Therapy - Risk Stratification and Long-Term Outcome",

abstract = "Heart failure is a condition that will affect 2-3% of the population. Around one third of the patients have a decreased LVEF and a widened QRS complex as a sign of ventricular dyssynchrony. CRT has emerged as a treatment that reduces morbidity, mortality and improve functional status in this population. However, a substantial amount of treated patients do not respond satisfactory after implantation. This thesis sought to assess characteristics and factors associated with long term mortality and outcome in a cohort of CRT patients.The thesis includes four papers:Paper I assessed the association between early subjective response after implantation and long term outcome in CRT-P patients. We found that those who exhibited a self-assessed positive therapy response after 1-2 months had a significantly better survival rate compared with those who did not. The second paper investigated long term mortality in CRT-P and primary prophylactic CRT-D patients. Patients with CRT-D had better crude survival rates than those with CRT-P. However, the CRT-P group was older and had more comorbidities. CRT-D was not significantly associated with better survival when adjusting for confounders, as compared to CRT-P.The third paper assessed a method of estimating myocardial scar burden from a standard 12-lead ECG (Selvester QRS score) in patients with Left Bundle Branch Block. 401 patients were assessed and divided into a high-score and a low-score group. The group with high Selvester QRS score was found to have a worse survival rate compared to the group of patients with lower scores.The last paper found that the CHA2DS2-VASc score, which is commonly used for stroke risk estimation in atrial fibrillation patients, was associated with long term mortality and a composite endpoint of mortality or hospitalization for heart failure in a CRT population. When comparing CHA2DS2-VASc to other, CRT-specific scores, it performed approximately as well in predicting mortality and the composite endpoint. ",

keywords = "Cardiac Resynchronization Therapy, heart Failure, Device therapy, long-term outcome",

author = "Christian Reitan",

note = "Defence details Date: 2018-09-07 Time: 13:00 Place: Segerfalksalen, BMC A10, S{\"o}lvegatan 17 i Lund External reviewer(s) Name: Birgersdotter-Green, Ulrika Title: professor Affiliation: University of California, San Diego",

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series = "Lund University, Faculty of Medicine Doctoral Dissertation Series",

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school = "Department of Clinical Sciences, Lund",

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AU - Reitan, Christian

N1 - Defence details Date: 2018-09-07 Time: 13:00 Place: Segerfalksalen, BMC A10, Sölvegatan 17 i Lund External reviewer(s) Name: Birgersdotter-Green, Ulrika Title: professor Affiliation: University of California, San Diego

PY - 2018

Y1 - 2018

N2 - Heart failure is a condition that will affect 2-3% of the population. Around one third of the patients have a decreased LVEF and a widened QRS complex as a sign of ventricular dyssynchrony. CRT has emerged as a treatment that reduces morbidity, mortality and improve functional status in this population. However, a substantial amount of treated patients do not respond satisfactory after implantation. This thesis sought to assess characteristics and factors associated with long term mortality and outcome in a cohort of CRT patients.The thesis includes four papers:Paper I assessed the association between early subjective response after implantation and long term outcome in CRT-P patients. We found that those who exhibited a self-assessed positive therapy response after 1-2 months had a significantly better survival rate compared with those who did not. The second paper investigated long term mortality in CRT-P and primary prophylactic CRT-D patients. Patients with CRT-D had better crude survival rates than those with CRT-P. However, the CRT-P group was older and had more comorbidities. CRT-D was not significantly associated with better survival when adjusting for confounders, as compared to CRT-P.The third paper assessed a method of estimating myocardial scar burden from a standard 12-lead ECG (Selvester QRS score) in patients with Left Bundle Branch Block. 401 patients were assessed and divided into a high-score and a low-score group. The group with high Selvester QRS score was found to have a worse survival rate compared to the group of patients with lower scores.The last paper found that the CHA2DS2-VASc score, which is commonly used for stroke risk estimation in atrial fibrillation patients, was associated with long term mortality and a composite endpoint of mortality or hospitalization for heart failure in a CRT population. When comparing CHA2DS2-VASc to other, CRT-specific scores, it performed approximately as well in predicting mortality and the composite endpoint.

AB - Heart failure is a condition that will affect 2-3% of the population. Around one third of the patients have a decreased LVEF and a widened QRS complex as a sign of ventricular dyssynchrony. CRT has emerged as a treatment that reduces morbidity, mortality and improve functional status in this population. However, a substantial amount of treated patients do not respond satisfactory after implantation. This thesis sought to assess characteristics and factors associated with long term mortality and outcome in a cohort of CRT patients.The thesis includes four papers:Paper I assessed the association between early subjective response after implantation and long term outcome in CRT-P patients. We found that those who exhibited a self-assessed positive therapy response after 1-2 months had a significantly better survival rate compared with those who did not. The second paper investigated long term mortality in CRT-P and primary prophylactic CRT-D patients. Patients with CRT-D had better crude survival rates than those with CRT-P. However, the CRT-P group was older and had more comorbidities. CRT-D was not significantly associated with better survival when adjusting for confounders, as compared to CRT-P.The third paper assessed a method of estimating myocardial scar burden from a standard 12-lead ECG (Selvester QRS score) in patients with Left Bundle Branch Block. 401 patients were assessed and divided into a high-score and a low-score group. The group with high Selvester QRS score was found to have a worse survival rate compared to the group of patients with lower scores.The last paper found that the CHA2DS2-VASc score, which is commonly used for stroke risk estimation in atrial fibrillation patients, was associated with long term mortality and a composite endpoint of mortality or hospitalization for heart failure in a CRT population. When comparing CHA2DS2-VASc to other, CRT-specific scores, it performed approximately as well in predicting mortality and the composite endpoint.

KW - Cardiac Resynchronization Therapy

KW - heart Failure

KW - Device therapy

KW - long-term outcome

M3 - Doctoral Thesis (compilation)

SN - 978-91-7619-667-0

VL - 2018:99

T3 - Lund University, Faculty of Medicine Doctoral Dissertation Series

PB - Lund University: Faculty of Medicine

CY - Lund

ER -

Cardiac Resynchronization Therapy - Risk Stratification and Long-Term Outcome

Abstract

Bibliographical note

Subject classification (UKÄ)

Free keywords

Access to Document

Fingerprint

Research output

Semi-automated QRS score as a predictor of survival in CRT treated patients with strict left bundle branch block

Long-term Results of Cardiac Resynchronization Therapy; A Comparison Between CRT-Pacemakers Versus Primary Prophylactic CRT-Defibrillators.

Patient-assessed short-term positive response to cardiac resynchronization therapy is an independent predictor of long-term mortality.

Cite this