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Electrical optimization of cardiac resynchronization in chronic heart failure is associated with improved clinical long‐term outcome
Author(s) -
Adlbrecht Christopher,
Hülsmann Martin,
Gwechenberger Marianne,
Graf Senta,
Wiesbauer Franz,
Strunk Guido,
Khazen Cesar,
Brodnjak Isabella,
Neuhold Stephanie,
Binder Thomas,
Maurer Gerald,
Pacher Richard
Publication year - 2010
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/j.1365-2362.2010.02311.x
Subject(s) - medicine , cardiac resynchronization therapy , heart failure , cardiology , clinical endpoint , retrospective cohort study , proportional hazards model , implantable cardioverter defibrillator , pharmacotherapy , clinical trial , ejection fraction
Eur J Clin Invest 2010; 40 (8): 678–684 Abstract Background Cardiac resynchronization therapy (CRT) is an established treatment option for symptomatic chronic heart failure (CHF) patients with pharmacological baseline therapy, but not all patients benefit from device therapy. One reason for this may be inadequate device settings. In real‐world practice, echocardiographic evaluation of atrioventricular (AV) delay is not performed in a high proportion of patients, as the effect of electrical optimization of CRT is an issue open for investigation. Materials and methods We performed a retrospective observational study analysing the effect of AV‐interval evaluation with echocardiography on long‐term [32 (23?43) months] clinical outcome in 205 CHF patients. A stepwise Cox regression model including a co‐morbidity score, failed AV‐interval evaluation, satisfactory device function after the first implantation attempt, failure to reach 100% of the recommended renin‐angiotensin system inhibitor and beta‐blocker dose at follow‐up and CRT device implantation compared with CRT in combination with an implanted cardioverter defibrillator (ICD) was applied. Results In the total study cohort, 124 (60·5%) patients had reached the primary combined endpoint death or cardiac hospitalization and 59 (28·8%) had died. Cox regression analysis revealed that failed AV‐interval evaluation [HR = 1·72 (1·19–2·49), P = 0·004] non‐optimized CHF pharmacotherapy dosages [HR = 2·12 (1·32–3·42), P = 0·002], the presence of a CRT/ICD combination device [HR = 1·87 (1·28–2·71), P = 0·001] and satisfactory device function after the first implantation attempt [HR = 0·44 (0·25–0·77), P = 0·004] were associated with the primary endpoint. Conclusion Echocardiographic evaluation of the AV‐interval in patients with CRT was independently associated with improved clinical outcome, impacting on daily clinical practice of HF patient care.