The association of mechanical dyssynchrony and resynchronization therapy with survival in heart failure with a wide QRS complex: a two-world study

Autor: Jens-Uwe Voigt, Lothar Faber, Agnieszka Ciarka, Tomasz Kukulski, Stefan Winter, Aleksandar N. Neskovic, Ivan Stanković, Rik Willems, Wolfgang Fehske, Marit Aarones, Christian Prinz, Mariola Szulik, Milica Stefanovic, Ana Maria Daraban, Martin Kotrc, Martin Penicka, Svend Aakhus
Rok vydání: 2020
Předmět:
Male
medicine.medical_specialty
Time Factors
genetic structures
medicine.medical_treatment
Cardiac resynchronization therapy
Wide QRS complex
Action Potentials
030204 cardiovascular system & hematology
Ventricular Function
Left
law.invention
Cardiac Resynchronization Therapy
03 medical and health sciences
0302 clinical medicine
Randomized controlled trial
law
Heart Rate
Risk Factors
Internal medicine
medicine
Humans
Radiology
Nuclear Medicine and imaging
cardiovascular diseases
030212 general & internal medicine
Aged
Retrospective Studies
Aged
80 and over
Heart Failure
business.industry
Hazard ratio
Retrospective cohort study
Cardiovascular Agents
Stroke Volume
Recovery of Function
Middle Aged
medicine.disease
Confidence interval
Eastern european
Europe
Treatment Outcome
Echocardiography
Heart failure
cardiovascular system
Cardiology
Female
Cardiology and Cardiovascular Medicine
business
Zdroj: The international journal of cardiovascular imaging. 36(8)
ISSN: 1875-8312
Popis: Setting up a randomized trial to assess the association of mechanical dyssynchrony (MD) and the success of cardiac resynchronization therapy (CRT) in heart failure with a wide QRS complex is ethically challenging. We therefore investigated this association in a retrospective cohort study observing different treatment strategies which were chosen based on the availability of health care resources. The survival of 500 patients from six Western European centers treated with CRT was compared to their 137 Eastern European counterparts not treated with CRT, with regard to the presence of MD. MD was visually assessed and was defined as the presence of apical rocking and/or septal flash. Patients were followed for a mean of 26 ± 8 months for the occurrence of death of any cause. As compared with medical therapy alone, CRT was associated with a more favorable survival (hazard ratio (HR), 0.53; 95% confidence interval (CI) 0.35–0.79; P = 0.002). Patients with MD treated by CRT had better survival than patients belonging to all other groups—they showed 72%, 66% and 56% reduction in all-cause mortality, respectively, compared to patients with MD not treated by CRT (HR 0.28; 95% CI 0.17–0.44), patients without MD treated by CRT (HR 0.34; 95% CI 0.22–0.52) and patients without MD not treated by CRT (HR 0.44; 95% CI 0.25–0.76). Patients with wide QRS complex who are treated with CRT have a significantly better survival when MD is present.
Databáze: OpenAIRE
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