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http://hdl.handle.net/1942/13433
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Title: | Improving Long-Term Outcomes with Cardiac Resynchronization Therapy: Importance of Adjunctive Heart Failure Optimization Immediately After Implantation. |
Authors: | Mullens, Wilfried Kepa, Jacek De Vusser, Philippe Vercammen, Jan Rivero-Ayerza, Maximo Wagner, Patrick Dens, Joseph Vrolix, Mathias Vandervoort, Pieter Tang, W.H. Wilson |
Issue Date: | 2011 |
Citation: | AMERICAN JOURNAL OF CARDIOLOGY, 108 (3), p. 409-415 |
Abstract: | Despite improvement in morbidity and mortality with cardiac resynchronization therapy
(CRT), disease progression continues to affect a subset of patients and there is limited effort
to identify contributing factors. Our objective was to investigate if a protocol-driven
approach incorporated in a management strategy of heart failure immediately after implantation
would provide incremental benefits beyond usual care after implantation. We
reviewed 114 consecutive patients with CRT implanted from 2005 through 2009 who
received usual care after implantation or underwent protocol-driven CRT care after
implantation. Preimplantation characteristics in patients receiving usual versus protocoldriven
care were similar in left ventricular (LV) dimension (LV internal diastolic diameter
6.2 0.8 vs 6.4 1.0 cm), LV ejection fraction (26 8% vs 25% 8%), QRS width, and
medication usage. Major adjustments during the protocol-driven approach were uptitration
of neurohormonal blockers (64%), echocardiographically guided atrioventricular optimization
(50%), heart failure education (42%), arrhythmia management (19%), and LV lead
repositioning (7%). Although positive LV remodeling was noted in the 2 groups at 6
months, extent was significantly greater in the protocol-driven approach compared to usual
care (change in LV internal diastolic diameter 0.7 0.6 cm vs 0.2 1.2 cm, p 0.01;
change in LV ejection fraction 11 7% vs 7 9%, p 0.01), which was associated with
fewer major adverse events (14% vs 53%, p <0.001). In conclusion, a protocol-driven
approach for patients with CRT started immediately after implantation is associated with
incremental favorable effects on reverse remodeling and fewer adverse events compared to
usual care after implantation. These effects appeared to be driven not only by changes in
device settings and arrhythmia management but also by concomitant medication optimization
and heart failure education. |
URI: | http://hdl.handle.net/1942/13433 |
DOI: | 10.1016/j.amjcard.2011.03.060 |
ISI #: | 000293767400013 |
ISSN: | 0002-9149 |
Category: | A1 |
Type: | Journal Contribution |
Validation: | ecoom, 2013
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Appears in Collections: | Research publications
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