Evaluating the efficacy, safety, and predictors of failure following cardiac resynchronization therapy in a developing country: an ambispective, multi-center study.

IF 2.1 3区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Cardiovascular diagnosis and therapy Pub Date : 2025-02-28 Epub Date: 2025-02-25 DOI:10.21037/cdt-24-408
Yem Van Nguyen, Trang Minh Bui, Vinh Nguyen Pham, Vu Hoang Vu, Khang Duong Nguyen, Hoa Ngoc Chau
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引用次数: 0

Abstract

Background: Multiple studies have demonstrated that cardiac resynchronization therapy (CRT) effectively improves the prognosis of heart failure. CRT has been proven to improve patients' quality of life and reduce the risk of readmission and death in selected patients. Nevertheless, a notable proportion of individuals undergoing CRT showed no response. Therefore, we conducted this study to describe CRT characteristics and reported the outcomes 1 year after discharge in Vietnam, along with predictors of non-response to CRT.

Methods: This was a multicenter, ambispective cohort study that enrolled all CRT implantation patients at five hospitals in Ho Chi Minh City: University Medical Center Ho Chi Minh City, Heart Institute of Ho Chi Minh City, Tam Duc Heart Hospital, Thong Nhat Hospital, and Vinmec Central Park Hospital. All patients received treatment according to established guidelines and were monitored for up to 1 year after being discharged. Primary outcomes included rehospitalization and mortality rate 1 year after discharge. Secondary outcomes included early and late complications related to the procedure.

Results: Between April 2016 and April 2020, 88 cases of successful CRT implantation from five hospitals were enrolled. The majority of the population was male (68.2%), mean age was 62.5±13.4 years old, New York Heart Association (NYHA) III/IV at admission (98.9%), and the mean left ventricular ejection fraction (LVEF) was 24%±5.9%. The incidence of early complications was 9.1%. The overall mortality rate was 12.5%, with 6.8% occurring within the 1-year follow-up period. The population experienced a significant decrease in readmission rate within 1 year after discharge (P=0.001). Additionally, there was a notable improvement in the NYHA function (P<0.001) and an enhancement in the quality of life (P=0.001). Five characteristics correlated with the lack of response to CRT were history of dobutamine usage, QRS interval (QRS) length before implantation, severe ventricular arrhythmias before implantation, atrial fibrillation after implantation, and severe ventricular arrhythmias after implantation.

Conclusions: Properly used CRT device improves heart failure symptoms, mortality, and readmissions. There are several predictors of cardiac resynchronization treatment failure. This information helps us comprehend the restricted patient group and develop better treatments, especially in low-income countries.

评估发展中国家心脏再同步化治疗后的疗效、安全性和衰竭预测因素:一项双视角、多中心研究。
背景:多项研究表明,心脏再同步化治疗(CRT)能有效改善心力衰竭的预后。CRT已被证明可以改善患者的生活质量,降低患者再入院和死亡的风险。然而,显著比例的接受CRT的个体没有反应。因此,我们进行了这项研究来描述CRT的特征,并报告了在越南出院1年后的结果,以及对CRT无反应的预测因素。方法:这是一项多中心、双视角队列研究,纳入了胡志明市五家医院的所有CRT植入患者:胡志明市大学医学中心、胡志明市心脏研究所、Tam Duc心脏医院、通芽医院和Vinmec中央公园医院。所有患者均按照既定指南接受治疗,出院后随访1年。主要结局包括出院后1年的再住院率和死亡率。次要结果包括与手术相关的早期和晚期并发症。结果:2016年4月至2020年4月,共纳入5家医院CRT植入成功病例88例。男性居多(68.2%),平均年龄62.5±13.4岁,入院时为纽约心脏协会(NYHA) III/IV级(98.9%),平均左室射血分数(LVEF)为24%±5.9%。早期并发症发生率为9.1%。总死亡率为12.5%,其中6.8%发生在1年随访期内。患者出院后1年内再入院率显著降低(P=0.001)。此外,NYHA功能也有显著改善。结论:正确使用CRT设备可改善心衰症状、死亡率和再入院率。有几个预测心脏再同步化治疗失败的因素。这些信息有助于我们了解受限制的患者群体并开发更好的治疗方法,特别是在低收入国家。
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来源期刊
Cardiovascular diagnosis and therapy
Cardiovascular diagnosis and therapy Medicine-Cardiology and Cardiovascular Medicine
CiteScore
4.90
自引率
4.20%
发文量
45
期刊介绍: The journal ''Cardiovascular Diagnosis and Therapy'' (Print ISSN: 2223-3652; Online ISSN: 2223-3660) accepts basic and clinical science submissions related to Cardiovascular Medicine and Surgery. The mission of the journal is the rapid exchange of scientific information between clinicians and scientists worldwide. To reach this goal, the journal will focus on novel media, using a web-based, digital format in addition to traditional print-version. This includes on-line submission, review, publication, and distribution. The digital format will also allow submission of extensive supporting visual material, both images and video. The website www.thecdt.org will serve as the central hub and also allow posting of comments and on-line discussion. The web-site of the journal will be linked to a number of international web-sites (e.g. www.dxy.cn), which will significantly expand the distribution of its contents.
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