Clinical phenotypes and outcomes associated with improved left ventricular ejection fraction after biventricular pacing.

IF 2.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Interventional Cardiac Electrophysiology Pub Date : 2025-04-09 DOI:10.1007/s10840-025-02040-9

Sameer A Kunte, Lurdes Y T Inoue, William T Abraham, John G F Cleland, Anne B Curtis, Daniel J Friedman, Michael R Gold, Valentina Kutyifa, Cecilia Linde, Anthony S Tang, Gillian D Sanders, Sana M Al-Khatib

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引用次数: 0

Abstract

Background: In some patients who receive a cardiac resynchronization therapy (CRT) device, the left ventricular ejection fraction (LVEF) does not improve.

Methods: We analyzed patients enrolled in the REVERSE, MADIT-CRT, and BLOCK-HF trials, restricting the analysis to those who received CRT. Characteristics of patients with or without improved LVEF were compared using two sample t-tests and Pearson's chi-square tests. Kaplan-Meier survival curves were constructed to display time-to-event data. A log-rank test was used to compare event rates for patients with or without improved LVEF. Mixed effects Cox Proportional-Hazards models adjusting for covariates were used to analyze time to death or heart failure hospitalization (HFH) and time to death.

Results: Of 1065 included patients, 75% (802) were men, 87% (793) were White, 11% (118) were Black, and 7% (72) were Hispanic. LVEF improved in 910 (85%) patients and did not in 155 (15%). Patients with an improved LVEF were less likely to have ischemic cardiomyopathy (ICM) (54% vs 76%; p = 0.004), more likely to have LBBB (73% vs 53%; p = < 0.001), and had longer QRS duration (159 vs 150 ms; p = < 0.001). In adjusted analyses, improved LVEF was associated with a longer time to HFH or death (HR 0.40; 95% CI 0.26-0.62; p < 0.001) or death alone (HR 0.27; 95% CI 0.15-0.48; p < 0.001).

Conclusions: Patients with improvement in LVEF post-CRT implantation are less likely to have ICM and more likely to have LBBB and a longer QRS interval. Improvement in LVEF was associated with better outcomes.

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双室起搏后左室射血分数改善的临床表型和结果。

背景：在一些接受心脏再同步化治疗（CRT）装置的患者中，左心室射血分数（LVEF）没有改善。方法：我们分析了参与REVERSE、MADIT-CRT和BLOCK-HF试验的患者，将分析限制在接受CRT的患者。采用两个样本t检验和Pearson卡方检验比较LVEF改善或未改善患者的特征。构建Kaplan-Meier生存曲线以显示时间到事件的数据。log-rank检验用于比较LVEF改善或未改善患者的事件发生率。采用混合效应Cox比例风险模型对协变量进行调整，分析死亡时间或心力衰竭住院时间（HFH）和死亡时间。结果：纳入的1065例患者中，75%（802例）为男性，87%（793例）为白人，11%（118例）为黑人，7%（72例）为西班牙裔。910例（85%）患者LVEF改善，155例（15%）患者无改善。LVEF改善的患者发生缺血性心肌病（ICM）的可能性较低(54% vs 76%；p = 0.004)，患LBBB的可能性更大(73% vs 53%；p =结论：crt植入后LVEF改善的患者发生ICM的可能性降低，发生LBBB的可能性增加，QRS间隔时间延长。LVEF的改善与更好的结果相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Interventional Cardiac Electrophysiology 医学-心血管系统

CiteScore

4.30

自引率

11.10%

发文量

320

审稿时长

4-8 weeks

期刊介绍： The Journal of Interventional Cardiac Electrophysiology is an international publication devoted to fostering research in and development of interventional techniques and therapies for the management of cardiac arrhythmias. It is designed primarily to present original research studies and scholarly scientific reviews of basic and applied science and clinical research in this field. The Journal will adopt a multidisciplinary approach to link physical, experimental, and clinical sciences as applied to the development of and practice in interventional electrophysiology. The Journal will examine techniques ranging from molecular, chemical and pharmacologic therapies to device and ablation technology. Accordingly, original research in clinical, epidemiologic and basic science arenas will be considered for publication. Applied engineering or physical science studies pertaining to interventional electrophysiology will be encouraged. The Journal is committed to providing comprehensive and detailed treatment of major interventional therapies and innovative techniques in a structured and clinically relevant manner. It is directed at clinical practitioners and investigators in the rapidly growing field of interventional electrophysiology. The editorial staff and board reflect this bias and include noted international experts in this area with a wealth of expertise in basic and clinical investigation. Peer review of all submissions, conflict of interest guidelines and periodic editorial board review of all Journal policies have been established.