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  • 1
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    Lateral left ventricular lead position is superior to posterior position in long‐term outcome of patients who underwent cardiac resynchronization therapy
    Wiley ; 2020
    In:  ESC Heart Failure Vol. 7, No. 6 ( 2020-12), p. 3374-3382
    Details
    In: ESC Heart Failure, Wiley, Vol. 7, No. 6 ( 2020-12), p. 3374-3382
    Abstract: Preferring side branch of coronary sinus during cardiac resynchronization therapy (CRT) implantation has been empirical due to the limited data on the association of left ventricular (LV) lead position and long‐term clinical outcome. We evaluated the long‐term all‐cause mortality by LV lead non‐apical positions and further characterized them by interlead electrical delay (IED). Methods and results In our retrospective database, 2087 patients who underwent CRT implantation were registered between 2000 and 2018. Those with non‐apical LV lead locations were classified into anterior ( n  = 108), posterior ( n  = 643), and lateral ( n  = 1336) groups. All‐cause mortality was assessed by Kaplan–Meier and Cox analyses. Echocardiographic response was measured 6 months after CRT implantation. During the median follow‐up time of 3.7 years, 1150 (55.1%) patients died—710 (53.1%) with lateral, 78 (72.2%) with anterior, and 362 (56.3%) with posterior positions. When we investigated the risk of all‐cause mortality, there was a significantly lower rate of death in patients with lateral LV lead location when compared with those with an anterior ( P   〈  0.01) or posterior ( P   〈  0.01) position. Multivariate analysis after adjustment for relevant clinical covariates such as age, sex, ischaemic aetiology, left bundle branch block morphology, atrial fibrillation, and device type revealed consistent results that lateral position is associated with a significant risk reduction of all‐cause mortality when compared with anterior [hazard ratio 0.69; 95% confidence interval (CI) 0.55–0.87; P   〈  0.01] or posterior (hazard ratio 0.84; 95% CI 0.74–0.96; P   〈  0.01) position. When echocardiographic response was evaluated within the lateral group, patients with an IED longer than 110 ms (area under the receiver operating characteristic curve, 0.63; 95% CI 0.53–0.73; P  = 0.012) showed 2.1 times higher odds of improvement in echocardiographic response 6 months after the implantation. Conclusions In this study, we proved in a real‐world patient population that after CRT implantation, lateral LV lead location was associated with long‐term mortality benefit and is superior to both anterior and posterior positions. Moreover, patients with this position showed the greatest echocardiographic response over 110 ms IED.
    Type of Medium: Online Resource
    ISSN: 2055-5822 , 2055-5822
    URL: Issue
    URL: Article
    DOI: 10.1002/ehf2.v7.6
    DOI: 10.1002/ehf2.13066
    Language: English
    Publisher: Wiley
    Publication Date: 2020
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  • 2
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    Topological data analysis to identify cardiac resynchronization therapy patients exhibiting benefit from an implantable cardioverter-defibrillator
    Springer Science and Business Media LLC ; 2023
    In:  Clinical Research in Cardiology
    Details
    In: Clinical Research in Cardiology, Springer Science and Business Media LLC
    Abstract: Current guidelines recommend considering multiple factors while deciding between cardiac resynchronization therapy with a defibrillator (CRT-D) or a pacemaker (CRT-P). Nevertheless, it is still challenging to pinpoint those candidates who will benefit from choosing a CRT-D device in terms of survival. Objective We aimed to use topological data analysis (TDA) to identify phenogroups of CRT patients in whom CRT-D is associated with better survival than CRT-P. Methods We included 2603 patients who underwent CRT-D (54%) or CRT-P (46%) implantation at Semmelweis University between 2000 and 2018. The primary endpoint was all-cause mortality. We applied TDA to create a patient similarity network using 25 clinical features. Then, we identified multiple phenogroups in the generated network and compared the groups’ clinical characteristics and survival. Results Five- and 10-year mortality were 43 (40–46)% and 71 (67–74)% in patients with CRT-D and 48 (45–50)% and 71 (68–74)% in those with CRT-P, respectively. TDA created a circular network in which we could delineate five phenogroups showing distinct patterns of clinical characteristics and outcomes. Three phenogroups (1, 2, and 3) included almost exclusively patients with non-ischemic etiology, whereas the other two phenogroups (4 and 5) predominantly comprised ischemic patients. Interestingly, only in phenogroups 2 and 5 were CRT-D associated with better survival than CRT-P (adjusted hazard ratio 0.61 [0.47–0.80], p  〈  0.001 and adjusted hazard ratio 0.84 [0.71–0.99], p = 0.033, respectively). Conclusions By simultaneously evaluating various clinical features, TDA may identify patients with either ischemic or non-ischemic etiology who will most likely benefit from the implantation of a CRT-D instead of a CRT-P. Graphical abstract Topological data analysis to identify phenogroups of CRT patients in whom CRT-D is associated with better survival than CRT-P. AF atrial fibrillation, CRT cardiac resynchronization therapy, CRT-D cardiac resynchronization therapy defibrillator, CRT-P cardiac resynchronization therapy pacemaker, DM diabetes mellitus, HTN hypertension, LBBB left bundle branch block, LVEF left ventricular ejection fraction, MDS multidimensional scaling, MRA mineralocorticoid receptor antagonist, NYHA New York Heart Association
    Type of Medium: Online Resource
    ISSN: 1861-0684 , 1861-0692
    URL: Article
    DOI: 10.1007/s00392-023-02281-6
    RVK:
    XA 37040
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2218331-0
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  • 3
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    Az SGLT2-inhibitorok alkalmazása szívelégtelenségben szenvedő vagy nagy kardiovaszkuláris rizikóval rendelkező betegeknél – szisztematikus irodalmi áttekintés
    Cardiologia Hungarica ; 2022
    In:  Cardiologia Hungarica Vol. 52, No. 2 ( 2022), p. 142-150
    Details
    In: Cardiologia Hungarica, Cardiologia Hungarica, Vol. 52, No. 2 ( 2022), p. 142-150
    Abstract: Háttér: A szívelégtelenségben szenvedő betegek egy igen fragilis betegcsoport, akik nagy kardiovaszkuláris (KV) mortalitási rizikóval rendelkeznek. Gyógyszeres kezelésükben paradigmaváltást hozott a nátrium-glükóz-kotranszporter-2 (SGLT2) gátlók alkalmazása, mivel csökkenteni tudta a kardiovaszkuláris és szívelégtelenség események rizikóját. Módszerek: Jelen szakirodalmi összefoglalónkban azokat az SGLT2-gátlókkal végzett nagy, multicentrikus, randomizált vizsgálatokat (RCT) és metaanalíziseket gyűjtöttük össze, amelyek az összmortalitást és szívelégtelenség-hospitalizációt végpontként vizsgálták. Eredmények: A PubMed-en történt szelekciónk alapján, 12 RCT-t, valamint 3 metaanalízist vontunk be. Összesen 5 RCT vizsgálta a diabéteszes, nagy KV-rizikóval rendelkező betegeket, emellett 3 krónikus- és 3 akut szívelégtelen betegcsoportot vizsgáló RCT-t találtunk, amelyekből csupán 1 esetben volt kritérium a diabétesz jelenléte. A vizsgálatok mindegyike (canagliflozin, dapagliflozin, empagliflozin, ertugliflozin, sotagliflozin) egybehangzóan igazolta a szívelégtelenség miatti hospitalizáció rizikójának csökkenését, 27-33%-kal csökkentette a szívelégtelenség miatti kórházi kezelések kockázatát placebóval szemben. Ugyanakkor az összmortalitás tekintetében a dapagliflozin a csökkent ejekciós frakcióval rendelkező szívelégtelen betegekben diabétesztől függetlenül (HR=0,83; 95% CI: 0,71–0,97), az empagliflozin a nagy kockázatú, diabéteszes betegcsoportban (HR=0,68; 95% CI: 0,57–0,82) szignifikánsan csökkentette az események előfordulását. Mellékhatások tekintetében az SGLT2-inhibitorok biztonságosan alkalmazhatók. A renális végpontok tekintetében még kedvezőbb kimenetel várható, mivel csökkenti a vesefunkció-romlás progressziójának mértékét placebóhoz képest. Következtetés: A korábbi RCT-k eredményei alapján az SGLT2-inhibitorok effektivitása a szívelégtelenség-események rizikójának csökkenésében egybehangzóan megmutatkozott, különösen a nagy kockázatú betegcsoportokban. Ezen felül hatékonysága az összmortalitás tekintetében, valamint a vesefunkció romlásának lassabb progressziójában is látható, amellett, hogy biztonságosan alkalmazható.
    Type of Medium: Online Resource
    ISSN: 0133-5596 , 1588-0230
    URL: Article
    DOI: 10.26430/CHUNGARICA.2022.52.2.142
    Language: Unknown
    Publisher: Cardiologia Hungarica
    Publication Date: 2022
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  • 4
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    Effect of single ventricular premature contractions on response to cardiac resynchronization therapy
    Springer Science and Business Media LLC ; 2022
    In:  BMC Cardiovascular Disorders Vol. 22, No. 1 ( 2022-12)
    Details
    In: BMC Cardiovascular Disorders, Springer Science and Business Media LLC, Vol. 22, No. 1 ( 2022-12)
    Abstract: We lack data on the effect of single premature ventricular contractions (PVCs) on the clinical and echocardiographic response after cardiac resynchronization therapy (CRT) device implantation. We aimed to assess the predictive value of PVCs at early, 1 month-follow up on echocardiographic response and all-cause mortality. Methods In our prospective, single-center study, 125 heart failure patients underwent CRT implantation based on the current guidelines. Echocardiographic reverse remodeling was defined as a ≥ 15% improvement in left ventricular ejection fraction (LVEF), end-systolic volume (LVESV), or left atrial volume (LAV) measured 6 months after CRT implantation. All-cause mortality was investigated by Wilcoxon analysis. Results The median number of PVCs was 11,401 in those 67 patients who attended the 1-month follow-up. Regarding echocardiographic endpoints, patients with less PVCs develop significantly larger LAV reverse remodeling compared to those with high number of PVCs. During the mean follow-up time of 2.1 years, 26 (21%) patients died. Patients with a higher number of PVCs than our median cut-off value showed a higher risk of early all-cause mortality (HR 0.97; 95% CI 0.38–2.48; P  = 0.04). However, when patients were followed up to 9 years, its significance diminished (HR 0.78; 95% CI 0.42–1.46; P  = 0.15). Conclusions In patients undergoing CRT implantation, lower number of PVCs predicted atrial remodeling and showed a trend for a better mortality outcome. Our results suggest the importance of the early assessment of PVCs in cardiac resynchronization therapy and warrant further investigations.
    Type of Medium: Online Resource
    ISSN: 1471-2261
    URL: Article
    DOI: 10.1186/s12872-022-02725-3
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
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  • 5
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    Kardiális reszinkronizációs terápia időskorban : Szisztematikus áttekintő tanulmány
    Cardiologia Hungarica ; 2022
    In:  Cardiologia Hungarica Vol. 52, No. 3 ( 2022), p. 208-217
    Details
    In: Cardiologia Hungarica, Cardiologia Hungarica, Vol. 52, No. 3 ( 2022), p. 208-217
    Abstract: A kardiovaszkuláris megbetegedéseken belül a krónikus szívelégtelenség az egyik vezető oka az időskori morbiditásnak, mortalitásnak és hospitalizációnak. Számos randomizált, kontrollált vizsgálat (RCT) igazolta, hogy a kardiális reszinkronizációs terápia (CRT) hatékonyan csökkenti a morbiditást és a mortalitást megfelelően szelektált betegekben. Azonban a legtöbb RCT-ben az idős populáció alulreprezentált volt, ezért az idősekben kialakult, a CRT-re adott válaszkészség leírására ezen vizsgálatok kevésbé alkalmasak. Ugyanakkor a népesség elöregedésével emelkedik a szívelégtelenség prevalenciája, valamint a fejlődő terápiás lehetőségeknek köszönhetően növekszik a betegek várható élettartama, aminek következtében emelkedik az idős, 70–75 év feletti szívelégtelen betegek száma. Fontos kérdés tehát, hogy az életkor negatívan befolyásolja-e a CRT-re adott válaszkészséget. Célul tűztük ki, hogy a nemzetközi szakirodalom legfrissebb, 2000 után publikált eredményei alapján életkor szerint megvizsgáljuk a CRT effektivitását, a peri- és posztprocedurális komplikációk arányát és a hosszú távú kimenetelt. Korábbi kutatások eredményei alapján CRT-implantációt követően szignifikánsan nő a bal kamrai ejekciós frakció és hasonló a reszponderek aránya valamennyi életkorban. A peri- és posztprocedurális komplikációk tekintetében nem találtak statisztikai különbséget az egyes korcsoportokban. A hosszú távú klinikai kimenetelt illetően, statisztikailag szignifikáns növekedést írtak le az összmortalitás tekintetében az idősebb csoportokban, ami a komorbiditások növekvő prevalenciájával magyarázható. Azonban az összhalálozás vagy szívelégtelenség-esemény miatti hospitalizáció kompozit végpontját, valamint önmagában a hospitalizációt vizsgálva nem találtak különbséget az életkor szerint. Az eddigi nemzetközi publikációk eredménye alapján, megfelelő indikáció esetén a CRT életkortól függetlenül hatékony terápia. Az idős, 70–75 év feletti betegekben a reszponderitás mértéke, a szívelégtelenség miatti hospitalizáció gyakorisága, valamint a szövődmények előfordulása összevethető a fiatal korcsoportokban leírtakkal. Az időskorban jellemző komorbiditások nagyobb arányú előfordulása miatt viszont összmortalitásuk magasabb, döntően a nonkardiovaszkuláris halálozásból eredően.
    Type of Medium: Online Resource
    ISSN: 0133-5596 , 1588-0230
    URL: Article
    DOI: 10.26430/CHUNGARICA.2022.52.3.208
    Language: Unknown
    Publisher: Cardiologia Hungarica
    Publication Date: 2022
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  • 6
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    Staged Hybrid Repair of a Complex Type B Aortic Dissection
    MDPI AG ; 2022
    In:  Journal of Cardiovascular Development and Disease Vol. 9, No. 9 ( 2022-09-06), p. 297-
    Details
    In: Journal of Cardiovascular Development and Disease, MDPI AG, Vol. 9, No. 9 ( 2022-09-06), p. 297-
    Abstract: Due to its heterogeneous clinical picture and lengthy evolution, the management of type B aortic dissection represents a clinical challenge, often calling for complex strategies combining medical, endovascular, and open surgical strategies. We present the case of a 45-year-old female who had previously suffered a complicated type B aortic dissection requiring a femoro-femoral crossover bypass and further conservative treatment. Seven years later, due to an aneurysmal development, a staged descending aortic management was strategized, beginning with the implantation of a frozen elephant trunk device due to an insufficient proximal landing zone for endovascular repair. However, the development of a distal stent graft-induced new entry complicated the dissection and led to the formation of a second false lumen, thus prompting an expedited hybrid reconstruction. We describe a hybrid repair strategy tailored to the patient’s particular aortic anatomic conformation, combining ilio-visceral debranching and thoracic endovascular aortic repair. Due to a lack of consensus on the ideal management strategy for type B aortic dissection, an individualized approach conducted by an experienced aortic team may generate the best outcome. The appropriate timing and planning of the intervention are the keys to successful results in complex type B aortic dissection cases with an elaborate anatomic conformation.
    Type of Medium: Online Resource
    ISSN: 2308-3425
    URL: Article
    DOI: 10.3390/jcdd9090297
    Language: English
    Publisher: MDPI AG
    Publication Date: 2022
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  • 7
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    The Prognostic Value of Anemia in Patients with Preserved, Mildly Reduced and Recovered Ejection Fraction
    MDPI AG ; 2022
    In:  Diagnostics Vol. 12, No. 2 ( 2022-02-17), p. 517-
    Details
    In: Diagnostics, MDPI AG, Vol. 12, No. 2 ( 2022-02-17), p. 517-
    Abstract: Data on the relevance of anemia in heart failure (HF) patients with an ejection fraction (EF) 〉 40% by subgroup—preserved (HFpEF), mildly reduced (HFmrEF) and the newly defined recovered EF (HFrecEF)—are scarce. Patients with HF symptoms, elevated NT-proBNP, EF ≥ 40% and structural abnormalities were registered in the HFpEF-HFmrEF database. We described the outcome of our HFpEF-HFmrEF cohort by the presence of anemia. Additionally, HFrecEF patients were also selected from HFrEF patients who underwent resynchronization and, as responders, reached 40% EF. Using propensity score matching (PSM), 75 pairs from the HFpEF-HFmrEF and HFrecEF groups were matched by their clinical features. After PMS, we compared the survival of the HFpEF-HFmrEF and HFrecEF groups. Log-rank, uni-and multivariate regression analyses were performed. From 375 HFpEF-HFmrEF patients, 42 (11%) died during the median follow-up time of 1.4 years. Anemia (HR 2.77; 95%CI 1.47–5.23; p 〈 0.01) was one of the strongest mortality predictors, which was also confirmed by the multivariate analysis (aHR 2.33; 95%CI 1.21–4.52; p = 0.01). Through PSM, the outcomes for HFpEF-HFmrEF and HFrecEF patients with anemia were poor, exhibiting no significant difference. In HFpEF-HFmrEF, anemia was an independent mortality predictor. Its presence multiplied the mortality risk in those with EF ≥ 40%, regardless of HF etiology.
    Type of Medium: Online Resource
    ISSN: 2075-4418
    URL: Article
    DOI: 10.3390/diagnostics12020517
    Language: English
    Publisher: MDPI AG
    Publication Date: 2022
    detail.hit.zdb_id: 2662336-5
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  • 8
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    Long-term survival following upgrade compared with de novo cardiac resynchronization therapy implantation: a single-centre, high-volume experience
    Oxford University Press (OUP) ; 2021
    In:  EP Europace Vol. 23, No. 8 ( 2021-08-06), p. 1310-1318
    Details
    In: EP Europace, Oxford University Press (OUP), Vol. 23, No. 8 ( 2021-08-06), p. 1310-1318
    Abstract: Patients with a pacemaker or implantable cardioverter-defibrillator are often considered for cardiac resynchronization therapy (CRT). However, limited comprehensive data are available regarding their long-term outcomes. Methods and results Our retrospective registry included 2524 patients [1977 (78%) de novo, 547 (22%) upgrade patients] with mild to severe symptoms, left ventricular ejection fraction ≤35%, and QRS ≥ 130ms. The primary outcome was the composite of all-cause mortality, heart transplantation (HTX), or left ventricular assist device (LVAD) implantation; secondary endpoints were death from any cause and post-procedural complications. In our cohort, upgrade patients were older [71 (65–77) vs. 67 (59–73) years; P  & lt; 0.001], were less frequently females (20% vs. 27%; P = 0.002) and had more comorbidities than de novo patients. During the median follow-up time of 3.7 years, 1091 (55%) de novo and 342 (63%) upgrade patients reached the primary endpoint. In univariable analysis, upgrade patients exhibited a higher risk of mortality/HTX/LVAD than the de novo group [hazard ratio (HR): 1.41; 95% confidence interval (CI): 1.23–1.61; P  & lt; 0.001]. However, this difference disappeared after adjusting for covariates (adjusted HR: 1.12; 95% CI: 0.86–1.48; P = 0.402), or propensity score matching (propensity score-matched HR: 1.10; 95% CI: 0.95–1.29; P = 0.215). From device-related complications, lead dysfunction (3.1% vs. 1%; P  & lt; 0.001) and pocket infections (3.7% vs. 1.8%; P = 0.014) were more frequent in the upgrade group compared to de novo patients. Conclusion In our retrospective analysis, upgrade patients had a higher risk of all-cause mortality than de novo patients, which might be attributable to their more significant comorbidity burden. The occurrence of lead dysfunction and pocket infections was more frequent in the upgrade group.
    Type of Medium: Online Resource
    ISSN: 1099-5129 , 1532-2092
    URL: Article
    DOI: 10.1093/europace/euab059
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
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  • 9
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    Data_Sheet_1.docx
    Frontiers Media SA ; 2021
    In:  Frontiers in Cardiovascular Medicine Vol. 8 ( 2021-2-25)
    Details
    In: Frontiers in Cardiovascular Medicine, Frontiers Media SA, Vol. 8 ( 2021-2-25)
    Abstract: Background: The relative importance of variables explaining sex-related differences in outcomes is scarcely explored in patients undergoing cardiac resynchronization therapy (CRT). We sought to implement and evaluate machine learning (ML) algorithms for the prediction of 1- and 3-year all-cause mortality in CRT patients. We also aimed to assess the sex-specific differences in predictors of mortality utilizing ML. Methods: Using a retrospective registry of 2,191 CRT patients, ML models were implemented in 6 partially overlapping patient subsets (all patients, females, or males with 1- or 3-year follow-up). Each cohort was randomly split into training (80%) and test sets (20%). After hyperparameter tuning in the training sets, the best performing algorithm was evaluated in the test sets. Model discrimination was quantified using the area under the receiver-operating characteristic curves (AUC). The most important predictors were identified using the permutation feature importances method. Results: Conditional inference random forest exhibited the best performance with AUCs of 0.728 (0.645–0.802) and 0.732 (0.681–0.784) for the prediction of 1- and 3-year mortality, respectively. Etiology of heart failure, NYHA class, left ventricular ejection fraction, and QRS morphology had higher predictive power, whereas hemoglobin was less important in females compared to males. The importance of atrial fibrillation and age increased, while the importance of serum creatinine decreased from 1- to 3-year follow-up in both sexes. Conclusions: Using ML techniques in combination with easily obtainable clinical features, our models effectively predicted 1- and 3-year all-cause mortality in CRT patients. Sex-specific patterns of predictors were identified, showing a dynamic variation over time.
    Type of Medium: Online Resource
    ISSN: 2297-055X
    URL: Article
    URL: Article
    DOI: 10.3389/fcvm.2021.611055
    DOI: 10.3389/fcvm.2021.611055.s001
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2021
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  • 10
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    Long-term outcome of cardiac resynchronization therapy patients in the elderly
    Springer Science and Business Media LLC ; 2023
    In:  GeroScience
    Details
    In: GeroScience, Springer Science and Business Media LLC
    Abstract: Heart failure (HF) is a leading cause of mortality and hospitalization in the elderly. However, data are scarce about their response to device treatment such as cardiac resynchronization therapy (CRT). We aimed to evaluate the age-related differences in the effectiveness of CRT, procedure-related complications, and long-term outcome. Between 2000 and 2020, 2656 patients undergoing CRT implantation were registered and analyzed retrospectively. Patients were divided into 3 groups according to their age: group I,  〈  65; group II, 65–75; and group III,  〉  75 years. The primary endpoint was the echocardiographic response defined as a relative increase  〉  15% in left ventricular ejection fraction (LVEF) within 6 months, and the secondary endpoint was the composite of all-cause mortality, heart transplantation, or left ventricular assist device implantation. Procedure-related complications were also assessed. After implantation, LVEF showed significant improvement both in the total cohort [28% ( IQR 24/33) vs. 35% ( IQR 28/40); p   〈  0.01)] and in each subgroup (27% vs. 34%; p   〈  0.01, 29% vs. 35%; p   〈  0.01, 30% vs. 35%; p   〈  0.01). Response rate was similar in the 3 groups (64% vs. 62% vs. 56%; p  = 0.41). During the follow-up, 1574 (59%) patients died. Kaplan–Meier curves revealed a significantly lower survival rate in the older groups (log-rank p   〈  0.001). The cumulative complication rates were similar among the three age groups (27% vs. 28% vs. 24%; p  = 0.15). Our results demonstrate that CRT is as effective and safe therapy in the elderly as for young ones. The present data suggest that patients with appropriate indications benefit from CRT in the long term, regardless of age.
    Type of Medium: Online Resource
    ISSN: 2509-2715 , 2509-2723
    URL: Article
    DOI: 10.1007/s11357-023-00739-z
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2886418-9
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