Impact on long-term cardiovascular outcomes of different cardiac resynchronization therapy response criteria
Introduction: There is a lack of consensus on the definition of response to cardiac resynchronization therapy (CRT), and it is not clear which response criteria have most influence on cardiac event-free survival. Objectives: To assess the predictive value of various response criteria in patients und...
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Elsevier
2018-12-01
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Series: | Revista Portuguesa de Cardiologia (English Edition) |
Online Access: | http://www.sciencedirect.com/science/article/pii/S2174204918304185 |
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language |
English |
format |
Article |
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DOAJ |
author |
Inês Rodrigues Ana Abreu Mário Oliveira Pedro S. Cunha Helena Santa Clara Paulo Osório Ana Lousinha Bruno Valente Guilherme Portugal Pedro Rio Luís A. Morais Vanessa Santos Miguel M. Carmo Rui C. Ferreira |
spellingShingle |
Inês Rodrigues Ana Abreu Mário Oliveira Pedro S. Cunha Helena Santa Clara Paulo Osório Ana Lousinha Bruno Valente Guilherme Portugal Pedro Rio Luís A. Morais Vanessa Santos Miguel M. Carmo Rui C. Ferreira Impact on long-term cardiovascular outcomes of different cardiac resynchronization therapy response criteria Revista Portuguesa de Cardiologia (English Edition) |
author_facet |
Inês Rodrigues Ana Abreu Mário Oliveira Pedro S. Cunha Helena Santa Clara Paulo Osório Ana Lousinha Bruno Valente Guilherme Portugal Pedro Rio Luís A. Morais Vanessa Santos Miguel M. Carmo Rui C. Ferreira |
author_sort |
Inês Rodrigues |
title |
Impact on long-term cardiovascular outcomes of different cardiac resynchronization therapy response criteria |
title_short |
Impact on long-term cardiovascular outcomes of different cardiac resynchronization therapy response criteria |
title_full |
Impact on long-term cardiovascular outcomes of different cardiac resynchronization therapy response criteria |
title_fullStr |
Impact on long-term cardiovascular outcomes of different cardiac resynchronization therapy response criteria |
title_full_unstemmed |
Impact on long-term cardiovascular outcomes of different cardiac resynchronization therapy response criteria |
title_sort |
impact on long-term cardiovascular outcomes of different cardiac resynchronization therapy response criteria |
publisher |
Elsevier |
series |
Revista Portuguesa de Cardiologia (English Edition) |
issn |
2174-2049 |
publishDate |
2018-12-01 |
description |
Introduction: There is a lack of consensus on the definition of response to cardiac resynchronization therapy (CRT), and it is not clear which response criteria have most influence on cardiac event-free survival. Objectives: To assess the predictive value of various response criteria in patients undergoing CRT and the agreement between them. Methods: We performed a secondary analysis of the BETTER-HF trial. Patient response was classified at six months after CRT according to eleven criteria used in previous trials. The predictive value of response criteria for survival free from mortality, cardiac transplantation and heart failure hospitalization was assessed by Cox regression analysis. Agreement between the different response criteria was assessed using Cohen's kappa (κ). Results: A total of 115 patients were followed for a mean of 25 months. During follow-up, 15 deaths occurred (13%) and 29 patients had at least one adverse cardiac event (25%). Only five of the eleven response criteria were predictors of event-free survival. The most powerful isolated clinical and echocardiographic predictors were a reduction of ≥1 NYHA functional class (HR 0.39 for responders; 95% CI 0.18-0.83, p=0.014) and an increase of at least 15% in left ventricular ejection fraction (HR 0.43, 95% CI 0.20-0.90, p=0.024), respectively. Agreement between the different response criteria was poor. Conclusions: Most currently used response criteria do not predict clinical outcomes and have poor agreement. It is essential to establish a consensus on the definition of CRT response in order to standardize studies. Resumo: Introdução: Não existe consenso na definição de respondedor à ressincronização cardíaca (TRC), e desconhece-se qual o critério de resposta que poderá ter maior influência na sobrevida livre de eventos cardíacos. Objectivos: Avaliar o valor preditivo de vários critérios de resposta em doentes submetidos à TRC, e analisar a concordância entre eles. Métodos: Subanálise do ensaio BETTER-HF. Os doentes foram classificados aos seis meses após TRC em respondedores, de acordo com onze critérios utilizados na literatura. O valor preditivo dos diferentes critérios de resposta para uma sobrevida livre de morte, transplante cardíaco e hospitalização por insuficiência cardíaca foi avaliado usando a regressão de Cox. A concordância entre os diferentes critérios foi avaliada usando o coeficiente k de Cohen. Resultados: 115 doentes foram seguidos durante um período médio de 25 meses. Durante o follow-up ocorreram 15 mortes (13%) e 29 doentes tiveram, pelo menos, um evento cardíaco adverso (25%). Apenas cinco dos onze critérios de resposta foram preditores de sobrevida livre de eventos. Os preditores clínicos e ecocardiográficos isolados mais poderosos foram a redução de, pelo menos, uma classe funcional de NYHA (HR 0,39; IC 95% 0,18-0,83, p=0,014) e um aumento de, pelo menos, 15% na fração de ejeção ventricular esquerda (FEVE) (HR 0,43; IC 95% 0,20-0,90, p=0,024), respetivamente. A concordância entre os diferentes critérios de resposta foi fraca. Conclusão: A maioria dos critérios de resposta utilizados não prevê outcomes clínicos e têm fraca concordância. É essencial criar um consenso na definição de resposta à TRC de forma a uniformizar os estudos. Keywords: Cardiac resynchronization therapy, Heart failure, Predictors of events, Response criteria, Palavras-chave: Terapia de ressincronização cardíaca, Insuficiência cardíaca, Preditores de eventos, Critérios de resposta |
url |
http://www.sciencedirect.com/science/article/pii/S2174204918304185 |
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doaj-13eab4a8ef72445d933aa0ded3a3ca182020-11-25T01:30:40ZengElsevierRevista Portuguesa de Cardiologia (English Edition)2174-20492018-12-013712961969Impact on long-term cardiovascular outcomes of different cardiac resynchronization therapy response criteriaInês Rodrigues0Ana Abreu1Mário Oliveira2Pedro S. Cunha3Helena Santa Clara4Paulo Osório5Ana Lousinha6Bruno Valente7Guilherme Portugal8Pedro Rio9Luís A. Morais10Vanessa Santos11Miguel M. Carmo12Rui C. Ferreira13Cardiology Department, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, Portugal; Corresponding author.Cardiology Department, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, PortugalCardiology Department, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, PortugalCardiology Department, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, PortugalExercise and Health Laboratory, CIPER, Faculty of Human Kinetics, University of Lisbon, Lisbon, PortugalCardiology Department, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, PortugalCardiology Department, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, PortugalCardiology Department, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, PortugalCardiology Department, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, PortugalCardiology Department, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, PortugalCardiology Department, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, PortugalExercise and Health Laboratory, CIPER, Faculty of Human Kinetics, University of Lisbon, Lisbon, PortugalCardiology Department, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, PortugalCardiology Department, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, PortugalIntroduction: There is a lack of consensus on the definition of response to cardiac resynchronization therapy (CRT), and it is not clear which response criteria have most influence on cardiac event-free survival. Objectives: To assess the predictive value of various response criteria in patients undergoing CRT and the agreement between them. Methods: We performed a secondary analysis of the BETTER-HF trial. Patient response was classified at six months after CRT according to eleven criteria used in previous trials. The predictive value of response criteria for survival free from mortality, cardiac transplantation and heart failure hospitalization was assessed by Cox regression analysis. Agreement between the different response criteria was assessed using Cohen's kappa (κ). Results: A total of 115 patients were followed for a mean of 25 months. During follow-up, 15 deaths occurred (13%) and 29 patients had at least one adverse cardiac event (25%). Only five of the eleven response criteria were predictors of event-free survival. The most powerful isolated clinical and echocardiographic predictors were a reduction of ≥1 NYHA functional class (HR 0.39 for responders; 95% CI 0.18-0.83, p=0.014) and an increase of at least 15% in left ventricular ejection fraction (HR 0.43, 95% CI 0.20-0.90, p=0.024), respectively. Agreement between the different response criteria was poor. Conclusions: Most currently used response criteria do not predict clinical outcomes and have poor agreement. It is essential to establish a consensus on the definition of CRT response in order to standardize studies. Resumo: Introdução: Não existe consenso na definição de respondedor à ressincronização cardíaca (TRC), e desconhece-se qual o critério de resposta que poderá ter maior influência na sobrevida livre de eventos cardíacos. Objectivos: Avaliar o valor preditivo de vários critérios de resposta em doentes submetidos à TRC, e analisar a concordância entre eles. Métodos: Subanálise do ensaio BETTER-HF. Os doentes foram classificados aos seis meses após TRC em respondedores, de acordo com onze critérios utilizados na literatura. O valor preditivo dos diferentes critérios de resposta para uma sobrevida livre de morte, transplante cardíaco e hospitalização por insuficiência cardíaca foi avaliado usando a regressão de Cox. A concordância entre os diferentes critérios foi avaliada usando o coeficiente k de Cohen. Resultados: 115 doentes foram seguidos durante um período médio de 25 meses. Durante o follow-up ocorreram 15 mortes (13%) e 29 doentes tiveram, pelo menos, um evento cardíaco adverso (25%). Apenas cinco dos onze critérios de resposta foram preditores de sobrevida livre de eventos. Os preditores clínicos e ecocardiográficos isolados mais poderosos foram a redução de, pelo menos, uma classe funcional de NYHA (HR 0,39; IC 95% 0,18-0,83, p=0,014) e um aumento de, pelo menos, 15% na fração de ejeção ventricular esquerda (FEVE) (HR 0,43; IC 95% 0,20-0,90, p=0,024), respetivamente. A concordância entre os diferentes critérios de resposta foi fraca. Conclusão: A maioria dos critérios de resposta utilizados não prevê outcomes clínicos e têm fraca concordância. É essencial criar um consenso na definição de resposta à TRC de forma a uniformizar os estudos. Keywords: Cardiac resynchronization therapy, Heart failure, Predictors of events, Response criteria, Palavras-chave: Terapia de ressincronização cardíaca, Insuficiência cardíaca, Preditores de eventos, Critérios de respostahttp://www.sciencedirect.com/science/article/pii/S2174204918304185 |