bluuebunny/crossref_metadata_2025_split huggingface dataset:
What determines who gets cardiac resynchronization therapy in europe?
Authors: Gatti P , Thorvaldsen T , Benson L , Normand C , Savarese G , Dahlstrom U , Maggioni A , Lund L H , Linde C , Dickstein K 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Supported by Swedish Heart and Lung foundation and Stockholm County Council.

Background/Introduction
Cardiac resynchronization therapy (CRT) is a valuable treatment in selected patients with heart failure (HF) but is still underutilized.

Aim
We compared three informative data sources, which enrolled patients with HF at different organization setting and identified clinical, organizational, and level of care factors linked to CRT implantation in these cohorts.

Methods
Data from three large cohorts of patients with HF were compared. Patients with HF with reduced ejection fraction (HFrEF) in an ESC HF-Long Term Registry (ESC-HF-LT, n=25,621), a National HF Registry - Swede HF (n=156,621) and in the ESC-CRT Survey II (n=11088, all receiving CRT across 42 ESC countries), contributed data to the analysis. The ESC Survey II recruited patients at implanting centers, ESC-HF-LT at HF centers, whereas SwedeHF enrolled HF patients at different levels of care. Firstly, we compared patient characteristics, socio-economic and organizational factors between cohorts as well as between overlapping countries participating both in CRT Survey II and ESC HF LT. Secondly, we identified independent predictors of CRT use in the two registries using multivariable logistic regressions.

Results
Of the 1031 patients in ESC-HF-LT and the 5008 patients in Swede-HF, CRT was not used in 53-75 % of guideline- indicated patients. Women constituted 22% and median age ranged between 68-72 years. Guideline Directed Medical Therapy (GDMT), atrial fibrillation, previous myocardial infarction (SwedeHF) and HF hospitalization (ESC-HF-LT) was associated with more CRT use as was enrollment at university hospital and follow-up at HF center/Hospital. In Swede-HF above median income and higher education level were also independently associated with use of CRT. In the ESC-CRT Survey II (n=11.088) all patients received CRT with differences in the clinical indications between countries.

Conclusion(s)
CRT is an important treatment option for eligible patients with HF, which is still largely underused. The findings reported demonstrate that awareness of CRT indications as well as demographics, organizational and economic factors play an important role in CRT utilization.
Correction of dyssynchrony by conduction system pacing: results of LEVEL-AT trial
Authors: Pujol-Lopez M , Garcia-Ribas C , Jimenez-Arjona R , Borras R , Garre P , Guasch E , Ferro E , Niebla M , Guichard J B , Porta-Sanchez A , Roca-Luque I , Sitges M , Tolosana J M , Doltra A , Mont L 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Catalan Society of Cardiology; Asociación del Ritmo Cardiaco (Spanish Society of Cardiology).

Background
Correction of dyssynchrony measured with echo strain, in conduction system pacing (CSP) vs biventricular pacing (BIVP) has not been reported.

Objectives
Our purpose was to compare echocardiographic dyssynchrony correction and strain improvement during follow-up between CSP and BIVP.

Methods
A treatment received analysis was performed in patients (n=29 CSP; BIVP 40). Patients were evaluated at baseline (ON and OFF programming) and at 6 and 12 months. All echocardiograms were completed by operators blinded to the type of device implanted. Intraventricular (septal flash), interventricular (difference between left and right ventricular outflow times), and auriculoventricular (diastolic filling time) dyssynchrony, as well as strain parameters (septal rebound, global longitudinal strain (GLS), and Risum pattern (typical left bundle branch block contraction pattern)) were analyzed.

Results
32% (22/69) were women; baseline LVEF was 27.5% (7% SD) and left ventricular end-systolic volume (LVESV) 138ml (77ml SD) without differences between groups. At the 12-month follow-up, there were no differences in CSP vs. BIVP in LVEF (45.8% (10% SD) vs. 42.7% (12% SD), p=0.25) and LVESV (81.5 ml (41 ml SD) vs. 101.7 ml (56 ml SD), p=0.08).
Longitudinal analyses showed that the improvement of all echocardiographic dyssynchrony parameters over time was similar between groups (p&lt;0.001) (Table 1 and Fig 1A). GLS acute correction significantly correlated with LVEF and LVESV at the 12-month follow-up (Fig 1B).

Conclusions
CSP and BIVP provided a similar dyssynchrony and strain correction over time. Acute strain correction predicted ventricular remodeling at 12 months follow-up.
Long-term outcome in patients with heart failure and diabetes mellitus treated with cardiac resynchronization therapy
Authors: Jedrzejczyk-Patej E , Mazurek M , Kotalczyk A , Gumprecht J , Lenarczyk R , Sokal A , Pruszkowska P , Szulik M , Kowalski O , Sredniawa B , Kalarus Z 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiac resynchronization therapy (CRT) is a proven therapy in patients with heart failure (HF) with reduced left ventricular ejection fraction (LVEF). However, little is known about the long-term prognosis and the risk of cardiac device-related infective endocarditis (CDRIE) in patients with HF and diabetes mellitus (DM) treated with CRT.

Aim
To assess the long-term outcomes, mortality predictors, and the risk of CDRIE in patients with HF and DM undergoing CRT.

Methods
Study population consisted of 1059 consecutive patients with CRT implanted between 2002 and 2019 in a tertiary care university hospital in a densely inhabited, urban region of Poland (949 subjects [89.6%] with CRT-D; 110 patients with CRT-P [10.4%]; 832 men [78.6%]). Population was divided into DM and control group (without DM); n=367 (34.7%) vs. n=692 (65.3%), respectively.

Results
During the median follow-up of 1661 days (10th and 90th percentile: 323-3995), all-cause mortality in DM group was significantly higher than in control group (61.9% vs. 50.3%, P=0.0003; Figure 1). The risk of CDRIE was 6.5% vs. 4.9% respectively in both groups (P=0.27). On multivariable regression analysis, older age (HR 1.03, 95%CI 1.01-1.05, P&lt;0.001), ischemic cardiomyopathy (HR 1.60, 95%CI 1.18-2.19, P=0.003), lower left ventricular ejection fraction (HR 0.96, 95%CI 0.94-0.99, P=0.002), higher creatinine level (HR 1.004, 95%CI 1.001-1.006, P=0.001), and diabetes treated with insulin (HR 1.56, 95%CI 1.19-2.05, P=0.001) were identified as independent predictors of higher mortality in patients with DM undergoing CRT impantation.

Conclusions
Compared with patients without diabetes, mortality rates of those with DM treated with CRT implantation are significantly higher and nearly 2/3 of patients die within 4.5 years. Advanced age, ischemic cardiomyopathy, lower left ventricular ejection fraction, higher creatinine level, and diabetes treated with insulin are independent mortality predictors in subjects with HF and DM treated with cardiac resynchronization therapy.
Figure 1. Kaplan-Meier curves for survival of patients with and without diabetes mellitus (DM) treated with cardiac resynchronization therapy (log rank P&lt;0.001)
Cardiac resynchronization therapy guided by activation mapping in non-left bundle branch block patients
Authors: Quesada Ocete F J , Vallejo Yuste A , Rojas Escriva B , Quesada Ocete B , Cervero Rubio A , Jimenez Bello J , Palanca Gil V , Luengo Perez S , Llopis Gisbert G , Perez Bosca J L , Cubillos Arango A , Moruno Benita M A , Gradoli Palmero J , Paya Serrano R , Quesada Dorador A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Various studies have questioned the magnitude of the benefit of cardiac resynchronization therapy (CRT) in patients without left bundle branch block (LBBB). This worse response could be due to the suboptimal location of the electrodes.

Purpose
We hypothesize that in non-LBBB patients, an implant guided by ventricular electroanatomic mapping by locating the areas with the greatest activation delay will improve the outcome of CRT.

Material and methods
We included 7 patients non-LBBB. To locate the most delayed activation zones, an electromagnetic activation map was created using the Ensite Precision navigator connected to the right ventricular catheter and to a guidewire with electrical recording capacity at its distal end. ECG, clinical, and echocardiographic data were recorded at baseline and post-implantation, compared with 7 patients LBBB (control group).

Results
In non-LBBB patients, several activation patterns could be defined according to the conduction disorder, including right bundle branch block (RBBB)+left anterior hemiblock (figure 1A) or RBBB alone (figure 1B). All patients with non-LBBB improved at follow-up in the NYHA functional class (p=0,011) and in the Minnesota test (7,85±4,63; p=0.004). The mean reduction in QRS duration was 14,57±9,86 ms (p=0.008), LVEF increased 8.22±4.62 ms (p=0.003), LVOTS decreased by 15,71±12,23 ml (p=0.015) and the LVEDV in 10,42±5,15 ml (p=0.002). There were no significant differences between the response to CTR in non-LBBB patients and LBBB patients (table 1), including LVEF (8.22±4.62 vs 11.54±5.54, p=0.248) and difference in Minnesota test (7.85±4.63 vs 9.71±5.87, p=0.524).

Conclusions
CRT guided by electroanatomical mapping produced significant clinical and structural improvement in non-LBBB patients. This improvement was of a similar magnitude to LBBB patients. Various patterns of ventricular activation according to the conduction disorder were observed.
Changes in myocardial perfusion according to left ventricular pacing site in cardiac resynchronization therapy
Authors: Stephansen C , Sommer A , Kronborg M , Jensen J M , Noergaard B L , Gerdes C , Kristensen J , Jensen H K , Fyenbo D , Tolbod L P , Bouchelouche K , Nielsen J C 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): 1. The Danish Heart Foundation
2. The Health Research Fund of the Central Denmark Region

Background/Introduction
Changes in left ventricular (LV) myocardial perfusion according to LV pacing site during cardiac resynchronization therapy (CRT) has only been sparsely described.

Purpose
To assess changes in LV global and regional myocardial perfusion according to LV pacing site after six months CRT.

Methods
Data from patients enrolled in the randomized controlled trial "Electrically vs. Imaging-guided Left Ventricular Lead Placement in Cardiac Resynchronization Therapy" was evaluated.
Global and segmental absolute myocardial perfusion in ml/g/min was assessed by 82Rb-PET the day before CRT implantation and at six-months follow-up (6MFU). The exact LV pacing site was determined by post-implant cardiac CT. Perfusion and pacing site were evaluated using the standard 17’-segment LV model. Echocardiographic assessment of LV ejection fraction (EF) was performed the day before CRT implantation and at 6MFU.

Results
93 patients (age 71±9 years; ischemic heart disease 48%; female 25%; median QRS 166±20 ms; mean LVEF 30±7%; NYHA class I/II/III/IV (%) 0/63/33/3) were included.
Distribution of LV pacing sites is shown in Figure 1.
No change in LV global perfusion was observed from baseline to 6MFU (0.79 to 0.81 ml/g/min, P=0.41; respectively).
LV EF increased by 9±10%. Baseline global perfusion was higher in the 39 patients in whom LV EF had increased ≥10% at 6MFU (0.86 vs. 0.74 ml/g/min, P=0.02; respectively). However, no difference in perfusion-change was observed between patients with ≥10% increase in LV EF at 6MFU and patients with &lt;10% increase (0.01 vs. 0.02 ml/g/min, P=0.76; respectively).
Baseline perfusion was higher in the segments chosen for LV-pacing than in the non-paced segments (0.96 vs. 0.78 ml/g/min, P=0.00; respectively). Perfusion in the paced segments dropped to 0.86 ml/g/min (P=0.00) at 6MFU. Perfusion in the neighbouring segments also dropped during six months (from 0.91 to 0.86 ml/g/min, P=0.03), while perfusion in the non-paced and non-neighbouring segments increased (from 0.75 to 0.80 ml/g/min, P=0.01).

Conclusion
Despite a mean increase in LV EF of 9%, global myocardial perfusion remained unchanged. CRT resulted in a homogenous distribution of myocardial perfusion with a decreased perfusion in segments concordant and adjacent to LV pacing site and a corresponding increased perfusion in remote segments.
The effect of Remote Monitor vs Standard of Care therapy on outcome A systematic review and meta-analysis
Authors: Veres B , Kiss B , Fehervari P , Engh M , Kuthi L , Schwertner W , Behon A , Richard M , Merkel E D , Hegyi P , Zima E , Merkely B , Kosztin A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Project no. RRF-2.3.1-21-2022-00004 (MILAB) has been implemented with the support provided by the European Union.

Background
Remote monitoring (RM) in heart failure (HF) patients with cardiac implantable electronic devices (CIED) is a reliable approach to strictly following the device-specific and heart failure-related parameters. Despite a few positive outcome data, results are incomprehensive.

Aims
We aimed to assess the benefit of continuous RM vs. standard of care (SoC) in the reduction of all-cause mortality, heart failure hospitalization (HF), and cardiovascular-related hospitalization (CV), and inappropriate therapy.

Methods
A systematic review and meta-analysis of randomized controlled trials (RCT) testing RM vs. SoC for the management of HF patients were performed. Endpoints were all-cause mortality, CV- and HF hospitalizations and inappropriate therapy. Odds ratios (ORs) and 95% confidence intervals (CI) were calculated. CENTRAL, EMBASE and MEDLINE were searched up to 21th of December 2021. Only randomized controlled studies were included.

Results
Fourteen RCTs that enrolled a total of 8370 patients were identified to evaluate all-cause mortality, resulting in an OR 0.88 (95% CI 0.75 to 1.03). When CV - and HF hospitalizations were assessed, there were no differences between the RM group and SoC group, and the OR was 0.93 (95% CI 0.82 to 1.05) and 0.95 (95% CI 0.75 to 1.19), respectively.Moreover RM did not have an effect on the rate of inappropriate therapy, OR was 0.73. (95% CI 0.30 to 1.81).

Conclusions
RM proved to be non-inferior in reducing all-cause mortality, CV- and HF hospitalization and rate of inappropriate therapy when compared to standard of care despite of the heterogeneous study cohorts and unstandardized alert actions.
Predictive value of scar burden assessed by cardiac MRI on sudden cardiac death in cardiac resynchronization therapy patients: a systematic review and meta-analysis
Authors: Masszi R , Turan C , Sayour A , Zsigmond E , Hegyi P , Fehervari P , Kosztin A , Merkely B 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Innovation and the National Research, project no. RRF-2.3.1-21-2022-00003 and Project no. RRF-2.3.1-21-2022-00004 (MILAB) has been implemented with the support provided by the European Union.

Background
Myocardial fibrosis (MF) is associated with a higher prevalence of ventricular arrhythmias (VA) and sudden cardiac death (SCD). Late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR) can accurately evaluate the extent of MF. Clinical evidence suggests that scar assessment may help the decision of adding an implantable cardioverter defibrillator (ICD) to cardiac resynchronization therapy (CRT) to reduce the risk of VA and SCD.

Purpose
In this systematic review and meta-analysis, we collected and analyzed evidence pertaining to the association between scar burden and the risk of VA and SCD, and we evaluated the impact of appropriate device choice for CRT.

Methods
We performed a systematic literature search on MEDLINE using the PubMed, Embase, Scopus and CENTRAL databases. The target population were adults with heart failure with reduced ejection fraction who underwent CRT. The primary outcome was the association between the incidence of VA and/or SCD and scar burden assessment. Meta-analyses were performed using the META and DMETAR packages in R, using a random-effects model. The risk of bias was assessed using RoB2and the quality of evidence was evaluated using the GRADE assessment.

Results
6 eligible articles have been included in our study, with a total of 1548 patients, of whom 465, 696, and 387 have been implanted with an ICD, CRT-D, CRT-P respectively. Altogether 62,68 % of the total population were LGE-CMR positive. The proportion of appropriate ICD shock reached 15,65 % in the total population during the median follow-up time of 51,59 months. The risk of developing appropriate ICD shocks in the LGE positive population was almost 70% higher (Hazard ratio 1,69, 95% Confidence interval: 1,29- 2,21; p&lt;0,001) compared to LGE negative patients.

Conclusion
In our meta-analysis, LGE-CMR was significantly associated with appropriate device therapy and can identify a subgroup of patients with an increased risk of life-threatening VA. Based on our results performing an MRI before device implantation might be important to select the high-risk patients for SCD in the elderly with ischaemic etiology and older age.
Combination of device-detected heart failure status and sleep-disordered breathing for the prediction of atrial fibrillation occurrence
Authors: Vitali F , Bertini M , D'onofrio A , Vitulano G , Calo' L , Savarese G , Santobuono V E , Dello Russo A , Mattera A , Santoro A , Calvanese R , Arena G , Valsecchi S , Mazza A , Boriani G 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Aims
Patients with atrial fibrillation (AF) frequently experience sleep disorder breathing, and both conditions are highly prevalent in presence of heart failure (HF). We explored the association between sleep apnea (SA) and the HF status and the incidence of AF in patients with implantable defibrillators (ICD).

Methods
Data were prospectively collected from 411 consecutive HF patients with ICD. The HF status was measured by the multisensor HeartLogic Index, and the ICD-measured Respiratory Disturbance Index (RDI) was computed to identify severe SA. The endpoints were: daily AF burden of ≥5minutes, ≥6hours and ≥23hours.

Results
During a median follow-up of 26 months, the time IN-alert HF state was 13% of the total observation period, according to the HeartLogic algorithm (Index &gt;16). The RDI value was ≥30 episodes/h (severe SA) during 58% of the observation period. An AF burden of ≥5 minutes/day was documented in 139 (34%) patients, ≥6 hours/day in 89 (22%) patients, and ≥23 hours/day in 68 (17%) patients. The IN-alert HF state was independently associated with AF regardless of the daily burden threshold: hazard ratios from 2.17 for ≥5 min/day to 3.43 for ≥23 h/day (p&lt;0.01). The occurrence of severe SA was associated only with AF burden ≥5 min/day (hazard ratio 1.55 [95%CI:1.11-2.16], p=0.001). The combination of HF alert and severe SA accounted for only 6% of the follow-up period and was associated with high rates of AF occurrence (from 28 events/100 patient-years for AF burden≥5 min/day to 22 events/100 patient-years for AF burden≥23 h/day).

Conclusions
In patients with heart failure (HF) and implantable defibrillators (ICD), the occurrence of atrial fibrillation (AF) was independently associated with the worsened HF status measured by a multisensor ICD algorithm and with ICD-diagnosed severe sleep apnea (SA). The HF status was independently associated with AF regardless of the daily burden, while severe SA was mainly associated with shorter AF episodes. The coexistence of these two conditions occurs rarely but is associated with a very high rate of AF occurrence.
Novelty about pocket histology at cardiac implantable electronic device reopening procedures
Authors: Massaro G , Leone O , Valzania C , Angeletti A , Corti B , Martignani C , Diemberger I , Baldovini C , Ziacchi M , Biffi M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiac implantable electronic device (CIED) procedures, characterized by reopening of the CIED pocket, increase infectious risk. In particular, pocket adhesions’ debridement may prolong procedure time, increasing the infectious risk. Nowadays, only few data are available on pocket histology at CIED reopening procedures.

Purpose
The aim of this study was to describe CIED pocket histology in a cohort of patients undergoing CIED replacement or upgrade.

Methods
All patients undergoing CIED replacement or upgrade at our center between November 2019 and May 2020 were enrolled. Subclinical pocket infection was ruled out by physical inspection and laboratory parameters. Pocket tissue specimens from anterior and posterior pocket wall were obtained. A systematic histological analysis of capsular thickness, fibrotic tissue, neovascularization, inflammation, and calcifications was performed.

Results
30 patients (80% male) were enrolled. Mean capsular thickness of anterior and posterior wall was 0.8±0.3 mm and 1.1±0.4 mm, respectively. Subcapsular fibrosis was mild and multifocal in the anterior wall, and moderate and focal in the posterior. Neovascularization was mainly focal, and in most cases vessel remodelling involved the tunica media. Chronic inflammation was usually mild and non-granulomatous, and in a quarter of cases subacute exudative inflammation was detected in the posterior pocket wall.

Conclusion
CIED pocket is an histopathologically dynamic environment, characterized by the coexistence of a subacute foreign body response and a fibrous tissue growth, that produces a continuous remodelling due to injury-repair mechanisms. Strategies to reduce foreign body response might minimize inflammatory pocket activity, especially device encapsulation by fibrotic tissue, and simplify CIED reopening procedures. This can impact on CIED replacement or upgrade complications and infectious risk.