Structural and functional characteristics of the heart before and after CRT in patients with heart failure

Bagdat Akhyt 1, Roza Kuanyshbekova 1, Kurmangazy Madaliyev 1, Aisulu Mussagaliyeva 1, Kulzida Koshumbayeva 1, Assel Issabekova 1, Kuralay Atageldiyeva 2 *
More Detail
1 Department of Arrhythmology and Cardiology, Research Institute of Cardiology and Internal diseases, Almaty, Kazakhstan
2 Department of Medicine, School of Medicine, Nazarbayev University, Nur-Sultan, Kazakhstan
* Corresponding Author
J CLIN MED KAZ, Volume 19, Issue 4, pp. 44-47. https://doi.org/10.23950/jcmk/12324
OPEN ACCESS 949 Views 618 Downloads
Download Full Text (PDF)

ABSTRACT

Abstract: The aim of the study was to evaluate the clinical and hemodynamic effects of resynchronization therapy in patients with congestive heart failure.
Materials and methods: Seventy-six consecutive patients underwent echocardiography, NYHA classification, 6-minute walk test and clinical assessment scale modified by Mareev, before and after cardiac resynchronization therapy. All had complete left bundle branch block, with a QRS complex duration ≥ 130 ms. and left ventricular ejection fraction ≤ 35%. Also, all patients had received optimal medical therapy for at least 3 months before inclusion to the study.
Results: We observed significant increase in left ventricular ejection fraction (35.4±3.7%, p < 0.001, compared with baseline) and decrease in end-systolic volume of the left ventricle (20.2 ±3.0 %, p < 0.001 compared with baseline). Improvement in functional class of congestive heart failure by NYHA classification by > 1 was observed in 68.4% of individuals, in 26.3% of participants demonstrated no change and 5.3% of patients had worsening of CHF symptoms.
Conclusions: The response of patients with congestive heart failure to cardiac resynchronization therapy is heterogeneous. The relationship between left ventricular reverse remodeling and the functional class of the congestive heart failure was not significant.
Key words: congestive heart failure, cardiac resynchronizing therapy, optimal drug therapy.
Keywords: congestive heart failure, cardiac resynchronizing therapy, optimal drug therapy

CITATION

Akhyt B, Kuanyshbekova R, Madaliyev K, Mussagaliyeva A, Koshumbayeva K, Issabekova A, et al. Structural and functional characteristics of the heart before and after CRT in patients with heart failure. J CLIN MED KAZ. 2022;19(4):44-7. https://doi.org/10.23950/jcmk/12324

REFERENCES

  • Fomin I.V. Epidemiology of heart failure in Russian Federation (in Russian). Chronic heart failure, M: GEOTAR - Media, 2010, pages 7-77
  • Daneilyan M.O. Prognosis and treatment of chronic heart failure: results of 20 year follow-up (paper in Russian) Autoreferat dys.cand.med.sciences. M., 2001
  • Mosterd, A. Clinical epidemiology of heart failure. Heart. 2007; 93:1137-1146. https://doi.org/10.1136/hrt.2003.025270
  • Kiyutina M.V., Gordeev I.G., Samoilenko I.V., etc., Cardiac resynchronizing therapy : some pathophysiologic aspects of dyssynchrony and hemodynamic changes [in Russian]. Rossiyskiy cardiologicheski journal. 2012; 94(2):79-84.
  • M. Rivero - Ayerza et al. Effects of cardiac resynchronization therapy on all - cause mortality, mode of death and heart failure hospitalizations. A meta - analysis of randomized controlled trials. / Eur. Heart J. 2006; 27. Abstract Suppl. 608.
  • Sapelnikov O.V., Altypov R.S., Grishin I.R., et all., Anti-tachycardic and resynchronization devices in the treatment of chronic heart failure and prophylaxis of sudden cardiac death [in Russsian]. Kardiologia. 2011; 51(9):60-67.
  • Jorsal A, Pryds K, McMurray JJV, Wiggers H, Sommer A, Nielsen JC, Nielsen RR. Optimizing heart failure treatment following cardiac resynchronization therapy. Clin Res Cardiol. 2019; 109:638-645. https://doi.org/10.1007/s00392-019-01553-4
  • National Institute for Health and Clinical Excellence, 2014. Implantable cardioverter defibrillators and cardiac resynchronization therapy for arrhythmias and heart failure (review of TA95 and TA120). Available from: guidance.nice.org.uk/ta314 [accessed 14 July 201].
  • National recommendations on diagnostics and treatment of chronic heart failure of Heart failure society of Russia (fourth edition) [in Russian], Serdechnaya nedostatochnost. 2013; 14(7):377-472.
  • Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification: a report from the American society of echocardiography's guidelines and standards committee and the chamber quantification writing group, developed in conjunction copyright with the European association of echocardiography, a branch of the European society of cardiology. J Am Soc Echocardiogr. 2005;18:1440-63. https://doi.org/10.1016/j.echo.2005.10.005
  • Van't Sant J, Mast TP, Bos MM, ter Horst IA, van Everdingen WM, Meine M, Cramer MJ. Echo response and clinical outcome in CRT patients. Neth Heart J. 2016; 24(1):47-55. https://doi.org/10.1007/s12471-015-0767-5
  • Ypenburg C, van Bommel RJ, Borleffs CJ, Bleeker GB, Boersma E, Schalij MJ, Bax JJ. Long-term prognosis after cardiac resynchronization therapy is related to the extent of left ventricular reverse remodeling at midterm follow-up. J Am Coll Cardiol. 2009; 53:483–90. https://doi.org/10.1016/j.jacc.2008.10.032
  • Dhesi S., Lockwood E., Sandhu R.K. Troubleshooting Cardiac Resynchronization Therapy in Non-responders. Canad. J. Cardiol. 2017. https://doi.org/10.1016/j.cjca.2017.04.007
  • Ismail A.M.Z. et al. Responders vs Non-responders to Cardiac Resynchronization Therapy: a review article. Heart Science Journal. 2020; 1(2):3-10. https://doi.org/10.21776/ub.hsj.2020.001.02.2
  • Bradley DJ, Bradley EA, Baughman KL, Berger RD, Calkins H, Goodman SN et al. Cardiac Resynchronization and Death From Progressive Heart Failure: A Meta-analysis of Randomized Controlled Trials. JAMA. 2003; 289(6):730-40. https://doi.org/10.1001/jama.289.6.730
  • Cleland JGF, Daubert JC, Erdmann E. et al. The CARE-HF study (Cardiac REsynchronisation in Heart Failure study): rationale, design and end-points. European Journal of Heart Failure. 2001;3(4):481-9. https://doi.org/10.1016/S1388-9842(01)00176-3
  • Khan FZ, Salahshouri P, Duehmke R, et al. The impact of the right ventricular lead position on response to cardiac resynchronization therapy. Pacing Clin Electrophysiol. 2011; 34:467-474. https://doi.org/10.1111/j.1540-8159.2010.02995.x
  • Leyva F, Foley PW, Chalil S, et al. Female gender is associated with a better outcome after cardiac resynchronization therapy. Pacing Clin Electrophysiol 2011; 34:82-88. https://doi.org/10.1111/j.1540-8159.2010.02909.x
  • Muto C, Gasparini M, Neja CP, et al. Presence of left ventricular contractile reserve predicts midterm response to cardiac resynchronization therapy - results from the LOw dose DObutamine stress-echo test in Cardiac Resynchronization Therapy (LODO - CRT) trial. Heart Rhythm. 2010; 7:1600-1605. https://doi.org/10.1016/j.hrthm.2010.07.036
  • Fornwalt BK, Sprague WW, BeDell P, Suever JD, Gerritse B, Merlino JD et al. Agreement Is Poor Among Current Criteria Used to Define Response to Cardiac Resynchronization Therapy. Circulation. 2010; 121(18):1985-91. https://doi.org/10.1161/CIRCULATIONAHA.109.910778
  • Kuznetsov V.A., Yenina T.N., SoldatovevA.M., et all. Multi-marker assessment of efficacy of the cardiac resynchronization therapy in patients with sinus rhythm. Vestnik aritmologii, 2020; 99(1):21-29; https://doi.org/10.35336/VA-2020-1-21-29
  • Mitrophanova S.A., Sokolov A.A., Antonchenko I.V. et all. Vestnik aritmologii. 2007; 50:16-20.