“Real world” experience in cardiac resynchronisation therapy at a Swiss tertiary care centre: update 2016
BACKGROUND Based on a reduction in morbidity and mortality, cardiac resynchronisation therapy (CRT) has evolved as a standard therapy for patients with advanced heart failure. OBJECTIVE To provide insight into patient demographics, safety, echocard...
| Main Authors: | , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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SMW supporting association (Trägerverein Swiss Medical Weekly SMW)
2017-04-01
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| Series: | Swiss Medical Weekly |
| Subjects: | |
| Online Access: | https://www.smw.ch/index.php/smw/article/view/2294 |
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| author | Stephan Winnik Christian Elsener Burkhardt Seifert Christoph Starck Agnes Straub Ardan M. Saguner Alexander Breitenstein Nazmi Krasniqi Markus J. Wilhelm Laurent Haegeli Firat Duru Stefano Benussi Francesco Maisano Thomas F. Lüscher Johannes Holzmeister David Hürlimann Frank Ruschitzka Jan Steffel |
| author_facet | Stephan Winnik Christian Elsener Burkhardt Seifert Christoph Starck Agnes Straub Ardan M. Saguner Alexander Breitenstein Nazmi Krasniqi Markus J. Wilhelm Laurent Haegeli Firat Duru Stefano Benussi Francesco Maisano Thomas F. Lüscher Johannes Holzmeister David Hürlimann Frank Ruschitzka Jan Steffel |
| author_sort | Stephan Winnik |
| collection | DOAJ |
| description |
BACKGROUND
Based on a reduction in morbidity and mortality, cardiac resynchronisation therapy (CRT) has evolved as a standard therapy for patients with advanced heart failure.
OBJECTIVE
To provide insight into patient demographics, safety, echocardiographic remodelling and long-term follow-up of patients treated with CRT in a “real-world” setting at a Swiss tertiary care centre.
METHODS
Patients implanted with a CRT device at the University Heart Centre Zurich between 2000 and 2015 were consecutively enrolled. Initial clinical and echocardiographic therapy response as well as long-term follow-up for mortality (defined as all-cause death, heart transplantation or ventricular assist device implantation) and hospitalisation for heart failure were assessed.
RESULTS
A total of 418 patients with a median age of 66 years at the time of CRT implantation (78% male) were enrolled. Serious peri-interventional complications (from the time of implantation up to 14 days thereafter) were rare and included systemic infections in 2.4%, pneumothorax in 3.3% and haematoma requiring revision in 2.2% of cases. Overall, the Kaplan-Meier estimate for 5-year freedom from the composite endpoint (hospitalisation for heart failure or mortality) was 55.8%; the Kaplan-Meier estimate for 5-year freedom from mortality was 64.1%. CRT was associated with a significant symptomatic improvement and left ventricular reverse remodelling.
Overall, 3.9% of patients did not respond to cardiac resynchronisation therapy (decline in left ventricular ejection fraction [LVEF] >5%), whereas 35.1% experienced neither a continued decline nor a relevant improvement of LVEF (±5%). In the remaining 61% of patients we observed an improvement in LVEF of more than 5%. Forty percent and 31% of patients were super responders, defined as an absolute LVEF improvement of ≥10% and by a relative reduction of left ventricular end-diastolic volume index by 20% or more. Super-response to CRT was associated with a significant benefit in terms of survival and rehospitalisation rates.
CONCLUSION
Our data are consistent with large multicentre trials and indicate that CRT is similarly effective in a real-world setting in Switzerland.
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| first_indexed | 2024-04-13T03:37:48Z |
| format | Article |
| id | doaj.art-166cca70251b4b3face06a933f39ea6c |
| institution | Directory Open Access Journal |
| issn | 1424-3997 |
| language | English |
| last_indexed | 2024-04-13T03:37:48Z |
| publishDate | 2017-04-01 |
| publisher | SMW supporting association (Trägerverein Swiss Medical Weekly SMW) |
| record_format | Article |
| series | Swiss Medical Weekly |
| spelling | doaj.art-166cca70251b4b3face06a933f39ea6c2022-12-22T03:04:16ZengSMW supporting association (Trägerverein Swiss Medical Weekly SMW)Swiss Medical Weekly1424-39972017-04-01147151610.4414/smw.2017.14425“Real world” experience in cardiac resynchronisation therapy at a Swiss tertiary care centre: update 2016Stephan Winnik0Christian Elsener1Burkhardt Seifert2Christoph Starck3Agnes Straub4Ardan M. Saguner5Alexander Breitenstein6Nazmi Krasniqi7Markus J. Wilhelm8Laurent Haegeli9Firat Duru10Stefano Benussi11Francesco Maisano12Thomas F. Lüscher13Johannes Holzmeister14David Hürlimann15Frank Ruschitzka16Jan Steffel17University Heart Centre Zurich, Department of Cardiology, Zurich, SwitzerlandUniversity Heart Centre Zurich, Department of Cardiology, Zurich, SwitzerlandEpidemiology, Biostatistics and Prevention Institute, University of Zurich, SwitzerlandDeutsches Herzzentrum Berlin, Charité Berlin, GermanyUniversity Heart Centre Zurich, Department of Cardiology, Zurich, SwitzerlandUniversity Heart Centre Zurich, Department of Cardiology, Zurich, SwitzerlandUniversity Heart Centre Zurich, Department of Cardiology, Zurich, SwitzerlandUniversity Heart Centre Zurich, Department of Cardiology, Zurich, SwitzerlandUniversity Heart Centre Zurich, Department of Cardiovascular Surgery, Zurich, SwitzerlandUniversity Heart Centre Zurich, Department of Cardiology, Zurich, SwitzerlandUniversity Heart Centre Zurich, Department of Cardiology, Zurich, SwitzerlandUniversity Heart Centre Zurich, Department of Cardiovascular Surgery, Zurich, SwitzerlandUniversity Heart Centre Zurich, Department of Cardiovascular Surgery, Zurich, SwitzerlandUniversity Heart Centre Zurich, Department of Cardiology, Zurich, SwitzerlandUniversity Heart Centre Zurich, Department of Cardiology, Zurich, SwitzerlandUniversity Heart Centre Zurich, Department of Cardiology, Zurich, SwitzerlandUniversity Heart Centre Zurich, Department of Cardiology, Zurich, SwitzerlandUniversity Heart Centre Zurich, Department of Cardiology, Zurich, Switzerland BACKGROUND Based on a reduction in morbidity and mortality, cardiac resynchronisation therapy (CRT) has evolved as a standard therapy for patients with advanced heart failure. OBJECTIVE To provide insight into patient demographics, safety, echocardiographic remodelling and long-term follow-up of patients treated with CRT in a “real-world” setting at a Swiss tertiary care centre. METHODS Patients implanted with a CRT device at the University Heart Centre Zurich between 2000 and 2015 were consecutively enrolled. Initial clinical and echocardiographic therapy response as well as long-term follow-up for mortality (defined as all-cause death, heart transplantation or ventricular assist device implantation) and hospitalisation for heart failure were assessed. RESULTS A total of 418 patients with a median age of 66 years at the time of CRT implantation (78% male) were enrolled. Serious peri-interventional complications (from the time of implantation up to 14 days thereafter) were rare and included systemic infections in 2.4%, pneumothorax in 3.3% and haematoma requiring revision in 2.2% of cases. Overall, the Kaplan-Meier estimate for 5-year freedom from the composite endpoint (hospitalisation for heart failure or mortality) was 55.8%; the Kaplan-Meier estimate for 5-year freedom from mortality was 64.1%. CRT was associated with a significant symptomatic improvement and left ventricular reverse remodelling. Overall, 3.9% of patients did not respond to cardiac resynchronisation therapy (decline in left ventricular ejection fraction [LVEF] >5%), whereas 35.1% experienced neither a continued decline nor a relevant improvement of LVEF (±5%). In the remaining 61% of patients we observed an improvement in LVEF of more than 5%. Forty percent and 31% of patients were super responders, defined as an absolute LVEF improvement of ≥10% and by a relative reduction of left ventricular end-diastolic volume index by 20% or more. Super-response to CRT was associated with a significant benefit in terms of survival and rehospitalisation rates. CONCLUSION Our data are consistent with large multicentre trials and indicate that CRT is similarly effective in a real-world setting in Switzerland. https://www.smw.ch/index.php/smw/article/view/2294CRTmortalityregistryreverse remodelling |
| spellingShingle | Stephan Winnik Christian Elsener Burkhardt Seifert Christoph Starck Agnes Straub Ardan M. Saguner Alexander Breitenstein Nazmi Krasniqi Markus J. Wilhelm Laurent Haegeli Firat Duru Stefano Benussi Francesco Maisano Thomas F. Lüscher Johannes Holzmeister David Hürlimann Frank Ruschitzka Jan Steffel “Real world” experience in cardiac resynchronisation therapy at a Swiss tertiary care centre: update 2016 Swiss Medical Weekly CRT mortality registry reverse remodelling |
| title | “Real world” experience in cardiac resynchronisation therapy at a Swiss tertiary care centre: update 2016 |
| title_full | “Real world” experience in cardiac resynchronisation therapy at a Swiss tertiary care centre: update 2016 |
| title_fullStr | “Real world” experience in cardiac resynchronisation therapy at a Swiss tertiary care centre: update 2016 |
| title_full_unstemmed | “Real world” experience in cardiac resynchronisation therapy at a Swiss tertiary care centre: update 2016 |
| title_short | “Real world” experience in cardiac resynchronisation therapy at a Swiss tertiary care centre: update 2016 |
| title_sort | real world experience in cardiac resynchronisation therapy at a swiss tertiary care centre update 2016 |
| topic | CRT mortality registry reverse remodelling |
| url | https://www.smw.ch/index.php/smw/article/view/2294 |
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