Cardiac Magnetic Resonance, Electromechanical Activation, Kidney Function, and Natriuretic Peptides in Cardiac Resynchronization Therapy Upgrades
As the mechanism for worse prognosis after cardiac resynchronization therapy (CRT) upgrades in heart failure patients with RVP dependence (RVP-HF) has clinical implications for patient selection and CRT implementation approaches, this study’s objective was to evaluate prognostic implications of card...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-09-01
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| Series: | Journal of Cardiovascular Development and Disease |
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| Online Access: | https://www.mdpi.com/2308-3425/10/10/409 |
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| author | Derek J. Bivona Pim J. A. Oomen Yu Wang Frances L. Morales Mohamad Abdi Xu Gao Rohit Malhotra Andrew Darby Nishaki Mehta Oliver J. Monfredi J. Michael Mangrum Pamela K. Mason Wayne C. Levy Sula Mazimba Amit R. Patel Frederick H. Epstein Kenneth C. Bilchick |
| author_facet | Derek J. Bivona Pim J. A. Oomen Yu Wang Frances L. Morales Mohamad Abdi Xu Gao Rohit Malhotra Andrew Darby Nishaki Mehta Oliver J. Monfredi J. Michael Mangrum Pamela K. Mason Wayne C. Levy Sula Mazimba Amit R. Patel Frederick H. Epstein Kenneth C. Bilchick |
| author_sort | Derek J. Bivona |
| collection | DOAJ |
| description | As the mechanism for worse prognosis after cardiac resynchronization therapy (CRT) upgrades in heart failure patients with RVP dependence (RVP-HF) has clinical implications for patient selection and CRT implementation approaches, this study’s objective was to evaluate prognostic implications of cardiac magnetic resonance (CMR) findings and clinical factors in 102 HF patients (23.5% female, median age 66.5 years old, median follow-up 4.8 years) with and without RVP dependence undergoing upgrade and de novo CRT implants. Compared with other CRT groups, RVP-HF patients had decreased survival (<i>p</i> = 0.02), more anterior late-activated LV pacing sites (<i>p</i> = 0.002) by CMR, more atrial fibrillation (<i>p</i> = 0.0006), and higher creatinine (0.002). CMR activation timing at the LV pacing site predicted post-CRT LV functional improvement (<i>p</i> < 0.05), and mechanical activation onset < 34 ms by CMR at the LVP site was associated with decreased post-CRT survival in a model with higher pre-CRT creatinine and B-type natriuretic peptide (AUC 0.89; <i>p</i> < 0.0001); however, only the higher pre-CRT creatinine partially mediated (37%) the decreased survival in RVP-HF patients. In conclusion, RVP-HF had a distinct CMR phenotype, which has important implications for the selection of LV pacing sites in CRT upgrades, and only chronic kidney disease mediated the decreased survival after CRT in RVP-HF. |
| first_indexed | 2024-03-10T21:11:01Z |
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| id | doaj.art-a09e9bd021f043698a5ec59b8a2f08c4 |
| institution | Directory Open Access Journal |
| issn | 2308-3425 |
| language | English |
| last_indexed | 2024-03-10T21:11:01Z |
| publishDate | 2023-09-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Cardiovascular Development and Disease |
| spelling | doaj.art-a09e9bd021f043698a5ec59b8a2f08c42023-11-19T16:50:33ZengMDPI AGJournal of Cardiovascular Development and Disease2308-34252023-09-01101040910.3390/jcdd10100409Cardiac Magnetic Resonance, Electromechanical Activation, Kidney Function, and Natriuretic Peptides in Cardiac Resynchronization Therapy UpgradesDerek J. Bivona0Pim J. A. Oomen1Yu Wang2Frances L. Morales3Mohamad Abdi4Xu Gao5Rohit Malhotra6Andrew Darby7Nishaki Mehta8Oliver J. Monfredi9J. Michael Mangrum10Pamela K. Mason11Wayne C. Levy12Sula Mazimba13Amit R. Patel14Frederick H. Epstein15Kenneth C. Bilchick16Department of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA 22908, USADepartment of Biomedical Engineering, University of California Irvine, Irvine, CA 92617, USADepartment of Biomedical Engineering, University of Virginia Health System, Charlottesville, VA 22908, USADepartment of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA 22908, USADepartment of Biomedical Engineering, University of Virginia Health System, Charlottesville, VA 22908, USADepartment of Medicine, Northwestern University, Chicago, IL 60611, USADepartment of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA 22908, USADepartment of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA 22908, USADepartment of Medicine, William Beaumont Oakland University School of Medicine, Royal Oak, MI 48309, USADepartment of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA 22908, USADepartment of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA 22908, USADepartment of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA 22908, USADepartment of Medicine, University of Washington, Seattle, WA 98195, USADepartment of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA 22908, USADepartment of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA 22908, USADepartment of Biomedical Engineering, University of Virginia Health System, Charlottesville, VA 22908, USADepartment of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA 22908, USAAs the mechanism for worse prognosis after cardiac resynchronization therapy (CRT) upgrades in heart failure patients with RVP dependence (RVP-HF) has clinical implications for patient selection and CRT implementation approaches, this study’s objective was to evaluate prognostic implications of cardiac magnetic resonance (CMR) findings and clinical factors in 102 HF patients (23.5% female, median age 66.5 years old, median follow-up 4.8 years) with and without RVP dependence undergoing upgrade and de novo CRT implants. Compared with other CRT groups, RVP-HF patients had decreased survival (<i>p</i> = 0.02), more anterior late-activated LV pacing sites (<i>p</i> = 0.002) by CMR, more atrial fibrillation (<i>p</i> = 0.0006), and higher creatinine (0.002). CMR activation timing at the LV pacing site predicted post-CRT LV functional improvement (<i>p</i> < 0.05), and mechanical activation onset < 34 ms by CMR at the LVP site was associated with decreased post-CRT survival in a model with higher pre-CRT creatinine and B-type natriuretic peptide (AUC 0.89; <i>p</i> < 0.0001); however, only the higher pre-CRT creatinine partially mediated (37%) the decreased survival in RVP-HF patients. In conclusion, RVP-HF had a distinct CMR phenotype, which has important implications for the selection of LV pacing sites in CRT upgrades, and only chronic kidney disease mediated the decreased survival after CRT in RVP-HF.https://www.mdpi.com/2308-3425/10/10/409cardiac magnetic resonanceheart failurecardiac resynchronization therapypacemakersnatriuretic peptides |
| spellingShingle | Derek J. Bivona Pim J. A. Oomen Yu Wang Frances L. Morales Mohamad Abdi Xu Gao Rohit Malhotra Andrew Darby Nishaki Mehta Oliver J. Monfredi J. Michael Mangrum Pamela K. Mason Wayne C. Levy Sula Mazimba Amit R. Patel Frederick H. Epstein Kenneth C. Bilchick Cardiac Magnetic Resonance, Electromechanical Activation, Kidney Function, and Natriuretic Peptides in Cardiac Resynchronization Therapy Upgrades Journal of Cardiovascular Development and Disease cardiac magnetic resonance heart failure cardiac resynchronization therapy pacemakers natriuretic peptides |
| title | Cardiac Magnetic Resonance, Electromechanical Activation, Kidney Function, and Natriuretic Peptides in Cardiac Resynchronization Therapy Upgrades |
| title_full | Cardiac Magnetic Resonance, Electromechanical Activation, Kidney Function, and Natriuretic Peptides in Cardiac Resynchronization Therapy Upgrades |
| title_fullStr | Cardiac Magnetic Resonance, Electromechanical Activation, Kidney Function, and Natriuretic Peptides in Cardiac Resynchronization Therapy Upgrades |
| title_full_unstemmed | Cardiac Magnetic Resonance, Electromechanical Activation, Kidney Function, and Natriuretic Peptides in Cardiac Resynchronization Therapy Upgrades |
| title_short | Cardiac Magnetic Resonance, Electromechanical Activation, Kidney Function, and Natriuretic Peptides in Cardiac Resynchronization Therapy Upgrades |
| title_sort | cardiac magnetic resonance electromechanical activation kidney function and natriuretic peptides in cardiac resynchronization therapy upgrades |
| topic | cardiac magnetic resonance heart failure cardiac resynchronization therapy pacemakers natriuretic peptides |
| url | https://www.mdpi.com/2308-3425/10/10/409 |
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