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1.
J Nucl Cardiol ; 26(3): 869-879, 2019 06.
Article in English | MEDLINE | ID: mdl-29209951

ABSTRACT

BACKGROUND: Heart failure (HF) is associated with cardiac autonomic denervation (AD), which can be non-invasively assessed by 123I-metaiodobenzylguanidine (123I-mIBG) scintigraphy and has prognostic implications. We aimed to study the relationship between myocardial contractility assessed by global longitudinal strain (GLS) and AD assessed by 123I-mIBG scintigraphy in advanced HF. METHODS/RESULTS: BETTER-HF is a prospective randomized clinical trial including HF patients (pts) submitted to cardiac resynchronization therapy (CRT) who are submitted to a clinical, echocardiographic, and scintigraphic assessment before and 6 months after CRT. 81 pts were included. An echocardiographic response (absolute increase in left ventricular ejection fraction ≥ 10%) was observed in 73.7% of pts. A higher baseline late heart-to-mediastinum ratio (HMR) was associated with a better echocardiographic response. There was a significant association between late HMR and GLS at baseline and 6 months. At baseline, GLS had an AUC of 0.715 for discrimination for a late HMR < 1.6. A GLS cut-off of - 9% maximized the likelihood of correctly classifying a pt as having severe AD (HMR < 1.6). CONCLUSION: Myocardial contractility as assessed by GLS is moderately correlated with AD as assessed by 123I-mIBG scintigraphy and has a good discrimination for the identification of severe cardiac denervation. GLS may allow for a more readily accessible estimation of the degree of AD in advanced HF pts.


Subject(s)
Autonomic Nervous System Diseases/etiology , Cardiac Resynchronization Therapy , Heart Failure/diagnostic imaging , Heart Failure/physiopathology , Radionuclide Imaging , 3-Iodobenzylguanidine , Adult , Aged , Aged, 80 and over , Autonomic Nervous System Diseases/diagnostic imaging , Female , Heart Failure/therapy , Humans , Male , Middle Aged , Radiopharmaceuticals , Stroke Volume/physiology , Ventricular Function, Left/physiology
2.
Rev Port Cardiol (Engl Ed) ; 37(12): 961-969, 2018 Dec.
Article in English, Portuguese | MEDLINE | ID: mdl-30545744

ABSTRACT

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.


Subject(s)
Cardiac Resynchronization Therapy , Heart Failure , Aged , Cardiac Resynchronization Therapy/adverse effects , Cardiac Resynchronization Therapy/mortality , Cardiac Resynchronization Therapy/statistics & numerical data , Echocardiography/statistics & numerical data , Female , Follow-Up Studies , Heart Failure/mortality , Heart Failure/therapy , Humans , Male , Middle Aged , Predictive Value of Tests , Prospective Studies , Risk Factors , Stroke Volume/physiology , Survival Analysis , Treatment Outcome
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