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Elyse Foster - One of the best experts on this subject based on the ideXlab platform.
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Cardiac Resynchronization Therapy is associated with reductions in left atrial volume and inappropriate implantable cardioverter defibrillator Therapy in madit crt
Heart Rhythm, 2014Co-Authors: Tyler Slyngstad, Scott D Solomon, Scott Mcnitt, Ilan Goldenberg, Elyse Foster, Annechristine Ruwald, Valentina Kutyifa, Paul J Wang, Bronislava Polonsky, Helmut KleinAbstract:Background There are no prior studies assessing the relationship between left atrial volume (LAV) and inappropriate implantable cardioverter-defibrillator (ICD) Therapy following treatment with Cardiac Resynchronization Therapy. Objective The purpose of this study was to investigate the hypothesis that patients randomized to Cardiac Resynchronization Therapy with defibrillator (CRT-D) in the Multicenter Automatic Defibrillator Trial–Cardiac Resynchronization Therapy (MADIT-CRT) who had significant LAV reductions would have reduced risks of inappropriate ICD Therapy. Methods Cardiac Resynchronization remodeling was assessed by measuring LAV change between baseline and 12-month echocardiograms in 751 CRT-D treated patients. Patients were stratified into quartiles based on percent reduction of LAV change. High LAV responders were those in the highest 3 quartiles of LAV reduction (LAV reduction ≥21%). Low LAV responders were those in the lowest quartile of LAV reduction (LAV reduction Results In Cox proportional hazards regression analyses, high LAV responders had a 39% reduction in the risk of inappropriate Therapy (hazard ratio 0.61, P = .04) and left bundle branch block patients exhibited an even greater risk reduction in inappropriate Therapy (hazard ratio 0.51, P = .02) compared to low LAV responders during follow-up extending up to 3 years after the 12-month echocardiogram. High LAV responders also had a significantly lower risk of heart failure or death during follow-up than did low LAV responders. Conclusion A ≥21% reduction in LAV with Cardiac Resynchronization Therapy is associated with significant reductions in inappropriate ICD Therapy and in heart failure or death during a 3-year follow-up.
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survival with Cardiac Resynchronization Therapy in mild heart failure
The New England Journal of Medicine, 2014Co-Authors: Ilan Goldenberg, Helmut U Klein, Elyse Foster, Valentina Kutyifa, James P Daubert, David S Cannom, Mary W Brown, Ariela Dan, N Mark A Estes, Henry GreenbergAbstract:BACKGROUND The Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy (MADIT-CRT) showed that early intervention with Cardiac-Resynchronization Therapy with a defibrillator (CRT-D) in patients with an electrocardiographic pattern showing left bundle-branch block was associated with a significant reduction in heart-failure events over a median follow-up of 2.4 years, as compared with defibrillator Therapy alone. METHODS We evaluated the effect of CRT-D on long-term survival in the MADIT-CRT population. Post-trial follow-up over a median period of 5.6 years was assessed among all 1691 surviving patients (phase 1) and subsequently among 854 patients who were enrolled in post-trial registries (phase 2). All reported analyses were performed on an intention-to-treat basis. RESULTS At 7 years of follow-up after initial enrollment, the cumulative rate of death from any cause among patients with left bundle-branch block was 18% among patients randomly assigned to CRT-D, as compared with 29% among those randomly assigned to defibrillator Therapy alone (adjusted hazard ratio in the CRT-D group, 0.59; 95% confidence interval [CI], 0.43 to 0.80; P<0.001). The long-term survival benefit of CRT-D in patients with left bundle-branch block did not differ significantly according to sex, cause of cardiomyopathy, or QRS duration. In contrast, CRT-D was not associated with any clinical benefit and possibly with harm in patients without left bundlebranch block (adjusted hazard ratio for death from any cause, 1.57; 95% CI, 1.03 to 2.39; P = 0.04; P<0.001 for interaction of treatment with QRS morphologic findings). CONCLUSIONS Our findings indicate that in patients with mild heart-failure symptoms, left ventricular dysfunction, and left bundle-branch block, early intervention with CRT-D was associated with a significant long-term survival benefit. (Funded by Boston Scientific; ClinicalTrials.gov numbers, NCT00180271, NCT01294449, and NCT02060110.)
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predictors of super response to Cardiac Resynchronization Therapy and associated improvement in clinical outcome the madit crt multicenter automatic defibrillator implantation trial with Cardiac Resynchronization Therapy study
Journal of the American College of Cardiology, 2012Co-Authors: Scott D Solomon, Mikhail Bourgoun, Scott Mcnitt, Ilan Goldenberg, Helmut U Klein, Arthur J Moss, Elyse FosterAbstract:Objectives The authors investigated predictors of left ventricular ejection fraction (LVEF) super-response to Cardiac Resynchronization Therapy with defibrillator (CRT-D) and whether super-response translated into improved event-free survival in patients with mildly symptomatic heart failure (HF). Background Few data exist on predictors of super-response to CRT-D and associated morbidity and mortality in mildly symptomatic HF populations. Methods Patients were assigned to CRT-D with paired echocardiograms at baseline and at 12 months (n = 752). Super-response was defined by the top quartile of LVEF change. Best-subset regression analysis identified predictors of LVEF super-response. Kaplan-Meier survival analysis and Cox proportional hazards regression were performed to investigate associations of response category with development of nonfatal HF event or all-cause death. Results All 191 super-responders experienced an LVEF increase of ≥14.5% (mean LVEF increase 17.5 ± 2.7%). Six predictors were associated with LVEF super-response to CRT-D Therapy: female sex (odds ratio [OR]: 1.96; p = 0.001), no prior myocardial infarction (OR: 1.80; p = 0.005), QRS duration ≥150 ms (OR: 1.79; p = 0.007), left bundle branch block (OR: 2.05; p = 0.006), body mass index 2 (OR: 1.51; p = 0.035), and smaller baseline left atrial volume index (OR: 1.47; p Conclusions Six baseline factors predicted LVEF super-response in CRT-D–treated patients with mild HF. Super-response was associated with reduced risk of subsequent Cardiac events. (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy [MADIT-CRT]; NCT00180271)
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predictors of super response to Cardiac Resynchronization Therapy and associated improvement in clinical outcome the madit crt multicenter automatic defibrillator implantation trial with Cardiac Resynchronization Therapy study
Journal of the American College of Cardiology, 2012Co-Authors: Jonathan C Hsu, Scott D Solomon, Mikhail Bourgoun, Scott Mcnitt, Ilan Goldenberg, Helmut U Klein, Arthur J Moss, Elyse FosterAbstract:Objectives: The authors investigated predictors of left ventricular ejection fraction (LVEF) super-response to Cardiac Resynchronization Therapy with defibrillator (CRT-D) and whether super-respons...
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Cardiac Resynchronization Therapy reduces left atrial volume and the risk of atrial tachyarrhythmias in madit crt multicenter automatic defibrillator implantation trial with Cardiac Resynchronization Therapy
Journal of the American College of Cardiology, 2011Co-Authors: Andrew Brenyo, Scott Mcnitt, Arthur J Moss, Elyse Foster, Paul J Wang, Wojciech Zareba, Alon Barsheshet, Mark S Link, David T Huang, Mark EstesAbstract:Objectives We hypothesized that reductions in left atrial volume (LAV) with a Cardiac Resynchronization Therapy–defibrillator (CRT-D) would translate into a subsequent reduction in the risk of atrial tachyarrhythmias (AT). Background There is limited information regarding the effect of CRT-D on the risk of AT. Methods Percent reduction in LAV at 1 year following CRT-D implantation (pre-specified as low [lowest quartile: Results The cumulative probability of AT 2.5 years after assessment of echocardiographic response was lowest among high LAV responders to CRT-D (3%) and significantly higher among both low LAV responders to CRT-D (9%) and implantable cardioverter-defibrillator–only patients (7%; p = 0.03 for the difference among the 3 groups). Consistently, multivariate analysis showed that high LAV responders to CRT-D experienced a significant 53% (p = 0.01) reduction in the risk of subsequent AT as compared with implantable cardioverter-defibrillator–only patients, whereas low LAV responders did not derive a significant risk reduction with CRT-D Therapy (hazard ratio [HR]: 1.05 [95% confidence interval (CI): 0.54 to 2.00]; p = 0.89). Patients who developed in-trial AT experienced significant increases in the risk for both the combined endpoint of heart failure or death (HR: 2.28 [95% CI: 1.45 to 3.59]; p Conclusions In the MADIT-CRT study, favorable reverse remodeling of the left atrium with CRT-D Therapy was associated with a significant reduction in risk of subsequent AT. (Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy [MADIT-CRT]; NCT00180271 )
Arthur J Moss - One of the best experts on this subject based on the ideXlab platform.
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multiple comorbidities and response to Cardiac Resynchronization Therapy madit crt long term follow up
Journal of the American College of Cardiology, 2017Co-Authors: Emily P Zeitler, Scott D Solomon, Scott Mcnitt, Arthur J Moss, James P Daubert, Wojciech Zareba, Daniel J Friedman, Sana M Alkhatib, Yitschak Biton, Valentina KutyifaAbstract:Background Data regarding Cardiac Resynchronization Therapy (CRT) in patients with multiple comorbidities are limited.
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abstract 15501 true bipolar left ventricular pacing is associated with better survival in Cardiac Resynchronization Therapy patients
Circulation, 2015Co-Authors: Valentina Kutyifa, Arthur J Moss, Paul J Wang, Paul W Jones, Kenneth M Stein, Dan Musat, Scott WehrenbergAbstract:Introduction: Prior studies suggested better outcomes in Cardiac Resynchronization Therapy (CRT) patients with true bipolar left ventricular (LV) pacing compared to unipolar or extended bipolar LV pacing. However, we lack confirmatory data from larger patient cohorts. Methods: We reviewed de-identified device data from 65,620 HF patients with an RF-enabled CRT-D device followed on the LATITUDE system (LATITUDE® system, Boston Scientific, St. Paul, MN). Long-term survival was assessed by LV lead pacing polarity. Patients with LV bipolar leads paced between the LV tip and ring were identified as LV true bipolar pacing, while those with LV bipolar leads paced between the LV tip or LV ring to the RV coil were identified as LV extended bipolar pacing. Unipolar LV pacing was assessed as a separate sub-group. Kaplan-Meier survival analysis and multivariable Cox hazards regressions models were utilized to assess all-cause mortality by LV lead pacing polarity. Results: There were 24,033 patients (37%) with LV true bipolar pacing, 38,327 patients (58%) with extended bipolar LV pacing, and 3260 patients (5%) with LV unipolar pacing. LV true bipolar pacing was associated with a significantly higher likelihood of survival during follow-up compared to patients with LV unipolar pacing (log-rank p Conclusion: In this large patient cohort, true bipolar LV pacing was associated with better long-term survival in Cardiac Resynchronization Therapy patients compared to LV unipolar or LV extended bipolar pacing. When feasible, programming true bipolar LV lead pacing polarity should be considered in Cardiac Resynchronization Therapy patients.
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left atrial volume and the benefit of Cardiac Resynchronization Therapy in the madit crt trial
Circulation-heart Failure, 2014Co-Authors: Rafael Kuperstein, Scott D Solomon, Mikhail Bourgoun, Scott Mcnitt, Ilan Goldenberg, Arthur J Moss, Wojciech Zareba, Amil M Shah, Robert KlempfnerAbstract:Background—Left atrial volume (LAV) is an important marker of heart failure (HF) severity. We hypothesized that LAV independently correlates with clinical outcomes in patients who receive Cardiac Resynchronization Therapy with a defibrillator (CRT-D) and can be used for improved risk assessment in this population. Methods and Results—The benefit of CRT-D versus defibrillator-only Therapy in reducing the risk of HF or death was assessed by LAV (dichotomized at the upper quartile >52 mL/m2) among 1785 patients enrolled in the Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy (MADIT-CRT) study. Landmark analysis was used to evaluate the relationship between LAV response to CRT-D and subsequent clinical outcomes. Multivariable analysis showed that patients with a higher baseline LAV experienced 69% (P<0.001) and 59% (P=0.02) increased hazard for HF or death and for all-cause mortality, respectively, independently of baseline left ventricular volume. CRT-D was associ...
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effect of metoprolol versus carvedilol on outcomes in madit crt multicenter automatic defibrillator implantation trial with Cardiac Resynchronization Therapy
Journal of the American College of Cardiology, 2013Co-Authors: Scott Mcnitt, Annechristine Ruwald, Martin H Ruwald, Christian Jons, Wojciech Zareba, Jeffrey Alexis, Arthur J MossAbstract:Objectives This study sought to compare the effects of metoprolol and carvedilol in the MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy) study. Background The impact of beta-blockers in heart failure (HF) patients with devices is uninvestigated. Methods All patients receiving either metoprolol or carvedilol in the MADIT-CRT study were identified and compared. Time-dependent Cox proportional hazard regression analyses were performed to assess differences in hospitalization for HF or death and ventricular arrhythmias. Results Hospitalization for HF or death occurred in 30% of the patients on metoprolol and in 23% on carvedilol. Treatment with carvedilol was associated with a significantly decreased risk of hospitalization for HF or death when compared with metoprolol (hazard ratio [HR]: 0.70, [95% confidence interval (CI): 0.57 to 0.87], p = 0.001). This reduction in risk was further attenuated in the subgroup of Cardiac Resynchronization Therapy with implantable cardioverter-defibrillator (CRT-D) patients (HR: 0.61 [95% CI: 0.46 to 0.82], p = 0.001) and CRT-D patients with left bundle branch block (LBBB) (HR: 0.51 [95% CI: 0.35 to 0.76], p Conclusions In HF patients in New York Heart Association functional class I and II and with wide QRS complexes, carvedilol was associated with a 30% reduction in hospitalizations for HF or death when compared with metoprolol. A novel beneficial and synergistic effect of carvedilol was seen in patients with CRT-D and LBBB. Furthermore, we found a pronounced dose-dependent relationship in carvedilol, but not in metoprolol. (MADIT-CRT: Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy; NCT00180271 )
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predictors of super response to Cardiac Resynchronization Therapy and associated improvement in clinical outcome the madit crt multicenter automatic defibrillator implantation trial with Cardiac Resynchronization Therapy study
Journal of the American College of Cardiology, 2012Co-Authors: Scott D Solomon, Mikhail Bourgoun, Scott Mcnitt, Ilan Goldenberg, Helmut U Klein, Arthur J Moss, Elyse FosterAbstract:Objectives The authors investigated predictors of left ventricular ejection fraction (LVEF) super-response to Cardiac Resynchronization Therapy with defibrillator (CRT-D) and whether super-response translated into improved event-free survival in patients with mildly symptomatic heart failure (HF). Background Few data exist on predictors of super-response to CRT-D and associated morbidity and mortality in mildly symptomatic HF populations. Methods Patients were assigned to CRT-D with paired echocardiograms at baseline and at 12 months (n = 752). Super-response was defined by the top quartile of LVEF change. Best-subset regression analysis identified predictors of LVEF super-response. Kaplan-Meier survival analysis and Cox proportional hazards regression were performed to investigate associations of response category with development of nonfatal HF event or all-cause death. Results All 191 super-responders experienced an LVEF increase of ≥14.5% (mean LVEF increase 17.5 ± 2.7%). Six predictors were associated with LVEF super-response to CRT-D Therapy: female sex (odds ratio [OR]: 1.96; p = 0.001), no prior myocardial infarction (OR: 1.80; p = 0.005), QRS duration ≥150 ms (OR: 1.79; p = 0.007), left bundle branch block (OR: 2.05; p = 0.006), body mass index 2 (OR: 1.51; p = 0.035), and smaller baseline left atrial volume index (OR: 1.47; p Conclusions Six baseline factors predicted LVEF super-response in CRT-D–treated patients with mild HF. Super-response was associated with reduced risk of subsequent Cardiac events. (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy [MADIT-CRT]; NCT00180271)
Scott Mcnitt - One of the best experts on this subject based on the ideXlab platform.
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multiple comorbidities and response to Cardiac Resynchronization Therapy madit crt long term follow up
Journal of the American College of Cardiology, 2017Co-Authors: Emily P Zeitler, Scott D Solomon, Scott Mcnitt, Arthur J Moss, James P Daubert, Wojciech Zareba, Daniel J Friedman, Sana M Alkhatib, Yitschak Biton, Valentina KutyifaAbstract:Background Data regarding Cardiac Resynchronization Therapy (CRT) in patients with multiple comorbidities are limited.
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Cardiac Resynchronization Therapy is associated with reductions in left atrial volume and inappropriate implantable cardioverter defibrillator Therapy in madit crt
Heart Rhythm, 2014Co-Authors: Tyler Slyngstad, Scott D Solomon, Scott Mcnitt, Ilan Goldenberg, Elyse Foster, Annechristine Ruwald, Valentina Kutyifa, Paul J Wang, Bronislava Polonsky, Helmut KleinAbstract:Background There are no prior studies assessing the relationship between left atrial volume (LAV) and inappropriate implantable cardioverter-defibrillator (ICD) Therapy following treatment with Cardiac Resynchronization Therapy. Objective The purpose of this study was to investigate the hypothesis that patients randomized to Cardiac Resynchronization Therapy with defibrillator (CRT-D) in the Multicenter Automatic Defibrillator Trial–Cardiac Resynchronization Therapy (MADIT-CRT) who had significant LAV reductions would have reduced risks of inappropriate ICD Therapy. Methods Cardiac Resynchronization remodeling was assessed by measuring LAV change between baseline and 12-month echocardiograms in 751 CRT-D treated patients. Patients were stratified into quartiles based on percent reduction of LAV change. High LAV responders were those in the highest 3 quartiles of LAV reduction (LAV reduction ≥21%). Low LAV responders were those in the lowest quartile of LAV reduction (LAV reduction Results In Cox proportional hazards regression analyses, high LAV responders had a 39% reduction in the risk of inappropriate Therapy (hazard ratio 0.61, P = .04) and left bundle branch block patients exhibited an even greater risk reduction in inappropriate Therapy (hazard ratio 0.51, P = .02) compared to low LAV responders during follow-up extending up to 3 years after the 12-month echocardiogram. High LAV responders also had a significantly lower risk of heart failure or death during follow-up than did low LAV responders. Conclusion A ≥21% reduction in LAV with Cardiac Resynchronization Therapy is associated with significant reductions in inappropriate ICD Therapy and in heart failure or death during a 3-year follow-up.
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the effect of intermittent atrial tachyarrhythmia on heart failure or death in Cardiac Resynchronization Therapy with defibrillator versus implantable cardioverter defibrillator patients a madit crt substudy multicenter automatic defibrillator implan
Journal of the American College of Cardiology, 2014Co-Authors: Annechristine Ruwald, Scott Mcnitt, Ilan Goldenberg, Grzegorz Pietrasik, Valentina Kutyifa, James P Daubert, Martin H Ruwald, Christian Jons, Paul J Wang, Wojciech ZarebaAbstract:Objectives This study aimed to investigate the effect of both history of intermittent atrial tachyarrhythmias (IAT) and in-trial IAT on the risk of heart failure (HF) or death comparing Cardiac Resynchronization Therapy with defibrillator (CRT-D) to implantable cardioverter-defibrillator (ICD) treatment in mildly symptomatic HF patients with left bundle branch block (LBBB). Background Limited data exist regarding the benefit of CRT-D in patients with IAT. Methods The benefit of CRT-D in reducing the risk of HF/death was evaluated using multivariate Cox models incorporating the presence of, respectively, a history of IAT at baseline and time-dependent development of in-trial IAT during follow-up in 1,264 patients with LBBB enrolled in the MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy) study. Results The overall beneficial effect of CRT-D versus ICD on the risk of HF/death was not significantly different between LBBB patients with or without history of IAT (HR: 0.50, p = 0.028, and HR: 0.46, p Conclusions In the MADIT-CRT study, the clinical benefit of CRT-D in LBBB patients was not attenuated by prior history of IAT or by the development of in-trial atrial tachyarrhythmias. (MADIT-CRT: Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy; NCT00180271).
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left atrial volume and the benefit of Cardiac Resynchronization Therapy in the madit crt trial
Circulation-heart Failure, 2014Co-Authors: Rafael Kuperstein, Scott D Solomon, Mikhail Bourgoun, Scott Mcnitt, Ilan Goldenberg, Arthur J Moss, Wojciech Zareba, Amil M Shah, Robert KlempfnerAbstract:Background—Left atrial volume (LAV) is an important marker of heart failure (HF) severity. We hypothesized that LAV independently correlates with clinical outcomes in patients who receive Cardiac Resynchronization Therapy with a defibrillator (CRT-D) and can be used for improved risk assessment in this population. Methods and Results—The benefit of CRT-D versus defibrillator-only Therapy in reducing the risk of HF or death was assessed by LAV (dichotomized at the upper quartile >52 mL/m2) among 1785 patients enrolled in the Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy (MADIT-CRT) study. Landmark analysis was used to evaluate the relationship between LAV response to CRT-D and subsequent clinical outcomes. Multivariable analysis showed that patients with a higher baseline LAV experienced 69% (P<0.001) and 59% (P=0.02) increased hazard for HF or death and for all-cause mortality, respectively, independently of baseline left ventricular volume. CRT-D was associ...
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effect of metoprolol versus carvedilol on outcomes in madit crt multicenter automatic defibrillator implantation trial with Cardiac Resynchronization Therapy
Journal of the American College of Cardiology, 2013Co-Authors: Scott Mcnitt, Annechristine Ruwald, Martin H Ruwald, Christian Jons, Wojciech Zareba, Jeffrey Alexis, Arthur J MossAbstract:Objectives This study sought to compare the effects of metoprolol and carvedilol in the MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy) study. Background The impact of beta-blockers in heart failure (HF) patients with devices is uninvestigated. Methods All patients receiving either metoprolol or carvedilol in the MADIT-CRT study were identified and compared. Time-dependent Cox proportional hazard regression analyses were performed to assess differences in hospitalization for HF or death and ventricular arrhythmias. Results Hospitalization for HF or death occurred in 30% of the patients on metoprolol and in 23% on carvedilol. Treatment with carvedilol was associated with a significantly decreased risk of hospitalization for HF or death when compared with metoprolol (hazard ratio [HR]: 0.70, [95% confidence interval (CI): 0.57 to 0.87], p = 0.001). This reduction in risk was further attenuated in the subgroup of Cardiac Resynchronization Therapy with implantable cardioverter-defibrillator (CRT-D) patients (HR: 0.61 [95% CI: 0.46 to 0.82], p = 0.001) and CRT-D patients with left bundle branch block (LBBB) (HR: 0.51 [95% CI: 0.35 to 0.76], p Conclusions In HF patients in New York Heart Association functional class I and II and with wide QRS complexes, carvedilol was associated with a 30% reduction in hospitalizations for HF or death when compared with metoprolol. A novel beneficial and synergistic effect of carvedilol was seen in patients with CRT-D and LBBB. Furthermore, we found a pronounced dose-dependent relationship in carvedilol, but not in metoprolol. (MADIT-CRT: Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy; NCT00180271 )
Ilan Goldenberg - One of the best experts on this subject based on the ideXlab platform.
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Cardiac Resynchronization Therapy is associated with reductions in left atrial volume and inappropriate implantable cardioverter defibrillator Therapy in madit crt
Heart Rhythm, 2014Co-Authors: Tyler Slyngstad, Scott D Solomon, Scott Mcnitt, Ilan Goldenberg, Elyse Foster, Annechristine Ruwald, Valentina Kutyifa, Paul J Wang, Bronislava Polonsky, Helmut KleinAbstract:Background There are no prior studies assessing the relationship between left atrial volume (LAV) and inappropriate implantable cardioverter-defibrillator (ICD) Therapy following treatment with Cardiac Resynchronization Therapy. Objective The purpose of this study was to investigate the hypothesis that patients randomized to Cardiac Resynchronization Therapy with defibrillator (CRT-D) in the Multicenter Automatic Defibrillator Trial–Cardiac Resynchronization Therapy (MADIT-CRT) who had significant LAV reductions would have reduced risks of inappropriate ICD Therapy. Methods Cardiac Resynchronization remodeling was assessed by measuring LAV change between baseline and 12-month echocardiograms in 751 CRT-D treated patients. Patients were stratified into quartiles based on percent reduction of LAV change. High LAV responders were those in the highest 3 quartiles of LAV reduction (LAV reduction ≥21%). Low LAV responders were those in the lowest quartile of LAV reduction (LAV reduction Results In Cox proportional hazards regression analyses, high LAV responders had a 39% reduction in the risk of inappropriate Therapy (hazard ratio 0.61, P = .04) and left bundle branch block patients exhibited an even greater risk reduction in inappropriate Therapy (hazard ratio 0.51, P = .02) compared to low LAV responders during follow-up extending up to 3 years after the 12-month echocardiogram. High LAV responders also had a significantly lower risk of heart failure or death during follow-up than did low LAV responders. Conclusion A ≥21% reduction in LAV with Cardiac Resynchronization Therapy is associated with significant reductions in inappropriate ICD Therapy and in heart failure or death during a 3-year follow-up.
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survival with Cardiac Resynchronization Therapy in mild heart failure
The New England Journal of Medicine, 2014Co-Authors: Ilan Goldenberg, Helmut U Klein, Elyse Foster, Valentina Kutyifa, James P Daubert, David S Cannom, Mary W Brown, Ariela Dan, N Mark A Estes, Henry GreenbergAbstract:BACKGROUND The Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy (MADIT-CRT) showed that early intervention with Cardiac-Resynchronization Therapy with a defibrillator (CRT-D) in patients with an electrocardiographic pattern showing left bundle-branch block was associated with a significant reduction in heart-failure events over a median follow-up of 2.4 years, as compared with defibrillator Therapy alone. METHODS We evaluated the effect of CRT-D on long-term survival in the MADIT-CRT population. Post-trial follow-up over a median period of 5.6 years was assessed among all 1691 surviving patients (phase 1) and subsequently among 854 patients who were enrolled in post-trial registries (phase 2). All reported analyses were performed on an intention-to-treat basis. RESULTS At 7 years of follow-up after initial enrollment, the cumulative rate of death from any cause among patients with left bundle-branch block was 18% among patients randomly assigned to CRT-D, as compared with 29% among those randomly assigned to defibrillator Therapy alone (adjusted hazard ratio in the CRT-D group, 0.59; 95% confidence interval [CI], 0.43 to 0.80; P<0.001). The long-term survival benefit of CRT-D in patients with left bundle-branch block did not differ significantly according to sex, cause of cardiomyopathy, or QRS duration. In contrast, CRT-D was not associated with any clinical benefit and possibly with harm in patients without left bundlebranch block (adjusted hazard ratio for death from any cause, 1.57; 95% CI, 1.03 to 2.39; P = 0.04; P<0.001 for interaction of treatment with QRS morphologic findings). CONCLUSIONS Our findings indicate that in patients with mild heart-failure symptoms, left ventricular dysfunction, and left bundle-branch block, early intervention with CRT-D was associated with a significant long-term survival benefit. (Funded by Boston Scientific; ClinicalTrials.gov numbers, NCT00180271, NCT01294449, and NCT02060110.)
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the effect of intermittent atrial tachyarrhythmia on heart failure or death in Cardiac Resynchronization Therapy with defibrillator versus implantable cardioverter defibrillator patients a madit crt substudy multicenter automatic defibrillator implan
Journal of the American College of Cardiology, 2014Co-Authors: Annechristine Ruwald, Scott Mcnitt, Ilan Goldenberg, Grzegorz Pietrasik, Valentina Kutyifa, James P Daubert, Martin H Ruwald, Christian Jons, Paul J Wang, Wojciech ZarebaAbstract:Objectives This study aimed to investigate the effect of both history of intermittent atrial tachyarrhythmias (IAT) and in-trial IAT on the risk of heart failure (HF) or death comparing Cardiac Resynchronization Therapy with defibrillator (CRT-D) to implantable cardioverter-defibrillator (ICD) treatment in mildly symptomatic HF patients with left bundle branch block (LBBB). Background Limited data exist regarding the benefit of CRT-D in patients with IAT. Methods The benefit of CRT-D in reducing the risk of HF/death was evaluated using multivariate Cox models incorporating the presence of, respectively, a history of IAT at baseline and time-dependent development of in-trial IAT during follow-up in 1,264 patients with LBBB enrolled in the MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy) study. Results The overall beneficial effect of CRT-D versus ICD on the risk of HF/death was not significantly different between LBBB patients with or without history of IAT (HR: 0.50, p = 0.028, and HR: 0.46, p Conclusions In the MADIT-CRT study, the clinical benefit of CRT-D in LBBB patients was not attenuated by prior history of IAT or by the development of in-trial atrial tachyarrhythmias. (MADIT-CRT: Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy; NCT00180271).
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left atrial volume and the benefit of Cardiac Resynchronization Therapy in the madit crt trial
Circulation-heart Failure, 2014Co-Authors: Rafael Kuperstein, Scott D Solomon, Mikhail Bourgoun, Scott Mcnitt, Ilan Goldenberg, Arthur J Moss, Wojciech Zareba, Amil M Shah, Robert KlempfnerAbstract:Background—Left atrial volume (LAV) is an important marker of heart failure (HF) severity. We hypothesized that LAV independently correlates with clinical outcomes in patients who receive Cardiac Resynchronization Therapy with a defibrillator (CRT-D) and can be used for improved risk assessment in this population. Methods and Results—The benefit of CRT-D versus defibrillator-only Therapy in reducing the risk of HF or death was assessed by LAV (dichotomized at the upper quartile >52 mL/m2) among 1785 patients enrolled in the Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy (MADIT-CRT) study. Landmark analysis was used to evaluate the relationship between LAV response to CRT-D and subsequent clinical outcomes. Multivariable analysis showed that patients with a higher baseline LAV experienced 69% (P<0.001) and 59% (P=0.02) increased hazard for HF or death and for all-cause mortality, respectively, independently of baseline left ventricular volume. CRT-D was associ...
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predictors of super response to Cardiac Resynchronization Therapy and associated improvement in clinical outcome the madit crt multicenter automatic defibrillator implantation trial with Cardiac Resynchronization Therapy study
Journal of the American College of Cardiology, 2012Co-Authors: Scott D Solomon, Mikhail Bourgoun, Scott Mcnitt, Ilan Goldenberg, Helmut U Klein, Arthur J Moss, Elyse FosterAbstract:Objectives The authors investigated predictors of left ventricular ejection fraction (LVEF) super-response to Cardiac Resynchronization Therapy with defibrillator (CRT-D) and whether super-response translated into improved event-free survival in patients with mildly symptomatic heart failure (HF). Background Few data exist on predictors of super-response to CRT-D and associated morbidity and mortality in mildly symptomatic HF populations. Methods Patients were assigned to CRT-D with paired echocardiograms at baseline and at 12 months (n = 752). Super-response was defined by the top quartile of LVEF change. Best-subset regression analysis identified predictors of LVEF super-response. Kaplan-Meier survival analysis and Cox proportional hazards regression were performed to investigate associations of response category with development of nonfatal HF event or all-cause death. Results All 191 super-responders experienced an LVEF increase of ≥14.5% (mean LVEF increase 17.5 ± 2.7%). Six predictors were associated with LVEF super-response to CRT-D Therapy: female sex (odds ratio [OR]: 1.96; p = 0.001), no prior myocardial infarction (OR: 1.80; p = 0.005), QRS duration ≥150 ms (OR: 1.79; p = 0.007), left bundle branch block (OR: 2.05; p = 0.006), body mass index 2 (OR: 1.51; p = 0.035), and smaller baseline left atrial volume index (OR: 1.47; p Conclusions Six baseline factors predicted LVEF super-response in CRT-D–treated patients with mild HF. Super-response was associated with reduced risk of subsequent Cardiac events. (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy [MADIT-CRT]; NCT00180271)
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prognostic value of echo doppler guided av delay optimization following Cardiac Resynchronization Therapy
Journal of the American College of Cardiology, 2016Co-Authors: Srikanth Koneru, Zoran B Popovic, Paul Cremer, Patrick J Tchou, Bruce L Wilkoff, Bruce D Lindsay, Brian P Griffin, Richard A GrimmAbstract:The utility of Atrio-Ventricular (AV) delay optimization following Cardiac Resynchronization Therapy (CRT) remains unclear. We aimed to determine the utility and outcome of interrogating and selectively optimizing AV synchrony using Echo-Doppler-Guided (EDG) AV optimization following CRT. All
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longitudinal strain delay index by speckle tracking imaging a new marker of response to Cardiac Resynchronization Therapy
Circulation, 2008Co-Authors: Adisai Buakhamsri, James D Thomas, Zoran B Popovic, Neil L Greenberg, Dimpi Patel, Richard A GrimmAbstract:BACKGROUND: In heart failure patients with left ventricular dyssynchrony, contractility in delayed segments does not fully contribute to end-systolic function. We quantified this reserve of contraction related to mechanical dyssynchrony to predict response to Cardiac Resynchronization Therapy by the strain delay index, which was defined as the sum of the difference between peak and end-systolic strain across 16 segments. METHODS AND RESULTS: In 100 heart failure patients (ejection fraction=26+/-9%, QRS=154+/-29 ms, 94% in New York Heart Association class III), we studied left ventricular dyssynchrony before Cardiac Resynchronization Therapy by the strain delay index using longitudinal strain by 2D speckle tracking and by the SD of time to peak myocardial velocity in 12 segments. The optimal cutoff value of the strain delay index to predict response to Cardiac Resynchronization Therapy was determined in a retrospective group (n=65) and then confirmed in a validation group (n=35). Left ventricular end-systolic volume reduction at 3 months >15% (responder) occurred in 64 of 100 patients. In the retrospective group, the strain delay index but not the SD of time to peak myocardial velocity was greater in responders (n=42/65) than nonresponders (35+/-8% versus 19+/-7%, P or =25% identified 82% (18/22) of responders and 92% (12/13) of nonresponders. Among the entire population (n=100), strain delay index correlated with reverse remodeling in both the ischemic (r=-0.68, P<0.0001) and nonischemic (r=-0.68, P<0.0001) population. CONCLUSIONS: Use of the strain delay index with longitudinal strain by speckle tracking has a strong predictive value for predicting response to Cardiac Resynchronization Therapy in both ischemic and nonischemic patients.
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longitudinal strain delay index by speckle tracking imaging a new marker of response to Cardiac Resynchronization Therapy
Circulation, 2008Co-Authors: Pascal Lim, James D Thomas, Zoran B Popovic, Adisai Buakhamsri, Neil L Greenberg, Dimpi Patel, Richard A GrimmAbstract:Background— In heart failure patients with left ventricular dyssynchrony, contractility in delayed segments does not fully contribute to end-systolic function. We quantified this reserve of contraction related to mechanical dyssynchrony to predict response to Cardiac Resynchronization Therapy by the strain delay index, which was defined as the sum of the difference between peak and end-systolic strain across 16 segments. Methods and Results— In 100 heart failure patients (ejection fraction=26±9%, QRS=154±29 ms, 94% in New York Heart Association class III), we studied left ventricular dyssynchrony before Cardiac Resynchronization Therapy by the strain delay index using longitudinal strain by 2D speckle tracking and by the SD of time to peak myocardial velocity in 12 segments. The optimal cutoff value of the strain delay index to predict response to Cardiac Resynchronization Therapy was determined in a retrospective group (n=65) and then confirmed in a validation group (n=35). Left ventricular end-systolic ...
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Cardiac Resynchronization Therapy in heart failure with narrow qrs complexes
The New England Journal of Medicine, 2007Co-Authors: John F Beshai, Richard A Grimm, Sherif F Nagueh, James H Baker, Scott L Beau, Steven M Greenberg, Luis A Pires, Patrick J TchouAbstract:Background Indications for Cardiac-Resynchronization Therapy (CRT) in patients with heart failure include a prolonged QRS interval (≥120 msec), in addition to other functional criteria. Some patients with narrow QRS complexes have echocardiographic evidence of left ventricular mechanical dyssynchrony and may also benefit from CRT. Methods We enrolled 172 patients who had a standard indication for an implantable cardioverter–defibrillator. Patients received the CRT device and were randomly assigned to the CRT group or to a control group (no CRT) for 6 months. The primary end point was the proportion of patients with an increase in peak oxygen consumption of at least 1.0 ml per kilogram of body weight per minute during cardiopulmonary exercise testing at 6 months. Results At 6 months, the CRT group and the control group did not differ significantly in the proportion of patients with the primary end point (46% and 41%, respectively). In a prespecified subgroup with a QRS interval of 120 msec or more, the pea...