Landmark Evolutions in Time and Indication for Cardiac Resynchronization Therapy: Results from a Multicenter Retrospective Registry
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Retrospective Registries
2.3. Arrangement by Time Periods and Indications
2.4. Endpoints
2.5. Statistical Analysis
3. Results
3.1. Demographics
3.2. Endpoint Analysis
3.3. Evolution in Time
3.4. Endpoint Prediction over Time
3.5. Endpoint Prediction According to Rhythm and QRS Morphology
4. Discussion
4.1. Evolution over Time
4.2. Implant Indication
4.3. Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variable | All Patients | Period 1 | Period 2 | Period 3 | Period 4 | p-Value |
---|---|---|---|---|---|---|
N | 2275 (100%) | 429 (18.9%) | 692 (30.4%) | 661 (29.1%) | 493 (21.7%) | |
Age implant (y) | 70.3 (61.8–76.8) | 67.1 (58.8–73.4) | 69.5 (62.3–76.4) | 72.7 (64.7–78.6) | 71.1 (62.8–78.1) | <0.001 |
Female | 596 (26.4%) | 97 (22.6%) | 194 (28.1%) | 192 (29.2%) | 113 (23.3%) | 0.026 |
ICD | 1452 (63.9%) | 312 (72.9%) | 437 (63.2%) | 387 (58.6%) | 316 (64.4%) | <0.001 |
Upgrade | 605 (26.6%) | 114 (26.6%) | 174 (25.1%) | 160 (24.2%) | 157 (32.0%) | 0.019 |
Epicardial | 136 (6.0%) | 37 (8.6%) | 45 (6.5%) | 32 (4.9%) | 22 (4.5%) | 0.028 |
ICMP | 962 (42.8%) | 211 (49.4%) | 303 (43.9%) | 255 (38.9%) | 193 (40.6%) | 0.005 |
LVEF (%) | 27.0 (21.0–34.0) | 25.0 (20.0–30.0) | 28.0 (22.9–35.0) | 28.0 (22.0–35.0) | 29.0 (22.0–34.3) | <0.001 |
LVEF ≤ 35% | 1890 (84.9%) | 386 (90.8%) | 578 (84.3%) | 536 (83.0%) | 390 (83.0%) | 0.002 |
NYHA | ||||||
I | 86 (3.9%) | 11 (2.6%) | 28 (4.1%) | 22 (3.4%) | 25 (5.4%) | <0.001 |
II | 695 (31.3%) | 76 (17.8%) | 231 (33.5%) | 216 (33.5%) | 172 (37.1%) | |
III | 1350 (60.7%) | 308 (72.3%) | 402 (58.4%) | 392 (60.9%) | 248 (53.5%) | |
IV | 92 (4.1%) | 31 (7.3%) | 28 (4.1%) | 14 (2.2%) | 19 (4.1%) | |
eGFR (mL/min) | 57.8 (41.2–74.7) | 56.0 (40.9–71.8) | 59.8 (41.3–76.2) | 59.9 (41.4–75.5) | 54.3 (40.2–72.5) | 0.065 |
CKD 1-2 | 1043 (47.1%) | 186 (43.6%) | 334 (49.6%) | 317 (49.8%) | 206 (42.9%) | 0.178 |
CKD 3a | 489 (22.1%) | 104 (24.4%) | 141 (21.0%) | 128 (20.1%) | 116 (24.2%) | |
CKD 3b | 401 (18.1%) | 86 (20.1%) | 121 (18.0%) | 106 (16.6%) | 88 (18.3%) | |
CKD 4-5 | 284 (12.8%) | 51 (11.9%) | 77 (11.4%) | 86 (13.5%) | 70 (14.6%) | |
QRS duration (ms) | 158 (138–176) | 162 (138–182) | 160 (140–178) | 156 (136–172) | 158 (140–174) | 0.003 |
≤130 ms | 420 (18.9%) | 76 (18.1%) | 130 (18.9%) | 131 (20.3%) | 83 (17.5%) | 0.204 |
130–150 ms | 487 (21.9%) | 79 (18.9%) | 140 (20.4%) | 154 (23.9%) | 114 (24.0%) | |
>150 ms | 1319 (59.3%) | 264 (63.0%) | 417 (60.7%) | 360 (55.8%) | 278 (58.5%) | |
Ventricular conduction | ||||||
Normal | 175 (7.8%) | 28 (6.7%) | 55 (8.0%) | 53 (8.2%) | 39 (8.2%) | <0.001 |
RBBB | 198 (8.9%) | 27 (6.4%) | 63 (9.2%) | 71 (10.9%) | 37 (7.8%) | |
LBBB | 1493 (66.8%) | 285 (67.7%) | 472 (68.6%) | 459 (70.7%) | 277 (58.2%) | |
Unspecific | 193 (8.6%) | 33 (7.8%) | 47 (6.8%) | 35 (5.4%) | 78 (16.4%) | |
Paced | 175 (7.8%) | 48 (11.4%) | 51 (7.4%) | 31 (4.8%) | 45 (9.5%) | |
Rhythm | ||||||
Sinus | 1680 (75.3%) | 319 (75.4%) | 514 (74.7%) | 514 (79.7%) | 333 (70.0%) | <0.001 |
AF | 391 (17.5%) | 62 (14.7%) | 127 (18.5%) | 108 (16.7%) | 94 (19.8%) | |
Atrial pacing | 161 (7.2%) | 42 (9.9%) | 47 (6.8%) | 23 (3.6%) | 49 (10.3%) | |
ACE/ARB/ARNI | 1945 (86.2%) | 393 (91.6%) | 606 (88.0%) | 571 (87.0%) | 375 (77.6%) | <0.001 |
BB | 1919 (85.0%) | 366 (85.3%) | 596 (86.5%) | 549 (83.7%) | 408 (84.5%) | 0.523 |
MRA | 1368 (60.6%) | 245 (57.1%) | 434 (63.1%) | 397 (60.5%) | 292 (60.5%) | 0.265 |
Loop diuretic | 1419 (63.2%) | 328 (78.1%) | 441 (64.0%) | 348 (53.3%) | 302 (62.7%) | <0.001 |
Amiodarone | 514 (22.8%) | 120 (28.0%) | 144 (21.0%) | 142 (21.7%) | 108 (22.4%) | 0.041 |
Hypertension | 1535 (68.0%) | 239 (55.7%) | 447 (64.7%) | 522 (79.7%) | 327 (67.7%) | <0.001 |
Dyslipidemia | 1451 (64.5%) | 266 (62.2%) | 390 (56.7%) | 467 (71.5%) | 328 (68.1%) | <0.001 |
History of stroke | 229 (10.2%) | 49 (11.5%) | 71 (10.3%) | 55 (8.4%) | 54 (11.4%) | 0.287 |
Diabetes mellitus | 602 (26.6%) | 122 (26.1%) | 174 (25.2%) | 177 (27.0%) | 139 (28.7%) | 0.600 |
Variable | Hazard Ratio | 95% CI | p-Value |
---|---|---|---|
Female | 0.64 | 0.52–0.80 | <0.001 |
ICD | 0.66 | 0.55–0.79 | <0.001 |
ICMP | 1.29 | 1.09–1.54 | 0.003 |
LVEF (/%) | 0.98 | 0.97–0.99 | 0.003 |
NYHA | |||
I | reference | ||
II | 1.80 | 0.86–3.74 | 0.116 |
III or IV | 2.09 | 1.02–4.30 | 0.045 |
Renal function | |||
CKD 1-2 | reference | ||
CKD 3a | 1.21 | 0.97–1.52 | 0.086 |
CKD 3b | 1.66 | 1.33–2.07 | <0.001 |
CKD 4-5 | 2.70 | 2.12–3.45 | <0.001 |
QRS duration | |||
≤130 ms | reference | ||
130–150 ms | 0.75 | 0.57–0.97 | 0.030 |
>150 ms | 0.78 | 0.63–0.97 | 0.027 |
LBBB | 0.73 | 0.62–0.87 | 0.001 |
ACE/ARB/ARNI | 0.58 | 0.46–0.73 | <0.001 |
Diabetes mellitus | 1.21 | 1.02–1.44 | 0.029 |
Stroke/TIA | 1.26 | 1.01–1.58 | 0.041 |
Events (n,%) | Incidence Rate (%/y, 95% CI) | Cumulative Event Rate (%) | Cox Regression | ||||
---|---|---|---|---|---|---|---|
1 y | 3 y | 5 y | Unadjusted | Adjusted | |||
Mortality/HTX/VAD | 656 (29.2%) | 8.0% (7.4–8.6) | 8.1% | 20.0% | 31.8% | ||
Period 1 | 260 (60.6%) | 9.9% (8.7–11.1) | 8.7% | 24.5% | 37.6% | reference | reference |
Period 2 | 208 (30.4%) | 7.0% (6.1–8.0) | 7.5% | 19.4% | 29.3% | 0.73 (0.60–0.88) | 0.93 (0.75–1.14) |
Period 3 | 105 (16.1%) | 5.9% (4.9–7.2) | 6.1% | 13.8% | 25.4% | 0.64 (0.50–0.81) | 0.87 (0.67–1.13) |
Period 4 | 83 (17.2%) | 9.9% (8.0–12.3) | 11.0% | 23.8% | NA | 1.05 (0.80–1.38) | 1.02 (0.76–1.37) |
Variable | SR + LBBB | SR + Non-LBBB | AF + LBBB | AF + Non-LBBB | QRS < 130 ms | p-Value |
---|---|---|---|---|---|---|
N | 986 | 170 | 149 | 49 | 310 | |
Age implant (y) | 69.3 (60.9–75.8) | 68.4 (59.7–75.3) | 74.0 (67.4–80.2) | 72.8 (66.5–80.0) | 67.7 (59.6–75.0) | <0.001 |
Female | 334 (33.7%) | 24 (14.1%) | 26 (17.3%) | 5 (10.2%) | 65 (20.8%) | <0.001 |
ICD | 694 (70.1%) | 132 (77.7%) | 77 (51.3%) | 32 (65.3%) | 241 (77.2%) | <0.001 |
Upgrade | 147 (14.9%) | 58 (34.1%) | 47 (31.3%) | 15 (30.6%) | 50 (16.0%) | <0001 |
Epicardial | 47 (4.8%) | 9 (5.3%) | 10 (6.8%) | 1 (2.0%) | 12 (3.9%) | 0.604 |
ICMP | 364 (36.8%) | 99 (58.6%) | 73 (48.7%) | 24 (49.0%) | 157 (50.7%) | <0.001 |
LVEF (%) | 25.0 (20.0–30.0) | 25.0 (20.0–30.0 | 25.0 (20.0–30.0 | 29.0 (25.0–30.0) | 25.0 (20.0–30.0 | 0.309 |
NYHA | ||||||
I | 35 (3.6%) | 9 (5.4%) | 5 (3.4%) | 0 (0.0%) | 9 (2.9%) | 0.214 |
II | 293 (29.8%) | 52 (51.1%) | 32 (21.5%) | 13 (27.7%) | 91 (29.6%) | |
III | 621 (63.1%) | 98 (58.7%) | 100 (67.1%) | 33 (77.2%) | 191 (62.0%) | |
IV | 36 (3.7%) | 8 (4.8%) | 12 (8.1%) | 1 (2.1%) | 17 (5.5%) | |
eGFR (mL/min) | 60.6 (43.0–77.3) | 55.0 (40.6–70.7) | 48.7 (32.9–61.9) | 47.2 (35.8–60.4) | 59.6 (41.6–74.2) | <0.001 |
CKD 1-2 | 500 (51.3%) | 72 (42.9%) | 44 (29.5%) | 13 (27.7%) | 151 (49.4%) | <0.001 |
CKD 3a | 201 (20.6%) | 43 (25.6%) | 40 (26.9%) | 12 (25.5%) | 68 (22.2%) | |
CKD 3b | 176 (18.1%) | 31 (18.5%) | 32 (21.5%) | 16 (34.0%) | 37 (12.1%) | |
CKD 4-5 | 97 (10.0%) | 22 (13.1%) | 33 (22.2%) | 6 (12.8%) | 50 (16.3%) | |
ACE/ARB/ARNI | 886 (89.5%) | 138 (81.2%) | 122 (81.3%) | 43 (87.8%) | 277 (88.8%) | 0.003 |
BB | 865 (87.4%) | 143 (84.1%) | 130 (86.7%) | 40 (81.6%) | 276 (88.5%) | 0.521 |
MRA | 651 (65.8%) | 105 (61.8%) | 98 (65.3%) | 23 (46.9%) | 208 (66.7%) | 0.075 |
Loop diuretics | 594 (60.4%) | 123 (72.4%) | 113 (75.3%) | 35 (71.4%) | 217 (70.0%) | <0.001 |
Amiodarone | 205 (20.7%) | 55 (32.4%) | 41 (27.3%) | 11 (22.5%) | 69 (22.2%) | 0.011 |
Hypertension | 635 (64.2%) | 118 (69.4%) | 120 (80.0%) | 33 (67.4%) | 211 (67.6%) | 0.004 |
Dyslipidemia | 613 (62.1%) | 121 (71.2%) | 105 (70.0%) | 28 (57.1%) | 198 (63.5%) | 0.069 |
Stroke | 102 (10.4%) | 14 (8.2%) | 23 (15.4%) | 4 (8.2%) | 19 (6.1%) | 0.025 |
Diabetes mellitus | 254 (25.7%) | 57 (33.5%) | 35 (23.3%) | 15 (30.6%) | 91 (29.2%) | 0.155 |
Rhythm | Morphology | Events (n,%) | Incidence Rate (%/y, 95% CI) | Cumulative Event Rate (%) | Cox Regression | ||||
---|---|---|---|---|---|---|---|---|---|
1 y | 3 y | 5 y | Unadjusted | Adjusted | |||||
SR | LBBB | 986 | 246 (25.0%) | 6.1% (5.3–6.9) | 4.4% | 16.0% | 25.6% | reference | reference |
SR | Non-LBBB | 170 | 62 (36.5%) | 11.8% (9.2–15.2) | 13.5% | 25.7% | 43.3% | 1.96 (1.49–2.60) | 1.51 (1.12–2.03) |
AF | LBBB | 149 | 56 (37.6%) | 10.7% (8.3–13.9) | 13.0% | 27.2% | 40.3% | 1.80 (1.34–2.41) | 1.33 (0.97–1.80) |
AF | Non-LBBB | 49 | 23 (46.9%) | 16.4% (10.8–25.0) | 24.1% | 40.6% | 47.1% | 2.76 (1.78–4.28) | 2.08 (1.30–3.33) |
QRS < 130 ms | 310 | 100 (32.3%) | 9.9% (8.1–12.1) | 9.6% | 21.2% | 39.8% | 1.68 (1.33–2.13) | 1.64 (1.29–2.09) |
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Bijnens, J.; Trenson, S.; Voros, G.; Martens, P.; Ingelaere, S.; Betschart, P.; Voigt, J.-U.; Dupont, M.; Breitenstein, A.; Steffel, J.; et al. Landmark Evolutions in Time and Indication for Cardiac Resynchronization Therapy: Results from a Multicenter Retrospective Registry. J. Clin. Med. 2024, 13, 1903. https://doi.org/10.3390/jcm13071903
Bijnens J, Trenson S, Voros G, Martens P, Ingelaere S, Betschart P, Voigt J-U, Dupont M, Breitenstein A, Steffel J, et al. Landmark Evolutions in Time and Indication for Cardiac Resynchronization Therapy: Results from a Multicenter Retrospective Registry. Journal of Clinical Medicine. 2024; 13(7):1903. https://doi.org/10.3390/jcm13071903
Chicago/Turabian StyleBijnens, Jeroen, Sander Trenson, Gabor Voros, Pieter Martens, Sebastian Ingelaere, Pascal Betschart, Jens-Uwe Voigt, Matthias Dupont, Alexander Breitenstein, Jan Steffel, and et al. 2024. "Landmark Evolutions in Time and Indication for Cardiac Resynchronization Therapy: Results from a Multicenter Retrospective Registry" Journal of Clinical Medicine 13, no. 7: 1903. https://doi.org/10.3390/jcm13071903