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"Real world" experience in Cardiac Resynchronization Therapy at a Swiss Tertiary Care Center.

Abstract：

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.

journal_name

Swiss Med Wkly

journal_title

Swiss medical weekly

authors

Winnik S,Elsener C,Seifert B,Starck C,Straub A,Saguner AM,Breitenstein A,Krasniqi N,Wilhelm MJ,Haegeli L,Duru F,Benussi S,Maisano F,Lüscher TF,Holzmeister J,Huerlimann D,Ruschitzka F,Steffel J

doi

10.4414/smw.2017.14425

subject

Has Abstract

pub_date

2017-04-18 00:00:00

pages

w14425

eissn

1424-7860

issn

1424-3997

pii

smw-14425

journal_volume

147

pub_type

杂志文章

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"Real world" experience in Cardiac Resynchronization Therapy at a Swiss Tertiary Care Center.