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Cardiac Resynchronization Therapy - Risk Stratification and Long-Term Outcome

Reitan, Christian LU (2018) In Lund University, Faculty of Medicine Doctoral Dissertation Series 2018(99).
Abstract
Heart failure is a condition that will affect 2-3% of the population. Around one third of the patients have a decreased LVEF and a widened QRS complex as a sign of ventricular dyssynchrony. CRT has emerged as a treatment that reduces morbidity, mortality and improve functional status in this population. However, a substantial amount of treated patients do not respond satisfactory after implantation. This thesis sought to assess characteristics and factors associated with long term mortality and outcome in a cohort of CRT patients.

The thesis includes four papers:

Paper I assessed the association between early subjective response after implantation and long term outcome in CRT-P patients. We found that those who exhibited... (More)
Heart failure is a condition that will affect 2-3% of the population. Around one third of the patients have a decreased LVEF and a widened QRS complex as a sign of ventricular dyssynchrony. CRT has emerged as a treatment that reduces morbidity, mortality and improve functional status in this population. However, a substantial amount of treated patients do not respond satisfactory after implantation. This thesis sought to assess characteristics and factors associated with long term mortality and outcome in a cohort of CRT patients.

The thesis includes four papers:

Paper I assessed the association between early subjective response after implantation and long term outcome in CRT-P patients. We found that those who exhibited a self-assessed positive therapy response after 1-2 months had a significantly better survival rate compared with those who did not.

The second paper investigated long term mortality in CRT-P and primary prophylactic CRT-D patients. Patients with CRT-D had better crude survival rates than those with CRT-P. However, the CRT-P group was older and had more comorbidities. CRT-D was not significantly associated with better survival when adjusting for confounders, as compared to CRT-P.

The third paper assessed a method of estimating myocardial scar burden from a standard 12-lead ECG (Selvester QRS score) in patients with Left Bundle Branch Block. 401 patients were assessed and divided into a high-score and a low-score group. The group with high Selvester QRS score was found to have a worse survival rate compared to the group of patients with lower scores.

The last paper found that the CHA2DS2-VASc score, which is commonly used for stroke risk estimation in atrial fibrillation patients, was associated with long term mortality and a composite endpoint of mortality or hospitalization for heart failure in a CRT population. When comparing CHA2DS2-VASc to other, CRT-specific scores, it performed approximately as well in predicting mortality and the composite endpoint. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • professor Birgersdotter-Green, Ulrika, University of California, San Diego
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Cardiac Resynchronization Therapy, heart Failure, Device therapy, long-term outcome
in
Lund University, Faculty of Medicine Doctoral Dissertation Series
volume
2018
issue
99
pages
74 pages
publisher
Lund University: Faculty of Medicine
defense location
Segerfalksalen, BMC A10, Sölvegatan 17 i Lund
defense date
2018-09-07 13:00:00
ISSN
1652-8220
ISBN
978-91-7619-667-0
language
English
LU publication?
yes
id
fe60da9c-9dd7-4c1b-ae60-eb2f5e19efd7
date added to LUP
2018-08-17 07:40:45
date last changed
2023-02-22 11:34:14
@phdthesis{fe60da9c-9dd7-4c1b-ae60-eb2f5e19efd7,
  abstract     = {{Heart failure is a condition that will affect 2-3% of the population. Around one third of the patients have a decreased LVEF and a widened QRS complex as a sign of ventricular dyssynchrony. CRT has emerged as a treatment that reduces morbidity, mortality and improve functional status in this population. However, a substantial amount of treated patients do not respond satisfactory after implantation. This thesis sought to assess characteristics and factors associated with long term mortality and outcome in a cohort of CRT patients.<br/><br/>The thesis includes four papers:<br/><br/>Paper I assessed the association between early subjective response after implantation and long term outcome in CRT-P patients. We found that those who exhibited a self-assessed positive therapy response after 1-2 months had a significantly better survival rate compared with those who did not. <br/><br/>The second paper investigated long term mortality in CRT-P and primary prophylactic CRT-D patients. Patients with CRT-D had better crude survival rates than those with CRT-P. However, the CRT-P group was older and had more comorbidities. CRT-D was not significantly associated with better survival when adjusting for confounders, as compared to CRT-P.<br/><br/>The third paper assessed a method of estimating myocardial scar burden from a standard 12-lead ECG (Selvester QRS score) in patients with Left Bundle Branch Block. 401 patients were assessed and divided into a high-score and a low-score group. The group with high Selvester QRS score was found to have a worse survival rate compared to the group of patients with lower scores.<br/><br/>The last paper found that the CHA2DS2-VASc score, which is commonly used for stroke risk estimation in atrial fibrillation patients, was associated with long term mortality and a composite endpoint of mortality or hospitalization for heart failure in a CRT population. When comparing CHA2DS2-VASc to other, CRT-specific scores, it   performed approximately as well in predicting mortality and the composite endpoint.}},
  author       = {{Reitan, Christian}},
  isbn         = {{978-91-7619-667-0}},
  issn         = {{1652-8220}},
  keywords     = {{Cardiac Resynchronization Therapy; heart Failure; Device therapy; long-term outcome}},
  language     = {{eng}},
  number       = {{99}},
  publisher    = {{Lund University: Faculty of Medicine}},
  school       = {{Lund University}},
  series       = {{Lund University, Faculty of Medicine Doctoral Dissertation Series}},
  title        = {{Cardiac Resynchronization Therapy - Risk Stratification and Long-Term Outcome}},
  url          = {{https://lup.lub.lu.se/search/files/49707650/KappaReitan.pdf}},
  volume       = {{2018}},
  year         = {{2018}},
}