Cardiac Resynchronization Therapy - Risk Stratification and Long-Term Outcome
(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:
https://lup.lub.lu.se/record/fe60da9c-9dd7-4c1b-ae60-eb2f5e19efd7
- author
- Reitan, Christian LU
- supervisor
- opponent
-
- professor Birgersdotter-Green, Ulrika, University of California, San Diego
- organization
- publishing date
- 2018
- 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}}, }