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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
2025-10-21 13:04:52
@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}},
}