Long-term effectiveness of cardiac resynchronization therapy in heart failure patients with unfavorable cardiac veins anatomy

Comparison of surgical versus hemodynamic procedure

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Objectives: This study sought to compare clinical, echocardiographic, and cardiopulmonary exercise testing response to cardiac resynchronization therapy (CRT) in patients with unfavorable anatomy of coronary sinus (CS) veins, randomized to transvenous versus surgical left ventricular (LV) lead implantation. Background: CRT efficacy depends on proper positioning of the LV lead over the posterolateral wall. A detailed pre-operative knowledge of CS anatomy might be of pivotal importance to accomplish a proper LV lead placement over this area. Methods: Study population included 40 patients (age 66 ± 4 years) with heart failure and indication to CRT, with unsuitable CS branches anatomy documented by pre-operative multislice computed cardiac tomography; 20 patients (Group 1) underwent surgical minithoracotomic LV lead implantation whereas 20 (Group 2) were implanted transvenously. New York Heart Association functional class, echocardiographic, and cardiopulmonary exercise testing data were assessed before and 1 year after CRT-system implant. Results: In all Group 1 patients, the LV leads were placed over the middle-basal segments of the posterolateral wall of the LV. This was not possible in Group 2 patients. One year after CRT, in Group 1, a significant improvement of New York Heart Association functional class, LV ejection fraction (from 28.8 ± 9.2% to 33.9 ± 7.2%, p <0.01), LV end-systolic volume (from 165 ± 53 ml to 134 ± 48 ml, p <0.001), and peak Vo2/kg (from 10.4 ± 4.5 ml/kg/min to 13.1 ± 3.1 ml/kg/min, p <0.02) was observed. However, no improvement was observed in Group 2: LV ejection fraction varied from 27.4 ± 4.8% to 27.4 ± 5.7% (p = 0.9), LV end-systolic volume from 175 ± 46 ml to 166 ± 44 ml (p = 0.15), and peak Vo2/kg from 11.2 ± 3.2 ml/kg/min to 11.3 ± 3.4 ml/kg/min (p = 0.9). Changes after CRT between groups were highly significant. Conclusions: In the setting of unfavorable CS branches of anatomy, CRT by a surgical minithoracotomic approach is preferable to transvenous lead implantation.

Original languageEnglish
Pages (from-to)483-490
Number of pages8
JournalJournal of the American College of Cardiology
Volume58
Issue number5
DOIs
Publication statusPublished - Jul 26 2011

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Cardiac Resynchronization Therapy
Veins
Anatomy
Heart Failure
Hemodynamics
Coronary Sinus
Stroke Volume
Exercise
Multidetector Computed Tomography
Coronary Vessels
Population

Keywords

  • biventricular pacing
  • cardiac computed tomography
  • resynchronization therapy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{a644a5bb0f5f4bf9a23e2fb6f3b0d983,
title = "Long-term effectiveness of cardiac resynchronization therapy in heart failure patients with unfavorable cardiac veins anatomy: Comparison of surgical versus hemodynamic procedure",
abstract = "Objectives: This study sought to compare clinical, echocardiographic, and cardiopulmonary exercise testing response to cardiac resynchronization therapy (CRT) in patients with unfavorable anatomy of coronary sinus (CS) veins, randomized to transvenous versus surgical left ventricular (LV) lead implantation. Background: CRT efficacy depends on proper positioning of the LV lead over the posterolateral wall. A detailed pre-operative knowledge of CS anatomy might be of pivotal importance to accomplish a proper LV lead placement over this area. Methods: Study population included 40 patients (age 66 ± 4 years) with heart failure and indication to CRT, with unsuitable CS branches anatomy documented by pre-operative multislice computed cardiac tomography; 20 patients (Group 1) underwent surgical minithoracotomic LV lead implantation whereas 20 (Group 2) were implanted transvenously. New York Heart Association functional class, echocardiographic, and cardiopulmonary exercise testing data were assessed before and 1 year after CRT-system implant. Results: In all Group 1 patients, the LV leads were placed over the middle-basal segments of the posterolateral wall of the LV. This was not possible in Group 2 patients. One year after CRT, in Group 1, a significant improvement of New York Heart Association functional class, LV ejection fraction (from 28.8 ± 9.2{\%} to 33.9 ± 7.2{\%}, p <0.01), LV end-systolic volume (from 165 ± 53 ml to 134 ± 48 ml, p <0.001), and peak Vo2/kg (from 10.4 ± 4.5 ml/kg/min to 13.1 ± 3.1 ml/kg/min, p <0.02) was observed. However, no improvement was observed in Group 2: LV ejection fraction varied from 27.4 ± 4.8{\%} to 27.4 ± 5.7{\%} (p = 0.9), LV end-systolic volume from 175 ± 46 ml to 166 ± 44 ml (p = 0.15), and peak Vo2/kg from 11.2 ± 3.2 ml/kg/min to 11.3 ± 3.4 ml/kg/min (p = 0.9). Changes after CRT between groups were highly significant. Conclusions: In the setting of unfavorable CS branches of anatomy, CRT by a surgical minithoracotomic approach is preferable to transvenous lead implantation.",
keywords = "biventricular pacing, cardiac computed tomography, resynchronization therapy",
author = "Francesco Giraldi and Gaia Cattadori and Maurizio Roberto and Corrado Carbucicchio and Mauro Pepi and Giovanni Ballerini and Francesco Alamanni and {Della Bella}, Paolo and Gianluca Pontone and Daniele Andreini and Claudio Tondo and Agostoni, {Piergiuseppe G.}",
year = "2011",
month = "7",
day = "26",
doi = "10.1016/j.jacc.2011.02.065",
language = "English",
volume = "58",
pages = "483--490",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "5",

}

TY - JOUR

T1 - Long-term effectiveness of cardiac resynchronization therapy in heart failure patients with unfavorable cardiac veins anatomy

T2 - Comparison of surgical versus hemodynamic procedure

AU - Giraldi, Francesco

AU - Cattadori, Gaia

AU - Roberto, Maurizio

AU - Carbucicchio, Corrado

AU - Pepi, Mauro

AU - Ballerini, Giovanni

AU - Alamanni, Francesco

AU - Della Bella, Paolo

AU - Pontone, Gianluca

AU - Andreini, Daniele

AU - Tondo, Claudio

AU - Agostoni, Piergiuseppe G.

PY - 2011/7/26

Y1 - 2011/7/26

N2 - Objectives: This study sought to compare clinical, echocardiographic, and cardiopulmonary exercise testing response to cardiac resynchronization therapy (CRT) in patients with unfavorable anatomy of coronary sinus (CS) veins, randomized to transvenous versus surgical left ventricular (LV) lead implantation. Background: CRT efficacy depends on proper positioning of the LV lead over the posterolateral wall. A detailed pre-operative knowledge of CS anatomy might be of pivotal importance to accomplish a proper LV lead placement over this area. Methods: Study population included 40 patients (age 66 ± 4 years) with heart failure and indication to CRT, with unsuitable CS branches anatomy documented by pre-operative multislice computed cardiac tomography; 20 patients (Group 1) underwent surgical minithoracotomic LV lead implantation whereas 20 (Group 2) were implanted transvenously. New York Heart Association functional class, echocardiographic, and cardiopulmonary exercise testing data were assessed before and 1 year after CRT-system implant. Results: In all Group 1 patients, the LV leads were placed over the middle-basal segments of the posterolateral wall of the LV. This was not possible in Group 2 patients. One year after CRT, in Group 1, a significant improvement of New York Heart Association functional class, LV ejection fraction (from 28.8 ± 9.2% to 33.9 ± 7.2%, p <0.01), LV end-systolic volume (from 165 ± 53 ml to 134 ± 48 ml, p <0.001), and peak Vo2/kg (from 10.4 ± 4.5 ml/kg/min to 13.1 ± 3.1 ml/kg/min, p <0.02) was observed. However, no improvement was observed in Group 2: LV ejection fraction varied from 27.4 ± 4.8% to 27.4 ± 5.7% (p = 0.9), LV end-systolic volume from 175 ± 46 ml to 166 ± 44 ml (p = 0.15), and peak Vo2/kg from 11.2 ± 3.2 ml/kg/min to 11.3 ± 3.4 ml/kg/min (p = 0.9). Changes after CRT between groups were highly significant. Conclusions: In the setting of unfavorable CS branches of anatomy, CRT by a surgical minithoracotomic approach is preferable to transvenous lead implantation.

AB - Objectives: This study sought to compare clinical, echocardiographic, and cardiopulmonary exercise testing response to cardiac resynchronization therapy (CRT) in patients with unfavorable anatomy of coronary sinus (CS) veins, randomized to transvenous versus surgical left ventricular (LV) lead implantation. Background: CRT efficacy depends on proper positioning of the LV lead over the posterolateral wall. A detailed pre-operative knowledge of CS anatomy might be of pivotal importance to accomplish a proper LV lead placement over this area. Methods: Study population included 40 patients (age 66 ± 4 years) with heart failure and indication to CRT, with unsuitable CS branches anatomy documented by pre-operative multislice computed cardiac tomography; 20 patients (Group 1) underwent surgical minithoracotomic LV lead implantation whereas 20 (Group 2) were implanted transvenously. New York Heart Association functional class, echocardiographic, and cardiopulmonary exercise testing data were assessed before and 1 year after CRT-system implant. Results: In all Group 1 patients, the LV leads were placed over the middle-basal segments of the posterolateral wall of the LV. This was not possible in Group 2 patients. One year after CRT, in Group 1, a significant improvement of New York Heart Association functional class, LV ejection fraction (from 28.8 ± 9.2% to 33.9 ± 7.2%, p <0.01), LV end-systolic volume (from 165 ± 53 ml to 134 ± 48 ml, p <0.001), and peak Vo2/kg (from 10.4 ± 4.5 ml/kg/min to 13.1 ± 3.1 ml/kg/min, p <0.02) was observed. However, no improvement was observed in Group 2: LV ejection fraction varied from 27.4 ± 4.8% to 27.4 ± 5.7% (p = 0.9), LV end-systolic volume from 175 ± 46 ml to 166 ± 44 ml (p = 0.15), and peak Vo2/kg from 11.2 ± 3.2 ml/kg/min to 11.3 ± 3.4 ml/kg/min (p = 0.9). Changes after CRT between groups were highly significant. Conclusions: In the setting of unfavorable CS branches of anatomy, CRT by a surgical minithoracotomic approach is preferable to transvenous lead implantation.

KW - biventricular pacing

KW - cardiac computed tomography

KW - resynchronization therapy

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U2 - 10.1016/j.jacc.2011.02.065

DO - 10.1016/j.jacc.2011.02.065

M3 - Article

VL - 58

SP - 483

EP - 490

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 5

ER -