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المؤلفون: Mohamed Kanj, David M. Nemer, Divyang Patel, Ayman A. Hussein, Khaldoun G. Tarakji, Bruce L. Wilkoff, Anirudh Kumar, Daniel J. Cantillon, Trejeeve Martyn, Bryan Baranowski, Zachary J. Il'Giovine, Randall C. Starling, Thomas Callahan, Niraj Varma, Eoin Donnellan, W.H. Wilson Tang, Laurie Ann Moennich, Kevin Trulock, John Rickard, Oussama M. Wazni
المصدر: Heart. 108:274-278
مصطلحات موضوعية: medicine.medical_specialty, Anthracycline, Population, Cardiomyopathy, Ventricular Function, Left, Cardiac Resynchronization Therapy, Ventricular Dysfunction, Left, Internal medicine, Humans, Medicine, Anthracyclines, cardiovascular diseases, education, Aged, Retrospective Studies, Heart Failure, Retrospective review, education.field_of_study, Ejection fraction, Ventricular Remodeling, business.industry, Cancer, Stroke Volume, Mean age, Middle Aged, medicine.disease, Defibrillators, Implantable, Treatment Outcome, Heart failure, cardiovascular system, Cardiology, Cardiomyopathies, Cardiology and Cardiovascular Medicine, business
الوصف: IntroductionChemotherapy-induced cardiomyopathy has been increasingly recognised as patients are living longer with more effective treatments for their malignancies. Anthracyclines are known to cause left ventricular (LV) dysfunction. While heart failure medications are frequently used, some patients may need consideration for device-based therapies such as cardiac resynchronisation therapy (CRT). However, the role of CRT in anthracycline-induced cardiomyopathy (AIC) is not well understood.MethodsWe performed a retrospective review of all patients undergoing CRT implantation at our centre from 2003 to 2019 with a diagnosis of AIC. The LV remodelling and survival outcomes of this population were obtained and then compared with consecutive patients with other aetiologies of non-ischaemic cardiomyopathy (NICM).ResultsA total of 34 patients underwent CRT implantation with a diagnosis of AIC with a mean age of 60.5±12.7 years, left ventricular ejection fraction (LVEF) of 21.7%±7.4%, and 11.3±7.5 years and 10.2±7.4 years from cancer diagnosis and last anthracycline exposure, respectively. At 9.6±8.1 months after CRT implantation, there was an increase of LVEF from 21.8%±7.6% to 30.4%±13.0% (pConclusionsPatients with AIC undergo LV remodelling with CRT at rates similar to other aetiologies of NICM. Furthermore, AIC post-CRT responders have a favourable long-term mortality compared with non-responders.
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المؤلفون: Nicholas Kassis, Ashish Kumar, Shravani Gangidi, Alex Milinovich, Ankur Kalra, Ajay Bhargava, Venu Menon, Oussama M. Wazni, John Rickard, Umesh N. Khot
المصدر: Journal of electrocardiology. 75
مصطلحات موضوعية: Adult, Male, Electrocardiography, Tachycardia, Sinus, Atrial Fibrillation, Humans, COVID-19, Female, Prospective Studies, Cardiology and Cardiovascular Medicine, Prognosis, Aged
الوصف: The electrocardiography (ECG) has short-term prognostic value in coronavirus disease 2019 (COVID-19), yet its ability to predict long-term mortality is unknown. This study aimed to elucidate the predictive role of initial ECG on long-term all-cause mortality in patients diagnosed with COVID-19.In this prospective cohort study, adults with COVID-19 who underwent ECG testing within a 17-hospital health system in Northeast Ohio and Florida between 03/2020-06/2020 were identified. An expert ECG reader analyzed all studies blinded to patient status. The associations of ECG characteristics with long-term all-cause mortality and intensive care unit (ICU) admission were assessed using Cox proportional hazards regression model and multivariable logistic regression models, respectively. Status of long-term mortality was adjudicated on 01/07/2022.Of 837 patients (median age 65 years, 51% female, 44% Black), 683 (81.6%) were hospitalized, 281 (33.6%) required ICU admission, 67 (8.0%) died in-hospital, and 206 (24.6%) died at final follow-up after a median (IQR) of 21 (9-103) days after ECG. Overall, 179 (20.7%) patients presented with sinus tachycardia, 12 (1.4%) with atrial flutter, and 45 (5.4%) with atrial fibrillation (AF). After multivariable adjustment, sinus tachycardia (E-value for HR=3.09, lower CI=2.2) and AF (E-value for HR=3.13, lower CI=2.03) each independently predicted all-cause mortality. At final follow-up, patients with AF had 64.5% probability of death compared with 20.5% for those with normal sinus rhythm (P.0001).Sinus tachycardia and AF on initial ECG strongly predict long-term all-cause mortality in COVID-19. The ECG can serve as a powerful long-term prognostic tool in COVID-19.
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المؤلفون: Eugene S. Chung, John Rickard, Xiaoxiao Lu, Maral DerSarkissian, Miriam L. Zichlin, Hoi Ching Cheung, Natalia Swartz, Alexandra Greatsinger, Mei S. Duh
المصدر: Current medical research and opinion. 38(9)
مصطلحات موضوعية: Cardiac Resynchronization Therapy, Heart Failure, Treatment Outcome, Humans, General Medicine, Cardiac Resynchronization Therapy Devices, Aged, Defibrillators, Implantable, Proportional Hazards Models
الوصف: Cardiac resynchronization therapy (CRT) can improve cardiac function in patients with heart failure (HF); however, in some patients, HF worsens despite CRT. This study characterized the long-term clinical burden of patients with and without HF worsening (HFW) within 6 months post CRT implantation. A claims database (2007–2018) was used to identify two cohorts of adults: those with HFW within 180 days post-CRT and those with no HFW (NHFW). The evaluated clinical outcomes were cardiovascular events/complications, HF-related interventions, hospice enrollment, and all-cause mortality. Inverse probability of treatment weighting (IPTW) was used to adjust for confounders; adjusted comparisons were assessed using weighted Cox proportional hazard ratios (HRs). Among the 12,753 adults analyzed (HFW: N = 4,785; NHFW: N = 7,968), the mean age was 72 years and the mean duration of follow-up was approximately 2 years. The clinical burden was greater for HFW than for NHFW in terms of all-cause mortality (19.7% vs. 12.1%) and occurrence of atrial fibrillation (57.4% vs. 51.2%). In the IPTW-adjusted Cox proportional hazard analyses, patients with HFW had a 54% higher average hazard of experiencing all-cause mortality compared to NHFW (adjusted average HR = 1.54, 95% confidence interval [CI]: 1.41–1.70; p < .001). Of the clinical events experienced by ≥5% of patients, the greatest differences in average hazard were for HF decompensation (adjusted average HR = 1.83, 95% CI: 1.60–2.09) and HF decompensation or death (HR = 1.63, 95%CI: 1.50–1.77). Patients with early HFW post-CRT experienced a significantly higher clinical burden than those without HFW. Vigilance for signs of worsening HF in the first 6 months post-CRT is warranted.
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المؤلفون: Natalia Swartz, Hoi Ching Cheung, Alexandra Greatsinger, Xiaoxiao Lu, Maral DerSarkissian, John Rickard, Eugene S. Chung, Mei Sheng Duh, Miriam L. Zichlin
المصدر: Advances in Therapy. 38:441-467
مصطلحات موضوعية: Male, Cardiac function curve, 030213 general clinical medicine, medicine.medical_specialty, medicine.medical_treatment, Cardiac resynchronization therapy, Cardiac Resynchronization Therapy, 03 medical and health sciences, 0302 clinical medicine, Cost of Illness, Internal medicine, medicine, Humans, Pharmacology (medical), In patient, Aged, Retrospective Studies, Heart Failure, business.industry, Confounding, Health Care Costs, General Medicine, Emergency department, medicine.disease, Confidence interval, Rheumatology, Treatment Outcome, 030220 oncology & carcinogenesis, Heart failure, Female, business
الوصف: Although cardiac resynchronization therapy (CRT) has the potential to improve cardiac function in patients with heart failure (HF), a considerable portion of patients do not respond to therapy. This study assessed the economic burden among patients with and without HF worsening after receiving CRT in real-world practice. In this retrospective claims-based study using Optum’s de-identified Clinformatics® Data Mart Database (January 2007–December 2018), adults who received CRT were stratified into two cohorts based on whether they showed evidence of HF worsening within 180 days post-CRT implantation. Inverse probability of treatment weighting (IPTW) was used to adjust for confounding, accounting for demographics (e.g., age, sex), the Quan–Charlson Comorbidity Index, other clinical characteristics, healthcare resource utilization (HRU), and healthcare costs during the 180 days pre-CRT (baseline period). Annualized all-cause and congestive HF-related HRU and healthcare costs from payer and patient perspectives were assessed from day 181 post-CRT (follow-up period), and compared between cohorts using incidence rate ratios (IRRs) and cost ratios (CRs). This study included 12,753 patients (n = 4785 with HF worsening; n = 7968 without). Mean age was 72 years and roughly two-thirds were male. Baseline characteristics were balanced between cohorts post-IPTW. During follow-up, patients with HF worsening had significantly greater annual all-cause inpatient [adjusted IRR (95% confidence interval) = 1.55 (1.44, 1.66), p
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::e1c2e1990d1b3fc50eeeb04d979ed8fb
https://doi.org/10.1007/s12325-020-01536-2 -
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المؤلفون: Johnny Chahine, Mohamed Kanj, Mark Niebauer, Bryan Baranowski, Ayman A. Hussein, Niraj Varma, Walid Saliba, Khaldoun G. Tarakji, Daniel J. Cantillon, John Rickard, Mandeep Bhargava, Mina K. Chung, Mohamed M. Gad, Bruce L. Wilkoff, Mohamed Diab, Oussama M. Wazni, Thomas Callahan, Patrick J. Tchou, Thomas Dresing
المصدر: Heart Rhythm. 17:1298-1303
مصطلحات موضوعية: Male, medicine.medical_specialty, Ventricular lead, medicine.medical_treatment, Perforation (oil well), Cardiac resynchronization therapy, 030204 cardiovascular system & hematology, Coronary Angiography, Electrocardiography, 03 medical and health sciences, 0302 clinical medicine, Physiology (medical), Cardiac tamponade, medicine, Humans, In patient, Cardiac Resynchronization Therapy Devices, 030212 general & internal medicine, Coronary sinus, Aged, Retrospective Studies, Heart Failure, business.industry, Prognosis, medicine.disease, Coronary Vessels, Electrodes, Implanted, Surgery, Dissection, Heart Injuries, Female, Cardiology and Cardiovascular Medicine, Lead Placement, business, Follow-Up Studies
الوصف: Background Injury to the cardiac venous structures can complicate left ventricular lead placement for cardiac resynchronization therapy (CRT). Little is known about the outcomes of coronary sinus (CS) dissection with or without perforation. Objective The purpose of this study was to determine the outcomes in patients who had a CS injury during CRT implantation. Methods All patients undergoing procedures for CRT implantation at the Cleveland Clinic (2001–2018) were enrolled in a prospectively maintained registry for procedural profiles and complications. All patients with cardiac venous injuries during the procedures were included. Results CS injury occurred in 35 of 5011 patients (0.7%; 6 perforations (17.1%), 29 dissections without perforation (82.9%)). In patients with dissection in the absence of perforation, attempts at CS lead placement after dissection were successful in 21 of 29 patients (72.4%). In those with perforation (n=6, 17.1%), CS lead placement was successful in one of them (16.7%). Cardiac tamponade occurred in 2 patients (5.7%), and the procedure was aborted in both of them. Overall, CS lead placement failed in 13 patients (37%) but 9 (25.7%) underwent subsequent CRT with CS lead placement (n=6, 17.1%; median 58 days later) or epicardial leads (n=3, 8.6%). Three of the remaining 4 patients (8.6%) refused to undergo further procedures, and the fourth (2.9%) died of a complicated course. Conclusion CS injury is not common during CRT implantation procedures and did not preclude successful lead placement in 23 of 35 patients (65.7%) during the index procedure and 6 of 6 (100%) during the subsequent attempted procedures. A low rate of mortality was observed in such patients, but CS injury was associated with increased morbidity.
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المؤلفون: Deborah H Kwon, Seung-Jung Park, Niraj Varma, John Rickard
المصدر: Pacing and clinical electrophysiology : PACEREFERENCES. 44(11)
مصطلحات موضوعية: Male, medicine.medical_specialty, medicine.medical_treatment, Ventricular Dysfunction, Right, Bundle-Branch Block, Cardiac resynchronization therapy, Cardiomyopathy, QRS complex, Ventricular Dysfunction, Left, Cardiac magnetic resonance imaging, Internal medicine, medicine, Humans, In patient, Aged, medicine.diagnostic_test, Left bundle branch block, business.industry, General Medicine, Middle Aged, medicine.disease, Dilatation, Magnetic Resonance Imaging, Right ventricular dilatation, Quartile, Echocardiography, cardiovascular system, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Cardiomyopathies
الوصف: BACKGROUND Marked QRS widening in patients with left bundle branch block (LBBB) may reduce efficacy of cardiac resynchronization therapy (CRT). We hypothesized that extreme QRS prolongation may accompany right ventricular (RV) dilatation/systolic dysfunction (RVD/RVsD) as well as left ventricular dilatation/systolic dysfunction (LVD/LVsD). METHODS We assessed rates of both ventricular dilatation and systolic dysfunction according to widening of QRS duration (QRSd) in 100 consecutive cardiomyopathy patients with true LBBB (QRSd ≥ 130 ms in female or ≥140 ms in male, QS or rS in leads V1/V2, and mid-QRS notching/slurring in ≥2 contiguous leads of I, aVL, and V1/V2/V5/V6). Ventricular dimensions and function were measured by cardiac magnetic resonance imaging. RESULTS There was a trend toward an increase in the prevalence of LVD (13%, 20%, and 90%), LVsD (67%, 77%, and 90%), RVD (23%, 27%, and 50%), RVsD (27%, 27%, and 40%), RVD plus RVsD (13%, 17%, and 40%), or RVD/RVsD (37%, 37%, and 50%) according to the degree of QRS prolongation (
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المؤلفون: Daniel J. Cantillon, Saleem Toro, Laurie Anne Moennich, Eiran Z. Gorodeski, Divyang Patel, Kevin Trulock, John Rickard, Bruce L. Wilkoff, Mark Niebauer, Ayman A. Hussein, Niraj Varma
المصدر: Journal of Cardiovascular Electrophysiology. 30:1979-1983
مصطلحات موضوعية: Male, medicine.medical_specialty, Time Factors, medicine.medical_treatment, Bundle-Branch Block, Cardiac resynchronization therapy, 030204 cardiovascular system & hematology, Ventricular Function, Left, law.invention, Cardiac Resynchronization Therapy, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Physiology (medical), Internal medicine, medicine, Humans, In patient, Cardiac Resynchronization Therapy Devices, cardiovascular diseases, 030212 general & internal medicine, Survival analysis, Aged, Retrospective Studies, Ejection fraction, Proportional hazards model, business.industry, Stroke Volume, Recovery of Function, Middle Aged, medicine.disease, Treatment Outcome, Heart failure, Ventricular assist device, Chronic Disease, Disease Progression, Ventricular Function, Right, cardiovascular system, Cardiology, Heart Transplantation, Female, Heart-Assist Devices, Cardiology and Cardiovascular Medicine, business, Heart Failure, Systolic
الوصف: Introduction In patients with chronic systolic heart failure and frequent right ventricular pacing (RVP), upgrade to cardiac resynchronization therapy (CRT) has become common practice despite a lack of randomized clinical trials. We aimed to evaluate long term outcomes in patients upgraded to CRT from chronic RVP compared with de novo CRT implants. Methods and results We reviewed medical charts on consecutive patients with a left ventricular ejection fraction (LVEF) ≤ 35% and a QRSd ≥ 120 ms undergoing CRT. Survival free of left ventricular assist device (LVAD) and a heart transplant was compared amongst patients on the basis of pre-CRT QRS morphology. Improvement in LVEF was also compared across groups. A total of 1260 patients met inclusion criteria of whom 233 were upgraded from chronic RVP. Over a mean follow up 6.5 ± 4.0 years there were 821 endpoints (27 LVAD, 30 heart transplants, and 764 deaths). In a multivariate Cox regression model, upgraded patients had worse outcomes (HR 1.3(1.1-1.7) P = .007) compared with those with native LBBB and similar outcomes to patients with non-LBBB(HR 0.96(0.76-1.21) P = .7). The survival curve for chronic RVP parallels native LBBB for approximately 2.5 years before dropping sharply. Patients with chronic RVP derive similar improvements in LVEF compared with those with LBBB and superior improvements compared with those with non-LBBB. Conclusions Despite achieving similar levels of LVEF improvement, patients with systolic heart failure with chronic RVP undergoing upgrade to CRT have inferior long term outcomes compared with patients with native LBBB. Long term outcomes with CRT in patients with chronic RVP, RBBB, and IVCD are similar.
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المؤلفون: Mohamed Diab, Daniel J. Cantillon, John Rickard, Mina K. Chung, Mandeep Bhargava, Erika Hutt, Thomas Callahan, Oussama M. Wazni, Jad A. Ballout, Niraj Varma, Walid Saliba, Bryan Baranowski, Patrick J. Tchou, Thomas Dresing, Ayman A. Hussein, Khaldoun G. Tarakji, David O. Martin, Mohamed Kanj
المصدر: Circulation: Arrhythmia and Electrophysiology. 13
مصطلحات موضوعية: Male, medicine.medical_specialty, Databases, Factual, medicine.medical_treatment, Ablation of atrial fibrillation, Hemorrhage, Unnecessary Procedures, Risk Assessment, Risk Factors, Left atrial, Thromboembolism, Physiology (medical), Internal medicine, Atrial Fibrillation, medicine, Humans, Atrial Appendage, In patient, Prospective Studies, Registries, cardiovascular diseases, Stroke, Aged, Ohio, business.industry, Atrial fibrillation, Middle Aged, medicine.disease, Ablation, Treatment Outcome, Atrial Flutter, Pulmonary Veins, Catheter Ablation, cardiovascular system, Cardiology, Feasibility Studies, Female, Cardiology and Cardiovascular Medicine, business, Echocardiography, Transesophageal, Atrial flutter, Factor Xa Inhibitors
الوصف: Background: Many centers continue to routinely perform transesophageal echocardiograms before atrial fibrillation (AF) ablation procedures in patients treated with direct oral anticoagulants (DOACs). One study suggested that the procedures could be done without transesophageal echocardiogram but used intracardiac echocardiography imaging of the appendage from the right ventricular outflow. This study aimed to assess the safety of ablation for AF without transesophageal echocardiogram screening or intracardiac echocardiography imaging of the appendage in DOAC compliant patients. Methods: All patients undergoing AF ablation at the Cleveland Clinic (2011–2018) were enrolled in a prospectively maintained data registry. All consecutive patients presenting with AF or atrial flutter on DOAC were included. Periprocedural thromboembolic complications were assessed. Results: A total of 900 patients were included. Their median CHA 2 DS 2 -VASc score was 2 (interquartile range 1–3). All were on DOACs (333 rivaroxaban, 285 dabigatran, 281 apixaban, and 1 edoxaban). Thromboembolic complications occurred in 4 patients (0.3%): 2 ischemic strokes, 1 transient ischemic attack without residual deficit, and 1 splenic infarct; all with no further complications. Bleeding complications occurred in 5 patients (0.4%): 2 pericardial effusions (1 intraoperative, 1 after 30 days, both drained), 3 groin hematomas (1 of them due to needing heparin for venous thrombosis, none required interventions). No patients required emergent surgeries. Conclusions: In DOAC compliant patients who present for ablation in AF/atrial flutter, the procedures could be performed without transesophageal echocardiogram screening or intracardiac echocardiography imaging of the appendage; with low risk of complications.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::1c69eda50dbebe59eab7037bebc69be4
https://doi.org/10.1161/circep.119.008301 -
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المؤلفون: Bruce D. Lindsay, Niraj Varma, Bruce L. Wilkoff, Walid Saliba, Mina K. Chung, Mandeep Bhargava, Patrick J. Tchou, Khaldoun G. Tarakji, Thomas Callahan, Ryan J. Koene, Mohamed Kanj, Oussama M. Wazni, John Rickard, David O. Martin, Bryan Baranowski, Vivek Menon, Mark Niebauer, Ayman A. Hussein, Daniel J. Cantillon, Thomas Dresing
المصدر: Circulation: Arrhythmia and Electrophysiology. 13
مصطلحات موضوعية: Male, medicine.medical_specialty, Time Factors, Databases, Factual, medicine.medical_treatment, Electric Countershock, Cardiomyopathy, Dofetilide, Ventricular Function, Left, Ventricular Dysfunction, Left, Heart Rate, Recurrence, Physiology (medical), Internal medicine, Atrial Fibrillation, Phenethylamines, medicine, Humans, In patient, Aged, Retrospective Studies, Sulfonamides, Ejection fraction, business.industry, Stroke Volume, Atrial fibrillation, Recovery of Function, Middle Aged, medicine.disease, Implantable cardioverter-defibrillator, Defibrillators, Implantable, Treatment Outcome, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Anti-Arrhythmia Agents, medicine.drug
الوصف: Background: Dofetilide is one of the only anti-arrhythmic agents approved for atrial fibrillation (AF) in patients with reduced left ventricular ejection fraction (LVEF). However, postapproval data and safety outcomes are limited. In this study, we assessed the incidence and predictors of LVEF improvement, safety, and outcomes in patients with AF with LVEF ≤35% without prior implantable cardioverter defibrillator, cardiac resynchronization therapy, or AF ablation. Methods: An analysis of 168 consecutive patients from 2007 to 2016 was performed. Incidences of adverse events, drug continuation, implantable cardioverter defibrillator and cardiac resynchronization therapy implantation, LVEF improvement (>35%) and recovery (≥50%), AF recurrence, and AF ablation were determined. Multivariable regression analysis to identify predictors of LVEF improvement/recovery was performed. Results: The mean age was 64±12 years. Dofetilide was discontinued before hospital discharge in 46 (27%) because of QT prolongation (14%), torsades de pointe or polymorphic ventricular tachycardia/fibrillation (6% [sustained 3%, nonsustained 3%]), ineffectiveness (5%), or other causes (3%). At 1 year, 43% remained on dofetilide. Freedom from AF was 42% at 1 year, and 40% underwent future AF ablation. LVEF recovered (≥50%) in 45% and improved to >35% in 73%. Predictors of LVEF improvement included presence of AF during echocardiogram (odds ratio, 4.22 [95% CI, 1.71–10.4], P =0.002), coronary artery disease (odds ratio, 0.35 [95% CI, 0.16–0.79], P =0.01), left atrial diameter (odds ratio, 0.52 per 1 cm increase [95% CI, 0.30–0.90], P =0.01), and LVEF (odds ratio, per 1% increase, 1.09 [95% CI, 1.02–1.16], P =0.006). The C statistic was 0.78. Conclusions: In patients with LVEF ≤35%, who are potential implantable cardioverter defibrillator candidates, treated with dofetilide as an initial anti-arrhythmic strategy for AF, drug discontinuation rates were high, and many underwent future AF ablation. However, most patients had improvement in LVEF, obviating the need for primary prevention implantable cardioverter defibrillator.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::a9b4c1657674b6e366ceaf5bf5a65792
https://doi.org/10.1161/circep.119.008168 -
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المؤلفون: John Barnard, Niraj Varma, Mina K. Chung, Anant Madabhushi, Eiran Z. Gorodeski, Saleem Toro, John Rickard, Kevin Trulock, Divyang Patel, Richard A. Grimm, Laurie Ann Moennich, Mark Niebauer, Albert Feeny
المصدر: Circ Arrhythm Electrophysiol
مصطلحات موضوعية: Male, medicine.medical_specialty, Time Factors, medicine.medical_treatment, Bundle-Branch Block, Cardiac resynchronization therapy, 030204 cardiovascular system & hematology, Risk Assessment, Article, Ventricular Function, Left, Cardiac Resynchronization Therapy, 03 medical and health sciences, QRS complex, Electrocardiography, 0302 clinical medicine, Predictive Value of Tests, Risk Factors, Physiology (medical), Internal medicine, medicine, Humans, 030212 general & internal medicine, cardiovascular diseases, Diagnosis, Computer-Assisted, Lead (electronics), Aged, Retrospective Studies, Heart Failure, medicine.diagnostic_test, Bundle branch block, business.industry, Signal Processing, Computer-Assisted, Stroke Volume, Recovery of Function, Middle Aged, medicine.disease, Treatment Outcome, Heart failure, Cardiology, cardiovascular system, Disease Progression, Heart Transplantation, Female, Heart-Assist Devices, Cardiology and Cardiovascular Medicine, business, circulatory and respiratory physiology, Unsupervised Machine Learning
الوصف: Background: Cardiac resynchronization therapy (CRT) improves heart failure outcomes but has significant nonresponse rates, highlighting limitations in ECG selection criteria: QRS duration (QRSd) ≥150 ms and subjective labeling of left bundle branch block (LBBB). We explored unsupervised machine learning of ECG waveforms to identify CRT subgroups that may differentiate outcomes beyond QRSd and LBBB. Methods: We retrospectively analyzed 946 CRT patients with conduction delay. Principal component analysis (PCA) dimensionality reduction obtained a 2-dimensional representation of preCRT 12-lead QRS waveforms. k -means clustering of the 2-dimensional PCA representation of 12-lead QRS waveforms identified 2 patient subgroups (QRS PCA groups). Vectorcardiographic QRS area was also calculated. We examined following 2 primary outcomes: (1) composite end point of death, left ventricular assist device, or heart transplant, and (2) degree of echocardiographic left ventricular ejection fraction (LVEF) change after CRT. Results: Compared with QRS PCA Group 2 ( n =425), Group 1 ( n =521) had lower risk for reaching the composite end point (HR, 0.44 [95% CI, 0.38–0.53]; P P P P =0.001). QRS area also stratified outcomes but had significant differences from QRS PCA groups. A stratification scheme combining QRS area and QRS PCA group identified patients with LBBB with similar outcomes to non-LBBB patients (HR, 1.32 [95% CI, 0.93–1.62]; difference in mean LVEF change: 0.8% [95% CI, −2.1% to 3.7%]). The stratification scheme also identified patients with LBBB with QRSd Conclusions: Unsupervised machine learning of ECG waveforms identified CRT subgroups with relevance beyond LBBB and QRSd. This method may assist in objective classification of bundle branch block morphology in CRT.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::2a7d792336867db3d1c4a76d3feb18e2
https://europepmc.org/articles/PMC7901121/
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