EVALUATION OF THE EFFECTIVENESS OF RESYNCHRONIZING THERAPY IN PATIENTS WITH CHRONIC HEART FAILURE: RETROSPECTIVE ANALYSIS
Introduction. The article presents an analysis of the effectiveness of cardiac resynchronization therapy with defibrillation in the treatment of patients with CHF, refractory to optimal drug therapy.
Purpose of the study: evaluate the efficacy and safety of CRT-D in patients with chronic heart failure.
Materials and methods of research: A retrospective study was conducted, involving 34 patients who had been implanted with the CRT-D system according to standard indications. Evaluation of the effectiveness of procedures was conducted on the basis of analysis of ventricular dyssynchrony revealed by ECG, echocardiography; both before and after the procedure (on the 7th day). Statistical analysis of the data (calculation of mean values, standard deviation, and correlation coefficient) was carried out using application packages Microsoft Excel, SPSS18.0.
Research results: The study included 34 patients, mean age 64,44 ± 9,95 years, while the proportion of men was 70,5%, women 29,5%. Initially, all patients had an advanced stage of CHF: II functional class was 26,5%, III FC 52.9%, IV FC 20,6%. All patients had heart failure of ischemic and non-ischemic (dilated cardiomyopathy) genesis – 88,2% and 11,8% respectively. Initially, the width of the QRS complex averaged 146,95 ± 20,54 ms. After the CRT-D, the QRS complex averaged 126,24 ± 12,92 ms. The mean fraction of the left ventricular ejection was 32,43 ± 11,52%, the average dynamics after the procedure was 37,14 ± 8,09%. During the analysis, no single intraoperative lethal case was detected. The total hospital mortality was 2.9% - 1 case, due to the initially severe decompensation of CHF.
Conclusions: Thus, the analysis showed a positive effect of CRT-D on the clinical status of patients with HF - a decrease in CHF’s FC of the majority of patients. In addition, a positive trend was observed in the rates of ventricular dissynchrony after CRT-D implantation as a shortening of the QRS interval by 16,1%, which is the most important indicator of its effectiveness. Already on the 7th day revealed the growth of left ventricular ejection fraction of 14,5%. An important fact is the absence of periprocedural complications and a high level of its safety.
Ersyn T. Sabitov 1, https://orcid.org/0000-0003-0937-5813
Altay A. Dyussupov 1, http://orcid.org/0000-0003-0875-1020
Ayan S. Abdrakhmanov 2,
Andrey Yu. Orekhov 1, https://orcid.org/0000-0001-7201-1399
1 Semey State Medical University,
Semey, Republic of Kazakhstan;
2 JSC "National Scientific Cardiac Surgery Center",
Astana, Republic of Kazakhstan.
1. Бокерия О.Л., Коцоева О.Т. Современное состояние проблемы сердечной ресинхронизирующей терапии // Анналы аритмологии. 2013; Т 10. № 4. С. 210-220. DOI:10.15275/annaritmol.2013.4.5.
2. Бокерия Л.А., Бокерия О.Л., Базарсадаева Т.С. Ретроспективный анализ результатов применения хронической ресинхронизирующей терапии у пациентов с сердечной недостаточностью // Анналы аритмологии. 2012. Т 9. № 1. С. 32-36.
3. Мареев В.Ю., Фомин И.В., Агеев Ф.Т., Арутюнов Г.П., Беграмбекова Ю.Л., Беленков Ю.Н. и др. Клинические рекомендации. Хроническая сердечная недостаточность (ХСН) // Сердечная Недостаточность. 2017. Т 18. №1. С. 3–40
4. Ponikowski P., Voors A., D. Anker S., Bueno H., J. S . Coats A., Falk V., Gonzаlez-Juanatey J., Harjola V., A. Jankowska E., Jessup M., Linde C., Nihoyannopoulos P., T. Parissis J., Pieske B., P. Riley J., M. C. Rosano G., M. Ruilope L., Ruschitzka F., H. Rutten F., van der Meer P. Рекомендации ESC по диагностике и лечению острой и хронической сердечной недостаточности. 2016 // Российский кардиологический журнал. 2017. № 1. С. 7-81
5. Roberto M. Lang, Michelle Bierig, Richard B. Devereux, Frank A. Flachskampf, Elyse Foster, Patricia A. Pellikka, Michael H. Picard, Mary, J. Roman, James Seward, Jack Shanewise, Scott Solomon, Kirk T. Spencer, Martin St. John Sutton, William Stewart. Рекомендаций по количественной оценке структуры и функции камер сердца. 2012 // Российский кардиологический журнал. 2012 № 3. С 1-27.
6. Anthony S.L. Tang, George A. Wells, Mario Talajic, Malcolm O. Arnold, Robert Sheldon, Stuart Connolly, Stefan H. Hohnloser, Graham Nichol, David H. Birnie, John L. Sapp, Raymond Yee, Jeffrey S. Healey, Jean L. Rouleau. Cardiac-Resynchronization Therapy for Mild-to-Moderate Heart Failure // The New England Journal of Medicine. 2010. № 363. рр 2385-2395.
7. Arthur J. Moss, Mary W. Brown, David S. Cannom, James P. Daubert, Mark Estes, Elyse Foster, Henry M. Greenberg and al. Multicenter Automatic Defibrillator Implantation Trial–Cardiac Resynchronization Therapy (MADIT-CRT): Design and Clinical Protocol // Annals of Noninvasive Electrocardiology. 2004. №10 (4). рр. 34-43
8. Erwan Donal, Christophe Leclercq, Cecilia Linde, Jean-Claude Daubert. Effects of cardiac resynchronization therapy on disease progression in chronic heart failure // European Heart Journal. 2006. № 27. рр. 1018–1025
9. Gautam G Lalani, Ulrika Birgersdotter-Green. Cardiac resynchronisation therapy in patients with chronic heart failure // Heart – BMJ. 2015. № 101(13). рр. 1008-1014
10. Ilan Goldenberg, Valentina Kutyifa, Helmut U. Klein, David S. Cannom, Mary W. Brown, Ariela Dan, James P. Daubert, Mark Estes III, Elyse Foster, Henry Greenberg, and al. Survival with Cardiac-Resynchronization Therapy in Mild Heart Failure // The New England Journal of Medicine. 2014. № 370. рр 1694-1701.
11. John G. Cleland,William T. Abraham, Cecilia Linde, Michael R. Gold, James B. Young, J. Claude Daubert, Lou Sherfesee, George A.Wells, Anthony S.L. Tang. An individual patient meta-analysis of five randomized trials assessing the effects of cardiac resynchronization therapy on morbidity and mortality in patients with symptomatic heart failure // European Heart Journal. 2013. № 34. рр. 3547–3556
12. John J.V. McMurray, Milton Packer, Akshay S. Desai, M.P.H., Jianjian Gong, Martin P. Lefkowitz, Adel R. Rizkala, Jean L. Rouleau, Victor C. Shi, Scott D. Solomon, Karl Swedberg, Michael R. Zile. Angiotensin–Neprilysin Inhibition versus Enalapril in heart failure // The New England Journal of Medicine. 2014. № 371. рр. 993-1004
13. MERIT-HF Study Group. Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF) // Lancet. 1999. № 12. рр. 2001-2007
14. Michele Brignole, Angelo Auricchio, Gonzalo Baron-Esquivias, Pierre Bordachar, Giuseppe Boriani, Ole-A Breithardt, John Cleland and al. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy // European Heart Journal. 2013. № 34. рр. 2281–2329
15. Michael R. Bristow, Leslie A. Saxon, John Boehmer, Steven Krueger, David A. Kass, Teresa De Marco, Peter Carson, Lorenzo DiCarlo, David DeMets, Bill G. White, Dale W. DeVries, Arthur M. Feldman. Cardiac-Resynchronization Therapy with or without an Implantable Defibrillator in Advanced Chronic Heart Failure // The New England Journal of Medicine. 2004. № 350. рр 2140-2150.
16. Rachit M. Shah, Dhavalkumar Patel, Janos Molnar, Kenneth A. Ellenbogen, Jayanthi N. Koneru. Cardiac-resynchronization therapy in patients with systolic heart failure and QRS interval ≤ 130ms: insights from a meta-analysis // European Heart Journal. 2015. № 17. рр. 267–273
17. Robert Miller, Jonathan G. Howlett, Derek V. Exner, Patricia Campbell, Andrew Grant, Stephen Wilton. Baseline functional class and therapeutic efficacy of common heart failure interventions: a systematic review and meta-analysis // Canadian Journal of Cardiology. 2015. № 31(6). рр. 792-799.
18. Tang A.S., Wells G.A., Arnold M., Connolly S., Hohnloser S., Nichol G., Rouleau J., Sheldon R., Talajic M. Resynchronization /defibrillation for ambulatory heart failure trial: rationale and trial design // Current Opinion in Cardiology. 2009. № 24(1). рр. 1-8.
19. Wei-Ping Sun, Chun-Lei Li, Jin-Cheng Guo, Li-Xin Zhang, Ran Liu, Hai-Bin Zhang, Ling Zhang. Long-term efficacy of implantable cardiac resynchronization therapy plus defibrillator for primary prevention of sudden cardiac death in patients with mild heart failure: an updated meta-analysis // Heart Failure Reviews. 2016. №4. pp. 447-453
20. William T. Abraham, James B. Young, Angel R. León, Stuart Adler, Alan J. Bank, Shelley A. Hall, Randy Lieberman, L. Bing Liem, John B. O’Connell, John S. Schroeder, Kevin R. Wheelan. Effects of Cardiac Resynchronization on Disease Progression in Patients With Left Ventricular Systolic Dysfunction, an Indication for an Implantable Cardioverter-Defibrillator, and Mildly Symptomatic Chronic Heart Failure // Circulation. 2004. № 110. рр. 2864-2868
21. Wojciech Kosmala, Thomas H. Marwick. Meta-Analysis of еffects of оptimization of cardiac resynchronization therapy on left ventricular function, exercise capacity, and quality of life in patients with heart failure // The American Journal of Cardiology. 2014. № 113 (6). рр. 988-994
Rеfеrеncеs:
1. Bokeriya O.L., Kotsoeva O.T. Sovremennoe sostoyanie problemy serdechnoĭ resinkhroniziruyushcheĭ terapi [State of the art of cardiac resynchronization therapy]. Annaly aritmologii [Annaly aritmologii]. 2013; Vol. 10. № 4. pp. 210-220. http://arrhythmology.pro/2013-4-210-220 (Дата обращения: 17.05.2018) [In Russian]
2. Bokeriya L.A., Bokeriya O.L., Bazarsadaeva T.S. Retrospektivnyi analiz rezul'tatov primeneniya khronicheskoi resinkhroniziruyushhei terapii u patsientov s serdechnoi nedostatochnost'yu [Retrospective analysis of chronic resynchronization therapy outcomes in patients with cardiac insufficiency]. Annaly aritmologii [Annaly aritmologii]. 2012. Vol. 9. № 1. pp. 32-36. http://arrhythmology.pro/2012-1-032-036 (Дата обращения: 17.05.2018) [in Russian]
3. Mareev V.Yu., Fomin I. V., Ageev F. T., Arutyunov G. P., Begrambekova Yu. L., Belenkov Yu. N. i dr. Klinicheskie rekomendatsii. Khronicheskaya serdechnaya nedostatochnost' (KhSN) [Clinical guidelines. Chronic heart failure (CHF)]. Zhurnal Serdechnaya Nedostatochnost' [Russian Heart Failure Journal] 2017. Vol 18. №1. pp. 3–40. [in Russian]
4. Ponikowski P., A. Voors A., D. Anker S., Bueno H., G.F. Cleland J., J.S . Coats A., Falk V., González-Juanatey J., Harjola V., A. Jankowska E., Jessup M., Linde C., Nihoyannopoulos P., T. Parissis J., Pieske B., P. Riley J., M.C. Rosano G., M. Ruilope L., Ruschitzka F., H. Rutten F., van der Meer P. Rekomendatsii ESC po diagnostike i lecheniyu ostroi i khronicheskoi serdechnoi nedostatochnosti. 2016 [2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure]. Rossiiskii kardiologicheskii zhurnal [Russian Journal of Cardiology]. 2017. № 1. pp. 7-81. [in Russian]
5. Roberto M. Lang, Michelle Bierig, Richard B. Devereux, Frank A. Flachskampf, Elyse Foster, Patricia A. Pellikka, Michael H. Picard, Mary, J. Roman, James Seward, Jack Shanewise, Scott Solomon, Kirk T. Spencer, Martin St. John Sutton, William Stewart. Rekomendatsii po kolichestvennoi otsenke struktury i funktsii kamer serdtsa. 2012 [Recommendations for chamber quantification. ESC]. Rossiiskii kardiologicheskii zhurnal [Russian Journal of Cardiology]. 2012. № 3. pp. 1-27. [in Russian]
6. Anthony S.L. Tang, George A. Wells, Mario Talajic, Malcolm O. Arnold, Robert Sheldon, Stuart Connolly, Stefan H. Hohnloser, Graham Nichol, David H. Birnie, John L. Sapp, Raymond Yee, Jeffrey S. Healey, Jean L. Rouleau. Cardiac-Resynchronization Therapy for Mild-to-Moderate Heart Failure. The New England Journal of Medicine. 2010. № 363. рр 2385-2395.
7. Arthur J. Moss, Mary W. Brown, David S. Cannom, James P. Daubert, Mark Estes, Elyse Foster, Henry M. Greenberg and al. Multicenter Automatic Defibrillator Implantation Trial–Cardiac Resynchronization Therapy (MADIT-CRT): Design and Clinical Protocol. Annals of Noninvasive Electrocardiology. 2004. №10 (4). рр. 34-43.
8. Cecilia Linde, William T. Abraham, Michael R. Gold, Martin St. John Sutton, Stefano Ghio, Claude Daubert. Randomized Trial of Cardiac Resynchronization in Mildle Symptomatic Heart Failure Patients and in Asymptomatic Patients With Left Ventricular Dysfunction and Previous Heart Failure Symptoms. Journal of the American College of Cardiology. 2008. № 52. pp 1834-1843
9. Erwan Donal, Christophe Leclercq, Cecilia Linde, Jean-Claude Daubert. Effects of cardiac resynchronization therapy on disease progression in chronic heart failure. European Heart Journal. 2006. № 27. рр. 1018–1025
10. Ilan Goldenberg, Valentina Kutyifa, Helmut U. Klein, David S. Cannom, Mary W. Brown, Ariela Dan, James P. Daubert, Mark Estes III, Elyse Foster, Henry Greenberg, and al. Survival with Cardiac-Resynchronization Therapy in Mild Heart Failure. The New England Journal of Medicine. 2014. № 370. рр 1694-1701.
11. John G. Cleland,William T. Abraham, Cecilia Linde, Michael R. Gold, James B. Young, J. Claude Daubert, Lou Sherfesee, George A.Wells, Anthony S.L. Tang. An individual patient meta-analysis of five randomized trials assessing the effects of cardiac resynchronization therapy on morbidity and mortality in patients with symptomatic heart failure. European Heart Journal. 2013. № 34. рр. 3547–3556.
12. John J.V. McMurray, Milton Packer, Akshay S. Desai, M.P.H., Jianjian Gong, Martin P. Lefkowitz, Adel R. Rizkala, Jean L. Rouleau, Victor C. Shi, Scott D. Solomon, Karl Swedberg, Michael R. Zile. Angiotensin–Neprilysin Inhibition versus Enalapril in heart failure. The New England Journal of Medicine. 2014. № 371. рр. 993-1004.
13. MERIT-HF Study Group. Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF). Lancet. 1999. № 12. рр. 2001-2007.
14. Michele Brignole, Angelo Auricchio, Gonzalo Baron-Esquivias, Pierre Bordachar, Giuseppe Boriani, Ole-A Breithardt, John Cleland and al. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. European Heart Journal. 2013. № 34. рр. 2281–2329
15. Michael R. Bristow, Leslie A. Saxon, John Boehmer, Steven Krueger, David A. Kass, Teresa De Marco, Peter Carson, Lorenzo DiCarlo, David DeMets, Bill G. White, Dale W. DeVries, Arthur M. Feldman. Cardiac-Resynchronization Therapy with or without an Implantable Defibrillator in Advanced Chronic Heart Failure. The New England Journal of Medicine. 2004. № 350. рр 2140-2150.
16. Rachit M. Shah, Dhavalkumar Patel, Janos Molnar, Kenneth A. Ellenbogen, Jayanthi N. Koneru. Cardiac-resynchronization therapy in patients with systolic heart failure and QRS interval ≤ 130ms: insights from a meta-analysis. European Heart Journal. 2015. № 17. рр. 267–273.
17. Robert Miller, Jonathan G. Howlett, Derek V. Exner, Patricia Campbell, Andrew Grant, Stephen Wilton. Baseline functional class and therapeutic efficacy of common heart failure interventions: a systematic review and meta-analysis. Canadian Journal of Cardiology. 2015. № 31(6). рр. 792-799.
18. Tang A.S., Wells G.A., Arnold M., Connolly S., Hohnloser S., Nichol G., Rouleau J., Sheldon R., Talajic M. Resynchronization/ defibrillation for ambulatory heart failure trial: rationale and trial design. Current Opinion in Cardiology. 2009. № 24(1). рр. 1-8.
19. Wei-Ping Sun, Chun-Lei Li, Jin-Cheng Guo, Li-Xin Zhang, Ran Liu, Hai-Bin Zhang, Ling Zhang. Long-term efficacy of implantable cardiac resynchronization therapy plus defibrillator for primary prevention of sudden cardiac death in patients with mild heart failure: an updated meta-analysis. Heart Failure Reviews. 2016. №4. pp. 447-453
20. William T. Abraham, James B. Young, Angel R. León, Stuart Adler, Alan J. Bank, Shelley A. Hall, Randy Lieberman, L. Bing Liem, John B. O’Connell, John S. Schroeder, Kevin R. Wheelan. Effects of Cardiac Resynchronization on Disease Progression in Patients with Left Ventricular Systolic Dysfunction, an Indication for an Implantable Cardioverter-Defibrillator, and Mildly Symptomatic Chronic Heart Failure. Circulation. 2004. № 110. рр. 2864-2868
21. Wojciech Kosmala, Thomas H. Marwick. Meta-Analysis of еffects of оptimization of cardiac resynchronization therapy on left ventricular function, exercise capacity, and quality of life in patients with heart failure. The American Journal of Cardiology. 2014. № 113 (6). рр. 988-994.
Bibliography link
Сабитов Е.Т., Дюсупов А.А., Абдрахманов А.С., Орехов А.Ю. Оценка эффективности ресинхронизирующей терапии у больных с хронической сердечной недостаточностью: ретроспективный анализ / / Наука и Здравоохранение. 2018. 4 (Т.20). С. 22-33.
Sabitov E.T., Dyussupov A.A., Abdrakhmanov A.S., Orekhov A.Yu. Evaluation of the effectiveness of resynchronizing therapy in patients with chronic heart failure: retrospective analysis. Nauka i Zdravookhranenie [Science & Healthcare]. 2018, (Vol.20) 4, pp. 22-33.
Сабитов Е.Т., Дюсупов А.А., Абдрахманов А.С., Орехов А.Ю. Созылмалы жүрек жетіспеушілігі бар науқастарға ресинхрондаушы терапияның тиімділігін бағалау: ретроспективті анализ / / Ғылым және Денсаулық сақтау. 2018. 4 (Т.20). Б. 22-33