Real-world outcomes in cardiac resynchronization therapy patients: Primary results of the SMART registry
Aims: Cardiac resynchronization therapy (CRT) is guideline recommended for the treatment of symptomatic heart failure (HF) with reduced left ventricular ejection fraction and prolonged QRS. However, patients with common comorbidities, such as persistent/permanent atrial fibrillation (AF), are often...
| Autores: | , , , , , , , , , , , , , , , , , |
|---|---|
| Tipo de documento: | artigo |
| Data de publicação: | 2024 |
| País: | España |
| Recursos: | Universidad de Navarra |
| Repositório: | Dadun. Depósito Académico Digital de la Universidad de Navarra |
| Idioma: | inglês |
| OAI Identifier: | oai:dadun.unav.edu:10171/116810 |
| Acesso em linha: | https://hdl.handle.net/10171/116810 |
| Access Level: | Acceso aberto |
| Palavra-chave: | Atrioventricular optimization Cardiac resynchronization therapy Electrical delay Heart failure |
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Real-world outcomes in cardiac resynchronization therapy patients: Primary results of the SMART registry |
| title |
Real-world outcomes in cardiac resynchronization therapy patients: Primary results of the SMART registry |
| spellingShingle |
Real-world outcomes in cardiac resynchronization therapy patients: Primary results of the SMART registry Garcia-Bolao, I. (Ignacio)|||/items/c29cdf3e-401f-4293-b138-6843f6f6bf5b Atrioventricular optimization Cardiac resynchronization therapy Electrical delay Heart failure |
| title_short |
Real-world outcomes in cardiac resynchronization therapy patients: Primary results of the SMART registry |
| title_full |
Real-world outcomes in cardiac resynchronization therapy patients: Primary results of the SMART registry |
| title_fullStr |
Real-world outcomes in cardiac resynchronization therapy patients: Primary results of the SMART registry |
| title_full_unstemmed |
Real-world outcomes in cardiac resynchronization therapy patients: Primary results of the SMART registry |
| title_sort |
Real-world outcomes in cardiac resynchronization therapy patients: Primary results of the SMART registry |
| dc.creator.none.fl_str_mv |
Garcia-Bolao, I. (Ignacio)|||/items/c29cdf3e-401f-4293-b138-6843f6f6bf5b Gardner, R.S. (Roy S.)|||/items/2818e0ab-598b-4c82-bb41-842cb2a2b55a Gras, D. (Daniel)|||/items/9e4d82ea-9187-4072-bf13-5ff2d3242c37 D’Onofrio, A. (Antonio)|||/items/1e632892-43dc-4a10-91d1-e0f5c8e1f647 Mark, G. (George)|||/items/f8481b23-b5fd-4158-8e4d-aacc171487aa Nair, D. (Devi)|||/items/e3d27fda-96dd-4012-a4da-071d6f4fe874 Lellouche, N. (Nicolas)|||/items/d179870c-1602-4bb7-80e8-87a3ddfe2186 Novak, M. (Miroslav)|||/items/25cdc21f-5913-4089-b6ef-ca2b9fec189b Lo, R. (Ronald)|||/items/9565aa8e-8c18-43bd-bd6b-1e3fc91833fe Chew, E. (Engwooi)|||/items/30251bf1-96af-4fe1-a936-d928f9c18f45 Wright, D.W. (David W.)|||/items/99d091f8-e6b3-442a-b391-240c2e3b399c Kaplan, A. (Andrew)|||/items/dab35c32-124d-4aff-96cf-10dc22731d59 Bertini, M. (Matteo)|||/items/5327dc67-1f6a-457a-95e9-6bcc3daf1f6d Veraghtert, S. (Sara)|||/items/e6ca59c1-732f-4786-ad5d-bdc7557fd3cf Harbin, M.M. (Michelle M.)|||/items/531fa47b-370d-4181-a2eb-4ce189fe585c Matznick, E. (Elizabeth)|||/items/2b758b0a-9ac4-4ff7-afed-64f896cb4868 Yong, P. (Patrick)|||/items/f20ddf24-a9dd-453a-bd2f-091c683ea62a Stein, K.M. (Kenneth M.)|||/items/d5b0e2c1-d1e8-4672-9df9-9cb2e96e1973 |
| author |
Garcia-Bolao, I. (Ignacio)|||/items/c29cdf3e-401f-4293-b138-6843f6f6bf5b |
| author_facet |
Garcia-Bolao, I. (Ignacio)|||/items/c29cdf3e-401f-4293-b138-6843f6f6bf5b Gardner, R.S. (Roy S.)|||/items/2818e0ab-598b-4c82-bb41-842cb2a2b55a Gras, D. (Daniel)|||/items/9e4d82ea-9187-4072-bf13-5ff2d3242c37 D’Onofrio, A. (Antonio)|||/items/1e632892-43dc-4a10-91d1-e0f5c8e1f647 Mark, G. (George)|||/items/f8481b23-b5fd-4158-8e4d-aacc171487aa Nair, D. (Devi)|||/items/e3d27fda-96dd-4012-a4da-071d6f4fe874 Lellouche, N. (Nicolas)|||/items/d179870c-1602-4bb7-80e8-87a3ddfe2186 Novak, M. (Miroslav)|||/items/25cdc21f-5913-4089-b6ef-ca2b9fec189b Lo, R. (Ronald)|||/items/9565aa8e-8c18-43bd-bd6b-1e3fc91833fe Chew, E. (Engwooi)|||/items/30251bf1-96af-4fe1-a936-d928f9c18f45 Wright, D.W. (David W.)|||/items/99d091f8-e6b3-442a-b391-240c2e3b399c Kaplan, A. (Andrew)|||/items/dab35c32-124d-4aff-96cf-10dc22731d59 Bertini, M. (Matteo)|||/items/5327dc67-1f6a-457a-95e9-6bcc3daf1f6d Veraghtert, S. (Sara)|||/items/e6ca59c1-732f-4786-ad5d-bdc7557fd3cf Harbin, M.M. (Michelle M.)|||/items/531fa47b-370d-4181-a2eb-4ce189fe585c Matznick, E. (Elizabeth)|||/items/2b758b0a-9ac4-4ff7-afed-64f896cb4868 Yong, P. (Patrick)|||/items/f20ddf24-a9dd-453a-bd2f-091c683ea62a Stein, K.M. (Kenneth M.)|||/items/d5b0e2c1-d1e8-4672-9df9-9cb2e96e1973 |
| author_role |
author |
| author2 |
Gardner, R.S. (Roy S.)|||/items/2818e0ab-598b-4c82-bb41-842cb2a2b55a Gras, D. (Daniel)|||/items/9e4d82ea-9187-4072-bf13-5ff2d3242c37 D’Onofrio, A. (Antonio)|||/items/1e632892-43dc-4a10-91d1-e0f5c8e1f647 Mark, G. (George)|||/items/f8481b23-b5fd-4158-8e4d-aacc171487aa Nair, D. (Devi)|||/items/e3d27fda-96dd-4012-a4da-071d6f4fe874 Lellouche, N. (Nicolas)|||/items/d179870c-1602-4bb7-80e8-87a3ddfe2186 Novak, M. (Miroslav)|||/items/25cdc21f-5913-4089-b6ef-ca2b9fec189b Lo, R. (Ronald)|||/items/9565aa8e-8c18-43bd-bd6b-1e3fc91833fe Chew, E. (Engwooi)|||/items/30251bf1-96af-4fe1-a936-d928f9c18f45 Wright, D.W. (David W.)|||/items/99d091f8-e6b3-442a-b391-240c2e3b399c Kaplan, A. (Andrew)|||/items/dab35c32-124d-4aff-96cf-10dc22731d59 Bertini, M. (Matteo)|||/items/5327dc67-1f6a-457a-95e9-6bcc3daf1f6d Veraghtert, S. (Sara)|||/items/e6ca59c1-732f-4786-ad5d-bdc7557fd3cf Harbin, M.M. (Michelle M.)|||/items/531fa47b-370d-4181-a2eb-4ce189fe585c Matznick, E. (Elizabeth)|||/items/2b758b0a-9ac4-4ff7-afed-64f896cb4868 Yong, P. (Patrick)|||/items/f20ddf24-a9dd-453a-bd2f-091c683ea62a Stein, K.M. (Kenneth M.)|||/items/d5b0e2c1-d1e8-4672-9df9-9cb2e96e1973 |
| author2_role |
author author author author author author author author author author author author author author author author author |
| dc.contributor.none.fl_str_mv |
Dadun. Depósito Académico Digital Universidad de Navarra |
| dc.subject.none.fl_str_mv |
Atrioventricular optimization Cardiac resynchronization therapy Electrical delay Heart failure |
| topic |
Atrioventricular optimization Cardiac resynchronization therapy Electrical delay Heart failure |
| description |
Aims: Cardiac resynchronization therapy (CRT) is guideline recommended for the treatment of symptomatic heart failure (HF) with reduced left ventricular ejection fraction and prolonged QRS. However, patients with common comorbidities, such as persistent/permanent atrial fibrillation (AF), are often under-represented in clinical trials. Methods: The Strategic Management to Optimize Response to Cardiac Resynchronization Therapy (SMART) registry (NCT03075215) was a global, multicentre, registry that enrolled de novo CRT implants, or upgrade from pacemaker or implantable cardioverter defibrillator to CRT-defibrillator (CRT-D), using a quadripolar left ventricular lead in real-world clinical practice. The primary endpoint was CRT response between baseline and 12 month follow-up defined as a clinical composite score (CCS) consisting of all-cause mortality, HF-associated hospitalization, New York Heart Association (NYHA) class and quality of life global assessment. Results: The registry enrolled 2035 patients, of which 1558 had completed CCS outcomes at 12 months. The patient cohort was 33.0% female, mean age at enrolment was 67.5 ± 10.4 years and the mean left ventricular ejection fraction was 29.6 ± 7.9%. Notably, there was a high prevalence of mildly symptomatic patients (NYHA class I/II 51.3%), non-left bundle branch block (LBBB) morphology (38.0%), AF (37.2%) and diabetes mellitus (34.7%) at baseline. CCS at 12 months improved in 58.9% (n = 917) of patients; 20.1% (n = 313) of patients stabilized and 21.0% (n = 328) worsened. Several patient characteristics were associated with a lower likelihood of response to CRT including older age, ischaemic aetiology, renal dysfunction, AF, non-LBBB morphology and diabetes. Higher HF hospitalization (P < 0.001) and all-cause mortality (P < 0.001) were observed in patients with AF. These patients also had lower percentages of ventricular pacing than patients in sinus rhythm at baseline and follow-up (P < 0.001, both). A further association between AF and non-LBBB was observed with 81.4% of AF non-LBBB patients experiencing an HF hospitalization compared with 92.5% of non-AF LBBB patients (P < 0.001). Mortality between subgroups was also statistically significant (P = 0.019). Conclusions: This large, global registry enrolled a CRT-D population with higher incidence of comorbidities that have been historically underrepresented in clinical trials and provides new insight into factors influencing response to CRT. As defined by CCS, 58.9% of patients improved and 20.1% stabilized. Patients with AF had particularly worse clinical outcomes, higher HF hospitalization and mortality rates and lower percentages of ventricular pacing. High incidence of HF hospitalization in patients with AF and non-LBBB in this real-world cohort suggests that ablation may play an important role in increasing future CRT response rates. |
| publishDate |
2024 |
| dc.date.none.fl_str_mv |
2024 2024-01-01 2024 2024-01-01 |
| dc.type.none.fl_str_mv |
journal article http://purl.org/coar/resource_type/c_6501 |
| dc.type.openaire.fl_str_mv |
info:eu-repo/semantics/article |
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article |
| dc.identifier.none.fl_str_mv |
https://hdl.handle.net/10171/116810 |
| url |
https://hdl.handle.net/10171/116810 |
| dc.language.none.fl_str_mv |
Inglés eng |
| language_invalid_str_mv |
Inglés |
| language |
eng |
| dc.rights.none.fl_str_mv |
open access http://purl.org/coar/access_right/c_abf2 |
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info:eu-repo/semantics/openAccess |
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open access http://purl.org/coar/access_right/c_abf2 |
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openAccess |
| dc.format.none.fl_str_mv |
application/pdf |
| dc.publisher.none.fl_str_mv |
John Wiley & Sons Ltd |
| publisher.none.fl_str_mv |
John Wiley & Sons Ltd |
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reponame:Dadun. Depósito Académico Digital de la Universidad de Navarra instname:Universidad de Navarra |
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Universidad de Navarra |
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Dadun. Depósito Académico Digital de la Universidad de Navarra |
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Dadun. Depósito Académico Digital de la Universidad de Navarra |
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1869413410679029760 |
| spelling |
Real-world outcomes in cardiac resynchronization therapy patients: Primary results of the SMART registryGarcia-Bolao, I. (Ignacio)|||/items/c29cdf3e-401f-4293-b138-6843f6f6bf5bGardner, R.S. (Roy S.)|||/items/2818e0ab-598b-4c82-bb41-842cb2a2b55aGras, D. (Daniel)|||/items/9e4d82ea-9187-4072-bf13-5ff2d3242c37D’Onofrio, A. (Antonio)|||/items/1e632892-43dc-4a10-91d1-e0f5c8e1f647Mark, G. (George)|||/items/f8481b23-b5fd-4158-8e4d-aacc171487aaNair, D. (Devi)|||/items/e3d27fda-96dd-4012-a4da-071d6f4fe874Lellouche, N. (Nicolas)|||/items/d179870c-1602-4bb7-80e8-87a3ddfe2186Novak, M. (Miroslav)|||/items/25cdc21f-5913-4089-b6ef-ca2b9fec189bLo, R. (Ronald)|||/items/9565aa8e-8c18-43bd-bd6b-1e3fc91833feChew, E. (Engwooi)|||/items/30251bf1-96af-4fe1-a936-d928f9c18f45Wright, D.W. (David W.)|||/items/99d091f8-e6b3-442a-b391-240c2e3b399cKaplan, A. (Andrew)|||/items/dab35c32-124d-4aff-96cf-10dc22731d59Bertini, M. (Matteo)|||/items/5327dc67-1f6a-457a-95e9-6bcc3daf1f6dVeraghtert, S. (Sara)|||/items/e6ca59c1-732f-4786-ad5d-bdc7557fd3cfHarbin, M.M. (Michelle M.)|||/items/531fa47b-370d-4181-a2eb-4ce189fe585cMatznick, E. (Elizabeth)|||/items/2b758b0a-9ac4-4ff7-afed-64f896cb4868Yong, P. (Patrick)|||/items/f20ddf24-a9dd-453a-bd2f-091c683ea62aStein, K.M. (Kenneth M.)|||/items/d5b0e2c1-d1e8-4672-9df9-9cb2e96e1973Atrioventricular optimizationCardiac resynchronization therapyElectrical delayHeart failureAims: Cardiac resynchronization therapy (CRT) is guideline recommended for the treatment of symptomatic heart failure (HF) with reduced left ventricular ejection fraction and prolonged QRS. However, patients with common comorbidities, such as persistent/permanent atrial fibrillation (AF), are often under-represented in clinical trials. Methods: The Strategic Management to Optimize Response to Cardiac Resynchronization Therapy (SMART) registry (NCT03075215) was a global, multicentre, registry that enrolled de novo CRT implants, or upgrade from pacemaker or implantable cardioverter defibrillator to CRT-defibrillator (CRT-D), using a quadripolar left ventricular lead in real-world clinical practice. The primary endpoint was CRT response between baseline and 12 month follow-up defined as a clinical composite score (CCS) consisting of all-cause mortality, HF-associated hospitalization, New York Heart Association (NYHA) class and quality of life global assessment. Results: The registry enrolled 2035 patients, of which 1558 had completed CCS outcomes at 12 months. The patient cohort was 33.0% female, mean age at enrolment was 67.5 ± 10.4 years and the mean left ventricular ejection fraction was 29.6 ± 7.9%. Notably, there was a high prevalence of mildly symptomatic patients (NYHA class I/II 51.3%), non-left bundle branch block (LBBB) morphology (38.0%), AF (37.2%) and diabetes mellitus (34.7%) at baseline. CCS at 12 months improved in 58.9% (n = 917) of patients; 20.1% (n = 313) of patients stabilized and 21.0% (n = 328) worsened. Several patient characteristics were associated with a lower likelihood of response to CRT including older age, ischaemic aetiology, renal dysfunction, AF, non-LBBB morphology and diabetes. Higher HF hospitalization (P < 0.001) and all-cause mortality (P < 0.001) were observed in patients with AF. These patients also had lower percentages of ventricular pacing than patients in sinus rhythm at baseline and follow-up (P < 0.001, both). A further association between AF and non-LBBB was observed with 81.4% of AF non-LBBB patients experiencing an HF hospitalization compared with 92.5% of non-AF LBBB patients (P < 0.001). Mortality between subgroups was also statistically significant (P = 0.019). Conclusions: This large, global registry enrolled a CRT-D population with higher incidence of comorbidities that have been historically underrepresented in clinical trials and provides new insight into factors influencing response to CRT. As defined by CCS, 58.9% of patients improved and 20.1% stabilized. Patients with AF had particularly worse clinical outcomes, higher HF hospitalization and mortality rates and lower percentages of ventricular pacing. High incidence of HF hospitalization in patients with AF and non-LBBB in this real-world cohort suggests that ablation may play an important role in increasing future CRT response rates.John Wiley & Sons LtdDadun. Depósito Académico Digital Universidad de Navarra20242024-01-0120242024-01-01journal articlehttp://purl.org/coar/resource_type/c_6501info:eu-repo/semantics/articleapplication/pdfhttps://hdl.handle.net/10171/116810reponame:Dadun. Depósito Académico Digital de la Universidad de Navarrainstname:Universidad de NavarraInglésengopen accesshttp://purl.org/coar/access_right/c_abf2info:eu-repo/semantics/openAccessoai:dadun.unav.edu:10171/1168102026-06-21T12:47:57Z |
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15,811543 |