Cardiac Magnetic Resonance, Electromechanical Activation, Kidney Function, and Natriuretic Peptides in Cardiac Resynchronization Therapy Upgrades
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Baseline Characteristics and Response Measures of Entire Patient Cohort
3.2. Mechanical and Electrical Activation at the Left Ventricular Pacing Site by Upgrade/De Novo Group
3.3. All-Cause Mortality by Group
3.4. L1-Regularization for Selection of Covariates Associated with Survival
3.5. Training and Test Sets with Standard Logistic Regression
3.6. Receiver Operating Characteristic Analysis and Nomogram
3.7. Kaplan–Meier Analysis and Cox Proportional Hazards Analysis
3.8. Mediation Effects
4. Discussion
Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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All (N = 102) | De Novo CRT (N = 50) | CRT Upgrade with RVP (N = 29) | CRT Upgrade w/o RVP (N = 23) | p Value (All Groups) | p Value (Group 1 vs. 2) | |
---|---|---|---|---|---|---|
Demographics | ||||||
Age, years | 66.5 (58.3–72.9) | 65.4 (60.4–70.8) | 74.0 (64.0–79.0) | 62.0 (56.0–70.0) | 0.02 | 0.03 |
BMI, kg/m2 | 28.3 (24.2–33.2) | 28.0 (24.0–31.7) | 28.2 (23.3–33.1) | 29.1 (25.4–35.5) | 0.8 | |
Weight, kg | 85.3 (75.3–103.0) | 82.6 (73.6–99.8) | 91.6 (73.9–103.0) | 93.8 (80.2–103.9) | 0.5 | |
Female | 24 (23.5) | 15 (30.0) | 3 (10.3) | 6 (26.1) | 0.1 | |
NYHA Heart Failure Class | <0.0001 | <0.0001 | ||||
II | 35 (34.3) | 3 (6.0) | 18 (62.1) | 14 (60.9) | ||
III | 67 (65.7) | 47 (94.0) | 11 (37.9) | 9 (39.1) | ||
Race | 0.5 | |||||
Black | 16 (15.7) | 6 (12.0) | 5 (17.2) | 5 (21.7) | ||
White/Other | 86 (84.3) | 44 (88.0) | 24 (82.8) | 18 (78.3) | ||
SHFM Score | 0.38 (0.005–0.81) | 0.55 (0.22–0.89) | 0.19 (−0.01–0.79) | 0.2 (−0.015–0.41) | 0.1 | |
Comorbid Conditions | ||||||
Ischemic Cardiomyopathy | 49 (48.0) | 23 (46.0) | 11 (37.9) | 15 (65.2) | 0.1 | |
Atrial Fibrillation | 33 (32.4) | 11 (22.0) | 18 (62.1) | 4 (17.4) | 0.0004 | 0.0006 |
Chronic Kidney Disease | 36 (35.3) | 14 (28.0) | 14 (48.3) | 8 (34.8) | 0.2 | |
Prior CABG | 27 (26.5) | 11 (22.0) | 7 (24.1) | 9 (39.1) | 0.3 | |
Medications | ||||||
Beta-Blocker | 96 (94.1) | 49 (98.0) | 25 (86.2) | 22 (95.7) | 0.07 | |
ACE Inhibitor/ARB | 85 (83.3) | 46 (92.0) | 19 (65.5) | 20 (87.0) | 0.01 | 0.005 |
Loop Diuretic | 79 (77.5) | 40 (80.0) | 18 (62.1) | 21 (91.3) | 0.04 | 0.1 |
Statin | 67 (65.7) | 28 (56.0) | 19 (65.5) | 20 (87.0) | 0.04 | 0.5 |
Laboratory Studies, Vital Signs & Exercise Testing | ||||||
Systolic BP, mmHg | 118.5 (102.0–130.0) | 118.0 (108.0–129.8) | 127.0 (110.0–138.0) | 107.0 (96.5–120.0) | 0.01 | 0.2 |
Sodium, mEq/L | 138.0 (136.3–140.0) | 138.0 (137.0–139.8) | 139.0 (138.0–141.0) | 137.0 (136.0–139.0) | 0.1 | |
Creatinine, mg/dL | 1.2 (0.96–1.4) | 1.05 (0.9–1.3) | 1.3 (1.2–1.6) | 1.1 (0.95–1.4) | 0.004 | 0.002 |
Hemoglobin, g/dL | 13.3 (12.3–14.5) | 13.6 (12.3–14.4) | 13.1 (12.3–14.5) | 13.1 (12.4–14.6) | 0.9 | |
GFR, mL/min/1.72 m2 | 64.1 (51.5–82.6) | 72.2 (59.1–87.0) | 58.0 (43.0–74.0) | 63.0 (54.0–77.0) | 0.02 | 0.006 |
BNP, pg/mL | 272.0 (137.3–752.8) | 210.5 (118.3–699.0) | 272.0 (124.0–879.0) | 304.0 (262.0–642.0) | 0.2 | |
Peak VO2, mL/kg/min | 0.075 (−0.88–1.4) | 14.3 (12.2–16.1) | 14.4 (13.4–14.8) | 14.4 (12.7–14.6) | 0.9 | |
CMR/Echocardiography Assessment Parameters | ||||||
LVEF, % | 23.7 (17.4–29.8) | 23.2 (18.9–28.0) | 29.0 (20.0–35.0) | 19.0 (16.5–26.0) | 0.02 | 0.06 |
LVEDVI, mL/m2 | 127.9 (104.8–165.0) | 133.7 (112.2–170.2) | 102.0 (77.4–115.0) | 152.0 (126.2–183.5) | <0.0001 | 0.0002 |
LVESVI, mL/m2 | 97.2 (73.6–127.0) | 101.2 (84.9–134.9) | 71.3 (49.9–90.4) | 117.0 (95.9–148.5) | <0.0001 | 0.0005 |
RVEF, % | 36.1 (26.0–45.5) | 36.1 (24.4–48.7) | 37.5 (32.0–44.6) | 35.1 (27.8–40.1) | 0.7 | |
RVEDVI, mL/m2 | 65.8 (55.3–83.7) | 66.0 (53.5–81.2) | 65.3 (55.5–86.9) | 65.8 (57.3–79.3) | 0.9 | |
RVESVI, mL/m2 | 40.2 (32.7–55.2) | 42.0 (31.8–57.7) | 38.7 (31.6–52.8) | 39.6 (38.1–50.3) | 0.9 | |
LGE Presence | 55 (53.9) | 27 (54.0) | 14 (48.3) | 14 (60.9) | 0.7 | |
CURE-SVD | 0.57 (0.45–0.72) | 0.60 (0.45–0.78) | 0.55 (0.50–0.69) | 0.55 (0.37–0.67) | 0.4 | |
Scar at LV Free Wall | 29 (28.4) | 15 (30.0) | 5 (17.2) | 9 (39.1) | 0.2 | |
Electrical Parameters | ||||||
Paced QRS | 31 (30.4) | 0 (0.0) | 29 (100.0) | 0 (0.0) | <0.0001 | <0.0001 |
QRS, ms | 161.0 (147.0–180.0) | 160.0 (146.3–180.0) | 179.0 (164.0–200.0) | 152.0 (136.0–168.0) | 0.0004 | 0.002 |
QLV, ms | 130.0 (98.0–154.3) | 112.5 (81.3–140.0) | 160.0 (150.0–172.0) | 108.0 (99.0–127.0) | <0.0001 | <0.0001 |
QLV/QRS Ratio | 0.78 (0.67–0.89) | 0.74 (0.58–0.81) | 0.89 (0.84–0.96) | 0.76 (0.69–0.79) | <0.0001 | <0.001 |
LBBB | 67 (65.7) | 48 (96.0) | 0 (0) | 16 (69.6) | <0.0001 | <0.0001 |
RBBB | 7 (6.9) | 3 (6.0) | 0 (0) | 3 (13.0) | 0.5 | |
TOS at LV Lead, ms | 87.5 (69.0–114.8) | 106.0 (72.3–118.0) | 86.0 (66.0–107.0) | 78.0 (68.0–96.5) | 0.06 | 0.1 |
TOS at Latest Activated LV Segment, ms | 119.5 (101.0–136.0) | 124.0 (97.3–136.0) | 112.0 (100.0–134.0) | 119.0 (104.0–141.0) | 0.7 | |
Response Measures at 6 Months Post-CRT | ||||||
Fractional Change in LVESVI | −0.2 (−0.32–−0.08) | −0.18 (−0.36–−0.023) | −0.21 (−0.36–−0.09) | −0.2 (−0.265–−0.135) | 0.7 | |
BNP, pg/mL | 172.5 (63.8–442.8) | 132.5 (51.8–451.8) | 172.5 (70.0–526.0) | 195.0 (150.5–238.0) | 0.6 | |
Change in Peak VO2, mL/kg/min | 0.075 (−0.88–1.37) | 0.40 (−1.5–2.3) | −0.26 (−0.9–0.4) | 0.075 (−0.03–0.3) | 0.3 | |
Survival Status at 4 Years | 0.2 | |||||
Alive | 83 (81.4) | 44 (88.0) | 21 (72.4) | 18 (78.2) | ||
Dead | 19 (18.6) | 6 (12.0) | 8 (27.6) | 5 (21.8) |
De Novo CRT (N = 50) | CRT Upgrade with RVP (N = 29) | CRT Upgrade w/o RVP (N = 23) | p Value (All Groups) | p Value (Group 1 vs. 2) | |
---|---|---|---|---|---|
LV Lead Location | |||||
Longitudinal | 0.4 | ||||
Basal | 9 (18.0) | 7 (24.1) | 9 (39.1) | ||
Mid-ventricular | 29 (58.0) | 17 (58.6) | 11 (47.8) | ||
Apical | 12 (24.0) | 5 (17.2) | 3 (13.0) | ||
Circumferential | 0.6 | ||||
Anterior | 8 (16.0) | 1 (3.4) | 2 (8.7) | ||
Anteroseptal | 0 (0.0) | 0 (0.0) | 0 (0.0) | ||
Inferoseptal | 0 (0.0) | 0 (0.0) | 0 (0.0) | ||
Inferior | 1 (2.0) | 0 (0.0) | 1 (4.3) | ||
Inferolateral | 12 (24.0) | 7 (24.1) | 5 (21.7) | ||
Anterolateral | 29 (58) | 21 (72.4) | 15 (65.2) | ||
Location of Latest Mechanical Activation | |||||
Longitudinal | <0.0001 | ||||
Basal | 14 (28.0) | 25 (86.2) | 16 (69.6) | <0.0001 | <0.0001 |
Mid-ventricular | 31 (62.0) | 4 (13.8) | 6 (26.1) | <0.0001 | <0.0001 |
Apical | 5 (10.0) | 0 (0.0) | 1 (4.3) | 0.6 | |
Circumferential | 0.003 | ||||
Anterior | 5 (10.0) | 14 (48.3) | 9 (39.1) | 0.0002 | 0.0002 |
Anteroseptal | 0 (0.0) | 0 (0.0) | 0 (0.0) | ||
Inferoseptal | 0 (0.0) | 0 (0.0) | 0 (0.0) | ||
Inferior | 1 (2.0) | 1 (3.4) | 1 (4.3) | 0.8 | |
Inferolateral | 17 (34.0) | 2 (6.9) | 7 (30.4) | 0.02 | 0.007 |
Anterolateral | 27 (54) | 12 (41.4) | 6 (26.1) | 0.08 |
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Bivona, D.J.; Oomen, P.J.A.; Wang, Y.; Morales, F.L.; Abdi, M.; Gao, X.; Malhotra, R.; Darby, A.; Mehta, N.; Monfredi, O.J.; et al. Cardiac Magnetic Resonance, Electromechanical Activation, Kidney Function, and Natriuretic Peptides in Cardiac Resynchronization Therapy Upgrades. J. Cardiovasc. Dev. Dis. 2023, 10, 409. https://doi.org/10.3390/jcdd10100409
Bivona DJ, Oomen PJA, Wang Y, Morales FL, Abdi M, Gao X, Malhotra R, Darby A, Mehta N, Monfredi OJ, et al. Cardiac Magnetic Resonance, Electromechanical Activation, Kidney Function, and Natriuretic Peptides in Cardiac Resynchronization Therapy Upgrades. Journal of Cardiovascular Development and Disease. 2023; 10(10):409. https://doi.org/10.3390/jcdd10100409
Chicago/Turabian StyleBivona, Derek J., Pim J. A. Oomen, Yu Wang, Frances L. Morales, Mohamad Abdi, Xu Gao, Rohit Malhotra, Andrew Darby, Nishaki Mehta, Oliver J. Monfredi, and et al. 2023. "Cardiac Magnetic Resonance, Electromechanical Activation, Kidney Function, and Natriuretic Peptides in Cardiac Resynchronization Therapy Upgrades" Journal of Cardiovascular Development and Disease 10, no. 10: 409. https://doi.org/10.3390/jcdd10100409