PMID- 28202628
OWN - NLM
STAT- MEDLINE
DCOM- 20170615
LR  - 20170615
IS  - 1941-3084 (Electronic)
IS  - 1941-3084 (Linking)
VI  - 10
IP  - 2
DP  - 2017 Feb
TI  - Effects of Upgrade Versus De Novo Cardiac Resynchronization Therapy on Clinical 
      Response and Long-Term Survival: Results from a Multicenter Study.
PG  - e004471
LID - 10.1161/CIRCEP.116.004471 [doi]
AB  - BACKGROUND: Benefits of cardiac resynchronization therapy (CRT) on morbidity and 
      mortality in selected patients are well known. Although the number of upgrade 
      procedures from single- or dual-chamber devices to CRT is increasing, there are 
      only sparse data on the outcomes of upgrade procedures compared with de novo CRT. 
      This study aimed to evaluate clinical response and survival in patients receiving 
      de novo versus upgrade CRT defibrillator therapy. METHODS AND RESULTS: 
      Prospectively collected outcome data were compared in patients undergoing de novo 
      or upgrade CRT defibrillator implantation at 3 implant centers in Germany and 
      Hungary. Clinical response was defined as an improvement by at least one New York 
      Heart Association (NYHA) functional class. CRT implantation was performed in 552 
      consecutive patients of whom 375 underwent a de novo and 177 an upgrade 
      procedure. Upgrade patients were more often implanted for secondary prevention, 
      suffered more often from atrial fibrillation, chronic kidney disease, diabetes 
      mellitus, and dyslipidemia, and had more often a non-LBBB (left bundle branch 
      block) wide QRS complex, and lower left ventricular ejection fraction. Upgrade 
      procedures were associated with a lower response rate compared to the de novo 
      group (57% versus 69%, P univariate=0.008, P multivariate=0.021). During the 
      follow-up of 37+/-28 months, survival was worse after upgrade compared with de novo 
      CRT defibrillator implantations (hazard ratio, 1.65; 95% confidence interval, 
      1.22-2.24; P=0.001) even after careful adjustment for important baseline 
      variables (adjusted hazard ratio, 1.68; 95% confidence interval, 1.20-2.34; 
      P=0.002) and after propensity-score matching (propensity-adjusted hazard ratio, 
      1.79; 95% confidence interval, 1.08-2.95; P=0.023). CONCLUSIONS: Both clinical 
      response and long-term survival were less favorable in patients undergoing CRT 
      upgrade compared to de novo implantations.
CI  - (c) 2017 American Heart Association, Inc.
FAU - Vamos, Mate
AU  - Vamos M
AD  - From the Department of Cardiology, J.W. Goethe University, Frankfurt, Germany 
      (M.V., J.W.E., S.P.L., S.H.H.); Department of Cardiology, Medical Centre, 
      Hungarian Defence Forces, Budapest, Hungary (Z.B., D.V., G.Z.D.); and Department 
      of Cardiology, Evangelical Hospital Bielefeld, Germany (T.B., C.W.I.).
FAU - Erath, Julia W
AU  - Erath JW
AD  - From the Department of Cardiology, J.W. Goethe University, Frankfurt, Germany 
      (M.V., J.W.E., S.P.L., S.H.H.); Department of Cardiology, Medical Centre, 
      Hungarian Defence Forces, Budapest, Hungary (Z.B., D.V., G.Z.D.); and Department 
      of Cardiology, Evangelical Hospital Bielefeld, Germany (T.B., C.W.I.).
FAU - Bari, Zsolt
AU  - Bari Z
AD  - From the Department of Cardiology, J.W. Goethe University, Frankfurt, Germany 
      (M.V., J.W.E., S.P.L., S.H.H.); Department of Cardiology, Medical Centre, 
      Hungarian Defence Forces, Budapest, Hungary (Z.B., D.V., G.Z.D.); and Department 
      of Cardiology, Evangelical Hospital Bielefeld, Germany (T.B., C.W.I.).
FAU - Vagany, Denes
AU  - Vagany D
AD  - From the Department of Cardiology, J.W. Goethe University, Frankfurt, Germany 
      (M.V., J.W.E., S.P.L., S.H.H.); Department of Cardiology, Medical Centre, 
      Hungarian Defence Forces, Budapest, Hungary (Z.B., D.V., G.Z.D.); and Department 
      of Cardiology, Evangelical Hospital Bielefeld, Germany (T.B., C.W.I.).
FAU - Linzbach, Sven P
AU  - Linzbach SP
AD  - From the Department of Cardiology, J.W. Goethe University, Frankfurt, Germany 
      (M.V., J.W.E., S.P.L., S.H.H.); Department of Cardiology, Medical Centre, 
      Hungarian Defence Forces, Budapest, Hungary (Z.B., D.V., G.Z.D.); and Department 
      of Cardiology, Evangelical Hospital Bielefeld, Germany (T.B., C.W.I.).
FAU - Burmistrava, Tatsiana
AU  - Burmistrava T
AD  - From the Department of Cardiology, J.W. Goethe University, Frankfurt, Germany 
      (M.V., J.W.E., S.P.L., S.H.H.); Department of Cardiology, Medical Centre, 
      Hungarian Defence Forces, Budapest, Hungary (Z.B., D.V., G.Z.D.); and Department 
      of Cardiology, Evangelical Hospital Bielefeld, Germany (T.B., C.W.I.).
FAU - Israel, Carsten W
AU  - Israel CW
AD  - From the Department of Cardiology, J.W. Goethe University, Frankfurt, Germany 
      (M.V., J.W.E., S.P.L., S.H.H.); Department of Cardiology, Medical Centre, 
      Hungarian Defence Forces, Budapest, Hungary (Z.B., D.V., G.Z.D.); and Department 
      of Cardiology, Evangelical Hospital Bielefeld, Germany (T.B., C.W.I.).
FAU - Duray, Gabor Z
AU  - Duray GZ
AD  - From the Department of Cardiology, J.W. Goethe University, Frankfurt, Germany 
      (M.V., J.W.E., S.P.L., S.H.H.); Department of Cardiology, Medical Centre, 
      Hungarian Defence Forces, Budapest, Hungary (Z.B., D.V., G.Z.D.); and Department 
      of Cardiology, Evangelical Hospital Bielefeld, Germany (T.B., C.W.I.).
FAU - Hohnloser, Stefan H
AU  - Hohnloser SH
AD  - From the Department of Cardiology, J.W. Goethe University, Frankfurt, Germany 
      (M.V., J.W.E., S.P.L., S.H.H.); Department of Cardiology, Medical Centre, 
      Hungarian Defence Forces, Budapest, Hungary (Z.B., D.V., G.Z.D.); and Department 
      of Cardiology, Evangelical Hospital Bielefeld, Germany (T.B., C.W.I.). 
      hohnloser@em.uni-frankfurt.de.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PL  - United States
TA  - Circ Arrhythm Electrophysiol
JT  - Circulation. Arrhythmia and electrophysiology
JID - 101474365
SB  - IM
CIN - Circ Arrhythm Electrophysiol. 2017 Feb;10(2):e004956. PMID: 28202631
MH  - Aged
MH  - Cardiac Resynchronization Therapy/*methods
MH  - Echocardiography
MH  - Female
MH  - Germany
MH  - Heart Failure/diagnostic imaging/mortality/*therapy
MH  - Humans
MH  - Hungary
MH  - Male
MH  - Patient Selection
MH  - Propensity Score
MH  - Prospective Studies
MH  - Retreatment
MH  - Risk Factors
MH  - *Secondary Prevention
MH  - Survival Rate
MH  - Time Factors
MH  - Treatment Outcome
OTO - NOTNLM
OT  - cardiac resynchronization therapy
OT  - heart failure
OT  - hypertension
OT  - morbidity
OT  - mortality
EDAT- 2017/02/17 06:00
MHDA- 2017/06/16 06:00
CRDT- 2017/02/17 06:00
PHST- 2016/07/05 00:00 [received]
PHST- 2016/12/13 00:00 [accepted]
PHST- 2017/02/17 06:00 [entrez]
PHST- 2017/02/17 06:00 [pubmed]
PHST- 2017/06/16 06:00 [medline]
AID - CIRCEP.116.004471 [pii]
AID - 10.1161/CIRCEP.116.004471 [doi]
PST - ppublish
SO  - Circ Arrhythm Electrophysiol. 2017 Feb;10(2):e004471. doi: 
      10.1161/CIRCEP.116.004471.