- Email: [email protected]
Central but not obstructive sleep apnea can be influenced by cardiac resynchronisation therapy
S98
with obstructive sleep apnea. Permanent pacing in this patient population does not appear justified. AB49-2 CENTRAL BUT NOT OBSTRUCTIVE SLEEP APNEA CAN BE INFLUENCED BY CARDIAC RESYNCHRONISATION THERAPY Olaf Oldenburg, MD, Volker To¨pfer, MD, *Ju¨rgen Vogt, MD, Dieter Horstkotte, MD and Barbara Lamp, MD. Heart Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany. Rationale: This study investigates the influence of cardiac resynchronization therapy (CRT) on sleep disordered breathing (SDB) in patients with severe chronic heart failure (CHF). Methods and Results: A total of 100 consecutive patients with CHF eligible for CRT (NYHA class ⬎⫽ III, LBBB, QRS width ⬎ 150 ms, EF ⬍ 35%, LVEDD ⬎ 60 mm) were screened for SDB using cardiorespiratory polygraphy (Embletta®) before device implantation. Mean age 64.8⫾9.8 years, CAD n⫽42, DCM n⫽54, valvular heart disease n⫽4, mean EF 25.7⫾6.8%, mean VO2peak 13.4⫾4.8 ml/kg/min, mean QRS width 185⫾18 ms. Central sleep apnea (CSA) was documented in 39 patients (39%) and obstructive sleep apnea (OSA) in 34 patients (34%). Only 27 patients (27%) had normal results during cardio- respiratory polygraphy. Twenty-two patients with CSA (central apnea index ⬎ 15/hr) and 8 patients with OSA were reinvestigated 12 - 24 weeks after biventricular pacemaker implantation for apnea-hypopnea-index (AHI), NYHA classification, and peak oxygen uptake. Eleven patients demonstrated a significant improvement of CSA by CRT: AHI 32.0 vs 10.8, p⬍0.0001, EF (23.1 vs 27.8%, p⫽0.026), NYHA (2.9 vs 2.1 p⫽0.0002), and oxygen uptake (13.7 vs 17.4, p⫽0.01). In contrast, CSA remained unchanged in the other 11 patients (AHI 33.9/hr vs 30.7/hr, ns). All nonresponders were also nonresponders with respect to CRT (neither improvement of NYHA, EF nor of oxygen uptake after 3 months of CRT). OSA was not influenced by CRT (AHI 14.0 versus 12.0, p⫽ns), despite good clinical response to CRT (NYHA 3.1 versus 2.3; VO2peak 13.7 versus 17.6 ml/kg/min, p⫽0.02). Conclusion: In appr. 50 % of patients with CRT, a short term improvement of heart failure symptoms and parameters correlates with a marked improvement in central sleep apnea. In patients who do not show a clinical improvement during the first 3 months of CRT, CSA does also not improve, which supports CSA being a marker for the severity of CHF. In contrast OSA is not influenced by CRT. Because of its pathophysiologic and prognostic significance and the availability of modern treatment options, cardiorespiratory screening should be routinely implemented in the evaluation of CRT patients. AB49-3 LONG-TERM OUTCOME OF HEART FAILURE PATIENTS TREATED WITH CARDIAC RESYNCHRONIZATION THERAPY: A COMPARISON BETWEEN DIABETIC AND NON-DIABETIC PATIENTS Cecilia Fantoni, MD, Santi Raffa, MD, Francois Regoli, MD, Silke I. Trautmann, MD, Mihoko Kawabata, MD, PhD, *Helmut U. Klein, MD and *Angelo Auricchio, MD, PhD. University Hospital, Magdeburg, Germany. Background: Cardiac resynchronization therapy (CRT) is able to improve symptoms, functional capacity and prognosis of patients (pts) with advanced heart failure (HF). Data on long-term outcome of diabetic (D) and non-diabetic (ND) advanced HF pts treated with CRT are still lacking.
Heart Rhythm, Vol 2, No 5, May Supplement 2005 Methods: We compared functional and structural changes and long term outcome of 127 D pts and 192 ND pts who consecutively received a CRT device. Events were considered death from any cause, urgent heart transplantation and implantation of a left ventricular (LV) assist device. Results: At baseline D pts were older (p⬍0,001), had larger LV enddiastolic diameter (p⬍0,05), higher pulmonary artery systolic pressure (p⬍0,05), higher prevalence of permanent atrial fibrillation (p⬍0,05) and received less beta-blockers (p⬍0,05) compared to ND pts. At 1 year follow-up both groups of pts showed a significant improvement of functional class (p⬍0,0001), peak oxygen consumption (p⬍0,001), LV ejection fraction (p⬍0,001) and a significant reduction of LV end-diastolic diameter (p⬍0,001). The magnitude of improvements was similar in both groups. Over a mean follow-up time of 833⫾621 days, the event-free survival rate was not significantly different between the 2 groups (See Kaplan Meier Curve). Conclusions: Diabetic and non-diabetic pts treated with CRT showed similar degree of improvement in functional and structural parameters. No difference in long term event-free survival rate was observed between the two groups.
AB49-4 BIVENTRICULAR IMPLANTABLE CARDIOVERTERDEFIBRILLATOR IN THE ELDERLY Hector Osorio, MD, Atul Bhatia, MD, Dinesh Pubbi, MD, Zalmen Blanck, MD, Anwer Dhala, MD, Jasbir Sra, MD, Marcie G. Berger, MD, Ryan Cooley, MD and Masood Akhtar, MD. Aurora Sinai/St. Luke’s Medical Centers, University of Wisconsin Medical School-MCC, Milwaukee, WI. Biventricular implantable cardioverter-defibrillator (BiVD) has been shown to improve clinical status and survival in patients with heart failure (HF) and intraventricular conduction defect. Although advanced age is an important variable in determining cardiovascular mortality, its impact on the outcome of patients with BiVD is unknown. The purpose of this study was to determine the effect of advanced age on the outcome of patients with BiVD. Methods: We performed multivariate analysis of data on 350 consecutive patients who underwent BiVD implant for cardiomyopathy and HF. Seventy-eight patients ⱖ79 years old (Group 1) were compared with 272 patients ⱕ79 years old (Group 2). Results: The 2 groups were similar in clinical presentation, left ventricular function (mean ejection fraction 25⫾3%) and gender distribution. The mean follow-up time was 12 and 14 months respectively for patients in Group 1 and Group 2. Actuarial survival at 1 year was 68% in Group 1 and 88% in Group 2 (p⬍0.005). This difference was primarily due to a higher rate of non sudden cardiac death in Group 1. On multivariate analysis, age ⬎79 years, NYHA Class IV and peri/postoperative complications were independently associated with increased mortality (odds ratio: 2.1, 3.5 and 1.4 respectively). Conclusion: Among patients with similar clinical presentations and ejection fractions, the mortality risk is increased two-fold in patients with BiVD who were ⬎79 years old. Extrapolation of results from younger patients is likely to overestimate the benefit of BiVD in the elderly.
with obstructive sleep apnea. Permanent pacing in this patient population does not appear justified. AB49-2 CENTRAL BUT NOT OBSTRUCTIVE SLEEP APNEA CAN BE INFLUENCED BY CARDIAC RESYNCHRONISATION THERAPY Olaf Oldenburg, MD, Volker To¨pfer, MD, *Ju¨rgen Vogt, MD, Dieter Horstkotte, MD and Barbara Lamp, MD. Heart Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany. Rationale: This study investigates the influence of cardiac resynchronization therapy (CRT) on sleep disordered breathing (SDB) in patients with severe chronic heart failure (CHF). Methods and Results: A total of 100 consecutive patients with CHF eligible for CRT (NYHA class ⬎⫽ III, LBBB, QRS width ⬎ 150 ms, EF ⬍ 35%, LVEDD ⬎ 60 mm) were screened for SDB using cardiorespiratory polygraphy (Embletta®) before device implantation. Mean age 64.8⫾9.8 years, CAD n⫽42, DCM n⫽54, valvular heart disease n⫽4, mean EF 25.7⫾6.8%, mean VO2peak 13.4⫾4.8 ml/kg/min, mean QRS width 185⫾18 ms. Central sleep apnea (CSA) was documented in 39 patients (39%) and obstructive sleep apnea (OSA) in 34 patients (34%). Only 27 patients (27%) had normal results during cardio- respiratory polygraphy. Twenty-two patients with CSA (central apnea index ⬎ 15/hr) and 8 patients with OSA were reinvestigated 12 - 24 weeks after biventricular pacemaker implantation for apnea-hypopnea-index (AHI), NYHA classification, and peak oxygen uptake. Eleven patients demonstrated a significant improvement of CSA by CRT: AHI 32.0 vs 10.8, p⬍0.0001, EF (23.1 vs 27.8%, p⫽0.026), NYHA (2.9 vs 2.1 p⫽0.0002), and oxygen uptake (13.7 vs 17.4, p⫽0.01). In contrast, CSA remained unchanged in the other 11 patients (AHI 33.9/hr vs 30.7/hr, ns). All nonresponders were also nonresponders with respect to CRT (neither improvement of NYHA, EF nor of oxygen uptake after 3 months of CRT). OSA was not influenced by CRT (AHI 14.0 versus 12.0, p⫽ns), despite good clinical response to CRT (NYHA 3.1 versus 2.3; VO2peak 13.7 versus 17.6 ml/kg/min, p⫽0.02). Conclusion: In appr. 50 % of patients with CRT, a short term improvement of heart failure symptoms and parameters correlates with a marked improvement in central sleep apnea. In patients who do not show a clinical improvement during the first 3 months of CRT, CSA does also not improve, which supports CSA being a marker for the severity of CHF. In contrast OSA is not influenced by CRT. Because of its pathophysiologic and prognostic significance and the availability of modern treatment options, cardiorespiratory screening should be routinely implemented in the evaluation of CRT patients. AB49-3 LONG-TERM OUTCOME OF HEART FAILURE PATIENTS TREATED WITH CARDIAC RESYNCHRONIZATION THERAPY: A COMPARISON BETWEEN DIABETIC AND NON-DIABETIC PATIENTS Cecilia Fantoni, MD, Santi Raffa, MD, Francois Regoli, MD, Silke I. Trautmann, MD, Mihoko Kawabata, MD, PhD, *Helmut U. Klein, MD and *Angelo Auricchio, MD, PhD. University Hospital, Magdeburg, Germany. Background: Cardiac resynchronization therapy (CRT) is able to improve symptoms, functional capacity and prognosis of patients (pts) with advanced heart failure (HF). Data on long-term outcome of diabetic (D) and non-diabetic (ND) advanced HF pts treated with CRT are still lacking.
Heart Rhythm, Vol 2, No 5, May Supplement 2005 Methods: We compared functional and structural changes and long term outcome of 127 D pts and 192 ND pts who consecutively received a CRT device. Events were considered death from any cause, urgent heart transplantation and implantation of a left ventricular (LV) assist device. Results: At baseline D pts were older (p⬍0,001), had larger LV enddiastolic diameter (p⬍0,05), higher pulmonary artery systolic pressure (p⬍0,05), higher prevalence of permanent atrial fibrillation (p⬍0,05) and received less beta-blockers (p⬍0,05) compared to ND pts. At 1 year follow-up both groups of pts showed a significant improvement of functional class (p⬍0,0001), peak oxygen consumption (p⬍0,001), LV ejection fraction (p⬍0,001) and a significant reduction of LV end-diastolic diameter (p⬍0,001). The magnitude of improvements was similar in both groups. Over a mean follow-up time of 833⫾621 days, the event-free survival rate was not significantly different between the 2 groups (See Kaplan Meier Curve). Conclusions: Diabetic and non-diabetic pts treated with CRT showed similar degree of improvement in functional and structural parameters. No difference in long term event-free survival rate was observed between the two groups.
AB49-4 BIVENTRICULAR IMPLANTABLE CARDIOVERTERDEFIBRILLATOR IN THE ELDERLY Hector Osorio, MD, Atul Bhatia, MD, Dinesh Pubbi, MD, Zalmen Blanck, MD, Anwer Dhala, MD, Jasbir Sra, MD, Marcie G. Berger, MD, Ryan Cooley, MD and Masood Akhtar, MD. Aurora Sinai/St. Luke’s Medical Centers, University of Wisconsin Medical School-MCC, Milwaukee, WI. Biventricular implantable cardioverter-defibrillator (BiVD) has been shown to improve clinical status and survival in patients with heart failure (HF) and intraventricular conduction defect. Although advanced age is an important variable in determining cardiovascular mortality, its impact on the outcome of patients with BiVD is unknown. The purpose of this study was to determine the effect of advanced age on the outcome of patients with BiVD. Methods: We performed multivariate analysis of data on 350 consecutive patients who underwent BiVD implant for cardiomyopathy and HF. Seventy-eight patients ⱖ79 years old (Group 1) were compared with 272 patients ⱕ79 years old (Group 2). Results: The 2 groups were similar in clinical presentation, left ventricular function (mean ejection fraction 25⫾3%) and gender distribution. The mean follow-up time was 12 and 14 months respectively for patients in Group 1 and Group 2. Actuarial survival at 1 year was 68% in Group 1 and 88% in Group 2 (p⬍0.005). This difference was primarily due to a higher rate of non sudden cardiac death in Group 1. On multivariate analysis, age ⬎79 years, NYHA Class IV and peri/postoperative complications were independently associated with increased mortality (odds ratio: 2.1, 3.5 and 1.4 respectively). Conclusion: Among patients with similar clinical presentations and ejection fractions, the mortality risk is increased two-fold in patients with BiVD who were ⬎79 years old. Extrapolation of results from younger patients is likely to overestimate the benefit of BiVD in the elderly.