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Impact of Diastolic Function on Systolic Function in Patients Undergoing Cardiac Resynchronization Therapy: A Meta-Analysis
S88 Journal of Cardiac Failure Vol. 14 No. 6S Suppl. 2008
283 Impact of Diastolic Function on Systolic Function in Patients Undergoing Cardiac Resynchronization Therapy: A Meta-Analysis Sanjay Kumar, Saurabh Kaushik, Richard A. Grimm; Cleveland Clinic Foundation, Cleveland, OH; New York University, New York, NY; Cleveland Clinic Foundation, Cleveland, OH Background: Cardiac Resynchronization Therapy (CRT) improves systolic function (SF) and appears to affect diastolic function (DF). Some studies suggested that favorable outcomes in CRT patients (pts) were coupled with improvement in DF parameters while others did not show much change in DF parameters. Poor Ejection Fraction (EF) response to CRT was also associated with abnormal diastolic filling pattern as measured by E wave to A wave ratio (E/A) and Deceleration Time (DT). Objective: To determine how DF (measured by E/A and DT) affects SF (measured by EF) in CRT pts at 3 to 6 months (m) follow-up? Methods: MEDLINE, EMBASE and the Cochrane register were searched. Eligible studies were cohort or randomized trial on CRT reporting E/A ratio, DT and EF before and 3 to 6 m after CRT. Pts had heart failure with EF ! 35%, NYHA class III & IV and QRS duration O 120 msec. Twelve studies with total 634 pts (mean age 64 6 7.7, males 67%) were included in metaanalysis (Review Manager 4.2). Weighted Mean Difference of effect size between pre and post CRT was calculated (with fixed effect, 95% confidence interval [CI]). For each study ratio of average DT and average E/A ratio were obtained and compared to average increment in EF (using SPSS 13). Results: CRT produced mean reduction in E/A ratio of 0.20 (CI 0.11e0.29), mean increase in DT of 34 msec (CI 25e43) and mean increase in EF of 6.9% (CI 5.9e7.8). Baseline DT correlated with increase in EF (r 5 0.69, p !0.01). There was non linear relationship between DT or DT/ (E/A) ratio and increment in EF among studies figure 1 & figure 2.
Conclusions: There is consistent evidence that improvement in SF induced by CRT is associated with improvement in DF. Combination of baseline DT and DT/ (E/A) ratio can predict increase in EF at 3 to 6 months after CRT.
284 Perceived Social Support Predicted Quality of Life in Patients with Heart Failure but the Effect Is Mediated by Depressive Symptoms Misook L. Chung1, Debra K. Moser2, Terry A. Lennie3; 1Nursing, University of Kentucky, Lexington, KY Background: Positive social support is associated with better outcomes in coronary artery disease patients. Depressive symptoms and anxiety are well-known predictors of poor quality of life and increased mortality and morbidity in heart failure (HF). However, the relationship between social support and quality of life has not been investigated in the context of depressive symptoms in patients with HF. Purpose: To determine the nature of the relationship among depressive symptoms, anxiety, social support, and quality of life. Methods: A total of 361 patients (68% male, 60 years, 52% NYHA class III/IV) completed questionnaires. Depressive symptoms were assessed using the Beck Depression Inventory-II (BDI-II). Social support was assessed with the Perceived Social Support Scale. Quality of life was assessed using the Minnesota Living with Heart Failure Questionnaire. A series of multiple regression analyses and 2x2 ANOVA were used to test direct, mediator, and moderator effects of social support and depressive symptoms on quality of life controlling for age, gender, NYHA class, and functional status (Duke Activity Scale). Results: One third of patients (30%) had depressive symptoms (BDI-II $ 13; mean 5 11 6 9). Both poor social support and presence of depressive symptoms were independently associated with poor quality of life (Table 1). Social support was associated with patients’ depressive symptoms. The relationship between social support and quality of life was mediated by patient’s depressive symptoms as the significant relationship between social support and quality of life disappeared when depressive symptoms were controlled. There was no moderating effect of social support or depressive symptoms on quality of life. Conclusion: These results suggest that promoting social support will only improve quality of life if patient’s depressive symptoms are also treated. Table 1. . Multiple regression of social support and depressive symptoms on quality of life Step 1 2 3 4
Predictors
Outcome
Standard b
p-value
Perceived social support Perceived social support Depressive symptoms Depressive symptoms Perceived social support
Quality of life Depressive symptoms Quality of life Quality of life
-.132 -.262 -.467 .464 -.010
! .001 ! .001 !.001 !.001 .769
283 Impact of Diastolic Function on Systolic Function in Patients Undergoing Cardiac Resynchronization Therapy: A Meta-Analysis Sanjay Kumar, Saurabh Kaushik, Richard A. Grimm; Cleveland Clinic Foundation, Cleveland, OH; New York University, New York, NY; Cleveland Clinic Foundation, Cleveland, OH Background: Cardiac Resynchronization Therapy (CRT) improves systolic function (SF) and appears to affect diastolic function (DF). Some studies suggested that favorable outcomes in CRT patients (pts) were coupled with improvement in DF parameters while others did not show much change in DF parameters. Poor Ejection Fraction (EF) response to CRT was also associated with abnormal diastolic filling pattern as measured by E wave to A wave ratio (E/A) and Deceleration Time (DT). Objective: To determine how DF (measured by E/A and DT) affects SF (measured by EF) in CRT pts at 3 to 6 months (m) follow-up? Methods: MEDLINE, EMBASE and the Cochrane register were searched. Eligible studies were cohort or randomized trial on CRT reporting E/A ratio, DT and EF before and 3 to 6 m after CRT. Pts had heart failure with EF ! 35%, NYHA class III & IV and QRS duration O 120 msec. Twelve studies with total 634 pts (mean age 64 6 7.7, males 67%) were included in metaanalysis (Review Manager 4.2). Weighted Mean Difference of effect size between pre and post CRT was calculated (with fixed effect, 95% confidence interval [CI]). For each study ratio of average DT and average E/A ratio were obtained and compared to average increment in EF (using SPSS 13). Results: CRT produced mean reduction in E/A ratio of 0.20 (CI 0.11e0.29), mean increase in DT of 34 msec (CI 25e43) and mean increase in EF of 6.9% (CI 5.9e7.8). Baseline DT correlated with increase in EF (r 5 0.69, p !0.01). There was non linear relationship between DT or DT/ (E/A) ratio and increment in EF among studies figure 1 & figure 2.
Conclusions: There is consistent evidence that improvement in SF induced by CRT is associated with improvement in DF. Combination of baseline DT and DT/ (E/A) ratio can predict increase in EF at 3 to 6 months after CRT.
284 Perceived Social Support Predicted Quality of Life in Patients with Heart Failure but the Effect Is Mediated by Depressive Symptoms Misook L. Chung1, Debra K. Moser2, Terry A. Lennie3; 1Nursing, University of Kentucky, Lexington, KY Background: Positive social support is associated with better outcomes in coronary artery disease patients. Depressive symptoms and anxiety are well-known predictors of poor quality of life and increased mortality and morbidity in heart failure (HF). However, the relationship between social support and quality of life has not been investigated in the context of depressive symptoms in patients with HF. Purpose: To determine the nature of the relationship among depressive symptoms, anxiety, social support, and quality of life. Methods: A total of 361 patients (68% male, 60 years, 52% NYHA class III/IV) completed questionnaires. Depressive symptoms were assessed using the Beck Depression Inventory-II (BDI-II). Social support was assessed with the Perceived Social Support Scale. Quality of life was assessed using the Minnesota Living with Heart Failure Questionnaire. A series of multiple regression analyses and 2x2 ANOVA were used to test direct, mediator, and moderator effects of social support and depressive symptoms on quality of life controlling for age, gender, NYHA class, and functional status (Duke Activity Scale). Results: One third of patients (30%) had depressive symptoms (BDI-II $ 13; mean 5 11 6 9). Both poor social support and presence of depressive symptoms were independently associated with poor quality of life (Table 1). Social support was associated with patients’ depressive symptoms. The relationship between social support and quality of life was mediated by patient’s depressive symptoms as the significant relationship between social support and quality of life disappeared when depressive symptoms were controlled. There was no moderating effect of social support or depressive symptoms on quality of life. Conclusion: These results suggest that promoting social support will only improve quality of life if patient’s depressive symptoms are also treated. Table 1. . Multiple regression of social support and depressive symptoms on quality of life Step 1 2 3 4
Predictors
Outcome
Standard b
p-value
Perceived social support Perceived social support Depressive symptoms Depressive symptoms Perceived social support
Quality of life Depressive symptoms Quality of life Quality of life
-.132 -.262 -.467 .464 -.010
! .001 ! .001 !.001 !.001 .769