Long-term outcomes of cardiac resynchronization therapy in adult congenital heart disease

Francisco Leyva, Abbasin Zegard, Tian Qiu, Joseph de Bono, Sara Thorne, Paul Clift, Howard Marshall, Lucy Hudsmith

Research output: Contribution to journalArticle

Abstract

Background and Aims: Randomized, controlled trials of cardiac resynchronization therapy (CRT) excluded patients with adult congenital heart disease (ACHD). We sought to explore long-term clinical outcomes. Methods and Results: In this single-center, observational study, events were collected from hospital records on patients with structural ACHD (sACHD) and adults with ischemic (ICM) or nonischemic (NICM) cardiomyopathy undergoing CRT. Patients with sACHD (n = 23, age: 41.6 ± 13.5 years [mean ± standard deviation]) and adults with ICM (n = 533) or NICM (n = 458) were followed-up for 4.1 years (median; interquartile range: 2.2-6.1). Total mortality was 5/23 (21.7%; 4.4 per 100 person-years) in sACHD, 221/533 (41.5%; 11.8 per 100 person-years) in ICM, and 154/458 (33.6%; 9.7 per 100 person-years) in NICM. In univariate analyses, total mortality in sACHD was lower than in ICM (hazard ratio [HR]: 0.38; 95% confidence interval [CI] 0.15-0.91), but similar to NICM (HR: 0.48, 95% CI 0.20-1.16). Cardiac mortality in sACHD was similar to ICM (HR: 0.78, 95% CI 0.32-1.92) and NICM (HR: 1.12, 95% CI 0.45-2.78). Heart failure (HF) hospitalization rates were similar to ICM (HR: 0.44, 95% CI 0.11-1.77) and NICM (HR: 0.75, 95% CI 0.18-3.08). In multivariate analyses, no differences emerged in total mortality, cardiac mortality, or HF hospitalization between sACHD and NICM or ICM, after adjustment for age, sex, New York Heart Association class, diabetes, atrial rhythm, QRS duration, QRS morphology, systemic ventricular ejection fraction, and medical therapy. Conclusion: Total mortality, cardiac mortality, and HF hospitalization after CRT in patients with sACHD was similar to adults with ICM or NICM.

Original languageEnglish
Pages (from-to)573-580
Number of pages8
JournalPACE - Pacing and Clinical Electrophysiology
Volume42
Issue number6
Early online date17 Apr 2019
DOIs
Publication statusPublished - 1 Jun 2019

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Cardiac Resynchronization Therapy
Heart Diseases
Confidence Intervals
Mortality
Heart Failure
Hospitalization
Hospital Records
Cardiomyopathies
Stroke Volume
Observational Studies
Multivariate Analysis
Randomized Controlled Trials

Bibliographical note

© 2019 The Authors. Pacing and Clinical Electrophysiology Published by Wiley Periodicals, Inc.

This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Keywords

  • adult congenital heart disease
  • cardiac resynchronization therapy
  • heart failure
  • mortality

Cite this

Leyva, F., Zegard, A., Qiu, T., de Bono, J., Thorne, S., Clift, P., ... Hudsmith, L. (2019). Long-term outcomes of cardiac resynchronization therapy in adult congenital heart disease. PACE - Pacing and Clinical Electrophysiology, 42(6), 573-580. https://doi.org/10.1111/pace.13670
Leyva, Francisco ; Zegard, Abbasin ; Qiu, Tian ; de Bono, Joseph ; Thorne, Sara ; Clift, Paul ; Marshall, Howard ; Hudsmith, Lucy. / Long-term outcomes of cardiac resynchronization therapy in adult congenital heart disease. In: PACE - Pacing and Clinical Electrophysiology. 2019 ; Vol. 42, No. 6. pp. 573-580.
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Leyva, F, Zegard, A, Qiu, T, de Bono, J, Thorne, S, Clift, P, Marshall, H & Hudsmith, L 2019, 'Long-term outcomes of cardiac resynchronization therapy in adult congenital heart disease', PACE - Pacing and Clinical Electrophysiology, vol. 42, no. 6, pp. 573-580. https://doi.org/10.1111/pace.13670

Long-term outcomes of cardiac resynchronization therapy in adult congenital heart disease. / Leyva, Francisco; Zegard, Abbasin; Qiu, Tian; de Bono, Joseph; Thorne, Sara; Clift, Paul; Marshall, Howard; Hudsmith, Lucy.

In: PACE - Pacing and Clinical Electrophysiology, Vol. 42, No. 6, 01.06.2019, p. 573-580.

Research output: Contribution to journalArticle

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T1 - Long-term outcomes of cardiac resynchronization therapy in adult congenital heart disease

AU - Leyva, Francisco

AU - Zegard, Abbasin

AU - Qiu, Tian

AU - de Bono, Joseph

AU - Thorne, Sara

AU - Clift, Paul

AU - Marshall, Howard

AU - Hudsmith, Lucy

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N2 - Background and Aims: Randomized, controlled trials of cardiac resynchronization therapy (CRT) excluded patients with adult congenital heart disease (ACHD). We sought to explore long-term clinical outcomes. Methods and Results: In this single-center, observational study, events were collected from hospital records on patients with structural ACHD (sACHD) and adults with ischemic (ICM) or nonischemic (NICM) cardiomyopathy undergoing CRT. Patients with sACHD (n = 23, age: 41.6 ± 13.5 years [mean ± standard deviation]) and adults with ICM (n = 533) or NICM (n = 458) were followed-up for 4.1 years (median; interquartile range: 2.2-6.1). Total mortality was 5/23 (21.7%; 4.4 per 100 person-years) in sACHD, 221/533 (41.5%; 11.8 per 100 person-years) in ICM, and 154/458 (33.6%; 9.7 per 100 person-years) in NICM. In univariate analyses, total mortality in sACHD was lower than in ICM (hazard ratio [HR]: 0.38; 95% confidence interval [CI] 0.15-0.91), but similar to NICM (HR: 0.48, 95% CI 0.20-1.16). Cardiac mortality in sACHD was similar to ICM (HR: 0.78, 95% CI 0.32-1.92) and NICM (HR: 1.12, 95% CI 0.45-2.78). Heart failure (HF) hospitalization rates were similar to ICM (HR: 0.44, 95% CI 0.11-1.77) and NICM (HR: 0.75, 95% CI 0.18-3.08). In multivariate analyses, no differences emerged in total mortality, cardiac mortality, or HF hospitalization between sACHD and NICM or ICM, after adjustment for age, sex, New York Heart Association class, diabetes, atrial rhythm, QRS duration, QRS morphology, systemic ventricular ejection fraction, and medical therapy. Conclusion: Total mortality, cardiac mortality, and HF hospitalization after CRT in patients with sACHD was similar to adults with ICM or NICM.

AB - Background and Aims: Randomized, controlled trials of cardiac resynchronization therapy (CRT) excluded patients with adult congenital heart disease (ACHD). We sought to explore long-term clinical outcomes. Methods and Results: In this single-center, observational study, events were collected from hospital records on patients with structural ACHD (sACHD) and adults with ischemic (ICM) or nonischemic (NICM) cardiomyopathy undergoing CRT. Patients with sACHD (n = 23, age: 41.6 ± 13.5 years [mean ± standard deviation]) and adults with ICM (n = 533) or NICM (n = 458) were followed-up for 4.1 years (median; interquartile range: 2.2-6.1). Total mortality was 5/23 (21.7%; 4.4 per 100 person-years) in sACHD, 221/533 (41.5%; 11.8 per 100 person-years) in ICM, and 154/458 (33.6%; 9.7 per 100 person-years) in NICM. In univariate analyses, total mortality in sACHD was lower than in ICM (hazard ratio [HR]: 0.38; 95% confidence interval [CI] 0.15-0.91), but similar to NICM (HR: 0.48, 95% CI 0.20-1.16). Cardiac mortality in sACHD was similar to ICM (HR: 0.78, 95% CI 0.32-1.92) and NICM (HR: 1.12, 95% CI 0.45-2.78). Heart failure (HF) hospitalization rates were similar to ICM (HR: 0.44, 95% CI 0.11-1.77) and NICM (HR: 0.75, 95% CI 0.18-3.08). In multivariate analyses, no differences emerged in total mortality, cardiac mortality, or HF hospitalization between sACHD and NICM or ICM, after adjustment for age, sex, New York Heart Association class, diabetes, atrial rhythm, QRS duration, QRS morphology, systemic ventricular ejection fraction, and medical therapy. Conclusion: Total mortality, cardiac mortality, and HF hospitalization after CRT in patients with sACHD was similar to adults with ICM or NICM.

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Leyva F, Zegard A, Qiu T, de Bono J, Thorne S, Clift P et al. Long-term outcomes of cardiac resynchronization therapy in adult congenital heart disease. PACE - Pacing and Clinical Electrophysiology. 2019 Jun 1;42(6):573-580. https://doi.org/10.1111/pace.13670