[논문]Contractibility sensor signal evolution predicts cardiovascular events in patients with cardiac resynchronization therapy

Garcia, Rodrigue; Guenancia, Charles; Le Gal, Franç; ois; Rehman, Michaela; Tao, Vincent; Christiaens, Luc; Ingrand, Pierre; Degand, Bruno

doi:10.1016/j.acvd.2018.07.003

[해외논문] Contractibility sensor signal evolution predicts cardiovascular events in patients with cardiac resynchronization therapy
L’évolution du signal de contractibilité myocardique prédit les événements cardiovasculaires chez les patients porteurs d’une resynchronisation cardiaque 원문보기

Archives of cardiovascular diseases, v.112 no.1, 2019년, pp.22 - 30

Garcia, Rodrigue (Service de cardiologie, CHU de Poitiers) , Guenancia, Charles (Faculté) , Le Gal, François (de mé) , Rehman, Michaela (decine et pharmacie, université) , Tao, Vincent (de Poitiers) , Christiaens, Luc (Service de cardiologie, CHU de Poitiers) , Ingrand, Pierre (Service de cardiologie, CHU de Poitiers) , Degand, Bruno (Service de cardiologie, CHU de Poitiers)

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Summary Background While a multicentre trial has demonstrated that the SonR™ contractibility sensor is as effective as echocardiography-guided optimization at improving response to cardiac resynchronization therapy, an association between SonR™ values and clinical endpoints has not been established. Aims The primary objective was to assess the predictive value of SonR™ signal evolution regarding cardiovascular events in patients implanted with a cardiac resynchronization therapy device. The secondary objective was to evaluate whether SonR™ signal evolution was associated with cardiovascular death. Methods All patients with a SonR™ system implanted between 2012 and 2016 were included in this retrospective study. SonR™ signal evolution was calculated over the first 6 months after implantation: ([month 6 value−month 1 value]/month 1 value)*100. The primary endpoint (cardiovascular events) was a composite of cardiovascular death, hospitalization for acute heart failure or ventricular arrhythmia. Results Seventy-four patients (median age 67 years; 81% men) were followed up over a median 20 (13; 29) months. Cumulative incidence function showed that SonR™ signal evolution was predictive of cardiovascular events (threshold<10.70%; P =0.023) and predictive of cardiovascular death (P =0.0018). After multivariable analysis, SonR™ signal evolution was independently associated with the onset of cardiovascular events (hazard ratio: 4.03, 95% confidence interval: 1.31–12.43; P =0.015), even after adjustment for left bundle branch block and chronic kidney disease. Conclusions In this first study publishing data on SonR™ signals in a real-life setting, SonR™ signal evolution over the first 6 months after cardiac resynchronization implantation was an independent predictor of cardiovascular events at follow-up. This variable could be useful to identify patients at higher risk of further adverse events after cardiac resynchronization implantation.

Abstract

Résumé Contexte Une étude a démontré que le SonR™ était aussi efficace que l’optimisation échographique après resynchronisation cardiaque. Cependant, l’association entre les valeurs SonR™ et les évènements cliniques n’a jamais été étudiée. Objectifs L’objectif primaire était d’évaluer la valeur prédictive du signal SonR™ vis-à-vis d’évènements cardiovasculaires chez les patients implantés d’une resynchronisation cardiaque. L’objectif secondaire était d’évaluer l’association entre les valeurs SonR™ et la survenue de décès cardiovasculaires. Méthodes Les patients implantés d’un système SonR™ entre 2012 et 2016 ont été inclus dans cette étude rétrospective. L’évolution du signal SonR™ lors des 6 premiers mois après l’implantation a été calculée : ([valeur M6−valeur M1]/valeur M1)*100. Le critère de jugement principal (évènements cardiovasculaires) associait décès cardiovasculaire, hospitalisation pour insuffisance cardiaque et arythmie ventriculaire. Résultats Soixante-quatorze patients (67 ans ; 81 % hommes) ont été suivis durant une médiane de 20 (13–29) mois. La fonction d’incidence cumulée a montré que l’évolution du signal SonR™ était prédictif d’évènements cardiovasculaires (seuil<10,70 % ; p =0,023) et de décès cardiovasculaires (p =0,0018). Après analyse multivariée, l’évolution du signal SonR™ était indépendamment associé avec la survenue d’évènements cardiovasculaires (HR : 4,03, IC95 % : 1,31–12,43 ; p =0,015) même après ajustement sur le bloc de branche gauche et l’insuffisance rénale chronique. Conclusion Cette étude, réalisée dans des conditions de vraie vie, a montré que l’évolution du signal SonR™ durant les 6 premiers mois après implantation d’une resynchronisation cardiaque était prédicteur de survenue d’évènements cardiovasculaires. Ce paramètre permettrait d’identifier les patients à haut risque d’évènements cardiovasculaire après implantation d’un resynchronisation cardiaque.

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