Predictors of Remodeling in the CRT Era: Influence of Mitral Regurgitation, BNP, and Gender
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Accession number;06A0306318
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| Title;Predictors of Remodeling in the CRT Era: Influence of Mitral Regurgitation, BNP, and Gender |
| Author;
CAPPOLA THOMAS P.
(From The Div. Of Cardiovascular Medicine, Univ. Of Pennsylvania School Of Medicine, Philadelphia, Pennsylvania)
HARSCH MANYA R.
(Medtronic, Inc., Minneapolis, Minnesota)
JESSUP MARIELL
(From The Div. Of Cardiovascular Medicine, Univ. Of Pennsylvania School Of Medicine, Philadelphia, Pennsylvania)
ABRAHAM WILLIAM T.
(Ohio State Univ. Heart Center, Columbus, Ohio)
YOUNG JAMES B.
(The Cleveland Clinic Foundation And Kaufman Center For Heart Failure, Cleveland, Ohio)
PETERSEN-STEJSKAL SUSAN
(Medtronic, Inc., Minneapolis, Minnesota)
PLAPPERT TED
(From The Div. Of Cardiovascular Medicine, Univ. Of Pennsylvania School Of Medicine, Philadelphia, Pennsylvania)
ST. JOHN SUTTON MARTIN
(From The Div. Of Cardiovascular Medicine, Univ. Of Pennsylvania School Of Medicine, Philadelphia, Pennsylvania)
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Journal Title;J Card Fail
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Journal Code:W1342A
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ISSN:1071-9164
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VOL.12;NO.3;PAGE.182-188(2006)
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| Figure&Table&Reference;FIG.2, TBL.4, REF.31 |
| Pub. Country;United States |
| Language;English |
| Abstract;We analyzed quantitative echocardiographic data from a large heart failure cohort receiving medical and cardiac resynchronization therapy (CRT) to determine baseline predictors of progressive left ventricular (LV) enlargement. Quantitative echocardiograms were obtained at baseline and after 6 months in 776 outpatients with chronic heart failure who participated in MIRACLE (Multicenter InSync Randomized Clinical Evaluation) and MIRACLE-ICD (Multicenter InSync ICD Randomized Clinical Evaluation). We used multivariable regression to determine clinical, therapeutic, and echocardiographic characteristics that predicted a subsequent change in left ventricular end-diastolic volume (LVEDV). Over 6 months, LVEDV increased in 308 (40%) and decreased in 468 (60%) patients. Baseline mitral regurgitation and levels of plasma brain natriuretic peptide (BNP) independently predicted LV enlargement, whereas CRT predicted a decrease in LVEDV (all P < .01). In all models tested, male gender was an independent risk factor for progressive LV enlargement (P < .0001). Men show more prominent LV dilation than women in chronic heart failure despite medical and device therapy. Rates of LV remodeling are influenced further by mitral regurgitation, plasma BNP, and CRT. Future studies should take these clinical factors into account when determining the influence of genetic factors and novel therapies on ventricular remodeling in chronic heart failure. Copyright 2006 Elsevier B.V., Amsterdam.All rights reserved. |
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