Person:
Heist, Edwin

Profile Picture

Email Address

AA Acceptance Date

Birth Date

Research Projects

Organizational Units

Job Title

Last Name

Heist

First Name

Edwin

Name

Heist, Edwin

Filters

20122

Settings

Author's Publications: search.filters.isAuthorOfPublication.7e75cc95-fd58-4e34-a30e-6cb3c37f070c

Search Results

Now showing 1 - 2 of 2
  • Thumbnail Image
    Publication
    Usefulness of Hemoglobin A1c to Predict Outcome After Cardiac Resynchronization Therapy in Patients With Diabetes Mellitus and Heart Failure
    (Elsevier BV, 2012) Shah, Ravi; Altman, Robert K.; Park, Mi Young; Zilinski, Jodi; Leyton-Mange, Jordan Stewart; Orencole, Mary; Picard, Michael; Barrett, Conor D.; Heist, Edwin; Upadhyay, Gaurav; Das, Ranendra; Singh, Jagmeet; Das, Saumya
    Patients with diabetes and heart failure (HF) have worse clinical outcomes compared to patients with HF without diabetes after cardiac resynchronization therapy (CRT). Patients with HF and diabetes represent a growing population at high risk for cardiovascular events and are increasingly treated with CRT. Although patients with diabetes and HF appear to benefit from CRT, their clinical outcomes are worse than those of patients without diabetes after CRT. The aim of this study was to identify clinical predictors that explain the differential hazard in patients with diabetes. We studied 442 patients (169 with diabetes) with systolic HF referred to the Massachusetts General Hospital CRT clinic from 2003 to 2010 to identify predictors of outcomes after CRT in patients with HF and diabetes. Patients with diabetes were more likely to have ischemic causes of HF than those without diabetes, but there was no difference in the left ventricular ejection fraction or HF classification at implantation. Patients with diabetes had poorer event-free survival (death or HF hospitalization) compared to those without diabetes (log-rank p = 0.04). The presence of diabetes was the most important independent predictor of differential outcomes in the entire population (hazard ratio 1.65, 95% confidence interval 1.10 to 2.51). Patients with diabetes receiving insulin therapy had poorer survival, whereas those not receiving insulin therapy had similar survival to patients without diabetes. Patients with peri-implantation glycosylated hemoglobin >7% had worse outcomes, whereas patients with glycosylated hemoglobin ≤7% had improved survival (hazard ratio 0.36, 95% confidence interval 0.15 to 0.86) equivalent to that of patients without diabetes. In conclusion, although the presence of diabetes, independent of other variables, increases the hazard of worse outcomes after CRT, there is additional risk conferred by insulin use and suboptimal peri-implantation glycemic control.
  • Thumbnail Image
    Publication
    Predictors of Sustained Ventricular Arrhythmias in Cardiac Resynchronization Therapy
    (Ovid Technologies (Wolters Kluwer Health), 2012) Friedman, D. J.; Altman, R. K.; Orencole, M.; Picard, Michael; Ruskin, Jeremy; Singh, Jagmeet; Heist, Edwin
    Background: Patients undergoing cardiac resynchronization therapy (CRT) are at high risk for ventricular arrhythmias and risk stratification in this population remains poor. Methods and Results: This study followed 269 patients (LVEF < 35%, QRS > 120ms, NYHA III/IV) undergoing CRT with defibrillator (CRT-D) for 553±464 days after CRT-D implantation to assess for independent predictors of appropriate device therapy for ventricular arrhythmias (VAs). Baseline medication use, medical comorbidities, and echocardiographic parameters were considered. The 4-year incidence of appropriate device therapy was 36%. A Cox proportional hazard model identified left ventricular end systolic diameter (LVESD) > 61mm as an independent predictor in the entire population (HR 2.66, p = 0.001). Those with LVESD > 61mm had a 51% 3-year incidence of VA compared to a 26% incidence among those with a less dilated ventricle (p = 0.001). Among patients with LVESD ≤61mm, multivariate predictors of appropriate therapy were absence of beta-blocker therapy (HR 6.34, p<0.001, LVEF < 20% (HR 4.22, p <0.001), and history of sustained VA (2.97, p = 0.013). Early (<180d after implant) shock therapy was found to be a robust predictor of heart failure hospitalization (HR 3.41, p < 0.004) and mortality (HR 5.16 p < 0.001.) Conclusions: Among CRT-D patients, LVESD > 61mm is powerful predictor of ventricular arrhythmias and further risk stratification of those with less dilated ventricles can be achieved based on assessment of EF, history of sustained VA, and absence of beta-blocker therapy.