Patients
We retrospectively reviewed the data bases of the CRT upgrade cases with NICM at Kobe University Graduate School of Medicine between 2006 and 2019 and Hyogo Brain and Heart Center between 2010 and 2019. The upgrade to CRT from a pacemaker or ICD was performed in patients with an LV ejection fraction (LVEF) of ≤ 35% and New York Heart Association (NYHA) class of Ⅱ-Ⅳ. The selection of CRT with or without a defibrillator was determined by the attending physicians. The CRT procedure upgrade was carried out with the use of standard transvenous techniques.
CS was diagnosed according to the current guidelines.11Seven patients with CS had a histological diagnosis. The other patients with CS were diagnosed based on the clinical and imaging findings, including echocardiography, 67Ga scintigraphy, myocardial perfusion scintigraphy (99mTc-tetrofosmin), positron emission tomography/computed tomography (PET/CT), and cardiac magnetic resonance.
The enrolled patients who underwent a CRT upgrade were divided into 3 groups: group 1 was comprised of patients with CS who had taken corticosteroids before the CRT upgrade; group 2 was comprised of patients with CS who had not taken corticosteroids before the CRT upgrade; and group 3 was comprised of patients with other NICMs. We compared the following outcomes among the three groups: 1) echocardiographic response to CRT (before and 6 months after the CRT upgrade), 2) sustained ventricular tachyarrhythmia events, 3) composite outcomes of cardiovascular death and hospitalizations for worsening heart failure.
This retrospective study complied with the principles of the Declaration of Helsinki. The study was approved by the ethics committee of Kobe University Hospital (No. B200243).