Arthur J Moss

University of Rochester, Rochester, New York, United States

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Publications (692)5881.31 Total impact

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    ABSTRACT: Background: Cardiac resynchronization with defibrillators (CRT-D) reduces heart failure and mortality compared with defibrillators alone. Whether this applies to all ages is unclear. Methods: We assessed the association of age on heart failure and death as a post-hoc analysis of the MADIT-CRT follow up study. 1281 patients with class I/II heart failure were randomized to CRT-D or ICD alone. Different age groups (<60, 60-74 and ≥75) were evaluated over 7 years for mortality and HF events. We compared events using amultivariate regression model. Results: Among the 3 groups, <60, 60-74 and ≥75, there were 399, 651 and 231 patients respectively. CRT-D compared to defibrillators alone significantly reduced the composite of HF or death across all age groups: <60 years, relative risk reduction (RRR) = 36%; 60-74 years RRR=61%; ≥75 years RRR=56%. CRT-D significantly reduced HF in all age groups <60 years RRR=49%; 60-74 years RRR=62%; ≥75 years RRR=74%. CRT-D was associated with significant mortality reduction only in the 60-74 year age group RRR 59%. Conclusions: CRT-D reduces HF events and the composite of mortality or HF events during long-term follow-up in all age groups. CRT-D reduced mortality only in the 60-74 year age group.
    Journal of cardiac failure 10/2015; DOI:10.1016/j.cardfail.2015.09.015 · 3.05 Impact Factor

  • The American journal of cardiology 10/2015; DOI:10.1016/j.amjcard.2015.09.027 · 3.28 Impact Factor
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    ABSTRACT: -Prospective data on the safety and efficacy of the wearable cardioverter defibrillator (WCD) in a real world setting are lacking. The Prospective Registry of Patients Using the Wearable Defibrillator (WEARIT-II) Registry was designed to provide real world data on the WCD as a strategy during a period of risk stratification. -The WEARIT-II Registry enrolled 2000 patients with ischemic (n=805, 40%), or non-ischemic cardiomyopathy (n=927, 46%), or congenital/inherited heart disease (n=268) prescribed WCD between August 2011 and February 2014. Clinical data, arrhythmia events, implantable cardioverter defibrillator (ICD) implantation, or improvement in ejection fraction (EF) were captured. The median age was 62 years, median EF was 25%. Median WCD wear-time was 90 days, with median daily use of 22.5 hours. There were a total of 120 sustained ventricular tachyarrhythmias (VT/VF) in 41 patients, of whom 54% received appropriate WCD shock. Only 10 patients (0.5%) received inappropriate WCD therapy. The rate of sustained VT/VF by 3 months was 3% among patients with ischemic cardiomyopathy and congenital/inherited heart disease, and 1% among non-ischemic patients (p=0.02). At the end of WCD use, 840 patients (42%) were implanted with ICD. The most frequent reason not to implant ICD following WCD use was improvement in EF. -The WEARIT-II prospective Registry demonstrate a high rate of sustained VT/VF at 3 months in at-risk patients who are not eligible for an ICD, and suggest that the WCD can be safely used to protect patients during this time period of risk assessment.
    Circulation 08/2015; DOI:10.1161/CIRCULATIONAHA.115.015677 · 14.43 Impact Factor
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    ABSTRACT: In Long QT Syndrome Type 1 (LQT1), the location and type of mutations have been shown to affect the clinical outcome. Although haploinsufficiency, including stop-codons and frameshift mutations, has been associated with lower risk of cardiac events in LQT1, nonsense mutations have been presumed functionally equivalent. To evaluate clinical differences among patients with nonsense mutations. The study sample comprised 1090 patients with genetically confirmed mutations. Patients were categorized into 5 groups depending on mutation type and location: missense not located in the high risk cytoplasmic-loop (c-loop) (n=698) used as reference, missense c-loop (n=192), stop-codons (ST) (n=67), frameshift (FS) (n=39), and others (n=94). Primary outcome was a composite end point of syncope, aborted cardiac arrest (ACA) and LQTS related death (cardiac events (CE)). Outcomes were evaluated with multivariate Cox regression analysis. Standard patch clamp techniques were used. When compared to missense non c-loop mutations, the risk of CE was reduced significantly in patients with ST mutations (HR 0.57 CI 0.34-0.96 p=0.035), but not in patients with FS mutations (HR 1.01 CI 0.58-1.77 p=0.97). Our data suggest that for the most common stop-codon mutant channel (Q530X), currents were larger than haploinsufficient channels (pA/pF: WT, 42±6, n=20; Q530X+WT, 79±14, n=20, P<0.05) and voltage dependence of activation was altered. Stop-codon mutations are associated with lower risk of cardiac events in LQT1 patients, while frameshift mutations show the same risk as the majority of the missense mutations. Our data indicate functional differences between these previously considered equivalent mutation subtypes. Copyright © 2015. Published by Elsevier Inc.
    Heart rhythm: the official journal of the Heart Rhythm Society 08/2015; DOI:10.1016/j.hrthm.2015.08.033 · 5.08 Impact Factor
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    Valentina Kutyifa · Ilan Goldenberg · Arthur J. Moss ·

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    ABSTRACT: Early intervention with cardiac resynchronization therapy with defibrillator (CRT-D) in mild heart failure (HF) patients with a left bundle branch block (LBBB) ECG pattern was associated with a significant reduction in mortality in the long-term MADIT-CRT trial. Whether patients in MADIT-CRT enrolled from centers in the USA and in Europe have different long-term clinical response to CRT-D remains unknown. We compared the baseline clinical characteristics and clinical and echocardiographic long-term clinical response to CRT-D between MADIT-CRT patients with LBBB who were enrolled in USA (n = 871) and European centers (n = 392). Although European patients had more advanced heart disease than US patients, CRT-D was associated with similar 60 % (p < 0.001) reductions in the risk of HF in US and European patients when compared to ICD-only therapy after adjustment for relevant baseline clinical covariates. US patients had significant long-term mortality reduction (38 %, p = 0.02) while among European patients the survival benefit associated with CRT-D was not statistically significant (HR 0.73, p = 0.18); subgroup analyses revealed a significantly greater CRT-D benefit among women who were enrolled in the USA, whereas no significant gender difference in the clinical benefit of CRT-D was observed in the European cohort. Reverse remodeling at 1 year was associated with significantly better clinical outcomes in both groups. Despite differences in baseline disease severity, European and US patients with LBBB experienced a similar clinical and echocardiographic response to cardiac resynchronization therapy during long-term follow-up. .
    Heart Failure Reviews 07/2015; 20(5). DOI:10.1007/s10741-015-9499-2 · 3.79 Impact Factor
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    Valentina Kutyifa · Arthur J Moss ·

    Nature Reviews Cardiology 07/2015; 12(9). DOI:10.1038/nrcardio.2015.114 · 9.18 Impact Factor
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    Valentina Kutyifa · Arthur J Moss ·

    European Heart Journal 07/2015; 36(37). DOI:10.1093/eurheartj/ehv324 · 15.20 Impact Factor
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    ABSTRACT: -Previous studies have shown that low blood pressure is associated with increased mortality and heart failure (HF) in patients with LV dysfunction. Cardiac resynchronization therapy (CRT) was shown to increase Systolic Blood Pressure (SBP). We therefore hypothesized that treatment with CRT would provide incremental benefit in patients with lower SBP values. -The independent contribution of SBP to outcome was analyzed in 1,267 patients with LBBB enrolled in MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy). SBP was assessed as continuous measures and further categorized into approximate quintiles. The risk of long-term HF or death, and CRT-D vs. ICD benefit was assessed in multivariate Cox proportional hazards regression models. Multivariate analysis showed that in the ICD arm, each 10 mmHg decrement of SBP was independently associated with a significant 21% (p<0.001) increased risk for HF or death, and patients with lower quintile SBP (<110 mm Hg) experienced a corresponding >2-fold risk-increase. CRT-D therapy provided the greatest HF or mortality risk reduction in patients with SBP<110 mmHg HR=0.34, p<0.001, compared to HR=0.52, p<0.001 in those with 110>SBP≥136 mmHg and HR=0.94, p=0.808 with SBP>136 mmHg (p for trend=0.001). -In patients with mild HF, prolonged QRS, and LBBB, low SBP is related to higher risk of mortality or HF with ICD therapy alone. Treatment with CRT is associated with incremental clinical benefits in patients with lower baseline systolic blood pressure values. Clinical Trial Registration-URL: Unique identifier: NCT00180271.
    Circulation Heart Failure 07/2015; DOI:10.1161/circheartfailure.115.002208 · 5.89 Impact Factor
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    ABSTRACT: We hypothesized that the relationship between LVEF and the risk of life-threatening ventricular tachyarrhythmias (VTAs) may modify the effect of a CRT device with a defibrillator (CRT-D) on VTA risk. The risk of fast (≥200 b.p.m.) ventricular tachycardia/ventricular fibrillation (VT/VF) and the benefit of CRT-D in reducing VT/VF were assessed by baseline LVEF (categorized as ≤30% or 30% and assessed as a continuous measurement) in 1783 patients with mild heart failure (HF) implanted with an implantable cardioverter defibrillator (ICD) or CRT-D, enrolled in MADIT-CRT. Higher LVEF (>30%) at baseline was associated with a significantly lower risk of fast VT/VF [hazard ratio (HR) 0.54, P = 0.006], VT/VF (HR 0.62, P = 0.005), and VT/VF/death (HR 0.64, P = 0.003). Treatment with CRT-D was shown to reduce the risk of fast VT/VF in patients with LVEF ≤ 30% (n = 1100) [HR 0.64, 95% confidence intrerval (CI) 0.48-0.85, P = 0.002], but not among those with LVEF > 30% (n = 683) (HR 1.19, 95% CI 0.73-1.91, P = 0.502, interaction P-value = 0.03). When LVEF was assessed as a continuous measure, each 5% increment was shown to be associated with a significant 30% (P < 0.001) reduction in the risk for fast VT/VF, and with a corresponding linear reduction in the benefit of CRT-D in reducing fast VTA risk (P -value for treatment by LVEF interaction = 0.003). Our data suggest that in mild HF patients with cardiomyopathy there is an inverse correlation between LVEF and the risk of life-threatening VTAs, possibly contributing to the attenuation in the antiarrhythmic properties of CRT with increasing left ventricular function. NCT00180271. © 2015 The Authors European Journal of Heart Failure © 2015 European Society of Cardiology.
    European Journal of Heart Failure 07/2015; 17(9). DOI:10.1002/ejhf.311 · 6.53 Impact Factor
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    ABSTRACT: Stimulants are the mainstay therapy for attention deficit/hyperactivity disorder (ADHD) and are associated with adrenergic side effects. There is limited data on the clinical course of patients treated for ADHD who have long-QT syndrome (LQTS), for which β-blockade is the goal of therapy. LQTS patients from the Rochester-based LQTS Registry (open-enrollment between 1979 and 2003; follow-up from 1979 to present) treated with stimulant or nonstimulant ADHD medications (n = 48) were compared to a 2:1 age-, gender-, and QTc-duration matched LQTS control group not exposed to ADHD medications (n = 96). Kaplan-Meier and Cox proportional hazards regression analyses were used to evaluate risk of cardiac events (syncope, aborted cardiac arrest, and sudden cardiac death) in LQTS patients treated with ADHD medications. During a mean follow-up of 7.9 ± 5.4 years after initiation of ADHD medication at a mean age 10.7 ±7.3 years, there was a 62% cumulative probability of cardiac events in the ADHD treatment group compared to 28% in the matched LQTS control group (P < 0.001). Time-dependent use of ADHD medication was associated with an increased risk for cardiac events (HR = 3.07; P = 0.03) in the multivariate Cox model adjusted for time-dependent β-blocker use and prior cardiac events. Subgroup gender analyses showed that time-dependent ADHD medication was associated with an increased risk in male LQTS patients (HR = 6.80, P = 0.04). LQTS patients treated with ADHD medications have increased risk for cardiac events, particularly syncope, and this risk is augmented in males. The findings highlight the importance of heightened surveillance for LQTS patients on ADHD medications. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Journal of Cardiovascular Electrophysiology 07/2015; 26(10). DOI:10.1111/jce.12739 · 2.96 Impact Factor
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    ABSTRACT: Previous studies have shown conflicting results regarding the benefit of cardiac resynchronization therapy (CRT) by sex and QRS duration. In the Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy (MADIT-CRT), we evaluated long-term clinical outcome of heart failure (HF) or death, death, and HF alone by sex and QRS duration (dichotomized at 150 ms) in left bundle-branch block patients with CRT with defibrillator backup (CRT-D) versus implantable cardioverter-defibrillator (ICD) only. There were 394 women (31%) and 887 men with left bundle-branch block. During the median follow-up of 5.6 years, women derived greater clinical benefit from CRT-D compared with implantable cardioverter-defibrillator only, with a significant 71% reduction in HF or death (hazard ratio [HR] 0.29, P<0.001) and a 77% reduction in HF alone (HR 0.23, P<0.001) compared with men, who had a 41% reduction in HF or death (HR 0.59, P<0.001) and a 50% reduction in HF alone (HR 0.50, P<0.001) (all sex-by-treatment interaction P<0.05). Men and women had similar reduction in long-term mortality with CRT-D versus implantable cardioverter-defibrillator only (men: HR 0.70, P=0.03; women: HR 0.59, P=0.04). The incremental benefit of CRT-D in women for HF or death and HF alone was consistent with QRS <150 or >150 ms. During long-term follow-up of mild HF patients with left ventricular dysfunction and wide QRS, both women and men with left bundle-branch block derived sustained benefit from CRT-D versus implantable cardioverter-defibrillator only, with significant reduction in HF or death, HF alone, and all-cause mortality regardless of QRS duration. There is an incremental benefit with CRT-D in women for the end points of HF or death and HF alone. URL: Unique identifiers: NCT00180271, NCT01294449, and NCT02060110. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.
    Journal of the American Heart Association 06/2015; 4(7). DOI:10.1161/JAHA.115.002013 · 4.31 Impact Factor
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    ABSTRACT: To understand modes of death and factors associated with the risk for cardiac and non-cardiac deaths in patients with cardiac resynchronization therapy with implantable cardioverter-defibrillator (CRT-D) vs. implantable cardioverter-defibrillator (ICD) therapy, which may help clarify the action and limitations of cardiac resynchronization therapy (CRT) in relieving myocardial dysfunction. In Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT), during 4 years of follow-up, 169 (9.3%) of 1820 patients died of known causes, 108 (63.9%) deemed cardiac, and 61 (36.1%) non-cardiac. In multivariate analysis, increased baseline creatinine was significantly associated with both cardiac and non-cardiac deaths [hazard ratio (HR) 2.97, P < 0.001; HR 1.80, P = 0.035, respectively], as was diabetes (HR 1.79, P = 0.006; HR 1.73, P = 0.038, respectively), and the worst New York Heart Association Class > II more than 3 months prior to enrolment (HR 1.90, P = 0.012; HR 2.46, P = 0.010, respectively). Baseline left atrial volume index was significantly associated only with cardiac mortality (HR 1.28 per 5 unit increase, P < 0.001). Ischaemic cardiomyopathy was associated only with non-cardiac death (HR 3.54, P = 0.001). CRT-D vs. an ICD-only was associated with a reduced risk for cardiac death in patients with left bundle branch block (LBBB) (HR 0.56, P = 0.029) but was associated with an increased risk for non-cardiac death in non-LBBB patients (HR 3.48, P = 0.048). In MADIT-CRT, two-thirds of the deaths were cardiac and one-third non-cardiac. Many of the same risk factors were associated with both cardiac and non-cardiac mortalities. CRT-D was associated with a reduced risk for cardiac death in LBBB but an increased risk for non-cardiac death in non-LBBB. Information for the MADIT-CRT main study, NCT00180271. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email:
    Europace 06/2015; DOI:10.1093/europace/euv201 · 3.67 Impact Factor
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    ABSTRACT: -We aimed to determine the impact of renal function on long-term outcomes with cardiac resynchronization therapy with defibrillator (CRT-D) among mild heart failure (HF) patients. -We stratified 1820 MADIT-CRT patients by QRS morphology into those with and without left bundle-branch block (LBBB). Subgroups within each QRS morphology category were created based on glomerular filtration rate (GFR): GFR<60 and GFR≥60 ml/min/1.73 m(2). Primary end point was death; secondary end points were HF/death and HF alone during long-term follow-up. Among 1274 LBBB patients, 413 (32%) presented with GFR<60 (mean 48.1±8.3). Relative to the 861 (68%) patients with GFR≥60 (mean 79.6±16.0), low-GFR patients experienced higher risk of death (HR=2.09, 95% confidence interval [CI]: 1.53-2.86, p<0.01) and HF/death (HR=1.46, 95% CI: 1.17-1.82, p<0.01). In both GFR groups, CRT-D was associated with reduction in death (GFR<60: HR=0.66, 95% CI: 0.44-1.00, p=0.05; GFR≥60: HR=0.68, 95% CI: 0.44-1.05, p=0.08) and HF/death (GFR<60: HR=0.49, 95% CI: 0.36-0.67, p<0.01; GFR≥60: HR=0.50, 95% CI: 0.38-0.66, p<0.01). In the low-GFR group, there was greater absolute reduction in risk of death (GFR<60: 14%; GFR≥60: 6%) and HF/death (GFR<60: 25%; GFR≥60: 15%). Among non-LBBB patients, low GFR predicted outcomes, however, no CRT-D benefit was observed. -In mild HF patients, moderate renal dysfunction is associated with higher risk of death and HF during long-term follow-up. Patients with LBBB, regardless of baseline renal function, derive long-term benefit from CRT-D, with greater absolute risk reduction in death and HF among those with moderate renal dysfunction. Clinical Trial Registration-URL: Unique identifiers: NCT00180271, NCT01294449, and NCT02060110.
    Circulation Heart Failure 06/2015; 8(4). DOI:10.1161/CIRCHEARTFAILURE.115.002082 · 5.89 Impact Factor
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    ABSTRACT: Digoxin's pharmacological, hemodynamic, and electrophysiological properties are well understood. However, in modern heart failure (HF) treatment, its effect has yet to be fully investigated. The aim of the current study was to determine the effects of digoxin on outcomes in patients with mild HF implanted with an ICD or CRT-D device. We investigated the effect of digoxin treatment on the end points of HF/death, HF alone, death alone, and ventricular tachycardia or ventricular fibrillation (VT/VF) in 1820 patients with mild HF (NYHA class I-II), prolonged QRS (≥130ms.), and depressed LVEF (≤30%) enrolled in the MADIT-CRT trial. Multivariate Cox proportional hazard regression models were used to determine the effect of time-dependent digoxin usage on the end points. Digoxin therapy was not associated with an increased or decreased risk of HF/death (HR=1.07 [0.86-1.33], p=0.0.56), HF alone (HR=1.1.04 [0.82-1.32], p=0.76) or death alone (HR=0.93 [0.67-1.32], p=0.71). However, digoxin was associated with a significant 41% increased risk of VT/VF (HR=1.41 [1.14-1.75], p=0.002), which was driven by a significantly increased risk of VT/VF ≥200 bpm (HR=1.65 [1.27-2.15], p=<0.001), whereas no increased risk of VT/VF <200 bpm was evident (HR=1.20 [0.92-1.57], p=0.19). No significant differences in digoxin's effect on any of the end points were found between ICD and CRT-D patients (interaction p-value >0.5). The use of digoxin in mild HF patients implanted with ICD or CRT-D was not associated with reductions in HF/death. However, digoxin therapy was associated with increased risk of high-rate VT/VF ≥200bpm. Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
    Heart rhythm: the official journal of the Heart Rhythm Society 05/2015; 12(9). DOI:10.1016/j.hrthm.2015.05.016 · 5.08 Impact Factor
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    ABSTRACT: Data on inappropriate ICD therapy and effects of programming by heart rate are lacking. We aimed to characterize inappropriate ICD therapy and assess the effects of novel programming by heart rate. Incidence and causes of inappropriate therapy by heart rate range (below or above 200bpm) were assessed. Predictors of inappropriate therapy and effects of programming by heart rate were evaluated using multivariate Cox regression models. Crossovers were excluded. Inappropriate therapy occurred in 9.2% of the total patient population, with 19% of patients randomized to Arm A, 3.6% in Arm B, and 4.7% in Arm C. Inappropriate therapies < 200bpm were due to supraventricular tachycardia (SVT)/sinus tachycardia (78%) or atrial fibrillation/flutter (20%). Inappropriate therapy ≥ 200bpm occurred due to SVT (47%), atrial fibrillation/flutter (41%), or EMI (13%). Conventional ICD programming was associated with more inappropriate therapy < 200bpm compared to high-rate or delayed therapy, as were younger age, history of atrial arrhythmia, advanced NYHA class, ICD versus CRT-D, and absence of diabetes. High-rate and long-delay therapy significantly reduced the risk of inappropriate therapy in the < 200bpm range. Long delay was associated with further reduction of fast (≥ 200bpm) inappropriate therapy (p=0.032), and reduction in subsequent inappropriate episodes (p=0.006). In MADIT-RIT, inappropriate ICD therapy is the most frequent at rates below 200bpm and can be predicted, and effectively prevented with high rate cut-off programming. Long delay therapy effectively reduces fast inappropriate therapy ≥ 200bpm and subsequent events. Copyright © 2015. Published by Elsevier Inc.
    Heart rhythm: the official journal of the Heart Rhythm Society 05/2015; 12(9). DOI:10.1016/j.hrthm.2015.05.021 · 5.08 Impact Factor
  • Arthur J. Moss · Valentina Kutyifa ·

    Journal of the American College of Cardiology 05/2015; 65(24). DOI:10.1016/j.jacc.2015.04.048 · 16.50 Impact Factor
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    ABSTRACT: Diabetes mellitus (DM) modify outcome in patients with heart failure (HF). We aimed to analyze the risk for death, HF alone, combined end point HF/death, and ventricular tachycardia/ventricular fibrillation (VT/VF) in patients with mild HF without DM and in those with DM, further stratified by the presence of insulin treatment. We determined whether cardiac resynchronization therapy with defibrillator (CRT-D) versus implantable cardioverter defibrillator improves clinical outcomes in these 3 subgroups. Cox proportional hazards regression models were used to analyze 1,278 patients with left bundle branch block in the Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy trial. Treatment with CRT-D versus implantable cardioverter defibrillator was associated with 76% risk reduction in all-cause mortality (hazard ratio 0.24; 95% confidence interval 0.08 to 0.74, p = 0.012) in subgroup of diabetic patients treated with insulin only (interaction p = 0.043). Significant risk reduction in HF alone, HF/death, and the VT/VF after CRT-D was observed across investigated groups and similar left ventricular reverse remodeling to CRT-D. In conclusion, patients with mild HF with DM treated with insulin derive significant risk reduction in mortality, in HF, and VT/VF after implantation of CRT-D. Diabetic patients not receiving insulin benefit from CRT-D by reduction of HF events. Copyright © 2015 Elsevier Inc. All rights reserved.
    The American Journal of Cardiology 05/2015; DOI:10.1016/j.amjcard.2015.04.053 · 3.28 Impact Factor
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    Valentina Kutyifa · Ilan Goldenberg · Arthur J. Moss ·
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    ABSTRACT: Cardiac resynchronization therapy (CRT) has evolved as a Class I treatment indication with Level of Evidence A, in patients with mild heart failure, depressed left ventricular ejection fraction, and wide QRS. In this review article, we will discuss the major findings of sub-studies published from the Multicenter Automatic Defibrillator Implantation Trial - Cardiac Resynchronization Therapy (MADIT-CRT). Copyright © 2015 Elsevier Inc. All rights reserved.
    Trends in Cardiovascular Medicine 04/2015; DOI:10.1016/j.tcm.2015.04.013 · 2.91 Impact Factor
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    ABSTRACT: MADIT-CRT showed that cardiac resynchronization therapy with a defibrillator (CRT-D) improves long-term outcomes in currently mildly symptomatic heart failure (HF) patients with LBBB regardless of the presence of prior advanced HF symptoms. We aimed to evaluate the long-term benefit of CRT-D in patients who never experienced advanced HF symptoms prior to device implantation. Interaction term analysis was used to compare the clinical and echocardiographic benefit of CRT-D vs. implantable cardioverter defibrillator (ICD)-only therapy during long-term follow-up (median 5.6 years) between LBBB patients with or without a history of advanced HF [defined as NYHA class ≥ III or past hospitalization for worsening HF >3 months prior to enrolment in MADIT-CRT (n = 529 and 752, respectively)]. Multivariable analysis showed that treatment with CRT-D was associated with a significant reduction in the risk of HF or death during long-term follow-up regardless of the presence of prior advanced HF symptoms [hazard ratio 0.53 (P < 0.001) and 0.47 (P < 0.001) in the respective groups of patients with and without prior advanced HF; interaction P for the difference = 0.58]. Echocardiographic response to CRT at 1 year was also similar between the two groups (P > 0.10 for all comparisons). Our findings suggest that treatment with CRT-D is associated with pronounced echocardiographic and long-term clinical benefit in patients with LV dysfunction and LBBB who never experienced advanced HF symptoms. These data further emphasize the benefit of early intervention with CRT in this population. © 2015 The Authors European Journal of Heart Failure © 2015 European Society of Cardiology.
    European Journal of Heart Failure 04/2015; 17(9). DOI:10.1002/ejhf.281 · 6.53 Impact Factor

Publication Stats

39k Citations
5,881.31 Total Impact Points


  • 1988-2015
    • University of Rochester
      • • Department of Medicine
      • • Division of Hospital Medicine
      • • Department of Electrical and Computer Engineering
      Rochester, New York, United States
  • 1983-2015
    • University Center Rochester
      • • Department of Medicine
      • • Cardiology Division
      Рочестер, Minnesota, United States
  • 2013
    • Southcoast Health System
      New Bedford, Massachusetts, United States
  • 2012
    • Lund University
      • Department of Cardiology
      Lund, Skåne, Sweden
    • Duke University Medical Center
      • Division of Cardiology
      Durham, North Carolina, United States
  • 2011
    • University of Florence
      Florens, Tuscany, Italy
    • Harvard Medical School
      • Department of Medicine
      Boston, Massachusetts, United States
    • King Saud University
      Ar Riyāḑ, Ar Riyāḑ, Saudi Arabia
  • 2010
    • Azienda Ospedaliera Niguarda Ca' Granda
      Milano, Lombardy, Italy
  • 2008
    • Oregon Health and Science University
      • Division of Cardiovascular Medicine
      Portland, Oregon, United States
  • 1992-2005
    • New York University College of Dentistry
      New York City, New York, United States
    • St. Luke's Hospital
      CID, Iowa, United States
  • 2004
    • Southwest Foundation For Biomedical Research
      San Antonio, Texas, United States
  • 2002
    • The University of Arizona
      • Department of Medicine
      Tucson, AZ, United States
  • 2000
    • Unity Health System
      Rochester, New York, United States
    • University of Florida
      Gainesville, Florida, United States
  • 1999
    • Middlebury College
      Middlebury, Indiana, United States
    • Shiga University of Medical Science
      • First Department of Internal Medicine
      Ōtu, Shiga, Japan
  • 1996
    • American Heart Association
      Dallas, Texas, United States
  • 1995
    • Baylor College of Medicine
      • Department of Pediatrics
      Houston, Texas, United States
  • 1994
    • Tufts University
      • Division of Cardiology
      Georgia, United States
    • Washington Hospital Center
      Washington, Washington, D.C., United States
  • 1993
    • University of Dallas
      Irving, Texas, United States
    • Howard Hughes Medical Institute
      Ashburn, Virginia, United States
  • 1987
    • Columbia University
      • Division of Cardiology
      New York, New York, United States