Mary Orencole - Academia.edu (original) (raw)
Papers by Mary Orencole
Circulation, Nov 26, 2013
Circulation, Nov 22, 2011
Circulation, Oct 31, 2007
Circulation, Nov 22, 2011
Circulation, Nov 20, 2012
Circulation, Nov 22, 2011
Heart rhythm : the official journal of the Heart Rhythm Society, Jan 24, 2016
We thank Kutyifa et. al. for highlighting their sub-analysis of the MADIT-CRT study which assesse... more We thank Kutyifa et. al. for highlighting their sub-analysis of the MADIT-CRT study which assessed prolonged PR interval (PRI) in a subset of patients with non-LBBB QRS configuration. At the time of their publication, our article had been submitted for review and therefore not included in our original review.
Circulation, Nov 22, 2011
Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing, 2015
Although a substantial proportion of patients with heart failure (HF) have anemia, there is a pau... more Although a substantial proportion of patients with heart failure (HF) have anemia, there is a paucity of data evaluating the impact of anemia on clinical outcome in CRT patients. Our goal was to examine the ability of baseline hemoglobin (Hb) level and change in Hb level over time to predict clinical 2-year outcome and echocardiographic response to CRT. Three hundred consecutive CRT patients (median 72 years [interquartile range (IQR) 16 years], 19 % female) with baseline and follow-up hematological profiles available were examined. Baseline anemia was defined as Hb <12 g/dL in women and <13 g/dL in men, and patients were grouped into equal quartiles based on change in Hb. Two-year clinical outcome was determined using a composite endpoint that included HF hospitalization, left ventricular assist device (LVAD) placement, heart transplantation, and all-cause mortality. Echocardiographic reverse remodeling was examined at 6-month follow-up. One hundred fifty-one anemic patients ...
Journal of Interventional Cardiac Electrophysiology, 2015
Although a substantial proportion of patients with heart failure (HF) have anemia, there is a pau... more Although a substantial proportion of patients with heart failure (HF) have anemia, there is a paucity of data evaluating the impact of anemia on clinical outcome in CRT patients. Our goal was to examine the ability of baseline hemoglobin (Hb) level and change in Hb level over time to predict clinical 2-year outcome and echocardiographic response to CRT. Three hundred consecutive CRT patients (median 72 years [interquartile range (IQR) 16 years], 19 % female) with baseline and follow-up hematological profiles available were examined. Baseline anemia was defined as Hb &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;12 g/dL in women and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;13 g/dL in men, and patients were grouped into equal quartiles based on change in Hb. Two-year clinical outcome was determined using a composite endpoint that included HF hospitalization, left ventricular assist device (LVAD) placement, heart transplantation, and all-cause mortality. Echocardiographic reverse remodeling was examined at 6-month follow-up. One hundred fifty-one anemic patients were compared to 149 non-anemic patients. Changes in left ventricular dimensions and ejection fraction were similar for both groups. Univariate predictors of 2-year clinical outcome included baseline creatinine level, diuretic usage, and anemia; in multivariable regression, baseline anemia was an independent predictor for outcome (hazard ratio [HR] 1.79, 95 % confidence interval [CI] [1.22-2.63], p = 0.003). The quartile with the most negative change in Hb concentration over time (≤-1.00 g/dL) had poorer event-free 2-year survival (HR 1.84, CI [1.13-3.00], p = 0.014). Baseline anemia and early postimplantation decline in Hb levels are associated with a worse 2-year prognosis in CRT patients, even though the magnitude of left ventricular reverse remodeling is similar compared to non-anemic patients.
Pacing and Clinical Electrophysiology, 2015
Chronic kidney disease (CKD) severity is associated with increased morbidity and mortality in con... more Chronic kidney disease (CKD) severity is associated with increased morbidity and mortality in congestive heart failure (CHF). There is a paucity of data regarding renal improvement after cardiac resynchronization therapy (CRT) and its potential impact on clinical outcomes, especially in patients with severe CKD. This was a retrospective analysis of a prospectively collected cohort of 260 patients with CKD undergoing CRT at a single center. Renal function was compared before and after CRT. The primary endpoint was a composite of death, heart transplant, and LVAD, assessed at 5 years. Patients with more severe CKD demonstrated increased risk of death, transplant, or LVAD following CRT (p = 0.015). Renal response (eGFR improvement ≥ 10mL/min/1.73m(2) ) was observed in 14% of all patients and 28% of patients with stage IV CKD. Independent predictors of renal response included LVEF improvement (OR 1.06, CI 1.01-1.10), ACE inhibitor/ARB use (OR 4.31, CI 1.08-17.23), and advanced CKD stage (OR 2.19, CI 1.14-4.23). Renal response independently decreased hazard of the primary outcome (HR 0.24, CI 0.08-0.73, p = 0.01). Renal responders with stage IV CKD had 80% five-year event-free survival, compared to 0% for non-renal responders in stage IV (p = 0.03). Although severity of CKD is associated with poorer outcome after CRT, improvement in renal function can occur in patients across all CKD stages. Renal responders, including those with stage IV CKD, demonstrate favorable five-year outcomes. Assessment of renal response may help better prognostic outcomes following CRT. This article is protected by copyright. All rights reserved.
Heart rhythm : the official journal of the Heart Rhythm Society, Jan 8, 2015
Prolongation of the baseline electrocardiographic PR interval is frequently encountered among car... more Prolongation of the baseline electrocardiographic PR interval is frequently encountered among cardiac resynchronization therapy (CRT) recipients. There is conflicting data regarding the association of a prolonged PR interval with long-term clinical outcome in this patient group. This study compared clinical outcomes and response to CRT in patients with normal (<200 ms) vs. prolonged (≥200 ms) baseline PR interval. In this study 283 patients (normal PR interval: n=158; prolonged PR interval: n=125) with documented baseline intrinsic PR interval were followed for 3 years after CRT implantation. The studied population was 24.7% women, with a mean age 66 ± 13, and left ventricular ejection fraction 24% ± 7%. A Cox proportional hazard model identified baseline PR interval as a predictor of the composite endpoint (all-cause mortality, heart failure HF hospitalization, left ventricular assist device implantation and heart transplantation) in univariate analysis (hazard ratio, HR 1.49; 9...
BACKGROUND Imaging the coronary venous (CV) tree to delineate the coronary sinus and its tributar... more BACKGROUND Imaging the coronary venous (CV) tree to delineate the coronary sinus and its tributaries can facilitate electrophysiological procedures, such as cardiac resynchronization therapy (CRT) and catheter ablation. Venography also allows visualization of the left atrial (LA) veins, which may be a potential conduit for ablative or pacing strategies given their proximity to foci that can trigger atrial fibrillation.
The American journal of cardiology, Jan 12, 2015
Hypothyroidism is associated with an adverse prognosis in cardiac patients in general and in part... more Hypothyroidism is associated with an adverse prognosis in cardiac patients in general and in particular in patients with heart failure (HF). The aim of this study was to evaluate the impact of hypothyroidism on patients with HF receiving cardiac resynchronization therapy (CRT). Additionally, the impact of level of control of hypothyroidism on risk of adverse events after CRT implantation was also evaluated. We included consecutive patients in whom a CRT device was implanted from April 2004 to April 2010 at our institution with sufficient follow-up data available for analysis; 511 patients were included (age 68.5 ± 12.4 years, women 20.4%); 84 patients with a clinical history of hypothyroidism, on treatment with thyroid hormone repletion or serum thyroid-stimulating hormone level ≥5.00 μU/ml, were included in the hypothyroid group. The patients were followed for up to 3 years after implant for a composite end point of hospitalization for HF, left ventricular assist device placement, ...
C ardiac resynchronization therapy (CRT) is an important device for the treatment of patients wit... more C ardiac resynchronization therapy (CRT) is an important device for the treatment of patients with congestive heart failure (HF) with systolic dysfunction and dyssynchrony, as evidenced by a prolonged QRS interval on a surface ECG. Many randomized trials have demonstrated that CRT is associated with a decrease in HF symptoms, HF hospitalizations, and all-cause mortality. 1-5 CRT has, therefore, become an important tool in the treatment of HF.
Heart Rhythm, 2014
BACKGROUND Cardiac resynchronization therapy (CRT) nonresponders have poor outcomes. The signific... more BACKGROUND Cardiac resynchronization therapy (CRT) nonresponders have poor outcomes. The significance of progressive ventricular dysfunction among nonresponders remains unclear.
Pacing and Clinical Electrophysiology, 2010
Results: There was a positive correlation between corrected LVLED and HD on lateral CXR (r = 0.36... more Results: There was a positive correlation between corrected LVLED and HD on lateral CXR (r = 0.361, P = 0.004) and a negative correlation between LVLED and VD on posteroanterior (PA) CXR (r = −0.281, P = 0.028). To account for this inverse relationship, we developed a composite anatomic distance (defined as: lateral HD-PA VD), which correlated most closely with LVLED (r = 0.404, P = 0.001). Follow-up was available for 48 patients. At a mean of 4.1 ± 3.2 months, patients with optimal values for both corrected LVLED (≥75%) and composite anatomic distance (≥15 cm) demonstrated greater reverse LV remodeling than patients with either one or neither of these optimized values.
Pacing and Clinical Electrophysiology, 2007
Background: Cardiac resynchronization therapy (CRT) outcome varies significantly among patients. ... more Background: Cardiac resynchronization therapy (CRT) outcome varies significantly among patients. We aimed to determine the impact of age, gender, and heart failure etiology on the long-term outcome of patients receiving CRT.
Journal of Cardiac Failure, 2009
Heart Rhythm, 2013
BACKGROUND Both anatomic and electrical locations of the left ventricular (LV) lead have been ide... more BACKGROUND Both anatomic and electrical locations of the left ventricular (LV) lead have been identified as important predictors of clinical outcomes in cardiac resynchronization therapy (CRT). The impact of LV lead location on incident device-treated ventricular arrhythmia (VA), however, is not well understood.
Circulation, Nov 26, 2013
Circulation, Nov 22, 2011
Circulation, Oct 31, 2007
Circulation, Nov 22, 2011
Circulation, Nov 20, 2012
Circulation, Nov 22, 2011
Heart rhythm : the official journal of the Heart Rhythm Society, Jan 24, 2016
We thank Kutyifa et. al. for highlighting their sub-analysis of the MADIT-CRT study which assesse... more We thank Kutyifa et. al. for highlighting their sub-analysis of the MADIT-CRT study which assessed prolonged PR interval (PRI) in a subset of patients with non-LBBB QRS configuration. At the time of their publication, our article had been submitted for review and therefore not included in our original review.
Circulation, Nov 22, 2011
Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing, 2015
Although a substantial proportion of patients with heart failure (HF) have anemia, there is a pau... more Although a substantial proportion of patients with heart failure (HF) have anemia, there is a paucity of data evaluating the impact of anemia on clinical outcome in CRT patients. Our goal was to examine the ability of baseline hemoglobin (Hb) level and change in Hb level over time to predict clinical 2-year outcome and echocardiographic response to CRT. Three hundred consecutive CRT patients (median 72 years [interquartile range (IQR) 16 years], 19 % female) with baseline and follow-up hematological profiles available were examined. Baseline anemia was defined as Hb <12 g/dL in women and <13 g/dL in men, and patients were grouped into equal quartiles based on change in Hb. Two-year clinical outcome was determined using a composite endpoint that included HF hospitalization, left ventricular assist device (LVAD) placement, heart transplantation, and all-cause mortality. Echocardiographic reverse remodeling was examined at 6-month follow-up. One hundred fifty-one anemic patients ...
Journal of Interventional Cardiac Electrophysiology, 2015
Although a substantial proportion of patients with heart failure (HF) have anemia, there is a pau... more Although a substantial proportion of patients with heart failure (HF) have anemia, there is a paucity of data evaluating the impact of anemia on clinical outcome in CRT patients. Our goal was to examine the ability of baseline hemoglobin (Hb) level and change in Hb level over time to predict clinical 2-year outcome and echocardiographic response to CRT. Three hundred consecutive CRT patients (median 72 years [interquartile range (IQR) 16 years], 19 % female) with baseline and follow-up hematological profiles available were examined. Baseline anemia was defined as Hb &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;12 g/dL in women and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;13 g/dL in men, and patients were grouped into equal quartiles based on change in Hb. Two-year clinical outcome was determined using a composite endpoint that included HF hospitalization, left ventricular assist device (LVAD) placement, heart transplantation, and all-cause mortality. Echocardiographic reverse remodeling was examined at 6-month follow-up. One hundred fifty-one anemic patients were compared to 149 non-anemic patients. Changes in left ventricular dimensions and ejection fraction were similar for both groups. Univariate predictors of 2-year clinical outcome included baseline creatinine level, diuretic usage, and anemia; in multivariable regression, baseline anemia was an independent predictor for outcome (hazard ratio [HR] 1.79, 95 % confidence interval [CI] [1.22-2.63], p = 0.003). The quartile with the most negative change in Hb concentration over time (≤-1.00 g/dL) had poorer event-free 2-year survival (HR 1.84, CI [1.13-3.00], p = 0.014). Baseline anemia and early postimplantation decline in Hb levels are associated with a worse 2-year prognosis in CRT patients, even though the magnitude of left ventricular reverse remodeling is similar compared to non-anemic patients.
Pacing and Clinical Electrophysiology, 2015
Chronic kidney disease (CKD) severity is associated with increased morbidity and mortality in con... more Chronic kidney disease (CKD) severity is associated with increased morbidity and mortality in congestive heart failure (CHF). There is a paucity of data regarding renal improvement after cardiac resynchronization therapy (CRT) and its potential impact on clinical outcomes, especially in patients with severe CKD. This was a retrospective analysis of a prospectively collected cohort of 260 patients with CKD undergoing CRT at a single center. Renal function was compared before and after CRT. The primary endpoint was a composite of death, heart transplant, and LVAD, assessed at 5 years. Patients with more severe CKD demonstrated increased risk of death, transplant, or LVAD following CRT (p = 0.015). Renal response (eGFR improvement ≥ 10mL/min/1.73m(2) ) was observed in 14% of all patients and 28% of patients with stage IV CKD. Independent predictors of renal response included LVEF improvement (OR 1.06, CI 1.01-1.10), ACE inhibitor/ARB use (OR 4.31, CI 1.08-17.23), and advanced CKD stage (OR 2.19, CI 1.14-4.23). Renal response independently decreased hazard of the primary outcome (HR 0.24, CI 0.08-0.73, p = 0.01). Renal responders with stage IV CKD had 80% five-year event-free survival, compared to 0% for non-renal responders in stage IV (p = 0.03). Although severity of CKD is associated with poorer outcome after CRT, improvement in renal function can occur in patients across all CKD stages. Renal responders, including those with stage IV CKD, demonstrate favorable five-year outcomes. Assessment of renal response may help better prognostic outcomes following CRT. This article is protected by copyright. All rights reserved.
Heart rhythm : the official journal of the Heart Rhythm Society, Jan 8, 2015
Prolongation of the baseline electrocardiographic PR interval is frequently encountered among car... more Prolongation of the baseline electrocardiographic PR interval is frequently encountered among cardiac resynchronization therapy (CRT) recipients. There is conflicting data regarding the association of a prolonged PR interval with long-term clinical outcome in this patient group. This study compared clinical outcomes and response to CRT in patients with normal (<200 ms) vs. prolonged (≥200 ms) baseline PR interval. In this study 283 patients (normal PR interval: n=158; prolonged PR interval: n=125) with documented baseline intrinsic PR interval were followed for 3 years after CRT implantation. The studied population was 24.7% women, with a mean age 66 ± 13, and left ventricular ejection fraction 24% ± 7%. A Cox proportional hazard model identified baseline PR interval as a predictor of the composite endpoint (all-cause mortality, heart failure HF hospitalization, left ventricular assist device implantation and heart transplantation) in univariate analysis (hazard ratio, HR 1.49; 9...
BACKGROUND Imaging the coronary venous (CV) tree to delineate the coronary sinus and its tributar... more BACKGROUND Imaging the coronary venous (CV) tree to delineate the coronary sinus and its tributaries can facilitate electrophysiological procedures, such as cardiac resynchronization therapy (CRT) and catheter ablation. Venography also allows visualization of the left atrial (LA) veins, which may be a potential conduit for ablative or pacing strategies given their proximity to foci that can trigger atrial fibrillation.
The American journal of cardiology, Jan 12, 2015
Hypothyroidism is associated with an adverse prognosis in cardiac patients in general and in part... more Hypothyroidism is associated with an adverse prognosis in cardiac patients in general and in particular in patients with heart failure (HF). The aim of this study was to evaluate the impact of hypothyroidism on patients with HF receiving cardiac resynchronization therapy (CRT). Additionally, the impact of level of control of hypothyroidism on risk of adverse events after CRT implantation was also evaluated. We included consecutive patients in whom a CRT device was implanted from April 2004 to April 2010 at our institution with sufficient follow-up data available for analysis; 511 patients were included (age 68.5 ± 12.4 years, women 20.4%); 84 patients with a clinical history of hypothyroidism, on treatment with thyroid hormone repletion or serum thyroid-stimulating hormone level ≥5.00 μU/ml, were included in the hypothyroid group. The patients were followed for up to 3 years after implant for a composite end point of hospitalization for HF, left ventricular assist device placement, ...
C ardiac resynchronization therapy (CRT) is an important device for the treatment of patients wit... more C ardiac resynchronization therapy (CRT) is an important device for the treatment of patients with congestive heart failure (HF) with systolic dysfunction and dyssynchrony, as evidenced by a prolonged QRS interval on a surface ECG. Many randomized trials have demonstrated that CRT is associated with a decrease in HF symptoms, HF hospitalizations, and all-cause mortality. 1-5 CRT has, therefore, become an important tool in the treatment of HF.
Heart Rhythm, 2014
BACKGROUND Cardiac resynchronization therapy (CRT) nonresponders have poor outcomes. The signific... more BACKGROUND Cardiac resynchronization therapy (CRT) nonresponders have poor outcomes. The significance of progressive ventricular dysfunction among nonresponders remains unclear.
Pacing and Clinical Electrophysiology, 2010
Results: There was a positive correlation between corrected LVLED and HD on lateral CXR (r = 0.36... more Results: There was a positive correlation between corrected LVLED and HD on lateral CXR (r = 0.361, P = 0.004) and a negative correlation between LVLED and VD on posteroanterior (PA) CXR (r = −0.281, P = 0.028). To account for this inverse relationship, we developed a composite anatomic distance (defined as: lateral HD-PA VD), which correlated most closely with LVLED (r = 0.404, P = 0.001). Follow-up was available for 48 patients. At a mean of 4.1 ± 3.2 months, patients with optimal values for both corrected LVLED (≥75%) and composite anatomic distance (≥15 cm) demonstrated greater reverse LV remodeling than patients with either one or neither of these optimized values.
Pacing and Clinical Electrophysiology, 2007
Background: Cardiac resynchronization therapy (CRT) outcome varies significantly among patients. ... more Background: Cardiac resynchronization therapy (CRT) outcome varies significantly among patients. We aimed to determine the impact of age, gender, and heart failure etiology on the long-term outcome of patients receiving CRT.
Journal of Cardiac Failure, 2009
Heart Rhythm, 2013
BACKGROUND Both anatomic and electrical locations of the left ventricular (LV) lead have been ide... more BACKGROUND Both anatomic and electrical locations of the left ventricular (LV) lead have been identified as important predictors of clinical outcomes in cardiac resynchronization therapy (CRT). The impact of LV lead location on incident device-treated ventricular arrhythmia (VA), however, is not well understood.