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Pubblicazioni recenti - cardiac resynchronization
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Hemodynamic monitoring by intracardiac impedance measured by cardiac resynchronization defibrillators: Evaluation in a controlled clinical setting (BIO.Detect HF II study).
Indian Pacing Electrophysiol J2021 Apr;():. doi: S0972-6292(21)00057-7.
Delnoy Peter-Paul Henri Marie, Gutleben Klaus-Jürgen, Bruun Niels Eske, Maier Sebastian K G, Oswald Hanno, Stellbrink Christoph, Johansen Jens Brock, Paule Stefan, Søgaard Peter,
Abstract
BACKGROUND:
In patients with cardiac resynchronization therapy defibrillators (CRT-Ds), intracardiac impedance measured by dedicated CRT-D software may be used to monitor hemodynamic changes. We investigated the relationship of hemodynamic parameters assessed by intracardiac impedance and by echocardiography in a controlled clinical setting.
METHODS:
The study enrolled 68 patients (mean age, 66?±?9 years; 74% males) at 12 investigational sites. The patients had an indication for CRT-D implantation, New York Heart Association class II/III symptoms, left ventricular ejection fraction 15%-35%, and a QRS duration ?150?ms. Two months after a CRT-D implantation, hemodynamic changes were provoked by overdrive pacing. Intracardiac impedance was recorded at rest and at four pacing rates ranging from 10 to 40 beats/min above the resting rate. In parallel, echocardiography measurements were performed. We hypothesized that a mean intra-individual correlation coefficient (r) between stroke impedance (difference between end-systolic and end-diastolic intracardiac impedance) measured by CRT-D and the aortic velocity time integral (i.e., stroke volume) determined by echocardiography would be significantly larger than 0.65.
RESULTS:
The hypothesis was evaluated in 40 patients with complete data sets. The r was 0.797, with a lower confidence interval bound of 0.709. The study hypothesis was met (p?=?0.007). A stepwise reduction of stroke impedance and stroke volume was observed with increasing heart rate.
CONCLUSIONS:
Intracardiac impedance measured by implanted CRT-Ds correlated well with the aortic velocity time integral (stroke volume) determined by echocardiography. The impedance measurements bear potential and are readily available technically, not requiring implantation of additional material beyond standard CRT-D system.
Copyright © 2021 Indian Heart Rhythm Society. Production and hosting by Elsevier B.V. All rights reserved.
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A Strain-Based Staging Classification of Left Bundle Branch Block-Induced Cardiac Remodeling.
JACC Cardiovasc Imaging2021 Apr;():. doi: S1936-878X(21)00198-4.
Calle Simon, Kamoen Victor, De Buyzere Marc, De Pooter Jan, Timmermans Frank,
Abstract
OBJECTIVES:
This study speculated that longitudinal strain curves in left bundle branch block (LBBB) could be shaped by the degree of LBBB-induced cardiac remodeling.
BACKGROUND:
LBBB independently affects left ventricular (LV) structure and function, but large individual variability may exist in LBBB-induced adverse remodeling.
METHODS:
Consecutive patients with LBBB with septal flash (LBBB-SF) underwent thorough echocardiographic assessment, including speckle tracking-based strain analysis. Four major septal longitudinal strain patterns (LBBB-1 through LBBB-4) were discerned and staged on the basis of: 1) correlation analysis with echocardiographic indexes of cardiac remodeling, including the extent of SF; 2) strain pattern analysis in cardiac resynchronization therapy (CRT) super-responders; and 3) strain pattern analysis in patients with acute procedural-induced LBBB.
RESULTS:
The study enrolled 237 patients with LBBB-SF (mean age: 67 ± 13 years; 57% men). LBBB-1 was observed in 60 (26%), LBBB-2 in 118 (50%), LBBB-3 in 29 (12%), and LBBB-4 in 26 (11%) patients. Patients at higher LBBB stages had larger end-diastolic volumes, lower LV ejection fractions, longer QRS duration, increased mechanical dyssynchrony, and more prominent SF compared with less advanced stages (p < 0.001 for all). Among CRT super-responders (n = 30; mean age: 63 ± 10 years), an inverse transition from stages LBBB-3 and -4 (pre-implant) to stages LBBB-1 and -2 (pace-off, median follow-up of 66 months [interquartile range: 32 to 78 months]) was observed (p < 0.001). Patients with acute LBBB (n = 27; mean age: 83 ± 5.1 years) only presented with a stage LBBB-1 (72%) or -2 pattern (24%).
CONCLUSIONS:
The proposed classification suggests a pathophysiological continuum of LBBB-induced LV remodeling and may be valuable to assess the attribution of LBBB to the extent of LV remodeling and dysfunction.
Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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Cardiac resynchronization therapy using a pacemaeker or a defibrillator: Patient selection and evidence to support it.
Prog Cardiovasc Dis2021 Apr;():. doi: S0033-0620(21)00040-2.
Canterbury Ann, Saba Samir,
Abstract
Cardiac resynchronization therapy (CRT) is an established treatment for patients with heart failure (HF), myocardial dysfunction and prolonged ventricular depolarization on surface electrocardiogram. CRT can be delivered by a pacemaker (CRTP) or a combined pacemaker-defibrillator (CRTD). Although these two types of devices are very different in size, function, and cost, current published guidelines do not distinguish between them, leaving the choice of which device to implant to the treating physician and the informed patient. In this paper, we review the published CRT clinical trial literature with focus on the outcomes of HF patients treated with CRT-P versus CRTD. We also attempt to provide guidance as to the appropriate choice of CRT device type, in the absence of randomized prospective trials geared to answer this specific question.
Copyright © 2018. Published by Elsevier Inc.
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Right ventricular lead location and outcomes among patients with cardiac resynchronization therapy: A meta-analysis.
Prog Cardiovasc Dis2021 Apr;():. doi: S0033-0620(21)00039-6.
Ali-Ahmed Fatima, Dalgaard Frederik, Allen Lapointe Nancy M, Kosinski Andrzej S, Blumer Vanessa, Morin Daniel P, Sanders Gillian D, Al-Khatib Sana M,
Abstract
BACKGROUND:
Cardiac resynchronization therapy (CRT) has been demonstrated to improve heart failure (HF) symptoms, reverse LV remodeling, and reduce mortality and HF hospitalization (HFH) in patients with a reduced left ventricular (LV) ejection fraction (LVEF). Prior studies examining outcomes based on right ventricular (RV) lead position among CRT patients have provided mixed results. We performed a systematic review and meta-analysis of randomized controlled trials and prospective observational studies comparing RV apical (RVA) and non-apical (RVNA) lead position in CRT.
METHODS:
Our meta-analysis was constructed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews and meta-analyses. We searched EMBASE and MEDLINE. Eligible studies reported on at least one of the following outcomes of interest: all-cause mortality, the composite endpoint of death and first HFH hospitalization, change in LVEF, New York Heart Association (NYHA) class improvement, and change in LV end systolic volume (LVESV). We performed meta-analysis summaries using a DerSimonian-Laird random-effects model and conservatively used the Knapp-Hartung approach to adjust the standard errors of the estimated model coefficients.
RESULTS:
We included nine studies representing a total of 1832 patients. Of those, 1318 (72%) patients had RVA lead placement and 514 (28%) had RVNA lead placement. The mean age of patients was 65.5?±?4.4?years, and they were predominantly men (69%-97%). There was no statistically significant difference in all-cause mortality by RVA vs. RVNA (OR?=?0.77, 95% CI 0.32-1.89; I?=?16.7%, p?=?0.31), or in the combined endpoint of all-cause mortality and first HFH (OR 0.88, 95% CI 0.62-1.25; I?=?0%, p?=?0.84). Also, there was no difference between RVA and RVNA for NYHA class improvement (OR?=?1.03, 95% CI 0.9-1.17; I?=?0%, p?=?0.99), change in LVEF (mean difference (MD)?=?1.33, 95% CI -1.45 to 4.10; I?=?47%; p?=?0.093), and change in LVESV (MD?=?-1.11, 95% CI -3.34 to 1.12; I?=?0%; p?=?0.92).
CONCLUSION:
This meta-analysis shows that in CRT pacing, RV lead position does not appear to be associated with clinical outcomes or LV reverse remodeling. Further studies should focus on the relationship of RV lead vis-à-vis LV lead location, and its clinical importance.
Copyright © 2018. Published by Elsevier Inc.
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Three-dimensional left ventricular mechanical dyssynchrony assessed by myocardial perfusion gated-SPECT: Is there a role in cardiac resynchronization therapy?
J Nucl Cardiol2021 Apr;():. doi: 10.1007/s12350-021-02614-w.
Valzania Cinzia, Mei Riccardo, Biffi Mauro,
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Left ventricle pacing challenges in cardiac resynchronization therapy systems.
Indian Pacing Electrophysiol J2021 Apr;():. doi: S0972-6292(21)00055-3.
Zoppo Franco, Gagno Giulia,
Abstract
Left ventricle (LV) pacing can be considered peculiar due to its different lead/tissue interface (epicardial pacing) and the small vein wedging lead locations with less reliable lead stability. The current technologies available for LV capture automatic confirmation adopt the evoked response (ER), as well as "LV pace to right ventricular (RV) sense" algorithms. The occurrence of anodal RV capture is today completely solved by the use of bipolar LV leads, while intriguing data are recently published regarding the unintentional LV anodal capture beside the cathodal one, which may enlarge the front wave of cardiac resynchronization therapy (CRT) delivery. The LV threshold behavior over time leading to ineffective CRT issues (subthreshold stimulation or concealed loss of capture), the extracardiac capture with phrenic nerve stimulation (PNS), the flexible electronic cathode reprogramming and the inadequate CRT delivery related to inadequate AV and VV pace timing (and its management by LV "dromotropic pace-conditioning") are discussed. Moreover, recently, His bundle pacing (HBP) and left bundle branch pacing (LBBP) have shown growing interest to prevent pacing-induced cardiomyopathy as well as for direct intentional CRT. The purpose of the present review is to explore these new challenges regarding LV pacing starting from old concepts.
Copyright © 2021 Indian Heart Rhythm Society. Production and hosting by Elsevier B.V. All rights reserved.
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A Role of Glucose Overload in Diabetic Cardiomyopathy in Nonhuman Primates.
J Diabetes Res2021 ;2021():9676754. doi: 10.1155/2021/9676754.
Wang Xiu, Jin Shi, Hu Weina,
Abstract
Type 2 diabetes (T2D) plays a major role in the development of heart failure. Patients with T2D have an increased risk to develop HF than healthy subjects, and they always have very poor outcomes and survival rates. However, the underlying mechanisms for this are still unclear. To help develop new therapeutic interventions, well-characterized animal models for preclinical and translational investigations in T2D and HF are urgently needed. Although studies in rodents are more often used, the research findings in rodents have often failed to be translated into humans due to the significant metabolic differences between rodents and humans. Nonhuman primates (NHPs) serve as valuable translational models between basic studies in rodent models and clinical studies in humans. NHPs can recapitulate the natural progress of these diseases in humans and study the underlying mechanism due to their genetic similarity and comparable spontaneous T2D rates to humans. In this review, we discuss the importance of using NHPs models in understanding diabetic cardiomyopathy (DCM) in humans with aspects of correlations between hyperglycemia and cardiac dysfunction progression, glucose overload, and altered glucose metabolism promoting cardiac oxidative stress and mitochondria dysfunction, glucose, and its effect on cardiac resynchronization therapy with defibrillator (CRT-d), the currently available diabetic NHPs models and the limitations involved in the use of NHP models.
Copyright © 2021 Xiu Wang et al.
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Evolving Cardiac Electrical Therapies for Advanced Heart Failure Patients.
Circ Arrhythm Electrophysiol2021 Apr;14(4):e009668. doi: 10.1161/CIRCEP.120.009668.
Sharif Zain I, Galand Vincent, Hucker William J, Singh Jagmeet P,
Abstract
Symptomatic heart failure (HF) patients despite optimal medical therapy and advances such as invasive hemodynamic monitoring remain challenging to manage. While cardiac resynchronization therapy remains a highly effective therapy for a subset of HF patients with wide QRS, a majority of symptomatic HF patients are poor candidates for such. Recently, cardiac contractility modulation, neuromodulation based on carotid baroreceptor stimulation, and phrenic nerve stimulation have been approved by the US Food and Drug Administration and are emerging as therapeutic options for symptomatic HF patients. This state-of-the-art review examines the role of these evolving electrical therapies in advanced HF.
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Assessing the facilities and healthcare services for heart failure: Taiwan versus European countries.
J Formos Med Assoc2021 Apr;():. doi: S0929-6646(21)00126-1.
Chang Hung-Yu, Hung Pei-Lun, Liao Chia-Te, Hsu Chien-Yi, Liao Ying-Chieh, Lu Kai-Hsi, Wang Chun-Chieh,
Abstract
BACKGROUND/PURPOSE:
The present study was designed to evaluate the local cardiology infrastructure and services for heart failure (HF) care in Taiwan hospitals and to compare the HF care with the hospitals in European countries.
METHODS:
Available data from a total of 98 medical centers and regional hospitals in Taiwan were analyzed. Each facility was given a single copy of the questionnaire between September and December 2019, and service records were extracted from the National Health Insurance Database. European data were adopted from the 2017 European Society of Cardiology Atlas.
RESULTS:
The number of cardiologists per million populations in Taiwan was 57.4, and it was lower than the European median (72.8). The median percentages of interventional and electrophysiologists among cardiologists were 64% and 15% in Taiwan, which were both higher than the European median values (12% and 5%, respectively). The accessibility rates to implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy (CRT) in Taiwan were both higher (3.4 and 3.0 centers per million populations) comparing to those in European countries (median 1.6 and 1.5 centers per million populations). Comparing to 67 hospitals without HF care teams in Taiwan, 31 hospitals (31.6%) with HF teams have significantly more cardiology staff, enhanced procedural capabilities with more alternatives on oral or intravenous HF relevant medications.
CONCLUSION:
Our analysis clearly demonstrated discrepancies in cardiology subspecialties and CRT/ICD accessibilities between European countries and Taiwan. Variations in HF-focused services and facilities plus HF-directed medications have demonstrated significant differences among Taiwanese hospitals with or without HF care team.
Copyright © 2021. Published by Elsevier B.V.
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Sporadic High Pacing and Shock Impedance at Remote Monitoring in Hybrid Implantable Cardioverter Defibrillators Systems: Clinical Impact and Management.
Heart Rhythm2021 Apr;():. doi: S1547-5271(21)00317-9.
Pignalberi Carlo, Mariani Marco Valerio, Castro Antonello, Piro Agostino, Magris Barbara, Albano Bruno, Aquilani Stefano, Magnocavallo Michele, Colivicchi Furio, Fedele Francesco, Lavalle Carlo,
Abstract
BACKGROUND:
Sporadic high impedance values without other anomalies have been recently described by remote monitoring for hybrid cardiac implantable electronic device (CIED) systems. The clinical significance and related hazard of this phenomenon are not fully understood.
OBJECTIVE:
To describe prevalence, management and outcomes associated with hybrid implantable cardioverter defibrillator (ICD) systems.
METHODS:
We collected data about patients with sporadic high lead impedance alert on remote monitoring, implanted between January 2015 and December 2019 with hybrid ICD system. Pacing thresholds, sensing and impedance values, alongside temporal pattern of impedance values, were collected by remote monitoring, at implantation and during in-office visit.
RESULTS:
Among 92 patients receiving hybrid ICDs, 15 (16.3%) had high impedance alert at remote monitoring, 14 Boston Scientific and 1 St. Jude Medical ICD canisters paired with Medtronic or Biotronik DF-1 leads. Four patients had a cardiac resynchronization therapy defibrillator (CRT-D), 7 patients had dual-chamber ICD and 4 patients single-chamber ICD. Three patients presented high atrial lead impedance, 7 patients high right ventricular lead impedance, 1 patient high left ventricular impedance and 2 patients high shock impedance values. All patients were followed-up via remote monitoring and sporadic high impedance values were not associated with adverse outcome or need of revision in all but one patient that presented continuously increasing pacing thresholds due to lead microfracture.
CONCLUSIONS:
In absence of clear signs of lead fracture or connection issues, sporadic high pacing and shock impedance in hybrid implantable defibrillator systems can be safely managed through close follow-up.
Copyright © 2021. Published by Elsevier Inc.
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Association of ventricular- arterial interaction with the response to cardiac resynchronization therapy.
Eur J Heart Fail2021 Apr;():. doi: 10.1002/ejhf.2186.
Karamichalakis Nikolaos, Ikonomidis Ignatios, Parissis John, Simitsis Panagiotis, Filippatos Gerasimos,
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Left Bundle Branch Pacing: Current Knowledge and Future Prospects.
Front Cardiovasc Med2021 ;8():630399. doi: 10.3389/fcvm.2021.630399.
Liu Peng, Wang Qiaozhu, Sun Hongke, Qin Xinghua, Zheng Qiangsun,
Abstract
Cardiac pacing is an effective therapy for treating patients with bradycardia due to sinus node dysfunction or atrioventricular block. However, traditional right ventricular apical pacing (RVAP) causes electric and mechanical dyssynchrony, which is associated with increased risk for atrial arrhythmias and heart failure. Therefore, there is a need to develop a physiological pacing approach that activates the normal cardiac conduction and provides synchronized contraction of ventricles. Although His bundle pacing (HBP) has been widely used as a physiological pacing modality, it is limited by challenging implantation technique, unsatisfactory success rate in patients with wide QRS wave, high pacing capture threshold, and early battery depletion. Recently, the left bundle branch pacing (LBBP), defined as the capture of left bundle branch (LBB) via transventricular septal approach, has emerged as a newly physiological pacing modality. Results from early clinical studies have demonstrated LBBP's feasibility and safety, with rare complications and high success rate. Overall, this approach has been found to provide physiological pacing that guarantees electrical synchrony of the left ventricle with low pacing threshold. This was previously specifically characterized by narrow paced QRS duration, large R waves, fast synchronized left ventricular activation, and correction of left bundle branch block. Therefore, LBBP may be a potential alternative pacing modality for both RVAP and cardiac resynchronization therapy with HBP or biventricular pacing (BVP). However, the technique's widespread adaptation needs further validation to ascertain its safety and efficacy in randomized clinical trials. In this review, we discuss the current knowledge of LBBP.
Copyright © 2021 Liu, Wang, Sun, Qin and Zheng.
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Use of T-wave duration and Tpeak-Tend interval as new prognostic markers for patients treated with cardiac resynchronization therapy.
Kardiol Pol2021 Mar;():. doi: 10.33963/KP.15919.
Usalp Songül, Gündüz Ramazan,
Abstract
BACKGROUND:
The use of electrocardiography (ECG) is a practical method to evaluate the response to cardiac resynchronization therapy (CRT) implantation, as it is easily performed and saves time.
AIMS:
In this study, it was aimed to assess the predictive value of the T-wave duration and Tpeak-Tend (Tp-e) interval following the CRT implantation administered to heart failure patients.
METHODS:
Sixty-seven patients with left ventricular ejection fraction ? 35, New York Heart Association (NYHA) II-III, ambulatory class-IV, normal sinus rhythm, who have complete left bundle branch block on ECG and treated with CRT were included in this study. Patients, who have manifested a ? 10% improvement in ejection fraction following CRT implantation, were categorized as "responders", and the remaining patients were categorized as "non-responders". ECGs and echocardiograms were evaluated both six months before and after CRT implantation.
RESULTS:
The post-CRT QRS duration (P = 0.01), cQT interval (P = 0.005), T-wave (P < 0.001), and Tp-e interval (P < 0.001) were found to be significantly reduced in the the responder group compared to the non-responder group. The receiver operating characteristics curve analyses revealed that the predictive optimal cut-off of the T-wave was < 182 ms (P < 0.001), and that of the Tp-e interval was < 92 ms (P < 0.001).
CONCLUSIONS:
T-wave and Tp-e interval may be independent predictors of a favorable CRT response in heart failure patients.
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Reassessment of Clinical Variables in Cardiac Resynchronization Defibrillator Patients at Time of First Replacement: DARC (Death After Replacement of CRT) score.
J Cardiovasc Electrophysiol2021 Apr;():. doi: 10.1111/jce.15031.
Theuns Dominic A M J, Niazi Kaijbar, Schaer Beat A, Sticherling Christian, Yap Sing-Chien, Caliskan Kadir,
Abstract
BACKGROUND:
Cardiac resynchronization defibrillator (CRT-D) as primary prevention is known to reduce mortality. At time of replacement, higher age and comorbidities may attenuate the benefit of implantable defibrillator (ICD) therapy. The purpose of this study was to evaluate the progression of comorbidities after implantation and their association with mortality following CRT-D generator replacement. In addition, a risk score was developed to identify patients at high risk for mortality after replacement.
METHODS AND RESULTS:
We identified patients implanted with a primary prevention CRT-D (n=648) who subsequently underwent elective generator replacement (n=218) from 2 prospective ICD registries. The cohort consisted of 218 patients (median age 70 years, male gender 73%, mean LVEF 36 ± 11% at replacement). Median follow-up after replacement was 4.2 years during which 64 patients (29%) died and 11 patients (5%) received appropriate ICD shocks. An increase in comorbidities was observed in 77 patients (35%). The 5-year mortality rate was 41% in patients with ? 2 comorbidities at time of replacement. A risk score incorporating age, gender, LVEF, atrial fibrillation, anemia, chronic kidney disease, and history of appropriate ICD shocks at time of replacement accurately predicted 5-year mortality (C-statistic 0.829). Patients with a risk score of >2.5 had excess mortality at 5-year post replacement compared with patients with a risk score <1.5 (57% vs 6%; P < 0.001).
CONCLUSION:
A simple risk score accurately predicts 5-year mortality after replacement in CRT-D patients, as patients with a risk score of >2.5 are at high risk of dying despite ICD protection. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
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Evaluation of the effectiveness of infusion of bone marrow derived cell in patients with heart failure: A network meta-analysis of randomized clinical trials and cohort studies.
Med J Islam Repub Iran2020 ;34():178. doi: 10.47176/mjiri.34.178.
Lotfi Farhad, Jafari Mojtaba, Rezaei Hemami Mohsen, Salesi Mahmood, Nikfar Shekoufeh, Behnam Morshedi Hossein, Kojuri Javad, Keshavarz Khosro,
Abstract
The aim of this study was to investigate the effectiveness of bone marrow-derived cells (BMC) technology in patients with heart failure and compare it with alternative therapies, including drug therapy, cardiac resynchronization therapy pacemaker (CRT-P), cardiac resynchronization therapy defibrillator (CRT-D). A systematic review study was conducted to identify all clinical studies published by 2017. Using keywords such as "Heart Failure, BMC, Drug Therapy, CRT-D, CRT-P" and combinations of the mentioned words, we searched electronic databases, including Scopus, Cochrane Library, and PubMed. The quality of the selected studies was assessed using the Cochrane Collaboration's tool and the Newcastle-Ottawa. The primary and secondary end-points were left ventricular ejection fraction (LVEF) (%), failure cases (Number), left ventricular end-systolic volume (LVES) (ml), and left ventricular end-diastolic volume (LVED) (ml). Random-effects network meta-analyses were used to conduct a systematic comparison. Statistical analysis was done using STATA. This network meta-analysis covered a total of 57 final studies and 6694 patients. The Comparative effectiveness of BMC versus CRT-D, Drug, and CRT-P methods indicated the statistically significant superiority of BMC over CRT-P (6.607, 95% CI: 2.92, 10.29) in LVEF index and overall CRT-P (-13.946, 95% CI: -18.59, -9.29) and drug therapy (-4.176, 95% CI: -8.02, -.33) in LVES index. In addition, in terms of LVED index, the BMC had statistically significant differences with CRT-P (-10.187, 95% CI: -18.85, -1.52). BMC was also dominant to all methods in failure cases as a final outcome and the difference was statistically significant i.e. BMC vs CRT-D: 0.529 (0.45, 0.62) and BMC vs Drug: 0.516 (0.44, 0.60). In none of the outcomes, the other methods were statistically more efficacious than BMC. The BMC method was superior or similar to the other methods in all outcomes. The results of this study showed that the BMC method, in general, and especially in terms of failure cases index, had a higher level of clinical effectiveness. However, due to the lack of data asymmetry, insufficient data and head-to-head studies, BMC in this meta-analysis might be considered as an alternative to existing treatments for heart failure.
© 2020 Iran University of Medical Sciences.
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The value of non-invasive myocardial work indices derived from left ventricular pressure-strain loops in predicting the response to cardiac resynchronization therapy.
Quant Imaging Med Surg2021 Apr;11(4):1406-1420. doi: 10.21037/qims-20-754.
Zhu Mengruo, Wang Yanan, Cheng Yufei, Su Yangang, Chen Haiyan, Shu Xianhong,
Abstract
Background:
Non-invasive left ventricular (LV) pressure-strain loops (PSLs), which are generated by combining LV longitudinal strain with brachial artery blood pressure, provide a novel method of quantifying global and segmental myocardial work (MW) indices with potential advantages over conventional echocardiographic strain data, which suffers from being load-dependent. This method has been recently introduced in echocardiographic software, enhancing the efficiency of MW calculations. This study aimed to evaluate the role of non-invasive MW indices derived from LV PSLs in predicting cardiac resynchronization therapy (CRT) response.
Methods:
A total of 106 heart failure (HF) patients scheduled for CRT were included in the MW analysis. Global and segmental (septal and lateral at the mid-ventricular level) MW indices were assessed before CRT and at a 6-month follow-up. Response to CRT was defined as ?15% reduction in LV end-systolic volume and ?1 NYHA functional class improvement at 6-month follow-up compared to baseline.
Results:
CRT response was observed in 78 (74%) patients. At baseline, the global work index (GWI) and global constructive work (GCW) were significantly higher in CRT responders than in non-responders (both P<0.05). Furthermore, responders exhibited significantly higher mid lateral MW and mid lateral constructive work (CW) (both P<0.001), but significantly lower mid septal MWI and mid septal myocardial work efficiency (MWE) than non-responders (all P<0.01). Baseline mid septal MWE (OR 0.975, 95% CI: 0.959-0.990, P=0.002) and mid lateral MWI (OR 1.003, 95% CI: 1.002-1.004, P<0.001) were identified as independent predictors of CRT response in multivariate regression analysis. Mid septal MWE ?42% combined with mid lateral MWI ?740 mmHg% predicted CRT response, with an optimal sensitivity of 79% and specificity of 82% [area under the receiver operating characteristic curve (AUC) =0.830, P<0.001].
Conclusions:
Assessment of MW indices before CRT could identify the marked imbalance in LV MW distribution and can be widely used as a reliable complementary tool for guiding patient selection for CRT in clinical practice.
2021 Quantitative Imaging in Medicine and Surgery. All rights reserved.
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Technical Features and Clinical Outcomes of Coronary Venous Left Ventricular Lead Removal and Reimplantation.
Circ J2021 Apr;():. doi: 10.1253/circj.CJ-20-1199.
Yagishita Daigo, Shoda Morio, Saito Satoshi, Kataoka Shohei, Yazaki Kyoichiro, Kanai Miwa, Ejima Koichiro, Hagiwara Nobuhisa,
Abstract
BACKGROUND:
The number of patients undergoing cardiac resynchronization therapy has increased. Consequently, there is increased frequency in the removal and reimplantation of coronary venous (CV) leads due to infection or malfunction.Methods?and?Results:A total of 345 consecutive patients referred for lead(s) extraction were reviewed. Of these, 34 patients who underwent a CV lead removal were investigated. The indications for CV leads removal were device-related infections in 29 patients and lead malfunctions in 5 patients. The average duration of the CV leads was 4.1±3.8 years. All CV leads were successfully removed without any major complications, except for 1 in-hospital death. Successful CV lead removal by simple traction (ST) was achieved in 21 patients (62%), whereas extraction tools were required in 13 patients (38%). Local infection and CV lead dwell time were significantly associated with successful ST (P=0.04 and P=0.014, respectively). CV lead re-implantation was successfully performed in 25 patients; however, a right-side approach was required in 92%, and occlusion/stenosis of the previous CV was observed in 80% of the patients.
CONCLUSIONS:
CV lead removal is relatively successful and safe. The presence of local infection and a shorter lead duration may enable successful ST of a CV lead. However, the re-implantation procedure should be well prepared for the complexity related to the right-side approach and occlusion/stenosis of the previous CV.
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Bradyarrhythmias and Physiologic Pacing in the ICU.
J Intensive Care Med2021 Apr;():885066621992740. doi: 10.1177/0885066621992740.
Lattell Jonathan, Upadhyay Gaurav A,
Abstract
Bradyarrhythmias represent a common pathology in the intensive care unit (ICU) with etiologies of varying severity. Treatment has often been focused on correcting underlying causes and may require pacing for urgent hemodynamic support. In recent years, there has been interest in physiologic pacing modalities which avoid the dyssynchrony from right ventricular (RV) only pacing. Cardiac resynchronization therapy (CRT) through biventricular pacing is a well-established device-based electrical therapy in patients with wide QRS and heart failure. Recently, it has been shown that biventricular pacing may also be pursued for hemodynamic rescue in the ICU setting. Efforts to re-engage the conduction system with His bundle pacing or further downstream have also emerged as alternative means to deliver resynchronization, with early applications in the ICU now being reported. The goal of the review is to examine bradyarrhythmia causes and management in the ICU as well as investigate new approaches in physiologic pacing and their potential roles in critically ill patients.
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Small decreases in biventricular pacing percentages are associated with multiple metrics of worsening heart failure as measured from a cardiac resynchronization therapy defibrillator.
Int J Cardiol2021 Apr;():. doi: S0167-5273(21)00632-X.
Cao Michael, Stolen Craig M, Ahmed Rezwan, Schloss Edward J, Lobban John H, Kwan Brian, Varma Niraj, Boehmer John P,
Abstract
BACKGROUND:
Lower BiVentricular (BiV) pacing percentages have been associated with significantly worse survival in patients with chronic heart failure (HF). However, the pathophysiology behind this observation has not been further delineated. This analysis evaluated whether small incremental decreases in BiV pacing percentages were associated with worse measures, related to HF physiology using individual sensor trends and the HeartLogic composite index.
METHODS:
Sensor data was obtained from 900 ambulatory HF patients with implanted CRT devices . The percent of cardiac cycles with BiV pacing was assessed for periods (median?=?7.3?days) between data downloads (median?=?55 periods/patient).
RESULTS:
The third heart sound (S3), respiration rate, RSBI, and night-time heart rate were significantly elevated with sub-optimal pacing (<98%), while the first heart sound (S1), thoracic impedance, and activity were significantly lower. All sensor changes were in the direction associated with worsening HF. While IN the HeartLogic alert state (threshold above an Index of 16) the odds of optimal BiV pacing (?98%) were less than when OUT of the HeartLogic alert state for a given subject (OR: 0.655; 95% CI: 0.626-0.686; p?
CONCLUSION:
Lower BiV pacing percent is associated with multiple sensor changes indicative of worsening HF, and patients in HeartLogic alert are more likely to have suboptimal BiV pacing. Collectively, these data provide strong evidence that even small decreases in BiV percent pacing can lead to worsening HF.
Copyright © 2021. Published by Elsevier B.V.
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Left Bundle Branch Block-induced Cardiomyopathy: Insights From Left Bundle Branch Pacing.
JACC Clin Electrophysiol2021 Mar;():. doi: S2405-500X(21)00125-0.
Ponnusamy Shunmuga Sundaram, Vijayaraman Pugazhendhi,
Abstract
OBJECTIVES:
The aim of the study was to report the efficacy of left bundle branch pacing (LBBP) in the management of left bundle branch block (LBBB)-induced cardiomyopathy (LIC).
BACKGROUND:
Chronic LBBB is known to cause mechanical dyssynchrony and cardiomyopathy. Hyperresponse to cardiac resynchronization therapy (CRT) with biventricular pacing (BVP) is a hallmark of LIC. LBBP has recently shown promise as an alternative to BVP.
METHODS:
Patients undergoing CRT between 2018 and 2020 were retrospectively screened, and those who met the criteria for LIC were included in the study. Duration of LBBB, CRT type, and response were documented. Pacing parameters, and electrocardiographic and echocardiographic data were collected.
RESULTS:
Possible LIC was identified in 17 of 159 patients undergoing CRT and LBBP was successfully performed in 13 patients. Duration of LBBB before left ventricular dysfunction was 4.2 ± 3.9 years. Temporary His bundle pacing corrected underlying LBBB in all patients. During LBBP, there was significant reduction in QRS duration (167.8 ± 11.6 ms to 110.4 ± 13.1 ms; p < 0.0001) and repolarization parameters of QTc, Tpeak-Tend, and Tpeak-Tend/QTc ratio. LBBP threshold and R waves at implant were 0.53 ± 0.21 V/0.5 ms and 11.7 ± 7.1 mV and remained stable. Cardiac magnetic resonance imaging showed no evidence of scar (n = 8). During follow-up, left ventricular ejection fraction improved from 30.4 ± 6.6% to 57.4 ± 4.7% (p < 0.0001) and New York Heart Association functional class improved from 3.1 ± 0.3 to 1.2 ± 0.4 (p < 0.0001) compared with baseline.
CONCLUSIONS:
LBBP is a reasonable option for CRT in patients with LIC, as it provides low and stable capture threshold with complete correction of underlying electrical and mechanical abnormalities associated with LBBB.
Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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