ABSTRACT
Correction to: European Review for Medical and Pharmacological Sciences 2021; 25 (18): 5690-5700-DOI: 10.26355/eurrev_202109_26788-PMID: 34604961, published online on 30 September 2021. After publication, the authors applied to change the first two lines of Table II as the second column results were erroneously shifted in the first column. In this way, the results were quite difficult to understand. There are amendments to this paper. The Publisher apologizes for any inconvenience this may cause. https://www.europeanreview.org/article/26788.
ABSTRACT
OBJECTIVE: Current guidelines recommend an implantable cardiac defibrillator (ICD) in patients with symptomatic heart failure and reduced ejection fraction (HFrEF; left ventricular ejection fraction [LVEF] ≤35%) despite ≥3 months of optimal medical therapy. Recent observations demonstrated that sacubitril/valsartan induces beneficial reverse cardiac remodeling in eligible HFrEF patients. Given the pivotal role of LVEF in the selection of ICD candidates, we sought to assess the impact of sacubitril/valsartan on ICD eligibility and its predictors in HFrEF patients. PATIENTS AND METHODS: We retrospectively evaluated 48 chronic HFrEF patients receiving sacubitril/valsartan and previously implanted with an ICD in primary prevention. We assumed that ICD was no longer necessary if LVEF improved >35% (or >30% if asymptomatics) at follow-up. RESULTS: Over a median follow-up of 11 months, sacubitril/valsartan induced a significant drop in LV end-systolic volume (-16.7 ml/m2, p=0.023) and diameter (-6.8 mm, p=0.022), resulting in a significant increase in LVEF (+3.9%, p<0.001). As a consequence, 40% of previously implanted patients resulted no more eligible for ICD at follow-up. NYHA class improved in 50% of the population. A dose-dependent effect was noted, with higher doses associated to more reverse remodeling. Among patients deemed no more eligible for ICD, lower NYHA class (odds ratio (OR) 3.73 [95% CI 1.05; 13.24], p=0.041), better LVEF (OR 1.23 [95% CI 1.01; 1.48], p=0.032) and the treatment with the intermediate or high dose of sacubitril/valsartan (OR 5.60 [1.15; 27.1], p=0.032) were the most important predictors of status change. CONCLUSIONS: In symptomatic HFrEF patients, sacubitril/valsartan induced beneficial cardiac reverse remodeling and improved NYHA class. These effects resulted in a significant reduction of patients deemed eligible for ICD in primary prevention.
Subject(s)
Aminobutyrates/administration & dosage , Biphenyl Compounds/administration & dosage , Defibrillators, Implantable , Heart Failure/therapy , Valsartan/administration & dosage , Aged , Aminobutyrates/pharmacology , Biosimilar Pharmaceuticals , Biphenyl Compounds/pharmacology , Chronic Disease , Drug Combinations , Female , Heart Failure/physiopathology , Humans , Male , Middle Aged , Patient Selection , Stroke Volume/drug effects , Treatment Outcome , Valsartan/pharmacology , Ventricular Function, Left/drug effects , Ventricular Remodeling/drug effectsABSTRACT
Cardiac resynchronization therapy by biventricular pacemaker/ICD implantation is a validated therapy for patients affected by heart failure with asynchrony of ventricular contraction. Considering the large number of parameters which play a role in cardiac resynchronization therapy, a comprehensive numerical model of cardiocirculatory system could be a useful tool to support clinical decisions. A variable elastance model of ventricles was updated to model the interventricular septum and to simulate the interventricular and the intraventricular desynchrony, and the effect of the biventricular stimulation. In addition, a numerical model of the biventricular pacemaker, which drives the beginning of the heart chambers and interventricular septum contraction, was also developed. In order to validate the model, five patients affected by dilated cardiomyopathy were analysed by echocardiography and electrocardiography before implantation, 24 h and 3 months after the implantation. The developed numerical model permits to reproduce clinical data and to estimate the trend of parameters that are difficult to measure (i.e. left ventricular systolic elastance). Furthermore, the model permits to study the effect of different biventricular pacemaker temporizations on hemodynamic variables.
Subject(s)
Cardiac Resynchronization Therapy/methods , Cardiomyopathy, Dilated/therapy , Models, Cardiovascular , Cardiac Output/physiology , Cardiomyopathy, Dilated/diagnostic imaging , Cardiomyopathy, Dilated/physiopathology , Electrocardiography/methods , Humans , Signal Processing, Computer-Assisted , UltrasonographyABSTRACT
OBJECTIVE: To determine the reliability of village community development workers in screening for blindness in the community and to suggest an extraordinary role for these cadres. DESIGN: Diagnostic study. SETTING: Chivi District, Zimbabwe. SUBJECTS: A simple random sample of 148 out of 886 people selected from notification forms. MAIN OUTCOME MEASURE: Sensitivity, specificity and predictive values. RESULTS: The screening method employed was found to have a sensitivity of 93% (95% CI), specificity of 32% (95% CI) and a predictive value for a positive result of 75%. CONCLUSION: The use of village community development workers to screen for blindness in the community has proved to be a reliable alternative when there is shortage of both ophthalmic trained personnel and funds.