RESUMO
OBJECTIVE: Whether modiï¬ed Glasgow prognostic score predicts prognosis in patients with cardiac resynchronization therapy with deï¬brillation is unknown. Our aim was to investigate the association of modiï¬ed Glasgow prognostic score with death and hospitalization in cardiac resynchronization therapy with deï¬brillation patients. METHODS: A total of 306 heart failure with reduced ejection fraction patients who underwent cardiac resynchronization therapy with deï¬brillation implantation were categorized into 3 groups based on their modiï¬ed Glasgow prognostic score categorical levels. C-reactive protein >10 mg/L or albumin <35 g/L was assigned 1 point each and the patients were classiï¬ed into 0, 1, and 2 points, respectively. Remodeling was determined according to the clinical event and myocardial remodeling criteria. Major adverse cardiac events were deï¬ned as mortality and/or hospitalization for heart failure. RESULTS: Age, New York Heart Association functional class, modiï¬ed Glasgow prognostic score prior to cardiac resynchronization therapy with deï¬brillation, sodium levels, and left atrial diameter were higher in the major adverse cardiac events(+) group. Age, left atrial diameter, and higher modiï¬ed Glasgow prognostic score were found to be predictors of heart failure hospitalization/death in multivariable penalized Cox regression analysis. Besides, patients with lower modiï¬ed Glasgow prognostic score showed better reverse left ventricular remodeling demonstrated by increase in left ventricle ejection fraction and decline in left ventricle end systolic volume. CONCLUSION: Modiï¬ed Glasgow prognostic score prior to cardiac resynchronization therapy with deï¬brillation can be used as a predictor of long-term heart failure hospitalization and death in addition to age and left atrial diameter. These results can guide the patient selection for cardiac resynchronization therapy with deï¬brillation therapy and highlight the importance of nutritional status.
Assuntos
Fibrilação Atrial , Terapia de Ressincronização Cardíaca , Insuficiência Cardíaca , Humanos , Prognóstico , Resultado do Tratamento , Fibrilação Atrial/terapia , Volume Sistólico , Remodelação VentricularRESUMO
INTRODUCTION: Major burn injury is an acute stress reaction with systemic effects. Major burn injury has been associated with a number of cardiovascular dysfunctions, including ventricular arrhythmias. The mechanism of increased ventricular arrhythmias in burn patients uncertain. The aim of the present study was to evaluate the ventricular repolarization by using the Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio as candidate markers of ventricular arrhythmias in patients with major burn patients. In addition, the relationship between the repolarization parameters and the CRP(C-reactive protein) and ABSI(Abbreviated Burn Severity Index) score was investigated. METHODS: 55 major burn patients, 55 age and sex matched healthy subjects were included in the study between January 2017 and September 2019. The risk of ventricular arrhythmias was evaluated by calculating the electrocardiographic Tp-e and QT interval, corrected QT(QTc), Tp-e/QT and Tp-e/QTc ratios. ABSI score was calculated in burn patients. Left ventricular functions were evaluated by echocardiography. RESULTS: Tp-e interval (80.7⯱â¯5.7 vs. 67.4⯱â¯5.7; pâ¯<â¯0.001), Tp-e/QT ratio (0.21⯱â¯0.01 vs. 0.18⯱â¯0.01; pâ¯<â¯0.001) and Tp-e/QTc ratio (0.20⯱â¯0.01 vs.0.17⯱â¯0.01; pâ¯<â¯0.001) were significantly higher in major burn patients than the control group. There was a significant positive correlation between Tp-e interval, Tp-e/QTc ratio and ABSI score in major burn patients (râ¯=â¯0.870, pâ¯<â¯0.001, râ¯=â¯0.312, pâ¯=â¯0.020 consecutively). CONCLUSION: Our study showed for the first time in literature that the Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio, which were evaluated electrocardiographically in major burn patients, were prolonged compared with normal healthy individuals. A positive correlation was determined between repolarization parameters and ABSI score. Whether these changes increase the risk of ventricular arrhythmia deserve further studies. TAKE-HOME MESSAGE: Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio, which were evaluated electrocardiographically in major burn patients, were prolonged compared with normal healthy individuals and a positive correlation was found between these repolarization parameters and burn severity.