Cardiac resynchronization therapy. Midterm follow-up of 128 patients.

OBJECTIVE: Cardiac resynchronization therapy has been used in the treatment of advanced heart failure with inter- and intraventricular dyssynchrony for more than ten years. AIM OF THE STUDY: A retrospective study was conducted to assess midterm results of biventricular (BiV) pacing in cardiac resynchronization therapy. METHODS: 128 consecutive patients (age 61.0+/-9.6, 98 males), with heart failure NYHA class 2.9+/-0.4 (2.5-3.5), with LBBB, QRS> or =130 ms, with dilated cardiomyopathy--DCM (86), with coronary artery disease--CAD (36), with both these etiologies (4) and with valvular disease (2) had a BiV PM (82) or BiV ICD (46) implanted in 2000-2007. AV delay was optimized individually, using echocardiography. Before and 3 months after implantation, the following was established: NYHA class, LVEF (echocardiographically), maximum oxygen uptake (spiroergometrically), left ventricle diastolic diameter and mitral regurgitation. The average follow-up time was 25.8+/-20.8 months. Complications and 2-year survival (n=68) were also assessed. RESULTS: 1) After 3 months of BiV pacing, NYHA class improved from 2.9+/-0.4 to 2.4+/-0.6 (n=99, p<0.001), LVEF increased from 20.2+/-4.9 to 23.9+/-6.6 % (n=92, p<0.001). Left ventricle diastolic diameter decreased from 69.8+/-8 to 67.5+/-10.0 mm (n=88, p=0.001) and mitral regurgitation was reduced from 2.2+/-0.9 to 1.9+/-0.9 (n=87, p=0.001) and maximum oxygen uptake during spiroergometry increased from 14.5+/-2.7 to 15.5+/-2.6 ml/min/kg (n=52, p=0.005). 2) Coronary sinus lead reposition was done in 2.3 %, epicardial lead implantation in 4.7 %, atrial lead reposition in 2.3 %, and right ventricular lead reposition in 2.3 % of patients. Contralateral reimplantation due to inflammatory complications in 1.6 % of patients. 3) Heart transplantation was performed on 9 patients. 4) Two-year survival was recorded in 77.9 % of 68 followed patients (72.2 % in CAD, 79.6 % in DCM). CONCLUSION: In the retrospective study of patients with BiV pacing a decline in heart failure, an increase in cardiac pump efficiency, reverse remodelling of left ventricle and acceptable occurrence of complications were confirmed (Tab. 4, Fig. 7, Ref. 18). Full Text (Free, PDF) www.bmj.sk

THE RELATIONSHIP BETWEEN CIRCADIAN BLOOD PRESSURE VARIATION AND AGE ANALYSED FROM 7-DAY MONITORING.

The relationship between age and circadian blood pressure (BP) variation was the aim of the present study. One hundred and eighty-seven subjects (130 males, 57 females), 20-77 years old, were recruited for seven-day BP monitoring. Colin medical instruments (Komaki, Japan) were used for ambulatory BP monitoring (oscillation method, 30-minute interval between measurements). A sinusoidal curve was fitted (minimum square method) and the mean value and amplitude of the curve (double amplitude corresponds to the night-day difference) were evaluated on every day of monitoring. The average 7-day values of the mean (M) and of double amplitude (2A) for systolic BP (SBP), diastolic BP (DBP), and heart rate (HR) were determined in each subject. The mean values of M (+/-SD) for the whole group were: SBP- 127+/-8, DBP - 79+/-6 mmHg, HR - 70+/-6 bpm; of 2A: SBP - 21+/-7, DBP - 15+/-5 mmHg, HR - 15+/-6 bpm. A linear relationship between M of SBP and age (r=0.341, p< 0.001) and DBP and age (r=0.384, p<0.001) was found (difference between 20 and 77 years: SBP - 16, DBP - 12 mmHg). 2A of SBP and DBP was increasing with age up to 35 years, then the curve remained relatively flat up to 55 years (maximum at 45 years), and then it decreased again (difference between 45 and 77 years: SBP - 13mmHg, DBP - 12 mmHg). Heart rate M and 2A were age-independent. The mean values of SBP and DBP were increasing with age up to 75 years, but the night-day difference of SBP and DBP reached its maximum value at 45 years and then decreased.

CIRCADIAN BLOOD PRESSURE VARIABILITY AND EXERCISE THERAPY.

The objective of this study was to find if there was a relationship between the time when cardiovascular rehabilitation was running in the patients after myocardial infarction and an average daily value of systolic and diastolic blood pressure at 7-day ambulatory blood pressure monitoring.Systolic and diastolic pressures significantly increased in patients who underwent cardiovascular rehabilitation in the morning from 9.00 a.m. to 10.15 a.m., and significantly decreased in those who did their physical exercise in the afternoon from 1.30 p.m. to 2.45 p.m., compared to their blood pressure values on days without rehabilitation.

[Interval and continuous training in cardiovascular rehabilitation]. / Intervalový a kontinuální trénink v kardiovaskulární rehabilitaci.

The objective of the study was to evaluate the physiological effectiveness and the influence of two modifications of aerobic training (interval and continuous) on the physical performance in the patients with coronary heart disease. 38 males with coronary heart disease (age 60 +/- 10.2 years) passed three months training programme of 60 min 3 times a week (10 min of warm up phase, 25 min of aerobic phase, 15 min of resistance training, 10 min of relaxing phase). Patients with coronarographically verified stenosis > 50% luminal diameter and/or left ventricular ejection fraction lower than 40 % (n = 22) had in terms of aerobic phase interval training prescribed (30 second work phases with work load intensity on the level of anaerobic threshold alternating with 60 second recovery phases with intensity of 5 W); other patients (n = 16) passed aerobic phase of the programme with continual work load of intensity on the level of ventilatory anaerobic threshold. After the determination of three month rehabilitation programme the maximal achieved performance as well as aerobic capacity evaluated by spiroergometric examination statistically significantly increased in the group of patients with interval training and also in the group with continuous training. Despite the group with interval training performed 2.5-3 times less work in each training unit (p < 0.01), the performance and aerobic capacity parameters after the termination of three month programme did not statistically significantly differ from the group with continuous training. The advantage of the continuous training is a possibility to achieve an improvement also in the patients with left ventricular dysfunction and chronic coronary heart disease who could have worse tolerance of the continual work load.

CIRCANNUAL VARIATION IN HUMAN DIASTOLIC BLOOD PRESSURE DURING CONSECUTIVE SOLAR CYCLES.

Putative circadecadal modulations of a circannual variation in diastolic blood pressure are explored in a still accumulating 35 year record of self-measurements by a clinically healthy man. Analyses of monthly means by gliding spectra, one-way analysis of variance (ANOVA), and cosinor were carried out after removing data collected during travel across time zones or during illness. An about yearly change in diastolic blood pressure may or may not be detected with statistical significance by cosinor or ANOVA, apparently as a function of solar cycle number and/or stage. It appears to be, however, 1 year synchronized in the entire span analysed as a whole. A given variable such as diastolic blood pressure may be characterized by multifrequency rhythms that may intermodulate, so that findings in different stages of cycles with the lowest (e.g., circadecadal) frequency mapped may determine different outcomes in cycles with higher frequencies, such as circannuals.