Effects of integrated disease management program on the outcome of patients with heart failure / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the feasibility and efficacy on the outcome of patients with heart failure of integrated disease management program with heart failure clinic, patient education and telephone follow-up.</p><p><b>METHODS</b>A total of 145 hospitalized patients with chronic heart failure and LVEF ≤ 45% or patients with LVEF > 45% and NT-proBNP > 1500 ng/L were divided into conventional group (n = 71) and interventional group (n = 74). Patients were followed for 10 to 12 months.</p><p><b>RESULTS</b>Baseline clinical characteristics, LVEF and dose of evidence-based medicine were similar between the 2 groups. During follow-up, the NYHA functional class was higher in conventional group than interventional group (3.2 ± 0.5 vs 1.4 ± 0.5, P < 0.05), and the LVEF deteriorated in the conventional group and improved from 34% to 40%in the interventional group. The proportions of self-monitoring of weight, blood pressure and pulse rate in the interventional group were significantly higher than those of conventional group (P < 0.05). Among patients with systolic heart failure, 40% patients in the interventional group and 11% patients in the conventional group achieved the target doses of β-blockers (P < 0.05). Cardiovascular event rate of conventional group and interventional group is 91.5% and 27.0% respectively (P < 0.05).</p><p><b>CONCLUSION</b>Integrated disease management program with heart failure clinic, patient education and telephone follow-up can improve patient compliance to heart failure treatment, improve cardiac function and reduce cardiovascular event rate.</p>

Determination of optimal left ventricular pacing site for cardiac resynchronization therapy by tissue Doppler imaging / 上海第二医科大学学报

Objective To investigate whether the left ventricular delayed contraction site determined by tissue Doppler imaging might be an optimal left ventricular lead position for improved outcomes of cardiac resynchronization therapy (CRT) in patients with non-ischemic cardiomyopathy. Methods Thirty-three patients subjected to CRT were selected, and all were performed conventional ultrasound cardiography and tissue Doppler examinations before operation. The left ventricular delayed contraction site was determined according to the interval between the onset of QRS and the peak systolic velocity. Retrograde coronary venography was performed during operation, and the left ventricular lead site was selected according to the left ventricular delayed contraction site determined by tissue Doppler examination before operation. The coronary sinus lead site was determined under the guidance of X ray of dorsaventral, lateral, right anterior oblique and left anterior oblique positions. Patients were divided into group A(n=20, the left ventricular lead site was in line with the delayed contraction site) and group B (n=13, the left ventricular lead site was not in line with the delayed contraction site). Results There was no significant difference in age, NYHA grading, left ventricular end-systolic volume(LVESV), left ventricular ejection fraction(LVEF), pulmonary arterial systolic pressure, QRS width and Ts-SD between the two groups before operation(P> 0.05). Six months after CRT, there was no significant difference in NYHA grading, LVESV and mitral regurgitation(MR) grading between the two groups(P>0.05), while the increase in LVEF and decrease in LVESV of group A were more significant than those of group B (P<0.01). Conclusion In patients with non-ischemic cardiomyopathy, CRT significantly improves left ventricular performance, and the more favourable outcomes are achieved in those pace at the delayed contraction site. Tissue Doppler imaging may help to guide the implant of left ventricular lead.

Factors associated with efficacy of cardiac resynchronization therapy for patients with congestive heart failure / 中华心血管病杂志

<p><b>OBJECTIVE</b>The efficacy of cardiac resynchronization therapy (CRT) in patients with congestive heart failure and the potential factors associated with responder or nonresponder were investigated.</p><p><b>METHODS</b>Fifty three patients with congestive heart failure (42 with sinus rhythm and 11 with atrial fibrillation) underwent CRT were enrolled in this study. Conventional echocardiography and tissue Doppler imaging were performed in each patient before implantation and 6 month post implantation. Clinical response was defined as improvement of one NYHA functional class and echocardiographic response was defined as a reduction in LV end-systolic volume by > 15% or an increase of absolute value of LVEF > 5%.</p><p><b>RESULTS</b>The clinical response rate was 75% and echocardiographic response rate was 69.8% during 6 month follow-up. The echocardiographic response rate for patients with atrial fibrillation was lower than that for patients with sinus rhythm (45.5% vs. 76.2%, P < 0.05). In patients with sinus rhythm, higher response rate was seen in patients with widen QRS duration, lower pulmonary systolic pressure and prolonged left ventricular pre-ejection time (LVPT) while response rate was not affected by LVEF, left ventricular volume, NYHA functional class and intra-ventricular dyssynchrony.</p><p><b>CONCLUSIONS</b>Response rate to CRT was lower in patients with atrial fibrillation compared to patients with sinus rhythm. In patients with sinus rhythm, QRS duration, LVPT and pulmonary systolic pressure were useful parameters to predict the response to CRT.</p>

Comparison of different pacing sites of the right ventricle on left ventricular mechanical synchrony and systolic performance using tissue Doppler imaging / 中华心血管病杂志

<p><b>OBJECTIVE</b>Right ventricular apical pacing may induce cardiac desynchronize and deteriorate left ventricular systolic performance. We hypothesized that right ventricular outflow tract (RVOT) pacing could produce better mechanical synchrony and left ventricular contraction.</p><p><b>METHODS</b>We enrolled nine patients without structural heart disease who underwent electrophysiological studies. The pacing sites (right apex, low septum, free wall and septum of RVOT of the right ventricle) were defined with fluoroscopy and ECG. The atrioventricular sequential pacing was applied every 5 minutes in a random order at a rate of 120 bpm. Tissue Doppler imaging was carried out with GE VIVID 7 for off-line analysis at each pacing site. The global systolic contraction amplitude (GSCA) was calculated as the average shortening amplitude of all 16 segments of left ventricle.</p><p><b>RESULTS</b>The GSCA during pacing was 5.76 mm +/- 0.66 mm at free wall of RVOT and 5.66 mm +/- 1.00 mm at septum of RVOT, respectively. The GSCA at both sites was significantly higher than that at apical pacing 4.82 mm +/- 0.94 mm (P < 0.05) or low septum pacing 4.82 mm +/- 1.06 mm (P < 0.05). Moreover, segmental displacement analysis showed that the longitudinal displacement of lateral, posterior, and inferior walls significantly decreased at apical pacing compared with RVOT pacing, although no difference could be demonstrated in anterior and septum walls. Accordingly, the curve of the myocardial displacement at apical or low septum pacing was M-shaped, and had a negative wave at the end of the diastole in lateral, posterior, and inferior walls. The tissue velocity during isovolumic contraction period was also higher than systolic tissue velocity in these walls. The phenomenon could seldom be seen at RVOT pacing.</p><p><b>CONCLUSION</b>RVOT pacing in patients without structural heart disease is associated with more favorable immediate myocardial contraction and mechanical synchrony compared with right apical pacing or low septum pacing.</p>

Immediate effect of cardiac resynchronization therapy by tissue synchronization imaging and tissue tracking in patients with congestive heart failure / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the immediate effect of cardiac resynchronization therapy (CRT) by Doppler tissue imaging (DTI), tissue synchronization imaging (TSI) and tissue tracking imaging (TTI) in patients with congestive heart failure.</p><p><b>METHODS</b>Ten patients with congestive heart failure who had cardiac resynchronization therapy were enrolled. The TSI and TTI imaging were performed by GE vivid 7 with M3s probe. The TTI image was obtained in diastole to determine delayed longitude contraction (DLC). The left ventricular ejection fraction (LVEF), the percentage of delayed longitude contraction segments (DLC), the standard deviation of the time to peak myocardial systolic contraction of 16 segments (Ts-SD), the standard deviation of the time to peak myocardial diastole of 16 segments (Td-SD), the systolic velocity of right ventricule (RV-Sm) and the average systolic velocity of mitral valve annulus (LV-Sm) were measured. The intraventricular dyssynchrony could be semi-quantified by TSI as 4 (red), 3 (orange), 2 (yellow), 1 (green), and the average value of 16 segments was defined as the TSI index. The immediate changes of these parameters were investigated when the pacemaker was turned on and off. The correlation of the Ts and TSI index was also analyzed.</p><p><b>RESULTS</b>When the pacemaker was on, the LVEF improved significantly from (37 +/- 11.30)% to (46 +/- 10.10)% (P < 0.01), and LV-Sm increased significantly from (3.16 +/- 0.87) cm/s to (3.76 +/- 0.74) cm/s (P < 0.01), RV-Sm increased significantly from (6.79 +/- 1.78) cm/s to (7.75 +/- 1.92) cm/s (P < 0.01). DLCs decreased significantly from (35 +/- 6.04)% to (18.13 +/- 9.97)% (P < 0.01), Ts-SD decreased from (83.97 +/- 33.02) ms to (52.67 +/- 19.65) ms, P < 0.05, Td-SD decreased from (87.81 +/- 22.34) ms to (63.45 +/- 31.49) ms, P < 0.05 and TSI index reduced from 2.11 +/- 0.15 to 1.60 +/- 0.33 (P < 0.01) respectively. In addition, the reduction of TSI index correlated significantly with that of Ts-SD (r = 0.75, P < 0.05).</p><p><b>CONCLUSIONS</b>CRT could immediately improve the systolic and diastolic synchrony of the left ventricle and ventricular function. TSI and TTI may be as the new effective modalities to assess the mechanical dyssynchrony. TSI index was direct and reliable in this study.</p>