RESUMEN
BACKGROUND: Biventricular pacing (BVP) has proven efficacy in treating heart failure with reduced ejection fraction (HFrEF) and ventricular dyssynchrony. Conduction system pacing (CSP), encompassing His bundle pacing (HBP) and left bundle area pacing (LBAP), has emerged as a promising alternative, but its benefits are still uncertain. METHODS: PubMed, Scopus and Cochrane databases were searched for randomized controlled trials (RCTs) that compared CSP to BVP for resynchronization therapy in patients with HFrEF and reported the outcomes of (1) paced QRS interval duration; (2) left ventricular ejection fraction (LVEF); and (3) New York Heart Association functional class (NYHA). Heterogeneity was examined with I² statistics. A random-effects model was used for all outcomes. RESULTS: We included 7 RCTs with 408 patients, of whom 200 (49%) underwent CSP. In patients undergoing CSP, there was significantly lower paced QRS duration (MD -13.34; 95% CI -24.32 to -2.36; p=0.02; Figure 1) and NYHA functional class (SMD -0.37; 95% CI -0.69 to -0.05; p=0.02; Figure 2). There was also a significant increase in LVEF in the CSP group (MD 2.06; 95% CI 0.16 to 3.97; p=0.03; Figure 3). No statistical difference was noted for LVESV (SMD -0.51; 95% CI -1.26 to 0.24; p=0.18; I²=83%), threshold for lead capture (MD -0.08; 95% CI -0.42 to 0.27; p=0.66; I²=66%), and procedure time (MD 5.99; 95% CI -15.91 to 27.89; p=0.59; I²=79%). Hospitalizations for HF were only noted in three studies, and no difference was observed between groups (9 vs 7; RR 1.02; 95% CI 0.21 to 4.90; p=0.98; I²=46%). Differences in mortality did not reach statistical significance (3 vs 8; RR 0.45; 95% CI 0.12 to 1.62; p=0.219; I²=0%). In subgroup analysis per CSP technique, there were no significant differences between groups for QRS duration and LVEF. LBAP was the main contributor for the significant difference observed in the NYHA functional class with a trend towards subgroup difference (p interaction=0.06). Although no significant difference was noted for the overall lead threshold, the LBAP subgroup had significantly lower values compared to HBP (p interaction=0.03). CONCLUSION: These findings suggest that CSP may have symptomatic, echocardiographic and electrophysiologic benefits for HFrEF patients requiring resynchronization.
Asunto(s)
Insuficiencia Cardíaca Sistólica , Electrofisiología CardíacaRESUMEN
Conduction system pacing (CSP) has emerged as a promising alternative to biventricular pacing (BVP) in patients with heart failure with reduced ejection fraction (HFrEF) and ventricular dyssynchrony, but its benefits are uncertain. In this study, we aimed to evaluate clinical outcomes of CSP vs BVP for cardiac resynchronization in patients with HFrEF. PubMed, Scopus, and Cochrane databases were searched for randomized controlled trials comparing CSP to BVP for resynchronization therapy in patients with HFrEF. Heterogeneity was examined with I2 statistics. A random-effects model was used for all outcomes. We included 7 randomized controlled trials with 408 patients, of whom 200 (49%) underwent CSP. Compared to BVP, CSP resulted in a significantly greater reduction in QRS duration (MD -13.34 ms; 95% confidence interval [CI] -24.32 to -2.36, P = .02; I2 = 91%) and New York Heart Association functional class (standardized mean difference [SMD] -0.37; 95% CI -0.69 to -0.05; P = .02; I2 = 41%), and a significant increase in left ventricular ejection fraction (mean difference [MD] 2.06%; 95% CI 0.16 to 3.97; P = .03; I2 = 0%). No statistical difference was noted for left ventricular end-systolic volume (SMD -0.51 mL; 95% CI -1.26 to 0.24; P = .18; I2 = 83%), lead capture threshold (MD -0.08 V; 95% CI -0.42 to 0.27; P = .66; I2 = 66%), and procedure time (MD 5.99 minutes; 95% CI -15.91 to 27.89; P = .59; I2 = 79%). These findings suggest that CSP may have electrocardiographic, echocardiographic, and symptomatic benefits over BVP for patients with HFrEF requiring cardiac resynchronization.
Asunto(s)
Terapia de Resincronización Cardíaca , Insuficiencia Cardíaca , Volumen Sistólico , Humanos , Terapia de Resincronización Cardíaca/métodos , Sistema de Conducción Cardíaco/fisiopatología , Insuficiencia Cardíaca/terapia , Insuficiencia Cardíaca/fisiopatología , Ensayos Clínicos Controlados Aleatorios como Asunto , Volumen Sistólico/fisiologíaRESUMEN
Conduction system pacing (CSP) has emerged as a promising alternative to biventricular pacing (BVP) heart failure patients with reduced ejection fraction (HFrEF) and ventricular dyssynchrony, but its benefits are still uncertain. In this study, we aim to evaluate clinical outcomes of CSP versus BVP for cardiac resynchronization in patients with HFrEF. PubMed, Scopus, and Cochrane databases were searched for randomized controlled trials (RCTs) comparing CSP to BVP for resynchronization therapy in patients with HFrEF. Heterogeneity was examined with I2 statistics. A random-effects model was used for all outcomes. We included 7 RCTs with 408 patients, of whom 200 (49%) underwent CSP. Compared to biventricular pacing, CSP resulted in a significantly greater reduction in QRS duration (MD -13.34 ms; 95% CI -24.32 to -2.36, p=0.02; I2=91%) and NYHA functional class (SMD -0.37; 95% CI -0.69 to -0.05;p=0.02; I2=41%), and a significant increase in left ventricular ejection fraction (LVEF) (MD 2.06%; 95% CI 0.16 to 3.97; p=0.03; I2=0%). No statistical difference was noted for LVESV (SMD -0.51 mL; 95% CI -1.26 to 0.24; p=0.18; I2=83%), lead capture threshold (MD -0.08 V; 95% CI -0.42 to 0.27; p=0.66; I2=66%), and procedure time (MD 5.99 min; 95% CI -15.91 to 27.89; p=0.59; I2=79%). These findings suggest that CSP may have electrocardiographic, echocardiographic, and symptomatic benefits over biventricular pacing for patients with HFrEF requiring cardiac resynchronization.
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Bloqueo de Rama , Terapia de Resincronización Cardíaca , Insuficiencia Cardíaca , Trastorno del Sistema de Conducción CardíacoRESUMEN
Aims: Develop and analyze triple-negative breast cancer targeted nanoparticles loaded with the demethylating agent decitabine. Materials & methods: The polymers were synthesized by ring-opening polymerization of D,L-lactide and formulated into nanoparticles via emulsion-evaporation method. The nanoparticles were characterized by physicochemical analysis as well as in vitro using breast cancer cell lineages. Results & conclusion: The targeted nanoparticles exhibited a hydrodynamic diameter of 75 ± 12 nm, zeta potential -6.3 ± 0.2 mV and spherical morphology, and displayed greater in vitro accumulation into MDA-MB-231 (triple-negative breast cancer cell-line) compared with MCF7 and HB4A cell lineages as verified by fluorescence confocal microscopy and significant demethylating effects via ADAM33 screening by PCR.
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Neoplasias de la Mama , Nanopartículas , Neoplasias de la Mama Triple Negativas , Humanos , Femenino , Neoplasias de la Mama Triple Negativas/tratamiento farmacológico , Neoplasias de la Mama Triple Negativas/genética , Epigénesis Genética , Ligandos , Línea Celular Tumoral , Nanopartículas/química , Proteínas ADAMRESUMEN
Ligand-mediated targeting represents the cutting edge in precision-guided therapy for several diseases. Surface engineering of nanomedicines with ligands exhibiting selective or tailored affinity for overexpressed biomolecules of a specific disease may increase therapeutic efficiency and reduce side effects and recurrence. This review focuses on newly developed approaches and strategies to improve treatment and overcome the mechanisms associated with breast cancer resistance.