ABSTRACT
BACKGROUND: Although cardiac resynchronization therapy (CRT) is beneficial in most heart failure patients, up to 40% do not respond to CRT. It has been suggested that multipoint left ventricle pacing (MPP) would increase the response rate. AIM: To assess the CRT response rate at 6 months in patients implanted with a CRT device with the MPP feature activated early after the implant. METHODS: This was a multicentre, prospective, open-label and non-randomized study. The primary endpoint was response to biventricular pacing defined as >15% relative reduction in left ventricular end-systolic volume (LVESV) comparing echocardiography measurements performed at baseline and 6 months by a core laboratory. Among secondary endpoints the combined endpoint of mortality or all-cause hospitalizations was evaluated. Primary study endpoint and clinical outcomes were compared to a Quarto II control cohort. RESULTS: Totally, 105 patients were included. The response rate was 64.6% (97.5% lower confidence bound 53%). Mean relative reduction in LVESV was 25.3%, and mean absolute increase in LVEF was 9.4%. The subjects with device programmed using anatomical approach showed a trend towards higher responder rate than those using the electrical approach (72% vs. 61.1%, p = 0.32). Finally, the combined incidence of mortality and or all-cause hospitalizations at 6 month was 12.4%. CONCLUSIONS: Early activation of MPP was not associated to an advantage increasing echocardiography responders to CRT at 6 months of follow-up. Nevertheless, patients programmed using widest pacing cathodes had a numerically higher responder rate. Finally, early activation of MPP was associated to a low incidence of clinical endpoints at 6 months of follow-up.
Subject(s)
Cardiac Resynchronization Therapy , Heart Failure , Humans , Prospective Studies , Ventricular Function, Left/physiology , Stroke Volume/physiology , Treatment Outcome , Cardiac Resynchronization Therapy DevicesABSTRACT
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Humans , Child, Preschool , Child , Heart Diseases/congenital , Child, Adopted , Congenital Abnormalities , Retrospective StudiesSubject(s)
Child, Adopted , Heart Defects, Congenital , Adoption , Child , Heart Defects, Congenital/epidemiology , Humans , PrevalenceABSTRACT
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Humans , Male , Female , Anisakis , Anisakis/isolation & purification , Diagnosis, Differential , Medical History Taking/methods , Medical History Taking/standards , Urticaria/complications , Urticaria/diagnosis , Primary Health Care/methods , Primary Health Care/trends , Primary Health CareABSTRACT
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Female , Humans , Male , Prunus/adverse effects , Food Hypersensitivity/diagnosis , Food Hypersensitivity/prevention & control , Food Hypersensitivity/therapy , Skin Tests/instrumentation , Skin Tests/methods , Skin Tests , Flavoring Agents/adverse effects , Causality , Pruritus/complications , Pruritus/diagnosis , Pruritus/therapy , Fibromyalgia/complications , Fibromyalgia/diagnosis , Urticaria/complications , Urticaria/diagnosis , Urticaria/therapyABSTRACT
BACKGROUND: Data on the cardiac characteristics of centenarians are scarce. Our aim was to describe electrocardiogram (ECG) and echocardiography in a cohort of centenarians and to correlate them with clinical data. METHODS: We used prospective multicenter registry of 118 centenarians (28 men) with a mean age of 101.5±1.7 years. Electrocardiogram was performed in 103 subjects (87.3%) and echocardiography in 100 (84.7%). All subjects underwent a follow-up for at least 6 months. RESULTS: Centenarians with abnormal ECG were less frequently females (72% vs 93%), had higher rates of previous consumption of tobacco (14% vs 0) and alcohol (24% vs 12%), and scored lower in the perception of health status (6.8±2.0 vs 8.3±6.8). Centenarians with significant abnormalities in echocardiography were less frequently able to walk 6 m (33% vs 54%). Atrial fibrillation/flutter was found in 27 subjects (26%). Mean left ventricular (LV) ejection fraction was 60.0±10.5%. Moderate or severe aortic valve stenosis was found in 16%, mitral valve regurgitation in 15%, and aortic valve regurgitation in 13%. Diastolic dysfunction was assessed in 79 subjects and was present in 55 (69.6%). Katz index and LV dilation were independently associated with the ability to walk 6 m. Age, Charlson and Katz indexes, and the presence of significant abnormalities in echocardiography were associated with mortality. CONCLUSIONS: Centenarians have frequent ECG alterations and abnormalities in echocardiography. More than one fifth has atrial fibrillation, and most have diastolic dysfunction. Left ventricular dilation was associated with the ability to walk 6 m. Significant abnormalities in echocardiography were associated with mortality.
Subject(s)
Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/physiopathology , Geriatric Assessment , Heart/physiopathology , Registries , Aged, 80 and over , Cardiovascular Diseases/diagnostic imaging , Electrocardiography , Female , Follow-Up Studies , Humans , Male , Prospective Studies , UltrasonographyABSTRACT
Las histiocitosis son cuadros caracterizados por la proliferación de células del sistema mononuclear fagocítico. Incluyen la histiocitosis de células de Langerhans (HCL) y las histiocitosis de células no Langerhans (entre ellas la enfermedad de Chester-Erdheim [ECE]). Aunque la diabetes insípida (DI) es la alteración hipotálamo hipofisaria (HH) más frecuente, están menos estudiados los déficits hipofisarios anteriores. Se analiza la frecuencia y la progresión de los déficits hormonales hipofisarios y los hallazgos radiológicos de 9 pacientes (7 HCL y 2 ECE) con afectación de la región HH. El 89% de los pacientes presentaba DI (62% al diagnóstico) y el 78%, uno o más déficits anteriores (71% al diagnóstico). Dado que la afectación HH es relativamente frecuente en pacientes con diagnóstico de histiocitosis y que los déficits hormonales pueden estar presentes al diagnóstico o aparecer de forma paulatina durante el curso de la enfermedad, es recomendable monitorizar de manera regular a este tipo de pacientes
Histiocytosis is characterized by proliferation of cells from the mononuclear phagocyte system, and may be divided into Langerhans cell histiocytosis (LCH) and non-Langerhans cell histiocytosis (including Erdheim-Chester disease [ECD]). While diabetes insipidus (DI) is the most common hypothalamic-pituitary consequence, anterior pituitary deficiencies are less known. This study analyzed the frequency and progression of pituitary hormone deficiencies and the radiographic findings in 9 patients (7 with LCH and 2 with ECD) with hypothalamic-pituitary (HP) axis. Eighty-nine percent of patients had DI (62% at diagnosis), and 78% had one or more anterior pituitary deficiencies (71% at diagnosis). HP involvement is relatively common in patients diagnosed with histiocytosis and hormone deficiencies may be present at diagnosis or appear gradually during the course of disease. Regular monitoring of these patients is recommended
Subject(s)
Humans , Male , Female , Young Adult , Adult , Middle Aged , Aged , Histiocytosis, Langerhans-Cell/complications , Diabetes Insipidus/epidemiology , Erdheim-Chester Disease/complications , Pituitary Gland, Anterior/physiopathology , Pituitary Diseases/epidemiology , Hypopituitarism/epidemiology , Retrospective StudiesABSTRACT
Histiocytosis is characterized by proliferation of cells from the mononuclear phagocyte system, and may be divided into Langerhans cell histiocytosis (LCH) and non-Langerhans cell histiocytosis (including Erdheim-Chester disease [ECD]). While diabetes insipidus (DI) is the most common hypothalamic-pituitary consequence, anterior pituitary deficiencies are less known. This study analyzed the frequency and progression of pituitary hormone deficiencies and the radiographic findings in 9 patients (7 with LCH and 2 with ECD) with hypothalamic-pituitary (HP) axis. Eighty-nine percent of patients had DI (62% at diagnosis), and 78% had one or more anterior pituitary deficiencies (71% at diagnosis). HP involvement is relatively common in patients diagnosed with histiocytosis and hormone deficiencies may be present at diagnosis or appear gradually during the course of disease. Regular monitoring of these patients is recommended.
Subject(s)
Diabetes Insipidus/etiology , Histiocytosis/physiopathology , Hypopituitarism/etiology , Hypothalamo-Hypophyseal System/physiopathology , Pituitary-Adrenal System/physiopathology , Adult , Aged , Diabetes Insipidus/epidemiology , Diabetes Insipidus/physiopathology , Female , Graves Disease/complications , Histiocytosis/complications , Humans , Hyperprolactinemia/etiology , Hypopituitarism/diagnostic imaging , Hypopituitarism/epidemiology , Hypopituitarism/physiopathology , Magnetic Resonance Imaging , Male , Middle Aged , Pituitary Hormones, Anterior/blood , Pituitary Hormones, Anterior/deficiency , Retrospective Studies , Young AdultSubject(s)
Humans , Female , Middle Aged , Peritoneal Cavity/pathology , Peritoneal Cavity , Abdominal Pain/complications , Abdominal Pain/diagnosis , Abdominal Pain/etiology , Diagnosis, Differential , Risk Factors , Dipyrone/therapeutic use , Obesity/complications , Primary Health Care/methods , Primary Health Care/trends , Primary Health Care , Radiography, Thoracic/methodsSubject(s)
Heart Atria/diagnostic imaging , Heart Valve Diseases/diagnostic imaging , Heart Valve Prosthesis Implantation , Rheumatic Heart Disease/diagnostic imaging , Aged , Female , Heart Valve Diseases/complications , Heart Valve Diseases/surgery , Humans , Mitral Valve Insufficiency/complications , Mitral Valve Insufficiency/diagnostic imaging , Mitral Valve Insufficiency/surgery , Radiography , Rheumatic Heart Disease/complications , Tricuspid Valve Insufficiency/complications , Tricuspid Valve Insufficiency/diagnostic imaging , Tricuspid Valve Insufficiency/surgeryABSTRACT
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Humans , Male , Middle Aged , Aortic Valve Stenosis/complications , Aortic Valve Stenosis/diagnosis , Cardiomyopathy, Hypertrophic/complications , Cardiomyopathy, Hypertrophic/diagnosis , Prognosis , Echocardiography, Doppler/methods , Echocardiography, Doppler/trends , Aortic Valve Stenosis , Cardiomyopathy, Hypertrophic/physiopathology , Cardiomyopathy, Hypertrophic , Mitral Valve Insufficiency/physiopathology , Mitral Valve InsufficiencySubject(s)
Asthma/drug therapy , Patient Compliance , Administration, Inhalation , Drug Therapy/methods , HumansABSTRACT
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