QRS analysis using wavelet transformation for the prediction of response to cardiac resynchronization therapy: a prospective pilot study.

BACKGROUND: Wider QRS and left bundle branch block morphology are related to response to cardiac resynchronization therapy (CRT). A novel time-frequency analysis of the QRS complex may provide additional information in predicting response to CRT. METHODS: Signal-averaged electrocardiograms were prospectively recorded, before CRT, in orthogonal leads and QRS decomposition in three frequency bands was performed using the Morlet wavelet transformation. RESULTS: Thirty eight patients (age 65±10years, 31 males) were studied. CRT responders (n=28) had wider baseline QRS compared to non-responders and lower QRS energies in all frequency bands. The combination of QRS duration and mean energy in the high frequency band had the best predicting ability (AUC 0.833, 95%CI 0.705-0.962, p=0.002) followed by the maximum energy in the high frequency band (AUC 0.811, 95%CI 0.663-0.960, p=0.004). CONCLUSIONS: Wavelet transformation of the QRS complex is useful in predicting response to CRT.

Primary percutaneous coronary intervention in an acute myocardial infarction due to the occlusion of the left main coronary artery.

A 75-year-old woman with no prior medical history was admitted to the hospital because of retrosternal pain for six hours, presenting in a state of cardiogenic shock, specifically hypotension, dyspnoea and slight confusion. Her admission ECG showed ST-segment elevation in the anterolateral leads. Having been started on aspirin, clopidogrel, heparin and dopamine, the patient was immediately transferred to the catheterisation laboratory. The coronary angiogram showed total occlusion of the bifurcation of the left main (LM) coronary artery and some collateral flow from the right coronary artery (RCA), the latter itself presenting multiple critical stenoses. Percutaneous coronary intervention (PCI) was performed with deployment of stents at the LM bifurcation, which resulted in the relief of the obstruction, the restoration of the flow in the left coronary artery and the immediate clinical improvement of the patient. The patient left the hospital in good general condition after being treated for ten days and underwent a successful second PCI in the RCA two months later.

Cholestatic jaundice as a paraneoplastic manifestation of prostate adenocarcinoma.

Malignancies may cause cholestatic jaundice through well-recognized mechanisms (e.g., bile duct obstruction or widespread hepatic infiltration). Paraneoplastic syndromes associated with malignancy, particularly with renal cell carcinoma (Stauffer's syndrome) and malignant lymphoproliferative diseases, can induce a reversible form of cholestasis through an unclear pathogenetic mechanism. Prostate cancer presenting initially with cholestatic jaundice without any obvious cause (i.e., obstruction or infiltration) has been reported in 2 cases in the medical literature. We report a patient who presented with pruritus and cholestatic jaundice. During the diagnostic work-up, prostate cancer was diagnosed. Conjugated bilirubin and alkaline phosphatase levels were increased markedly with modest increases of gamma-glutamyltranspeptidase and transaminase levels. The results of appropriate investigations performed during the patient's hospitalizations indicated no evidence of hepatic metastases or extrahepatic biliary obstruction. After treatment with flutamide and leuprolide, the patient's symptoms and the laboratory abnormalities reversed rapidly. We regard the cholestatic jaundice of this patient as part of a paraneoplastic syndrome; the cause of cholestasis remains an enigma. Patients with unexplained cholestasis should be investigated for malignancies, including prostate cancer.