Subject(s)
Cardiomyopathy, Dilated , Defibrillators, Implantable , Cardiomyopathy, Dilated/complications , Cardiomyopathy, Dilated/diagnosis , Cardiomyopathy, Dilated/epidemiology , Death, Sudden, Cardiac/epidemiology , Death, Sudden, Cardiac/etiology , Electrophysiology , Humans , Risk Assessment , Risk FactorsABSTRACT
Cardiac resynchronization therapy (CRT) is an established therapeutic option for the subset of patients with heart failure (HF), reduced ejection fraction (EF), and dyssynchrony evidenced by electrocardiography. Benefit from CRT has been proven in many clinical trials, yet a sizeable proportion of these patients with wide QRS do not respond to this intervention, despite the updated practice guidelines. Several echocardiographic indices, targeting mechanical rather than electrical dyssynchrony, have been suggested to address this issue, but research so far has not succeeded in providing a single and simple measurement with adequate sensitivity and specificity for identification of responders. While there is still ongoing research in this field, echocardiography proves helpful in other aspects of CRT implementation, such as site selection for left ventricular (LV) lead pacing and optimization of pacing parameters during follow-up visits.
Subject(s)
Cardiac Resynchronization Therapy/methods , Echocardiography/methods , Heart Ventricles/diagnostic imaging , Stroke Volume/physiology , Ventricular Function, Left/physiology , Electrocardiography , Heart Failure/physiopathology , Heart Ventricles/physiopathology , Humans , Treatment OutcomeSubject(s)
Aneurysm, False/diagnostic imaging , Cardiac Catheterization/adverse effects , Coronary Angiography/adverse effects , Thrombin/administration & dosage , Ulnar Artery/diagnostic imaging , Ultrasonography, Interventional/methods , Aged , Aneurysm, False/drug therapy , Aneurysm, False/etiology , Female , Humans , Treatment OutcomeABSTRACT
INTRODUCTION: The aim of this study was to evaluate the validity of an echocardiographic method of automatic boundary detection (ABD) in the assessment of the degree of atrial dysfunction in patients who had undergone external or internal cardioversion for idiopathic atrial fibrillation. METHODS: The study population included 31 patients (mean age 48 +/- 6.5 years) with idiopathic atrial fibrillation. The patients were randomised into two groups: Group 1 (14 patients, 8 +/- 3.13 joules), where internal cardioversion was applied, and Group 2 (17 patients, 200-360 joules), where external cardioversion was used for restoration of sinus rhythm. During the following 24 hours the ABD method was used in both groups to assess the following functional indices for both the left and the right atrium: a) total fractional change of atrial area (delta1), b) passive change of atrial area (delta2), c) change of atrial area due to atrial contraction (delta3) and d) index of % atrial expansion (delta4). RESULTS: All patients in both groups were successfully cardioverted (100%, p: NS). Post-cardioversion indices delta1-delta4 for both left and right atria did not differ between the 2 groups (p:NS). A negative correlation was found between left atrial function as assessed by ABD and the mean energy in joules delivered through the catheter in each patient for successful cardioversion (r = -0.55 to r = -0.67 and p = 0.04 to p = 0.01). However, no relevant correlations were found for the right atrium (p:NS). CONCLUSIONS: 1) The atrial dysfunction which follows the cardioversion of idiopathic atrial fibrillation (atrial stunning) is not related to the type of cardioversion (internal or external). 2) The higher the amount of energy delivered during internal cardioversion, the greater the degree of left atrial dysfunction observed.
Subject(s)
Atrial Fibrillation/physiopathology , Atrial Function/physiology , Echocardiography/methods , Electric Countershock/methods , Heart Atria/physiopathology , Atrial Fibrillation/diagnostic imaging , Atrial Fibrillation/therapy , Female , Heart Atria/diagnostic imaging , Heart Rate/physiology , Humans , Male , Middle Aged , Myocardial Contraction/physiology , Treatment OutcomeABSTRACT
BACKGROUND: Female patients with acute myocardial infarction (MI) exhibit higher unadjusted in-hospital mortality rates compared to male patients. However, contradictory evidence exists on whether this survival disadvantage disappears after adjustment for age and other prognostic factors. This study, based on a countrywide survey of consecutive unselected patients with acute MI, examined whether female gender is an independent predictor of poor short-term outcome and less intensive in-hospital treatment. METHODS: Data on a total of 7433 patients were analyzed. RESULTS: The mean age was 64+/-13 years and the proportion of females in this population was 23%. Univariate and multivariate predictors of in-hospital mortality in female patients were estimated. Unadjusted in-hospital mortality rates of women were significantly higher compared to men (17.7 vs. 8.6, p<0.001). In multivariate analysis, female gender was an independent predictor of in-hospital mortality in the total population [relative risk (RR)=1.29, 95% confidence interval (CI)=1.02-1.64, p=0.036]. The RR of women for in-hospital death was exaggerated among younger patients, aged <55 years (RR=3.84, 95% CI=1.07-13.74, p=0.039). Female gender was also independently and inversely associated with administration of thrombolytic treatment (RR=0.724, 95% CI=0.630-0.831, p=<0.001). CONCLUSION: Although female gender is an independent predictor of higher post-MI in-hospital mortality with a pronounced effect among younger patients, women are less likely to receive thrombolysis than men. Based on the results from this countrywide study, we should consider women, especially of younger age, as patients at particular high risk, who contrary to common practice, deserve more intensive and aggressive in-hospital treatment.
