Predictors of the right ventricular perforation caused by active-fixation pacing and defibrillator leads: A single-centre experience.

INTRODUCTION: Active-fixation leads have been associated with higher incidence of cardiac perforation. Large series specifically evaluating radiographic predictors of right ventricular (RV) lead perforation are lacking. METHODS: We conducted a retrospective observational study including 1691 consecutive patients implanted with an active fixation pacing and defibrillator lead at our institution between January 2015 and January 2021. Fourteen patients who had clinically relevant RV perforation caused by pacemaker and implantable cardioverter-defibrillator leads were included in the study. RESULTS: Univariate and multivariate analyses were used to identify predictors of RV perforation. In multivariate analysis, lead slack score (odds ratio [OR]: 3.694, 95% confidence interval [CI]: 1.066-12.807; p = .039), change in lead slack height (OR: 1.218, 95% CI: 1.011-1.467; p = .038) and width (OR: 1.253, 95% CI: 1.120-1.402; p = .001), left ventricular ejection fraction (OR: 0.995, 95% CI: 0.910-1.088; p = .032) were independent predictors of RV perforation. CONCLUSION: Fluoroscopic predictors of RV perforation associated with RV lead can be easily determined during implantation. Identification of these predictors may prevent the sequelae of RV perforation associated with active-fixation leads.

Electrocardiographic Predictors of Complete Heart Block During Right Ventricular Lead Implantation in Patients Who Underwent Cardiac Resynchronization Therapy.

Cardiac resynchronization therapy (CRT) device procedures have their own complications in addition to the complications associated with standard pacemaker implantations. This study aimed to analyze the predictors of the right bundle branch injury resulting in complete heart block (CHB) during right ventricular (RV) lead implantation in patients who underwent CRT with defibrillator. We conducted an observational study of consecutive 790 patients who underwent CRT with defibrillator device implantation at our institution from 2010 to 2022. Relevant clinical information and complete data regarding the echocardiographic data, implantation procedure, and clinical follow-up were collected into a computerized database. A total of 29 patients (3.7%) had CHB during RV lead implantation. In multivariate analysis, left axis deviation (odds ratio [OR] 2.408, 95% confidence interval [CI] 1.025 to 5.658, p = 0.044), QRS width (OR 1.022, 95% CI 1.001 to 1.043, p = 0.035) and QRS alternans (OR 4.214, 95% CI 1.788 to 9.930, p = 0.001) were found independently related to right bundle branch injury resulting in CHB development during RV lead implantation. In conclusion, left axis deviation, QRS width, and QRS alternans were associated with a higher rate of CHB, and these findings provide insight into optimal and safe CRT device implantation strategies based on preprocedural characteristics.

Prognostic value of non-alcoholic fatty liver disease fibrosis score in patients undergoing cardiac resynchronization therapy.

BACKGROUND: Cardiac resynchronization therapy (CRT) is an effective option in the treatment of patients with heart failure and wide QRS. Non-alcoholic fatty liver disease (NAFLD) fibrosis score (NFS) has been shown to predict cardiac events in several patient populations. However, the relationship between NFS and response to CRT has not been investigated. The aim of the study was to investigate the predictive role of NFS in the assessment of response after CRT. METHODS: Three hundred thirty-six patients with heart failure undergoing CRT were prospectively studied. Liver fibrosis were assessed according to the non-alcoholic fatty liver disease fibrosis score (NFS), which includes age, body mass index, impaired fasting glycemia or diabetes mellitus, aspartate aminotransferase /alanine aminotransferase ratio, platelets, and albumin. Echocardiographic response to CRT was defined by a ≥15% reduction in left ventricular end-systolic volume at six months at follow-up. RESULTS: Two hundred thirty-eight patients (71%) had CRT response after 6 months of follow-up. Receiver-operator characteristic curve analysis showed NFS cutoff value of < -1.12 for predicting CRT response with a sensitivity of 70.4% and a specificity of 52.9%. The patients were also divided into four groups according to the quartiles of NFS. The proportion of response to CRT was increased with lower level of NFS value. Multivariate logistic regression analysis demonstrated the NFS score < -1.12 and LVIDs were independent predictors of the CRT response. In the second model of analysis which included NFS, quartiles demonstrated that fourth NFS quartile and LVIDs were independent predictors of CRT response. CONCLUSION: Liver fibrosis assessed by NFS can provide valuable information to predict reverse remodeling in patients undergoing CRT. The present study supports monitoring of NFS to improve preoperative risk stratification of these patients.

Radiographic predictors of failure of simple manual traction of transvenous implantable cardioverter-defibrillator leads: a single-center experience.

BACKGROUND: Extraction of the implantable cardioverter-defibrillator (ICD) leads could be a difficult procedure due to fibrous tissue around the lead and anatomical variations. In this report, we present our experience in the radiographic predictors of failure of simple manual traction (SMT) in patients with dual-coil ICD requiring lead extraction (LE). METHODS: Between January 2017 and February 2021, 103 leads were removed in 65 consecutive patients; 65 (63.1%) were dual-coil ICD leads, 22 (21.4%) were atrial, and 16 (15.5%) were coronary sinus leads. Patient-based and procedural data were collected and analyzed retrospectively. Clinical and procedural characteristics were compared and radiographic predictors of failure of SMT of ICD leads were assessed. Projected anteroposterior (AP) lead tortuosity was measured and lead slack score was estimated on chest X-ray (CXR). RESULTS: Simple manual traction failed in 27 (42%) of the ICD leads. Ottawa slack score (odds ratio [OR] 2.368, 95% CI [1.261-4.447]; P = 0.007), AP lead tortuosity > 1.10 (OR 7.477, 95% CI [1.718-35.542]; P = 0.007), and number of previous interventions (OR 6.016, 95% CI [1.184-30.557]; P < 0.030) were found to be independently related to the failure of SMT. Receiver-operator characteristic curve analysis yielded an AP lead tortuosity cutoff value of > 1.10 for predicting the failure of SMT. The area under the curve was 0.744; the 95% confidence interval (CI) was 0.617 to 0.871 (P = 0.001), with a sensitivity of 63% and a specificity of 73%. CONCLUSION: Simple manual traction success in our study varied based on radiographic lead-related parameters. Before planning the procedure, increased AP lead tortuosity in vasculature and higher lead slack score can be easily determined on CXR and may be associated with more fibrous adherences, the complexity of the LE, and failure of SMT.

Comparison of selective coronary angiography through the ablation catheter versus conventional coronary angiography to guide ablation of premature ventricular contractions originating from aortic cusp.

BACKGROUND: Intraprocedural coronary angiography (CA) is recommended in patients undergoing ablation in aortic cusps to assess the relation of catheter tip and coronary ostia. In this report, we aimed to compare selective coronary angiography (SCA) through the contact force (CF)-sensing radiofrequency catheter with conventional coronary angiography (CCA) to guide ablation of premature ventricular contractions (PVC). METHODS: This was a retrospective observational cohort study of prospectively collected data of 87 consecutive patients undergoing PVC ablation at a single institution between February 2016 and June 2021. Forty-six patients (53%) underwent SCA and forty-one patients (47%) underwent CCA. Data were consecutively collected case-by-case and entered into a computerized database. Procedural characteristics, complications, and clinical outcomes were compared between the SCA and CCA groups. RESULTS: Successful ablation was achieved in seventy-seven (89%) patients. Total procedure and fluoroscopy time and radiation dose were significantly lower in SCA group (93 ± 22 min vs 102 ± 20 min, p = 0.042; 12 ± 3 min vs 14 ± 4 min, p = 0.030; 3292 ± 1221 µGy m2 vs 3880 ± 1229 µGy m2, p = 0.028, respectively). Median ambulation time was significantly longer in CCA group (6.8 ± 1 h vs 17.8 ± 1.8 h, p = 0.006). CONCLUSIONS: Selective coronary angiography through the CF-sensing ablation catheter to assess the relation between the ablation site and the coronary ostia is feasible and safe. This technique precludes the requirement of an additional arterial access and decreases the total procedure and fluoroscopy time and radiation dose.

Selective angiography through radiofrequency catheter during ablation of premature ventricular contractions originating from aortic cusp: A single-centre experience.

INTRODUCTION: Intraprocedural coronary angiography is recommeded in patients undergoing ablation in aortic cusps to assess the relation of catheter tip and coronary ostia. In this report, we present our experience in selective coronary angiography through the radiofrequency catheter during premature ventricular contraction (PVC) ablation. METHODS AND RESULTS: We prospectively recruited 43 consecutive patients who underwent PVC ablation in the aortic cusps between March 2018 and April 2021. We performed coronary angiography through the contact force (CF)-sensing ablation catheter at the ablation site. Successful ablation was achieved in 38 (88%) of patients. No technical problems occurred after the contrast injection and ablation parameters were within the normal values, without any change of impedance and CF-sensing values and neither electrogram signal quality after contrast injection. No complications occurred during the procedure, hospital stay, and during one-year follow-up (15.3 ± 3.1 months). CONCLUSION: Selective coronary angiography through the CF-sensing ablation catheter to assess the relation between the ablation site and the coronary ostia is feasible and no minor or major complications occurred in our experience.

Systolic aortic root motion predicts response to cardiac resynchronization therapy.

BACKGROUND: Cardiac resynchronization therapy (CRT) is recommended for patients with advanced chronic heart failure. Systolic aortic root motion (SARM) has been investigated in dilated cardiomyopathy patients and found that heart failure patients had reduced SARM. We aimed to investigate the relationship between SARM and response to CRT. METHODS: Fifty-six patients with advanced heart failure, wide QRS complex, and LVEF ≤35% were included. Transthoracic echocardiography was performed before, and repeated at 6 months in follow-up. Systolic aortic root motion was measured in each patient before the device implantation. Echocardiographic response to CRT was defined by a ≥15% reduction in left ventricular end-systolic volume at 6 months follow-up. RESULTS: Forty patients (71%) had CRT response after 6 months of follow-up. In multivariate analysis, significant associates of response to CRT was evaluated adjusting for functional capacity, etiology of cardiomyopathy, QRS duration, baseline left ventricular dimensions/volumes and SARM. SARM was the only predictor of response to CRT (OR 1.818, 95% CI, 1.101-3.003, P = .019). CONCLUSIONS: SARM predicts non-response to CRT and may help in the selection of CRT candidates.

Association between resolution of fragmented QRS and response to cardiac resynchronization therapy.

BACKGROUND: Cardiac resynchronization therapy (CRT) has been recommended for patients with symptomatic heart failure and a wide QRS. Fragmented QRS (fQRS) on a 12-lead electrocardiography (ECG) has been shown to predict cardiac events. We aimed to investigate the relationship between resolution of fQRS and response to CRT. METHODS: Sixty-seven consecutive patients (38 men, mean age 65 ± 11) with left bundle branch block and fQRS on ECG undergoing CRT were studied. The presence of fQRS was assessed using standardized criteria. Echocardiographic response to CRT was defined by a ≥15% reduction in left ventricular end-systolic volume (LVESV) and resolution of fQRS was defined as decrease in number of leads with fQRS on ECG at 6 months follow-up. RESULTS: Thirty-nine patients (58%) had response to CRT. LVESV significantly decreased from 150 ± 64 to 100 ± 48 in responders (P = 0.001). There was not any significant decrease in nonresponders (LVESV; from 157 ± 70 to 153 ± 66, P = 0.45). The number of leads with fQRS was decreased from 4.4 ± 1.8 to 1.7 ± 1.6 in responder patients (P < 0.001). The number of leads with fQRS was not significantly changed in nonresponders. (4.2 ± 2.2 vs. 5.1 ± 2.4, P = 0.06). In multivariate analysis, significant associates of response to CRT was evaluated adjusting for etiology of cardiomyopathy, baseline QRS width, left ventricular ejection fraction, number of leads with fQRS and resolution of fQRS. Resolution of fQRS was the only predictor of response to CRT (OR 0.018, 95% CI, 0.004-0.083, P < 0.001). CONCLUSIONS: After adjusting for potential confounders, resolution of fQRS, is associated with response to CRT.

Neutrophil-to-lymphocyte ratio predicts response to cardiac resynchronization therapy.

BACKGROUND: Neutrophil-to-lymphocyte (N/L) ratio has been associated with adverse outcomes in patients with acute coronary syndromes and increased risk for long-term mortality in patients with acute decompensated heart failure. We aimed to investigate the prognostic value of neutrophil-to-lymphocyte ratio on response to cardiac resynchronization therapy (CRT). MATERIAL AND METHODS: Seventy consecutive patients (mean age 58 ± 13 years; 40 men) undergoing CRT were included in the study. Hematological and echocardiographic parameters were measured before and 6 months after CRT. Echocardiographic response to CRT was defined as a ≥ 15% reduction in left ventricular end-systolic volume at 6-month follow-up. RESULTS: After 6 months of CRT, 49 (70%) patients were responders. After 6 months, left ventricular ejection fraction (LVEF) had significantly increased, from 21 ± 7% to 34 ± 11% in responder patients (p = 0.001). N/L ratio decreased significantly, from 2.4 ± 1 to 2.1 ± 0.7 in responders (p = 0.04). In multivariate analysis, significant associates of echocardiographic response to CRT was evaluated adjusting for age, etiology of cardiomyopathy, baseline LVEF, New York Heart Association functional class, C-reactive protein, and baseline N/L ratio. Baseline N/L ratio was the only predictor of response to CRT (OR 1.506, 95% CI, 1.011-2.243, p = 0.035). CONCLUSIONS: N/L ratio at baseline could help to identify patients with response to CRT.

Cardiac resynchronization treatment in a patient with hypertrophic cardiomyopathy after heart transplantation.

Hypertrophic cardiomyopathy (HCM) is characterized by heterogeneous clinical expression. Cardiac transplantation continues to be the gold standard for the treatment of end-stage cardiac diseases refractory to medical therapy. We presented a 27-year-old female patient with HCM who underwent successful cardiac resynchronization therapy after cardiac transplantation. Our patient had an indication for standard pacing. However, previous reports have shown that right ventricular apical pacing might lead to adverse clinical outcomes in patients with heart failure. We have discussed cardiac resynchronization therapy after heart transplantation in patients with standard pacing indications.

Number of leads with fragmented QRS predicts response to cardiac resynchronization therapy.

BACKGROUND: Cardiac resynchronization therapy (CRT) is an effective option in the treatment of patients with heart failure (HF) and wide QRS. Fragmented QRS (fQRS) on 12-lead electrocardiography has been shown to predict cardiac events in several patient populations. However, the relationship between the number of leads with fQRS and response to CRT has not been investigated. HYPOTHESIS: The number of leads with fQRS may predict response to CRT. METHODS: One hundred five patients with HF undergoing CRT were prospectively studied. The presence of fQRS was assessed using standardized criteria. Echocardiographic response to CRT was defined by a ≥15% reduction in left ventricular end-systolic volume at 6 months follow-up. RESULTS: Seventy-four patients (71%) had CRT response after 6 months of follow-up. In multivariate analysis, significant associates of response to CRT were evaluated adjusting for gender, etiology of cardiomyopathy, QRS width, baseline left ventricular ejection fraction, and the number of leads with fQRS. The number of leads with fQRS was the only predictor of response to CRT (odds ratio: 0.61, 95% confidence interval: 0.48-0.77, P < 0.001). CONCLUSIONS: The more leads with fQRS predicts nonresponse to CRT and may help in the selection of CRT candidates.

Assessment of shoulder pain and shoulder disability in patients with implantable cardioverter-defibrillator.

PURPOSE: Shoulder pain and disability is a common but overlooked disorder in patients with implantable cardioverter-defibrillators (ICD). We aimed to assess chronic shoulder pain and disability in patients with ICD. METHODS: Two hundred fifty-four patients (mean age, 66 ± 12 years; 156 men) with ICD were included in the study. The Shoulder Pain and Disability Index (SPADI) was used for assessment of shoulder pain and disability. RESULTS: Of the patients, 131 (52 %) have shoulder pain and disability. The total mean SPADI score in patients with shoulder pain and disability was 33 ± 18 and was significantly higher than in patients without shoulder pain and disability (11 ± 2; p < 0.001). Patients with three-lead ICD have significantly higher SPADI scores than patients with single-lead ICD (p < 0.001). Number of leads correlated with pain score (p = 0.001, r = 0.253), disability score (p = 0.006, r = 0.174) and total SPADI score (p = 0.001, r = 0.213). In multivariate analysis, significant associates of shoulder pain and disability were evaluated, adjusting for age, sex, body mass index, procedure time, implantation time interval, limitation of shoulder activity and number of leads. Number of leads was the only predictor of shoulder pain and disability (OR 0.518, 95 % CI, 0.372-0.721; p < 0.001). CONCLUSIONS: Patients with ICD implantation frequently have chronic shoulder pain and disability. Patients with three leads suffer more shoulder pain and disability.

Respiratory changes in the E/A wave pattern can be an early sign of diastolic dysfunction: an echocardiographic long-term follow-up study.

BACKGROUND: The left ventricular filling pattern may show changes during respiration, which are generally used in the diagnosis of diastolic dysfunction. The clinical importance of the respiratory E/A wave pattern change has been investigated in a limited number of studies. The aim of the present study was to assess the diastolic function of hypertensive patients with respiratory changes in mitral flow over a long-term follow-up period. MATERIAL/METHODS: Our study included 107 newly diagnosed and untreated hypertensive patients (49 males; mean age, 46±10 years) with respiratory changes during transthoracic echocardiography (TTE). In addition, the patient group was classified into 2 groups according to the change in E/A pattern by the Valsalva maneuver. After a mean follow-up period of 44±7 month, 90% of the hypertensive patients and the entire control group were re-examined. RESULTS: Relaxation abnormalities developed in 84% of the patients (58/80) in the Valsalva-positive group after the follow-up period. The frequency of relaxation abnormalities was 60% in the Valsalva-negative group and 3.1% in the control group (p<0.001). Based on multivariate regression analysis, the echocardiographic predictors of the development of relaxation impairment were mitral E velocity, A velocity, deceleration time, isovolumetric contraction time, E/E' ratio, and the presence of respiratory change. The most important parameter for the development of an abnormal relaxation pattern was the presence of respiratory change after adjustment according to the changes with the Valsalva maneuver. CONCLUSIONS: Respiratory change in mitral flow can be evaluated as an early sign of diastolic dysfunction in patients with hypertension.

Relationship between fragmented QRS and response to cardiac resynchronization therapy.

PURPOSE: Cardiac resynchronization therapy (CRT) is an effective treatment for heart failure (HF) with a wide QRS. Fragmented QRS (fQRS) on a 12-lead electrocardiography (ECG) has been shown to predict cardiac events in several patient populations. We aimed to investigate the relationship between fragmented wide QRS (f-wQRS) and left ventricular dyssynchrony and response to CRT. METHODS: Fifty-three patients with HF undergoing CRT were studied. The presence of fQRS was assessed using standardized criteria. Dyssynchrony was defined as interventricular mechanical delay (IVMD) ≥40 ms and tissue Doppler velocity opposing-wall delay ≥65 ms. Echocardiographic response to CRT was defined by a ≥15 % reduction in left ventricular end-systolic volume at 6 months follow-up. RESULTS: Fragmented wide QRS was present in 17 (32 %) patients. Interventricular and intraventricular dyssynchrony were highly prevalent in both patient groups with f-wQRS and nonf-wQRS (64.7 % vs 75 %, p = 0.44; 70.6 % vs 72.2 %, p = 0.25). Ischemic HF was significantly higher in patients with f-wQRS than patients with nonf-wQRS (64 % vs 33 %, p = 0.03). Reverse remodeling was developed in 32 (89 %) and 6 (35 %) of patients with nonf-wQRS and f-wQRS, respectively (p = 0.001). In multivariate analysis, significant associates of response to CRT were evaluated adjusting for etiology of cardiomyopathy, QRS width, IVMD, intraventricular delay, and f-wQRS. Lack of f-wQRS was the only predictor of response to CRT (OR 1.556, 95 % CI, 0.016-0.806, p = 0.028). CONCLUSIONS: Presence of dyssynchrony is necessary but not sufficient to select appropriate candidates for CRT. Presence of f-wQRS on baseline ECG may play a role in identifying patients who may not respond to CRT.

Association between red blood cell distribution width and response to cardiac resynchronization therapy.

PURPOSE: Red blood cell distribution width (RDW) predicts adverse outcomes in patients with heart failure. We aimed to investigate the prognostic value of RDW on response to cardiac resynchronization therapy (CRT). METHODS: Sixty-six consecutive patients (mean age, 57 ± 13 years; 42 men) undergoing CRT were included in the study. Hematological parameters and echocardiographic parameters were measured before and 6 months after CRT. An echocardiographic response to CRT was defined as a ≥15 % relative increase in left ventricular ejection fraction after 6 months. RESULTS: After 6 months of CRT, 47 (71 %) patients were responders. High baseline RDW levels were found in 11 (23 %) and 10 (52 %) patients in responders and non-responders, respectively (p < 0.05). In non-responders, RDW at 6 months was significantly high compared to baseline RDW (17.1 ± 2 vs. 19 ± 2.9) (p < 0.001). There was not any significant change in RDW after CRT in responders (16 ± 1.6 vs. 15.5 ± 1.4) (p > 0.05). In multivariate analysis, significant associates of response to CRT were evaluated adjusting for QRS width, QRS morphology, age, New York Heart Association functional class, hemoglobulin, and RDW level. Baseline RDW level was the only predictor of response to CRT (odds ratio, 1.435; 95 % confidence interval, 1.059-1.945, p = 0.020). CONCLUSIONS: Our data suggest that patients with elevated RDW at baseline are associated with poor response to CRT. Therefore, RDW at baseline could help to identify patients with response to CRT.

Relation of hs-CRP and BNP levels with the atrial spontaneous echo contrast and thrombi in permanent atrial fibrillation patients with different etiologies.

BACKGROUND: Thromboembolic risk in permanent atrial fibrillation (AF) is strongly associated with the underlying etiology, and inflammatory parameters may contribute. The present study aimed to investigate the relationship of hs-CRP and BNP levels with left and right atrial appendage (LAA and RAA) function, presence of spontaneous echo contrast (SEC) and thrombus. MATERIAL/METHODS: Eighty-four permanent AF patients with different etiologies (20 mitral stenosis, 44 hypertension and 20 hyperthyroidism) and 23 patients with sinus rhythm were included. LAA and RAA flow velocities were measured by pulsed-wave Doppler and wall motion velocities with tissue Doppler imaging (TDI) in transesophageal echocardiography. RESULTS: Hs-CRP and BNP levels significantly differed among the 3 AF groups: levels were highest in mitral stenosis patients (8.6 ± 5.3 mg/L and 98.0 ± 125.7 pg/mL, respectively), the lowest hs-CRP was in hyperthyroidism patients (4.3 ± 3.8 mg/L), and the lowest BNP was in hypertensive patients (64.8 ± 44.3 pg/mL). There were also significant differences between the AF group and controls regarding hs-CRP and BNP levels. In the correlation analysis, BNP level was not significantly correlated with LAA and RAA functions, whereas hs-CRP level was significantly correlated with some LAA and RAA functions. On the other hand, hs-CRP level was significantly related to the presence of mild-moderate SEC and thrombi, mainly in mitral stenosis patients. Moreover, hs-CRP was the most important determinant of RAA thrombus formation, followed by RAA ejection fraction. In contrast, no positive or negative correlation was found between BNP levels and RAA and LAA thrombi. CONCLUSIONS: Higher hs-CRP levels in AF patients may be a predictor for the presence of SEC and thrombi in the atria.

Effect of cardiac resynchronization therapy on thyroid function.

BACKGROUND: Heart failure patients frequently have thyroid function abnormalities. Cardiac resynchronization therapy (CRT) is a major treatment for patients with advanced chronic heart failure. We aimed to investigate the effects of CRT on thyroid functions. HYPOTHESIS: CRT improves thyroid functions. METHODS: Fifty-seven patients (42 male, 15 female; mean age 58 ± 13 y) undergoing CRT were included in the study. Serum levels of thyroid hormones and echocardiographic parameters were measured before and 6 months after CRT. A response to CRT was defined as a reverse remodeling detected by a relative increase of ≥15% in left ventricular ejection fraction. RESULTS: The clinical status and functional capacity of the patients in the remodeling group were improved significantly. The mean New York Heart Association class was reduced from 3.2 ± 0.4 to 2.2 ± 0.4 (P<0.001). The free triiodothyronine (fT3) level increased from 2.67 pg/mL to 2.97 pg/mL in the reverse remodeling group (P = 0.005). The fT3/fT4 ratio increased from 1.81 to 2.34 (P = 0.006). CONCLUSIONS: CRT improves fT3 levels and fT3/fT4 ratio, which may play an important role in reverse remodeling.

Relationship between left ventricular dyssynchrony and reverse remodeling after cardiac resynchronization therapy.

BACKGROUND: Cardiac resynchronization therapy (CRT) is recommended for patients with advanced chronic heart failure. The presence of left ventricular (LV) dyssynchrony before CRT is an important predictor of response to the therapy. We aimed to investigate time course of LV dyssynchrony after CRT and the relationship between LV dyssynchrony improvement and reverse remodeling (RR). HYPOTHESIS: The relationship between the improvement of LV dyssynchrony and RR may differ according to criteria used to determine RR. METHODS: Thirty patients with advanced heart failure, wide QRS complex, and LVEF ≤35% were included. Echocardiography coupled with tissue Doppler imaging was performed at baseline, and repeated at 1 and 6 months in follow-up. Patients were divided into RR and no-remodeling groups according to 10% decrease in left ventricular end-systolic volume (LVESV) and/or 25% increase in LVEF. RESULTS: Left ventricular dyssynchrony improvement was significant at the first month in both the RR and no-remodeling groups according to LVESV decrease. Left ventricular dyssynchrony improvement was continued in the RR group; however, it did not improve significantly in the no-remodeling group. Left ventricular dyssynchrony improvement was significant at the first and sixth month in the RR and no-remodeling groups according to LVEF increase. CONCLUSIONS: Our study suggests that LV dyssynchrony improvement plays an important role in the development of RR according to decrease in LVESV. Reverse remodeling according to the increase in LVEF was developed independently from LV dyssynchrony improvement. The improvement in LV dyssynchrony is a necessary but not sufficient explanation for improvement in LVEF and LVESV.

Effect of cardiac resynchronization therapy on libido and erectile dysfunction.

BACKGROUND: Chronic heart failure (HF) is a common, complex clinical syndrome characterized by dyspnea, fatigue and exercise intolerance. HF patients experience decreased libido and erectile dysfunction (ED). The effects of cardiac resynchronization therapy (CRT) on libido and erectile function have not been previously evaluated. We aimed to investigate the effects of CRT on libido and ED. HYPOTHESIS: Cardiac resynchronization therapy improves libido and ED. METHODS: Thirty-one male patients with advanced HF, scheduled for implantation of a CRT device, were included in the study. Left ventricular systolic function, New York Heart Association (NYHA) class, libido, and ED were assessed before and 6 months after CRT. Libido and ED were evaluated with the Aging Male Symptoms (AMS) rating scale and internationally validated Sexual Health Inventory for Men (SHIM) questionnaire, respectively. RESULTS: At the 6-month follow-up, the mean NYHA class improved from 3.4 ± 0.5 to 2.1 ± 0.6 (P<0.001). On echocardiographic examination, an improvement in left ventricular ejection fraction (LVEF) from 18 ± 5% to 32 ± 6% was detected (P<0.001). A significant increase in mean SHIM score and a significant decrease in mean AMS were noted. Changes in SHIM and AMS scores were correlated positively with the increase in LVEF (r = 0.47, P = 0.007 and r = - 0.36, P = 0.04, respectively). Similarly, SHIM scores were correlated negatively (r = - 0.57, P = 0.001) and AMS scores were correlated positively (r = 0.73, P = 0.0001) with the improvement in NYHA class. CONCLUSIONS: CRT results in a significant improvement in libido and erectile function in patients with congestive HF. This improvement is related to the improvements in the LVEF and functional capacity. .