Improvement in left ventricular ejection fraction and reverse remodeling in elderly heart failure patients on intense NT-proBNP-guided therapy.

BACKGROUND: In chronic heart failure, left ventricular ejection fraction (LVEF) is considered to be stable. Intensified therapy may improve survival, but little is known whether this is associated with reverse remodeling and dependent on age and NT-proBNP guidance. We aimed to define the evolution of LVEF under intensified therapy in relation to age and NT-proBNP guidance. METHODS AND RESULTS: Echocardiography was performed at baseline, 12 and 18months in TIME-CHF, a trial comparing NT-proBNP versus symptom-guided therapy in patients aged 60 to 74 and ≥75 years. LVEF, LV end diastolic volume index (LVEDVI) and end systolic volume index (LVESVI) were assessed. LVEF increased from 31.3 ± 10.7% to 39.1±11.8% at 18 months (p<0.001) in symptom-guided, and from 30.3 ± 11.7% to 44.0 ± 13.2% (p<0.001) in NT-proBNP-guided patients. The increase in LVEF was significantly larger in the NT-proBNP-guided treatment group (p for interaction=0.006), which was true for both age groups (p for interaction in both=0.091). LVEDVI and LVESVI decreased without influence by study group allocation. CONCLUSIONS: In elderly heart failure patients, intensified medical therapy leads to an improvement in LVEF and to reverse remodeling. NT-proBNP guided therapy was associated with a larger improvement in LVEF than symptom guided therapy both in patients aged 60 to 74 and ≥75 years. TRIAL REGISTRATION: http://isrctn.org Identifier: ISRCTN43596477.

Long-term performance of the Medtronic Sprint Fidelis lead: a matter of lead type?

AIMS: In 2007, the Medtronic™ Sprint Fidelis(®) lead was withdrawn from the market due to elevated failure rates. Since then, several studies were published with failure rates between 1.3 and 3.75%/year. However, they included a very high percentage of active fixation leads. Data in a population with passive leads are missing. METHODS AND RESULTS: All 166 patients who received a Fidelis lead between December 2004 and October 2007 in two teaching hospitals were identified. We excluded nine patients with incomplete data and 18 with active fixation leads. The study population thus consists of 139 patients with passive leads. Pacing and high-voltage impedance values were systematically collected at implant and in intervals of 6 months. Follow-up was 49 ± 15 months. All leads were 6948 models. During a follow-up of 41 ± 15 months, nine leads (6.5%) failed. Annual failure rate was 1.9%/year (95% CI 0.4-4.2), cumulative 5-year survival 95.8%. There were no differences between leads used in resynchronization and non-resynchronization devices (8.9 and 5.3%, P value 0.47). CONCLUSION: In a population with only passive leads, the Fidelis lead exhibited an impaired long-term survival, but performance was better than in previous studies in which >90% of leads were active models.

Nature of the Rh-H(2) Bond in a Dihydrogen Complex Stabilized Only by Nitrogen Donors. Inelastic Neutron Scattering Study of Tp(Me)2RhH(2)(eta(2)-H(2)) (Tp(Me)2 = Hydrotris(3,5-dimethylpyrazolyl)borate).

The tunnel splitting of the librational ground state and the torsional frequencies of the dihydrogen ligand in Tp(Me)()2RhH(2)(eta(2)-H(2)) (Tp(Me)()2 = hydrotris(3,5-dimethylpyrazolyl)borate) were measured using inelastic neutron scattering spectroscopy. The barrier for the rotation of the H(2) ligand and its H-H separation, calculated from these data, are 0.56(2) kcal/mol and 0.94 Å, respectively. These values indicate that pi-back-donation from the Tp(Me)()2RhH(2) fragment to H(2) is relatively weak and/or the interaction between the coordinated dihydrogen molecule and the two cis-hydride ligands significantly lowers the barrier for H(2) rotation.