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1.
Medicine (Baltimore) ; 99(40): e22640, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019488

RESUMO

INTRODUCTION: Danon disease is a rare X-linked dominant genetic disorder caused by defects in the lysosome-associated membrane protein 2 (LAMP2) gene. Unless treated, cardiogenic death is the main cause of mortality. This case report describes a 19-year-old man who was diagnosed with Danon disease and survived for 3 years from symptom onset to death. The mutation in his LAMP2 gene (p.Gly221Ilefs*19) had not been previously reported. PATIENT CONCERNS: A 19-year-old man patient was hospitalized for intermittent palpitations. He had no family history of cardiomyopathy, arrhythmia, or sudden cardiac death, but his sister had died of cirrhosis at age 12 years, but the exact cause of cirrhosis was unknown. DIAGNOSIS: Exome sequencing and Sanger sequencing identified a novel missense mutation (p.Gly221Ilefs*19) in the LAMP2 gene of the proband. This mutation was also detected in his mother, confirming the diagnosis of Danon disease. INTERVENTIONS: The patient experienced various types of arrhythmia throughout the clinical process, including Wolff-Parkinson-White syndrome, non-sustained atrial tachycardia, atrial flutter, and third-degree atrioventricular block. He was therefore treated with cardiac ablation procedures and cardiac resynchronization therapy. OUTCOMES: The period from the onset of symptoms to the onset of heart failure was 2 years. The patient died of cardiogenic death during the third year, at age 22 years. LESSONS: Danon disease is a rare disease that is difficult to recognize because of its hidden early manifestations. Early identification of its clinical symptoms can lead to early diagnosis and treatment.


Assuntos
Doença de Depósito de Glicogênio Tipo IIb/genética , Doença de Depósito de Glicogênio Tipo IIb/terapia , Proteína 2 de Membrana Associada ao Lisossomo/genética , Arritmias Cardíacas/etiologia , Terapia de Ressincronização Cardíaca/métodos , Ablação por Cateter/métodos , Evolução Fatal , Doença de Depósito de Glicogênio Tipo IIb/complicações , Doença de Depósito de Glicogênio Tipo IIb/diagnóstico , Insuficiência Cardíaca/etiologia , Humanos , Masculino , Mutação de Sentido Incorreto/genética , Sequenciamento Completo do Exoma/métodos , Síndrome de Wolff-Parkinson-White/genética , Síndrome de Wolff-Parkinson-White/terapia , Adulto Jovem
3.
Medicine (Baltimore) ; 99(33): e21097, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32871980

RESUMO

INTRODUCTION: Substantial advances in cardiac pacing technology have been developed in the past decades. However, efforts to improve pacing technology to achieve physiological electrical activity, such as with cardiac resynchronization therapy, are underway. Permanent His bundle pacing, which directly stimulates the His-Purkinje network and electrically activates both ventricles, simulates physiological electric activity in the heart, and has been considered an ideal pacing strategy to treat arrhythmias. For patients with atrial fibrillation complicated by third-degree atrioventricular block (AVB), permanent His bundle pacing is a better option than conventional right ventricular apical or septal pacing, the latter of which may be associated with risks, such as heart failure. However, His bundle pacing exhibits some shortcomings, including elevated pacing threshold, dislocation, and abnormal sensing. CASE PRESENTATION: A 69-year-old female patient who had atrial fibrillation (AF) complicated by third-degree AVB and who was treated with permanent His bundle pacing combined with left bundle branch pacing. DIAGNOSIS: AF complicated by third-degree AVB. INTERVENTIONS: We used the left bundle branch as a backup pacing site to overcome any shortcomings related to permanent His bundle pacing. OUTCOMES: The patient recovered well without any events. CONCLUSION: We selected His bundle pacing as the primary pacing, but also used left bundle branch pacing as a backup approach. If His bundle pacing results in an increased sensing threshold, pacing threshold changes, or dislocations, left bundle branch pacing can compensate for dysfunction of permanent deficiencies in His bundle pacing, preserving physiological pacing.


Assuntos
Fibrilação Atrial/complicações , Fibrilação Atrial/terapia , Bloqueio Atrioventricular/complicações , Bloqueio Atrioventricular/terapia , Terapia de Ressincronização Cardíaca/métodos , Idoso , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/fisiopatologia , Bloqueio Atrioventricular/diagnóstico por imagem , Bloqueio Atrioventricular/fisiopatologia , Fascículo Atrioventricular/fisiopatologia , Feminino , Humanos
4.
Pediatr Cardiol ; 41(7): 1532-1537, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32813029

RESUMO

In this review, we provide a brief description of recently published articles addressing topics relevant to pediatric cardiologists. Our aim is to provide a summary of the latest articles published recently in other journals in our field. The articles address (1) cardiac resynchronization in children with symptomatic ventricular dysfunction and dyssynchrony which seems to result in higher transplant-free survival, (2) outcomes of aortic leaflet reconstruction including Ozaki procedure to repair aortic valve disease in adolescents, (3) meta-analysis for risk factors of ventricular tachycardia and death after repaired tetralogy of Fallot which reiterates the known risk factors and showed that the severity of pulmonary regurgitation is not in itself associated with outcomes although the ventricular response to regurgitation (dilation and dysfunction) is, (4) preschool promotion of healthy life style did not associate with sustained effect when evaluated later in childhood although repeated intervention seems to have a dose-related effect to promote healthy life style, (5) the lack of beneficial effects of angiotensin-converting enzyme inhibitors in the interstage period, and (6) a new phenomenon of acute heart failure and multisystem inflammatory syndrome in children temporarily related to the COVID-19 pandemic.


Assuntos
Cardiopatias/complicações , Cardiopatias/terapia , Adolescente , Betacoronavirus , Terapia de Ressincronização Cardíaca/métodos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Criança , Pré-Escolar , Infecções por Coronavirus/complicações , Cardiopatias Congênitas/terapia , Cardiopatias/cirurgia , Insuficiência Cardíaca/complicações , Ventrículos do Coração/fisiopatologia , Humanos , Síndrome do Coração Esquerdo Hipoplásico/tratamento farmacológico , Pandemias , Pneumonia Viral/complicações , Fatores de Risco , Síndrome de Resposta Inflamatória Sistêmica/complicações , Taquicardia Ventricular/complicações , Tetralogia de Fallot/complicações , Tetralogia de Fallot/cirurgia
5.
Am J Cardiol ; 132: 79-86, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32819680

RESUMO

Clinical studies of heart failure (HF) generally utilize the 6-minute walk test (6MWT) for functional capacity (FC) assessment. However, data on the impact of cardiac resynchronization therapy (CRT) on 6MWT and its role to predict long-term outcomes in mild HF patients with CRT are lacking. We studied 1,381 subjects with mild HF enrolled in Multicenter Automatic Defibrillator Implantation Trial - Cardiac Resynchronization Therapy with 6MWT data at baseline and 1 year. We assessed the effects of CRT-D on percent change in 6MWT at 1 year by left bundle branch block (LBBB) status, identified independent predictors of 6MWT at 1 year, and evaluated the association between changes in 6MWT and risk for HF or death. Treatment with CRT-D versus implantable cardiac defibrillator (ICD) was not associated with a significant improvement in 6MWT at 1-year in LBBB subjects (2.2 % vs 0.0%, p = 0.428, but it was associated with a deterioration in 6MWT in non-LBBB subjects (4.1% vs 0.0%, p = 0.308). Multivariate analysis showed that each 5% reduction in 6MWT was independently associated with a corresponding 3% increase in the risk of subsequent HF or death (p = 0.014). In conclusion, our findings suggest that 6MWT has limited utility to identify CRT response in mild HF subjects with LBBB. However, 6MWT showed a signal toward deterioration in mild HF subjects with non-LBBB, and this was predictive of subsequent increased risk of HF or death.


Assuntos
Terapia de Ressincronização Cardíaca/métodos , Insuficiência Cardíaca/terapia , Volume Sistólico/fisiologia , Função Ventricular Esquerda/fisiologia , Teste de Caminhada/estatística & dados numéricos , Ecocardiografia , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
6.
Int Heart J ; 61(3): 611-615, 2020 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-32418964

RESUMO

Rate-responsive pacing is known to improve quality of life (QOL) in patients with sick sinus syndrome and chronotropic incompetence. However, the sensors for rate response include accelerometers, closed-loop stimulation (CLS), and minute ventilation sensors (MV sensors), each of which has a different mode of action. For this reason, it is important to select appropriate sensors that match the daily habits and behavioral patterns of the patient. For example, young and active patients are expected to have a rate increase when an accelerometer is used, while elderly patients and patients with a physical disability who are only able to move slowly often have a poor response to the accelerometer. MV sensors are therefore better suited to these patients. Furthermore, CLS is considered effective for patients who require an increase in heart rate when at rest, for example, patients undergoing maintenance dialysis.We describe a representative case, demonstrating the effectiveness of closed-loop stimulation in a patient with hypotension during dialysis.


Assuntos
Terapia de Ressincronização Cardíaca/métodos , Diálise Renal , Síndrome do Nó Sinusal/terapia , Idoso , Humanos , Masculino
9.
Medicine (Baltimore) ; 99(9): e19296, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32118744

RESUMO

OBJECTIVE: The aim of this study was to compare tissue doppler imaging (TDI) and equilibrium radionuclide angiography (ERNA) for detection of right ventricular (RV) dyssynchrony and prediction of the acute response to cardiac resynchronization therapy (CRT). METHODS: This study was approved by the local ethics committee of Huai'an First People's Hospital. Patient consent was not provided due to the use of completely anonymous images from which the individual could not be identified in this study. Thirty-three patients with nonischemic dilated cardiomyopathy underwent both TDI and ERNA before and within 48 hour after CRT implantation. RV dyssynchrony was measured with TDI using the difference in time to peak systolic velocity between the RV free wall and ventricular septum (RV-T). With ERNA, the standard of RV mean phase angle and RV phase standard deviation (RVmPA% and RVPSD%) were assessed. RESULTS: Moderate positive correlations were observed among baseline RVmPA%, RVPSD% and RV-T (r = 0.689 and 0.716, P < .001). Twenty patients (61%) with a reduction of at least 15% in LV end-systolic volume were categorized as acute responders after CRT. Responders showed significant reduction in RVmPA% and RVPSD% after CRT (53.60 ±â€Š4.15% to 43.95 ±â€Š6.88% and 14.00 ±â€Š2.41% to 10.40 ±â€Š1.67%, P < .05), whereas RV-T remained unchanged (50.10 ±â€Š10.28 ms to 49.25 ±â€Š13.64ms, NS). Receiver operating characteristic curve showed that the cut-off value of RV-T was 48.5ms, yielding 65% sensitivity and 77% specificity to predict acute respond to CRT. The cut-off value of RVmPA% was 49.5%, yielding 85% sensitivity and 85% specificity and the cut-off value of RVPSD% was 11.5%, yielding 85% sensitivity and 92% specificity. CONCLUSION: ERNA might be an appropriate alternative to TDI for assessment of RV dyssynchrony. Either RVmPA% or RVPSD% was highly predictive for acute response to CRT.


Assuntos
Terapia de Ressincronização Cardíaca/normas , Imagem do Acúmulo Cardíaco de Comporta/normas , Cardiopatias/diagnóstico , Função Ventricular Direita , Idoso , Terapia de Ressincronização Cardíaca/métodos , Terapia de Ressincronização Cardíaca/estatística & dados numéricos , Feminino , Imagem do Acúmulo Cardíaco de Comporta/métodos , Imagem do Acúmulo Cardíaco de Comporta/estatística & dados numéricos , Cardiopatias/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Curva ROC
10.
Am Heart J ; 222: 93-104, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32032927

RESUMO

BACKGROUND: Patients with heart failure having a low expected probability of arrhythmic death may not benefit from implantable cardioverter defibrillators (ICDs). OBJECTIVE: The objective was to validate models to identify cardiac resynchronization therapy (CRT) candidates who may not require CRT devices with ICD functionality. METHODS: Heart failure (HF) patients with CRT-Ds and non-CRT ICDs from the National Cardiovascular Data Registry and others with no device from 3 separate registries and 3 heart failure trials were analyzed using multivariable Cox proportional hazards regression for survival with the Seattle Heart Failure Model (SHFM; estimates overall mortality) and the Seattle Proportional Risk Model (SPRM; estimates proportional risk of arrhythmic death). RESULTS: Among 60,185 patients (age 68.6 ±â€¯11.3 years, 31.9% female) meeting CRT-D criteria, 38,348 had CRT-Ds, 11,389 had non-CRT ICDs, and 10,448 had no device. CRT-D patients had a prominent adjusted survival benefit (HR 0.52, 95% CI 0.50-0.55, P < .0001 versus no device). CRT-D patients with SHFM-predicted 4-year survival ≥81% (median) and a low SPRM-predicted probability of an arrhythmic mode of death ≤42% (median) had an absolute adjusted risk reduction attributable to ICD functionality of just 0.95%/year with the majority of survival benefit (70%) attributable to CRT pacing. In contrast, CRT-D patients with SHFM-predicted survival median had substantially more ICD-attributable benefit (absolute risk reduction of 2.6%/year combined; P < .0001). CONCLUSIONS: The SPRM and SHFM identified a quarter of real-world, primary prevention CRT-D patients with minimal benefit from ICD functionality. Further studies to evaluate CRT pacemakers in these low-risk CRT candidates are indicated.


Assuntos
Terapia de Ressincronização Cardíaca/métodos , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Insuficiência Cardíaca/terapia , Prevenção Primária/métodos , Sistema de Registros , Medição de Risco/métodos , Idoso , Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/etiologia , Feminino , Seguimentos , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/mortalidade , Humanos , Incidência , Masculino , Fatores de Risco , Taxa de Sobrevida/tendências , Suécia/epidemiologia , Fatores de Tempo , Resultado do Tratamento
11.
J Am Coll Cardiol ; 75(4): 347-359, 2020 02 04.
Artigo em Inglês | MEDLINE | ID: mdl-32000945

RESUMO

BACKGROUND: Cardiac resynchronization therapy (CRT) is usually performed by biventricular (BiV) pacing. Previously, feasibility of transvenous implantation of a lead at the left ventricular (LV) endocardial side of the interventricular septum, referred to as LV septal (LVs) pacing, was demonstrated. OBJECTIVES: The authors sought to compare the acute electrophysiological and hemodynamic effects of LVs with BiV and His bundle (HB) pacing in CRT patients. METHODS: Temporary LVs pacing (transaortic approach) alone or in combination with right ventricular (RV) (LVs+RV), BiV, and HB pacing was performed in 27 patients undergoing CRT implantation. Electrophysiological changes were assessed using electrocardiography (QRS duration), vectorcardiography (QRS area), and multielectrode body surface mapping (standard deviation of activation times [SDAT]). Hemodynamic changes were assessed as the first derivative of LV pressure (LVdP/dtmax). RESULTS: As compared with baseline, LVs pacing resulted in a larger reduction in QRS area (to 73 ± 22 µVs) and SDAT (to 26 ± 7 ms) than BiV (to 93 ± 26 µVs and 31 ± 7 ms; both p < 0.05) and LVs+RV pacing (to 108 ± 37 µVs; p < 0.05; and 29 ± 8 ms; p = 0.05). The increase in LVdP/dtmax was similar during LVs and BiV pacing (17 ± 10% vs. 17 ± 9%, respectively) and larger than during LVs+RV pacing (11 ± 9%; p < 0.05). There were no significant differences between basal, mid-, or apical LVs levels in LVdP/dtmax and SDAT. In a subgroup of 16 patients, changes in QRS area, SDAT, and LVdP/dtmax were comparable between LVs and HB pacing. CONCLUSIONS: LVs pacing provides short-term hemodynamic improvement and electrical resynchronization that is at least as good as during BiV and possibly HB pacing. These results indicate that LVs pacing may serve as a valuable alternative for CRT.


Assuntos
Terapia de Ressincronização Cardíaca/métodos , Fenômenos Eletrofisiológicos , Ventrículos do Coração/fisiopatologia , Hemodinâmica , Idoso , Bloqueio de Ramo/terapia , Eletrocardiografia , Eletrodos , Feminino , Fluoroscopia , Insuficiência Cardíaca/fisiopatologia , Septos Cardíacos/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Função Ventricular Esquerda
13.
Am J Cardiol ; 125(7): 1077-1082, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-31992439

RESUMO

The aim of the present study was to investigate the utility of the modified frailty index (mFI) to predict outcomes in patients who underwent cardiac resynchronization therapy (CRT) device implantation. A retrospective cohort study of patients undergoing CRT implantation or upgrade over a 5-year period was performed. The relation between the preprocedural 11-component mFI and clinical outcomes including 1-year mortality, periprocedural and 30-day adverse events, 30-day readmission, length of hospitalization after procedure, and response to CRT defined by changes in left ventricular ejection fraction and end-diastolic volume were studied. Of 283 patients studied, 134 (47.3%) were classified as frail (mFI ≥3). Frailty was associated with an increased risk of 1-year mortality (hazard ratio 5.87, p = 0.033 in multivariate analysis), and increased frequency of adverse events (p = 0.013), 30-day readmission (p = 0.0077), and postprocedural length of stay ≥3 days (p = 0.0005). Frail patients had significantly less echocardiographic response to CRT compared with nonfrail patients with change in left ventricular ejection fraction 6% versus 12% (p = 0.004) and change in left ventricular end-diastolic volume -19.9 versus -43.3 ml (p = 0.006). In conclusion, frailty as assessed by the mFI is associated with an increase in 1-year mortality, adverse events, 30-day readmission, length of stay, and poorer response to CRT after implantation.


Assuntos
Terapia de Ressincronização Cardíaca/métodos , Fragilidade/diagnóstico , Insuficiência Cardíaca/terapia , Idoso , Comorbidade , Feminino , Seguimentos , Fragilidade/epidemiologia , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , New York/epidemiologia , Readmissão do Paciente/tendências , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Resultado do Tratamento , Função Ventricular Esquerda/fisiologia
14.
Ir J Med Sci ; 189(3): 895-905, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31981072

RESUMO

BACKGROUND: Cardiac resynchronization therapy (CRT) has been shown to reduce mortality and morbidity in symptomatic patients with reduced left ventricular systolic function < 35%, a left bundle branch block (LBBB) and a widened QRS complex. This paper compares Irish national CRT practices with the European data that was gathered in the same multi-centre CRT Survey II. METHODS: Each recruiting centre completed an internet-based facilitating collection of information relating to health care resource utilization by each centre. A second form was completed for consecutive patients undergoing CRT implantation, to provide information on patient demographics, pre-implantation clinical evaluation and investigations, indication for implantation and the procedure as well as short-term complications and adverse events. RESULTS: A total of 85 patients from 2 centres were representative of the current Irish practice and compared with data obtained. This was 26.6% of all CRT implantations in Ireland during this period (total number 319, 88 CRT-P, 231 CRT-D). Of those receiving CRT device, mean age was 73 years, 74.1% were male, with predominantly NYHA class III symptoms, and left ventricular ejection fraction < 35%. NT-pro-BNP level was substantially elevated in most patients. 56% were in sinus rhythm, 31% in atrial fibrillation with overall mean QRS duration of 166 ms. CONCLUSIONS: Within Ireland, the majority of CRT implantation are adherent with ESC guidelines. It has also highlighted problems that are noted in other ESC member countries such as the underutilization of device therapy in women, lack of referrals from peripheral centres and further need for optimization of medical therapy before device implantation.


Assuntos
Dispositivos de Terapia de Ressincronização Cardíaca/normas , Terapia de Ressincronização Cardíaca/métodos , Idoso , Europa (Continente) , Feminino , Humanos , Irlanda , Masculino , Inquéritos e Questionários
15.
Chin Med J (Engl) ; 133(2): 141-147, 2020 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-31868806

RESUMO

BACKGROUND: Super-responders (SRs) to cardiac resynchronization therapy (CRT) regain near-normal or normal cardiac function. The extent of cardiac synchrony of SRs and whether continuous biventricular (BIV) pacing is needed remain unknown. The aim of this study was to evaluate the cardiac electrical and mechanical synchrony of SRs. METHODS: We retrospectively analyzed CRT recipients between 2008 and 2016 in 2 centers to identify SRs, whose left ventricular (LV) ejection fraction was increased to ≥50% at follow-up. Cardiac synchrony was evaluated in intrinsic and BIV-paced rhythms. Electrical synchrony was estimated by QRS duration and LV mechanical synchrony by single-photon emission computed tomography myocardial perfusion imaging. RESULTS: Seventeen SRs were included with LV ejection fraction increased from 33.0 ±â€Š4.6% to 59.3 ±â€Š6.3%. The intrinsic QRS duration after super-response was 148.8 ±â€Š30.0 ms, significantly shorter than baseline (174.8 ±â€Š11.9 ms, P = 0.004, t = -3.379) but longer than BIV-paced level (135.5 ±â€Š16.7 ms, P = 0.042, t = 2.211). Intrinsic LV mechanical synchrony significantly improved after super-response (phase standard deviation [PSD], 51.1 ±â€Š16.5° vs. 19.8 ±â€Š8.1°, P < 0.001, t = 5.726; phase histogram bandwidth (PHB), 171.7 ±â€Š64.2° vs. 60.5 ±â€Š22.9°, P < 0.001, t = 5.376) but was inferior to BIV-paced synchrony (PSD, 19.8 ±â€Š8.1° vs. 15.2 ±â€Š6.4°, P = 0.005, t = 3.414; PHB, 60.5 ±â€Š22.9° vs. 46.0 ±â€Š16.3°, P = 0.009, t = 3.136). CONCLUSIONS: SRs had significant improvements in cardiac electrical and LV mechanical synchrony. Since intrinsic synchrony of SRs was still inferior to BIV-paced rhythm, continued BIV pacing is needed to maintain longstanding and synchronized contraction.


Assuntos
Terapia de Ressincronização Cardíaca/métodos , Insuficiência Cardíaca/terapia , Função Ventricular Esquerda/fisiologia , Idoso , Feminino , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
16.
Am J Emerg Med ; 38(5): 1044.e3-1044.e4, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31870671

RESUMO

Placement of a transvenous pacer is an important procedure mainly used to treat hemodynamically unstable brady-arrhythmias. In the Emergency Department (ED), wire placement into the right ventricle is typically performed blindly, or in some cases, under transthoracic ultrasound guidance. This case report describes a patient with extensive cardiac history who presented after a witnessed arrest, and after return of spontaneous circulation, sustained an unstable bradycardia requiring emergent transvenous pacer placement while in the ED. A temporary pacer wire was placed transvenously without successful capture. Transesophageal echocardiography was then utilized to guide and adjust the pacer wire placement helping to successfully achieve capture. To our knowledge, this is the first report to describe transesophageal echocardiogram-assisted placement of a transvenous pacer wire while in the ED.


Assuntos
Bradicardia/terapia , Cateterismo Cardíaco/métodos , Terapia de Ressincronização Cardíaca/métodos , Ventrículos do Coração/diagnóstico por imagem , Idoso de 80 Anos ou mais , Bradicardia/etiologia , Cateterismo Cardíaco/efeitos adversos , Terapia de Ressincronização Cardíaca/efeitos adversos , Ecocardiografia Transesofagiana , Eletrocardiografia , Serviço Hospitalar de Emergência , Feminino , Humanos , Marca-Passo Artificial
17.
Am J Cardiol ; 125(5): 777-782, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31883682

RESUMO

Low systolic blood pressure (SBP) is associated with increased mortality and heart failure in patients with left ventricular dysfunction. Data on the relation between SBP measured following cardiac resynchronization therapy implantation and subsequent clinical events are limited. We hypothesized that assessment of systolic blood pressure at 12 months after cardiac resynchronization therapy can be used to identify patients with increased risk for adverse cardiovascular outcomes. The study population comprised 1000 patients who underwent cardiac resynchronization therapy implantation in MADIT-CRT. Outcomes were compared between patients with low (<110 mm Hg) and preserved SBP (≥110 mm Hg) at 1 year. At 1 year following cardiac resynchronization therapy, 800 patients (80%) had preserved systolic blood pressure. Kaplan-Meier survival analysis showed that the rate of heart failure or death during subsequent follow-up was significantly higher among patients with low SBP as compared with a preserved SBP at 12 months (2-year rates: 20% vs 12%, respectively; log-rank p value = 0.009 for the overall difference during follow-up). Consistently, multivariate analysis showed that patients with preserved SBP at 1 year had a 29% lower risk of HF or death when compared with the low SBP group (p = 0.024). The association between SBP measured following cardiac resynchronization therapy implantation and subsequent clinical events was more pronounced among patients with nonischemic cardiomyopathy (p value for SBP-by-HF etiology interaction = 0.034). In conclusion, assessment of SBP following cardiac resynchronization therapy can be used for improved long-term risk stratification in this population.


Assuntos
Pressão Sanguínea/fisiologia , Terapia de Ressincronização Cardíaca/métodos , Cardiomiopatias/terapia , Insuficiência Cardíaca/epidemiologia , Mortalidade , Disfunção Ventricular Esquerda/terapia , Idoso , Dispositivos de Terapia de Ressincronização Cardíaca , Cardiomiopatias/fisiopatologia , Desfibriladores Implantáveis , Feminino , Humanos , Estimativa de Kaplan-Meier , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Modelos de Riscos Proporcionais , Volume Sistólico , Sístole , Disfunção Ventricular Esquerda/fisiopatologia
18.
Medicine (Baltimore) ; 98(49): e18080, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804316

RESUMO

BACKGROUND: Tpeak-Tend interval (TpTe), a measurement of transmural dispersion of repolarization (TDR), has been shown to predict ventricular tachyarrhythmia in cardiac resynchronization therapy with defibrillator (CRT-D) patients. However, the ability of TpTe to predict ventricular tachyarrhythmia and mortality for heart failure patients with a cardioverter-defibrillator (ICD) is not clear. The purpose of this study was to assess the predictive ability of TpTe in heart failure patients with ICD. METHODS AND RESULTS: We enrolled 318 heart failure patients treated after ICD. Patients were divided into 3 groups according to their post-implantation TpTe values and were evaluated every 6 months. The primary endpoint was appropriate ICD therapy. The secondary endpoint was all-cause mortality. During long-term follow-up, the TpTe > 110 ms group (n = 111) experienced more VT/VF episodes (45%) and all-cause mortality (25.2%) than the TpTe 90-110 ms group (n = 109) (26.4%, 14.5%) and TpTe < 90 ms group (n = 98) (11.3%, 11.3%) (overall P < .05, respectively). In Cox regression, longer post-implantation TpTe was associated with an increased number of VT/VF episodes [HR: 1.017; 95% CI: 1.008-1.026; P < .001], all-cause mortality [HR: 1.015; 95% CI: 1.004-1.027; P = .010] and the combined endpoint [HR: 1.018; 95%CI: 1.010-1.026; P < .001]. CONCLUSIONS: Post-implantation TpTe was an independent predictor of both ventricular arrhythmias and all-cause mortality in heart failure patients with an implanted ICD.


Assuntos
Terapia de Ressincronização Cardíaca/métodos , Eletrocardiografia , Insuficiência Cardíaca/mortalidade , Taquicardia Ventricular/terapia , Adulto , Idoso , Desfibriladores Implantáveis , Feminino , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Taquicardia Ventricular/etiologia
19.
Rev. esp. cardiol. (Ed. impr.) ; 72(12): 1020-1030, dic. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-190766

RESUMO

Introducción y objetivos: Se describen los resultados en España de la segunda encuesta de la Sociedad Europea de Cardiología sobre terapia de resincronización cardiaca (CRT-Survey II) y se comparan con los de los demás países participantes. Métodos: Pacientes a los que se implantó un dispositivo de terapia de resincronización cardiaca entre octubre de 2015 y diciembre de 2016 en 36 centros participantes. Se recogieron datos sobre las características basales de los pacientes y del implante, y un seguimiento a corto plazo hasta el alta hospitalaria. Resultados: La tasa de éxito del implante fue del 95,9%. La mediana [intervalo intercuartílico] de implantes anuales/centro en España fue significativamente menor que en los demás países participantes: 30 [21-50] frente a 55 [33-100] implantes/año (p=0,00003). En los centros españoles hubo una menor proporción de pacientes de edad ≥ 75 años (el 27,9 frente al 32,4%; p=0,0071), una mayor proporción de pacientes en clase funcional II de la New York Heart Association (el 46,9 frente al 36,9%; p <0,00001) y un mayor porcentaje de pacientes con criterios electrocardiográficos de bloqueo de rama izquierda (el 82,9 frente al 74,6%; p <0,00001). La media de la estancia hospitalaria fue menor en los centros españoles (5,8+/-8,5 frente a 6,4+/-11,6; p <0,00001) y una mayor proporción de pacientes recibieron un cable de ventrículo izquierdo cuadripolar (el 74 frente al 56%; p <0,00001) y fueron seguidos a distancia (el 55,8 frente al 27,7%; p <0,00001). Conclusiones: La encuesta CRT-Survey II muestra que en España hay una menor proporción de pacientes de 75 o más años que reciben un dispositivo de terapia de resincronización cardiaca, una mayor proporción de pacientes en clase funcional II de la New York Heart Association, con bloqueo completo de la rama izquierda del haz de His y con seguimiento a distancia, con estancias hospitalarias significativamente menores


Introduction and objectives: We describe the results for Spain of the Second European Cardiac Resynchronization Therapy Survey (CRT-Survey II) and compare them with those of the other participating countries. Methods: We included patients undergoing CRT device implantation between October 2015 and December 2016 in 36 participating Spanish centers. We registered the patients' baseline characteristics, implant procedure data, and short-term follow-up information until hospital discharge. Results: Implant success was achieved in 95.9%. The median [interquartile range] annual implantation rate by center was significantly lower in Spain than in the other participating countries: 30 implants/y [21-50] vs 55 implants/y [33-100]; P=.00003. In Spanish centers, there was a lower proportion of patients ≥ 75 years (27.9% vs 32.4%; P=.0071), a higher proportion in NYHA class II (46.9% vs 36.9%, P <.00001), and a higher percentage with electrocardiographic criteria of left bundle branch block (82.9% vs 74.6%; P <.00001). The mean length of hospital stay was significantly lower in Spanish centers (5.8+/-8.5 days vs 6.4+/-11.6; P <.00001). Spanish patients were more likely to receive a quadripolar LV lead (74% vs 56%, P <.00001) and to be followed up by remote monitoring (55.8% vs 27.7%; P <.00001). Conclusions: The CRT-Survey II shows that, compared with other participating countries, fewer patients in Spain aged ≥ 75 years received a CRT device, while more patients were in New York Heart Association functional class II and had left bundle branch block. In addition, the length of hospital stay was shorter, and there was greater use of quadripolar LV leads and remote CRT monitoring


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Terapia de Ressincronização Cardíaca/métodos , Insuficiência Cardíaca/terapia , Arritmias Cardíacas/terapia , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Arritmias Cardíacas/epidemiologia , Insuficiência Cardíaca/epidemiologia , Eletrocardiografia/métodos , Espanha/epidemiologia , Europa (Continente)/epidemiologia , Estudos Retrospectivos
20.
Biomed Res Int ; 2019: 3202838, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31871936

RESUMO

Objective: To evaluate the effects of cardiac rehabilitation on exercise tolerance and cardiac function in heart failure patients undergoing cardiac resynchronization therapy (CRT). Methods: Randomized controlled trials were initially identified from systematic reviews of the literature about cardiac rehabilitation and heart failure patients with CRT. We undertook updated literature searches of the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, CBM, CNKI, and Wanfang databases until July 1, 2017. STATA12.0 software was used. Results: Four randomized controlled studies were included. The total sample size was 157 patients, including 77 in the control group. Cardiac rehabilitation treatment affected the peak VO2 in heart failure patients with CRT (P heterogeneity=0.491, I 2 = 0%). The results lacked heterogeneity, and the data were merged in a fixed-effects model (WMD = 2.17 ml/kg/min, 95% CI (1.42, 2.92), P < 0.001). The peak VO2 was significantly higher in the cardiac rehabilitation group than in the control group. The sensitivity analysis showed that the results of the meta-analysis were robust. Cardiac rehabilitation treatment affected LVEF in heart failure patients with CRT (P heterogeneity=0.064, I 2 = 63.6%); the heterogeneity among the various research results meant that the data were merged in a random-effects model (WMD = 4.75%, 95% CI (1.53, 7.97), P=0.004). The LVEF was significantly higher in the cardiac rehabilitation group than in the control group. The sources of heterogeneity were analyzed, and it was found that one of the studies was the source of significant heterogeneity. After the elimination of that study, the data were reanalyzed, and the heterogeneity was significantly reduced. There were still significant differences in the WMD and 95% CI. Conclusion: Cardiac rehabilitation can improve exercise tolerance and cardiac function in heart failure patients with CRT. Future studies are needed to evaluate whether these beneficial effects of cardiac rehabilitation may translate into an improvement in long-term clinical outcomes among these patients.


Assuntos
Reabilitação Cardíaca/métodos , Terapia de Ressincronização Cardíaca/métodos , Fenômenos Fisiológicos Cardiovasculares , Tolerância ao Exercício , Insuficiência Cardíaca/fisiopatologia , Bases de Dados Factuais , Terapia por Exercício/métodos , Humanos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
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