Aim. To investigate the agreement among different response criteria to cardiac resynchronization therapy (CRT) and long-term mortality in patients with congestive heart failure (CHF).Methods. The study enrolled 141 patients (men 77.3%; women 22.7%) with CHF (65.2% ischemic and 34.8% non-ischemic etiology). Mean age was 58.6 [53.0;66.0] years. All patients had NYHA II-IV, left ventricular ejection fraction (LVEF) ≤35%; QRS ≥130 мs and/or left bundle branch block. Mean follow-up period was 45.0±34.2 months. Response to CRT was defined according to dynamics of NYHA functional class, LVEF, and left-ventricular end-systolic volume (LVESV).Results. Moderate agreement was found among LVEF and LVESV (Cohen’s k coefficient 0.591±0.068) while we did not find the agreement among echocardiographic criteria and NYHA. Long-term mortality had moderate negative correlation with LVESV (r=-0.486; pConclusion. Agreement between different criteria to define response to CRT is poor. The strongest correlation with long-term mortality was found for LVESV. This inconsistency among different response criteria severely limits the ability to generalize results over multiple CRT studies.
Aim. To analyze 20 electrocardiographic (ECG) signs of left bundle branch block (LBBB) before and after septal myectomy in patients with hypertrophic cardio myopathy (HCM) and develop a criterion for proximal LBBB based on the selected signs.Material and methods. This retrospective non-randomized study included 50 patients with obstructive HCM who underwent septal myectomy. There were following inclusion criteria: QRS width <120 ms before surgery, transaortic access during septal myectomy, and QRS width ≥120 ms in the early postoperative period. For each patient, ECGs were analyzed before septal myectomy and in the first week after surgery. At the same time, 20 ECG signs proposed earlier in the LBBB criteria were independently assessed.Results. Exsection of a small myocardial area of the basal interventricular septal parts, weighing an average of 4,9±2 grams, led to a significant increase in the QRS width (by 61±14,6 ms) and the prevalence of almost all ECG signs of LBBB. In 100% of cases (n=50), the following signs demonstrated significant dynamics after surgery: (1) midQRS notching or slurring in ≥2 contiguous leads (I, aVL, V1-V2, V5-V6); (2) absence of q wave in V5-V6 and (3) discordant T wave in at least two leads (I, aVL, V5, V6). Based on the design of the study, (4) QRS width ≥120 ms was additionally included. These ECG characteristics were combined into a new criterion for proximal LBBBConclusion. A new criterion for proximal LBBB was developed using the pathophysiological model of iatrogenic conduction block of left bundle branch. Further estimation of this criterion on a set of candidates for CRT with heterogeneous level of LBBB is necessary.
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