BackgroundApproximately 30% of patients treated with cardiac resynchronization therapy (CRT) do not achieve favourable response. The purpose of the present study was to identify echocardiographic and clinical predictors of a positive response to CRT.MethodsThe study included 82 consecutive heart failure (HF) patients in New York Heart Association (NYHA) functional class III or IV with left bundle branch block (LBBB), QRS duration ≥ 120 ms and left ventricular ejection fraction (LVEF) ≤ 35%. Statistical analysis was performed using IBM SPSS statistical software (SPSS v.21.0 for Mac OS X). A p value < 0.05 was considered statistically significant.ResultsEchocardiographic response was established in 81.6% and clinical response was achieved in 82.9% of patients. Significant univariate predictors of favourable echocardiographic response after 12 months were smaller left ventricular end-diastolic diameter (LVEDD) (odds ratio [OR] 0.89; 95% confidence interval [CI] 0.82 - 0.97, p = 0.01), and smaller left ventricular end-systolic diameter (LVESD) (OR 0.91; 95% CI 0.85 - 0.98, p = 0.01). Lower uric acid concentration was associated with better echocardiographic response (OR 0.99; 95% CI 0.99 - 1.0, p = 0.01). Non-ischemic HF etiology (OR 4.89; 95% CI 1.39 - 17.15, p = 0.01) independently predicted positive clinical response. Multiple stepwise regression analysis demonstrated that LVEDD lower than 75 mm (OR 5.60; 95% confidence interval [CI] 1.36 - 18.61, p = 0.01) was the strongest independent predictor of favourable echocardiographic response.ConclusionsSmaller left ventricular end-diastolic and end-systolic diameters and lower serum uric acid concentration were associated with better response to CRT. Left ventricular end-diastolic diameter and non-ischemic heart failure etiology were the strongest independent predictors of positive response to CRT.

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Long QT syndrome (LQTS) is majorly an autosomal dominantly inherited electrical dysfunction, but there are exceptions (Jervell and Lange-Nielsen syndrome is inherited in an autosomal recessive pattern). This disorder prolongs ventricular repolarization and increases the risk of ventricular arrhythmias, syncope, and even sudden cardiac death. The risk of fatal events is reduced during pregnancy, but dramatically increases during the 9 months after delivery, especially in patients with LQT2. In women with LQTS, treatment with β-blockers at appropriate doses is recommended throughout pregnancy and the high-risk postnatal period. In this review, we summarize the management of LQTS during pregnancy and beyond.

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Lietuvos sveikatos mokslų universitetasLithuanian University of Health Sciences santrauka Reikšminiai žodžiai: širdies nepakankamumas, širdies resinchronizuojamasis gydymas, gyvenimo kokybė. Tikslas -įvertinti širdies resinchronizuojamojo gydymo (ŠRG) įtaką pacientų, sergančių sunkiu širdies nepakankamumu (ŠN), gyvenimo kokybei ir jos pokyčiams 12 mėnesių laikotarpiu. Tyrimo medžiaga ir metodai. Retrospektyviai išanalizuoti 40-ties III-IV funkcinės klasės (pagal Niujorko širdies asociacijos klasifikaciją -NŠA) ŠN sergančių pacientų, kuriems implantuoti širdies resinchronizuojamieji prietaisai (ŠRP), duomenys. Gyvenimo kokybei vertinti buvo naudojamas SF-36 klausimynas. Kliniškai ŠN sunkumas vertintas atsižvelgiant į 6 minučių ėjimo testo (6-MĖT) rezultatą bei ŠN funkcinę klasę pagal NŠA. Duomenys analizuoti naudojant statistinę SPSS 19.0 programą. Skirtumai vertinti kaip statistiškai patikimi, kai p < 0,05. Rezultatai. Lyginant su pradiniu, taikant ŠRG po 12 mėn. stebėtas statistiškai reikšmingas kiekvienos SF-36 srities vertinimo pagerėjimas: fizinio aktyvumo (FA) (30,69 ± 10,16 vs 38,66 ± 10,24, p = 0,0001), veiklos apribojimo dėl fizinių problemų (VFP) (30,81 ± 5,7 vs 36,11 ± 10,78, p = 0,0001), veiklos apribojimo dėl emocinių problemų (VEP) (31,88 ± 11,81 vs 40,57 ± 13,45, p = 0,0001), energingumo ir gyvybingumo (EG) (39,18 ± 10,64 vs 46,28 ± 9,64, p = 0,0001), emocinės būklės (EB) (36,13 ± 13,19 vs 43,34 ± 10,79, p = 0,001), socialinių ryšių (SF) (34,21 ± 10,32 vs 42,08 ± 10,01, p = 0,0001), skausmo (S) (38,89 ± 10,41 vs 48,35 ± 9,15, p = 0,0001), bendro sveikatos vertinimo (BSV) (31,97 ± 8,19 vs 38,28 ± 8,06, p = 0,0001), fizinės sveikatos (FS) (30,46 ± 7,92 vs 37,58 ± 9,90, p = 0,0001) ir psichinės sveikatos (PS) (37,81 ± 11,25 vs 45,11 ± 10,51, p = 0,0001). Geresnis 6-MĖT rezultatas ir ŠN funkcinė klasė prieš ŠRG buvo susijusi su geresne gyvenimo kokybe po 12 mėn. Statistiškai reikšmingo pacientų amžiaus ir lyties ryšio su gyvenimo kokybe nenustatyta. Išvados. ŠRG pagerina pacientų gyvenimo kokybę, ypač fizinę ir socialinę funkcijas. Didesnis 6-MĖT rezultatas ir geresnė ŠN funkcinė klasė pagal NŠA prieš ŠRG buvo susijusi su geresne gyvenimo kokybe po 12 mėn. taikant ŠRG. Amžius ir lytis statistiškai reikšmingos įtakos gyvenimo kokybei neturėjo. abstract Key words: heart failure, cardiac resynchronization therapy, quality of life. Purpose. To estimate the impact of cardiac resynchronization therapy (CRT) on health-related quality of life among patients with heart failure (HF).

Background: Limited data exists addressing the daily use of anticoagulants for atrial fibrillation (AF) and atrial flutter (AFL) patients before and after electrical cardioversion (ECV) or catheter ablation procedures. The purpose of the study was to evaluate the appropriateness of anticoagulant therapy. Methods: We evaluated the prescribed dosage of anticoagulant therapy for 257 non-valvular AF and AFL patients scheduled for ECV or catheter ablation and the appropriateness of periprocedural anticoagulation according to European Society of Cardiology (ESC) AF Guidelines. The statistical analysis was performed using IBM SPSS Statistics software (v.26.0). Results: The majority of the patients (84%) used nonvitamin K antagonist oral anticoagulants (NOACs) for pre-procedural anticoagulation. An intervention was not performed for 12.2% of warfarin users because of insufficient hypocoagulation, while anamnesis of patients’ missed doses with a possibility of inadequate hypocoagulation occurred only in 1.9% of patients on NOACs. The odds of having insufficient pre-procedural hypocoagulation were 7.4 times higher for warfarin users compared to the NOACs group (p=0.001, OR=7.4). An incorrect NOAC dose was assigned to 22 (8.6%) patients. Rivaroxaban was the most prescribed NOAC and this group of patients had the highest percentage of incorrect dosage according to the ESC guidelines. Conclusions: Mistakes of prescribing the dosage of anticoagulant therapy are common. The majority of the patients in the study were prescribed with NOACs before and after ECV or catheter ablation procedures. Warfarin users had higher odds of the intervention not being performed and not reaching sufficient hypocoagulation prior to the procedure compared to NOACs users.