Both twisting and untwisting motions are increased in patients with AL systemic amyloidosis with no evidence of cardiac involvement while they are reduced in patients with evident amyloidosis cardiac involvement. This finding suggests that impaired LV relaxation induces a compensatory mechanism in the early phase of the disease, which fails in more advanced stage when both twisting and untwisting rates are reduced. The increase in LV rotational mechanics could be a marker of subclinical cardiac involvement.
Background: The beneficial effects of cardiac resynchronization therapy (CRT) on left ventricular (LV) remodeling have been extensively described. Few data are available about the effects of CRT on right ventricular (RV) function and remodeling. Hypothesis: We hypothesized that CRT could also induce reverse remodeling in the right ventricle and that RV baseline functional status expressed as tricuspidal annular plane systolic excursion (TAPSE) could affect CRT response. Methods: Echocardiographic investigation was performed before and 6 months after CRT. In 192 patients, TAPSE, LV, and RV dimensions with functional parameters and LV dyssynchrony index were evaluated. Results: At 6 months' follow-up, 86 patients (45%) were responders to CRT according to at least 15% LV endsystolic volume reduction. Among baseline echocardiographic parameters, responders had significantly lower TAPSE, larger LV volumes, and higher LV dyssynchrony index. In responders, LV volume reduction, ejection fraction increase, and mitral regurgitation improvement were associated with RV dimensions reduction, increased TAPSE, and improved LV dyssynchrony. Receiver operating characteristic curve analysis showed that TAPSE, at 17 mm optimal cutoff, yielded 64% sensitivity and 60% specificity in predicting CRT response; similarly, LV dyssynchrony index, at 41.25 ms optimal cutoff, predicted CRT response with 60% sensitivity and 62% specificity. A subgroup analysis demonstrated that the coexistence of high TAPSE and high dyssynchrony index values increased probability of CRT response. Conclusions: Our results show that CRT induces RV and LV reverse remodeling and that CRT patient selection can be improved by simply measuring TAPSE value. IntroductionCongestive heart failure (CHF) is a major disorder associated with poor quality of life and high mortality. 1 At present, cardiac resynchronization therapy (CRT) is a new, well-established therapeutic strategy for patients with drugrefractory symptoms, advanced left ventricular (LV) systolic dysfunction, and wide QRS. 2 -7 However, because it was primarily developed to improve function and synchronism of the LV, the effects of CRT on right ventricular (RV) function have not been fully examined.The importance of the right ventricle has often been underestimated; it was long considered mainly as a conduit and the importance of its contractile performance was undervalued. Nowadays, few data are available about the effects of CRT on RV function and remodeling. 8 -10 Moreover, data about the relationship between baseline RV functional status and long-term LV reverse remodeling
The SHFM successfully stratifies HF patients on CRT/CRT-D and can be reliably applied to help clinicians in predicting survival in this clinical setting.
Our results show that amyloidosis and systemic hypertension produce both LV twist and untwist rate enhancement before LV hypertrophy is developed. In patients with amyloidosis irrespectively of LV infiltration degree, a significant LV untwisting rate peak delay occurs suggesting that different aetiology of cardiac involvement could differently affect LV untwisting rate.
An optimal acute response to CRT can be obtained by positioning the LV lead at the site associated with the maximum RV-to-LV conduction time. A significant correlation appears to exist between RV-to-LV conduction time and the improvement in systolic function with CRT.
Our study demonstrates that routine use of EXPORT catheter in patients with STEMI and coronary thrombosis is feasible, safe, and associated with significant improvements in flow-related angiographic parameters. The relative simplicity of this approach makes it an attractive option in this challenging situation.
Our results show that MIAD plays the main role in determining the optimal AV delay, thus caution should be taken when optimizing AV by IEGM-based methods.
LittleGloucester, United Kingdom Purpose: Cardiac resynchronization therapy (CRT) is indicated in patients with heart failure and bundle branch block. It is less clear whether this includes patients with pre-existing right ventricular pacemaker/defibrillator systems, particularly with respect to having a clinical benefit.The indication for CRT therapy has been constantly widened following publication of randomized prospective clinical trials.However, among other important unanswered questions regarding CRT, it has not been assessed whether patients with previously implanted right ventricular pacemakers or cardioverter defibrillator (ICD) systems derive similar benefit from resynchronization therapy compared with patients undergoing de novo CRT implantation. Method: CRT implantation occurred in 147 patients (64 + 11 years) between February 2010 -October 2015. From this cohort, we extracted data from 43 patients undergoing a CRT upgrade. The two groups were then compared, (de novo vs upgrade) and clinical outcomes were measured in terms of response, lead repositions and mortality.Inclusion criteria was class III-IV New York Heart Association heart failure symptoms and on optimal medical therapy. Furthermore, an LVEF 35% or a QRS width .120 ms was required and in patients with a previously implanted pacemaker or ICD with ventricular pacing, a paced QRS width was !160 ms present. Patients were followed up at 1 month in clinic and then at 4 monthly intervals either in clinic or via home monitoring after device implantation. In addition whenever clinical circumstances called for, unscheduled visits were made. At each visit, functional heart failure status (symptoms), and at the 6 months visit either the left ventricular ejection fraction or LV impairment were determined. Concomitant medication was adjusted according to the clinical status of the patient. Patients were considered responders to CRT if they survived to the 6 months follow-up and showed significant improvement in one out of three of the following criteria: improved clinical status (i.e. symptoms), and / or echocardiographic improvement. This was based on either an improved LVEF of .5% or an improved LV function i.e. from severe to moderate. Summary: Mean left ventricular ejection fraction was 27%. Over a mean follow-up of 3.7 +1.5 years, the response rate was significantly higher in the upgraded CRT vs de novo CRT (76%vs 62% (p ¼ 0.03). There was a significant difference between pacemaker upgrades and ICD upgrades. Pacemaker upgrades had the highest percentage of response (76% vs 44% p ¼ 0.05) . Heart failure hospitalisation within 30 days showed no significant differences between the two groups (p ¼ 0.15) Mortality rates showed borderline statistical significance (p ¼ 0.051), 10.5% in the patients de novo CRT and 4 (7.2%) mortality in upgraded CRT. Lead repositions were non-significant and occurred in 10.2% of upgrade CRT and 12.6% de novo implants. (p ¼ 1.0) Conclusion: Clinical response to CRT were comparable for patients undergoing de-novo vs. upgrade...
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