Background-For patients with symptomatic New York Heart Association class III or IV, ejection fraction Յ35%, and QRS Ն130 ms, cardiac resynchronization therapy (CRT) has become an established treatment option. However, use of these implant criteria fails to result in clinical or echocardiographic improvement in 30% to 45% of CRT patients. Methods and Results-The Predictors of Response to CRT (PROSPECT)-ECG is a substudy of the prospective observational PROSPECT trial. ECGs collected before, during, and after CRT implantation were analyzed. Primary outcomes were improvement in clinical composite score (CCS) and reduction of left ventricular end systolic volume (LVESV) of Ͼ15% after 6 months. Age, sex, cause of cardiomyopathy, myocardial infarction location, right ventricular function, mitral regurgitation, preimplantation QRS width, preimplantation PR interval, preimplantation right ventricular-paced QRS width, preimplantation axis categories, LV-paced QRS width, postimplantation axis categories, difference between biventricular (Bi-V) pacing and preimplantation QRS width, and QRS bundle branch morphological features were analyzed univariably in logistic regression models to predict outcomes. All significant predictors (␣ϭ0.1), age, and sex were used for multivariable analyses. Cardiomyopathy cause interaction and subanalyses were also performed.
Background Radiofrequency (RF) ablation of the left atrium (LA) in patients with atrial fibrillation (AF) is guided by electroanatomic mapping systems. The cardiovascular magnetic resonance (CMR) late gadolinium enhancement (LGE) technique can detect scar after ablation. Direct comparisons between the locations of intended RF ablation sites and locations of scar formation in the LA have not been performed. Objective We sought to develop and employ a method for comparing the sites of RF application with the sites of post-procedural scar formation in the LA. Methods A method for rigid registration of CMR LGE images with electroanatomic mapping data (CARTO data), visualization of the registered data sets, and quantification of the correlations was developed and employed in 19 studies of patients with AF. The distance between the CARTO points and the CMR LA surface was measured as the mean integration error. The distance between each CARTO ablation and the nearest scar was measured. The gaps in sites of LGE and in CARTO ablation were also assessed qualitatively, in six sectors of each PV. Results The custom registration method provided a mean integration error between CARTO and CMR of 2.7±0.7mm. The average distance between CARTO and LGE scar was 3.6±1.3mm. Qualitatively, 20% of sectors with sites of CARTO ablation showed no evidence of LGE. Conclusion There was a visual and quantitative correspondence between CARTO ablation sites and LGE scar, but for twenty percent of CARTO ablation sites there was no visible corresponding LGE.
Background: We report a case of pulmonary sarcoma which is a rare cause of the common symptom of dyspnea.
Background and purpose Prospectively collected data comparing the safety and effectiveness of individual non-vitamin K antagonists (NOACs) are lacking. Our objective was to directly compare the effectiveness and safety of NOACs in patients with newly diagnosed atrial fibrillation (AF). Methods In GLORIA-AF, a large, prospective, global registry program, consecutive patients with newly diagnosed AF were followed for 3 years. The comparative analyses for (1) dabigatran vs rivaroxaban or apixaban and (2) rivaroxaban vs apixaban were performed on propensity score (PS)-matched patient sets. Proportional hazards regression was used to estimate hazard ratios (HRs) for outcomes of interest. Results The GLORIA-AF Phase III registry enrolled 21,300 patients between January 2014 and December 2016. Of these, 3839 were prescribed dabigatran, 4015 rivaroxaban and 4505 apixaban, with median ages of 71.0, 71.0, and 73.0 years, respectively. In the PS-matched set, the adjusted HRs and 95% confidence intervals (CIs) for dabigatran vs rivaroxaban were, for stroke: 1.27 (0.79–2.03), major bleeding 0.59 (0.40–0.88), myocardial infarction 0.68 (0.40–1.16), and all-cause death 0.86 (0.67–1.10). For the comparison of dabigatran vs apixaban, in the PS-matched set, the adjusted HRs were, for stroke 1.16 (0.76–1.78), myocardial infarction 0.84 (0.48–1.46), major bleeding 0.98 (0.63–1.52) and all-cause death 1.01 (0.79–1.29). For the comparison of rivaroxaban vs apixaban, in the PS-matched set, the adjusted HRs were, for stroke 0.78 (0.52–1.19), myocardial infarction 0.96 (0.63–1.45), major bleeding 1.54 (1.14–2.08), and all-cause death 0.97 (0.80–1.19). Conclusions Patients treated with dabigatran had a 41% lower risk of major bleeding compared with rivaroxaban, but similar risks of stroke, MI, and death. Relative to apixaban, patients treated with dabigatran had similar risks of stroke, major bleeding, MI, and death. Rivaroxaban relative to apixaban had increased risk for major bleeding, but similar risks for stroke, MI, and death. Registration URL: https://www.clinicaltrials.gov. Unique identifiers: NCT01468701, NCT01671007. Date of registration: September 2013. Graphical abstract
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