No abstract

No abstract

No abstract

Background: The effects of upgrading from right ventricular (RV) pacing to cardiac resynchronization therapy (CRT) in patients with heart failure remains unclear. The aim of this study was to evaluate the improvement of cardiac function in patients upgraded from RV pacing to CRT.Methods: We studied 48 consecutive patients who underwent CRT implantation, and were followed up for more than 6 months. This group included 15 patients who were upgraded from RV pacing. We measured left ventricular (LV) dp/dt to determine the timing of LV-RV sequential pacing. Echocardiographic examination was performed before and 6-12 months after the CRT procedure to assess the LV ejection fraction (LVEF).Results: In overall patients, LVEF increased after CRT (31:4 AE 9:8 vs. 37:1 AE 13:6%, p ¼ 0:005). The increase of LVEF was more significant in the upgrade group (31:3 AE 9:4% to 41:9 AE 13:9%, p ¼ 0:01) than in the newly implanted group (31:5 AE 10:1% to 35:0 AE 13:1%, p ¼ 0:13). An increase of dp/dt during CRT was significantly positively associated with an increase of LVEF (r ¼ 0:74, p ¼ 0:01) in overall patients.Conclusion: The upgrading from RV pacing to CRT was associated with greater improvement of LV systolic function than de novo CRT implantation. The change of dp/dt might be useful to predict the improvement of LV systolic function. (J Arrhythmia 2010; 26: 16-20)

No abstract

No abstract

No abstract

Background Primary aldosteronism can cause cardiac dysfunction, including left ventricular hypertrophy, left ventricular diastolic dysfunction, and left atrial enlargement. A few studies have compared the cardioprotective effects between surgery and medication for primary aldosteronism, although most have not adjusted for baseline disease status. In this study, we investigated the difference in cardiovascular outcomes between surgery and medication treatment for primary aldosteronism after adjusting for baseline clinical characteristics, including aldosterone level and pretreatment echocardiographic information. Methods and Results We retrospectively analyzed 220 patients diagnosed with primary aldosteronism who underwent adrenalectomy (n=144) or medication treatment (n=76) between 2009 and 2019. Echocardiographic changes were evaluated pretreatment and 1 year posttreatment. The surgery group had lower potassium, lower plasma renin activity, and higher plasma aldosterone concentration than the medication group, indicating a severe primary aldosteronism phenotype in the former. The decrease in left ventricular mass index after treatment was significantly greater in the surgery group than in the medication group ( P =0.047). However, this relationship was not noted after multivariable regression analysis (standard β=−0.08, P =0.17). Additionally, decreased parameter values related to left ventricular diastolic dysfunction and left atrial enlargement were not different between the groups. Pretreatment echocardiographic values were most associated with changes in all echocardiographic parameters. The findings were consistent in the propensity score‐matched analysis. Conclusions This study's findings suggest that there is no difference in cardioprotective efficacy between surgical and medication treatment under similar disease severity; however, it should be considered that several study participants with severe hyperaldosteronism were managed surgically.