Impact of biventricular pacing on mortality in a randomized crossover study of patients with heart failure and ventricular arrhythmias

Abstract

Conclusion:The physiological immune response to exercise is diminished in CHF patients who also exhibit significant catabolic/anabolic imbalance. This finding supports the concept that CHF presents a complex clinical syndrome with alterations in metabolic and immunological pathways and that a reduced exercise capacity may be caused also by more peripherally rather than central, cardiac abnormalities. P106/9931Skeletal muscle atrophy and decreased muscle strength correlate with cytokine activation in chronic heart failure P.C. Schulze, S. MWius-Winkler, A. Linke, V. Adams, N. Schoene, S. Erbs, S. Gielen, M. Bus&, G. Schuler, R. Hambrecht. University of Leipzig, Heart Center, Department of Cardiology; ' University of Leipzig, Faculty of Sports, Department of Sports Medicine; Leipzig, GermanyPatients (pts) with chronic heart failure (CHF) show a progressive exercise intolerance and early muscle fatigue. Recently, activation of proinflammatory cytokines has been described in CHF. Animal studies showed muscle atrophy and a decreased in vitro muscle contractility under the influence of TNFcu. The aim of this study was to assess the relation between serum TNFa levels, muscle cross-sectional area (CSA) and muscle function of the thigh in pts with CHF and healthy controls. The study group consisted of 10 non-cachectic CHF pts and 8 agematched healthy controls (LVEF 23 f 2 vs. 69.7 * I%, BMI 26.9 f 0.6 vs. 28.8 f 1.0 kg/m*). Cross-sectional area (CSA) of the thigh was assessed by computerized tomography. Under electromyographical control, maximal quadriceps muscle strength and the relative decrease of muscle strength over a period of 20 s was measured. Serum-TNFcu was detected by immunoassay.Pts with CHF had elevated serum TNFu levels (2.84 f 0.37 pg/ml vs. 1.4 + 0.32 pg/ml, p < 0.01) and a reduced muscle CSA (139.3 f 9.7 cm* vs. 172.0 f 5.5 cm*, p < 0.01) as compared to healthy controls. Maximal quadriceps muscle strength did not significantly differ between the groups (236.9 f 30.9 N vs. 283.4 f 31.0 N). The decrease of maximal muscle strength as a parameter of fatiguebility was significantly higher in the CHF group (-0.115 f 0.025 N/s vs. -0.032 f 0.015 N/s, p < 0.01). Higher serum levels of TNFa correlated with a reduced muscle CSA (r = -0.48, p < 0.05). A faster decrease of muscle strenght correlated with both, a lower CSA (r = 0.5, p < 0.05) and higher serum levels of TNFar (r = -0.51, p < 0.05).Our data suggest that higher TNFor serum levels might contribute to a loss of muscle bulk and an impairment of muscle contractility in noncachectic patients with CHF. This could be a possible mechanism related to exercise intolerance and early muscle fatiguebility in CHF. P107/10164The early rehabilitation of patients with decompensated chmnic heart failure Cardiology, State Scienti$c-Clinical Centec Leninsk-Kuznetsky, Russian FederationThe purpose of this study was to investigate whether skeletal muscle electric stimulation could improve exercise performance in patients with decompensated chronic congestive heart failure (C...

Cardiac resynchronization therapy: a meta-analysis of randomized controlled trials

“…20,21,24,26,27 Seven trials compared cardiac resynchronization therapy and an implantable defibrillator (n = 2902) with an implantable defibrillator (n = 2281). 14,19,22,23,25,28,29 The length of follow-up ranged from 3 to 40 months. Five studies had a follow-up of 12 months or less.…”

“…The risk of bias was often low except for implantation of the cardiac synchronization therapy device after randomization [19][20][21][22][23]25,27,28 (Table 2). (For details see Appendix 5, at www.cmaj.ca /cgi /content /full /cmaj .101685 /DC1).…”

“…14,19,22,23,25,28,29 Patients with a spectrum of heart failure ranging from NYHA class I to IV were enrolled in these studies. A significant relative risk reduction of 17% was found (RR 0.83, 95% CI 0.72-0.96) (Figure 2).…”

Cardiac Resynchronization Therapy With or Without an Implantable Cardioverter Defibrillator in Different Groups of Heart Failure Patients

“…Studies were of good to moderate quality. Two trials reported that allocation to treatment group had been concealed (CARE-HF and MIRACLE), blinding occurred in three trials (CONTAK-CD, MUSTIC-SR and MIRACLE) and intention-to-treat was used in four analyses (CARE-HF, COMPANION, MIRACLE and MUSTIC-SR) [8][9][10][11]. In our study only patients who fulfilled criteria for an ICD also got the CRT-D pacemaker according to the guidelines of European Society of Cardiology [12].…”

Tratamiento de la insuficiencia cardíaca avanzada mediante estimulación biventricular. Experiencia inicial en una serie de 22 casos consecutivos

“…Asimismo, el reconocimiento de todos los factores predictores de respuesta clínica favorable y de los mecanismos que influyen en la mejoría de los pacientes, todavía no totalmente conocidos, sería de gran utilidad para refinar la selección de los pacientes que pueden beneficiarse de las técnicas de TRC. Por último, el efecto de este tratamiento en la supervivencia es el gran interrogante que en el futuro debe ser aclarado mediante los estudios multicéntricos actualmente en marcha 22 . En nuestra serie incluimos a 6 pacientes con insuficiencia cardíaca avanzada que ya estaban siendo estimulados crónicamente desde ápex de ventrículo derecho (VD) por bloqueo auriculoventricular completo para quienes no se disponía de otras opciones terapéu-ticas.…”