Clinical trials update and cumulative meta-analyses from the American College of Cardiology: WATCH, SCD-HeFT, DINAMIT, CASINO, INSPIRE, STRATUS-US, RIO-Lipids and cardiac resynchronisation therapy in heart failure

2004 ◽  
Vol 6 (4) ◽  
pp. 501-508 ◽  
Author(s):  
John G.F. Cleland ◽  
Justin Ghosh ◽  
Nick Freemantle ◽  
Gerry C. Kaye ◽  
Mansoor Nasir ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Trials ◽  
Cardiac Resynchronisation Therapy ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy ◽  
Meta Analyses

scholarly journals Širdies resinchronizacijos terapijos šiuolaikinės rekomendacijos: Vilniaus kardiologijos ir angiologijos centro patirtis

2010 ◽  
Vol 8 (3) ◽  
pp. 0-0
Author(s):  
Vytė Maneikienė ◽  
Germanas Marinskis ◽  
Audrius Aidietis ◽  
Sigita Aidietienė ◽  
Jelena Čelutkienė ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Trials ◽  
Cardiac Resynchronization Therapy ◽  
Clinical Guidelines ◽  
Cardiopulmonary Exercise Testing ◽  
Cardiac Resynchronisation Therapy ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy

Vytė Maneikienė, Germanas Marinskis, Audrius Aidietis, Sigita Aidietienė, Jelena Čelutkienė, Kęstutis Ručinskas, Vytautas Sirvydis, Aleksandras Laucevičius Vilniaus universiteto Širdies ir kraujagyslių ligų klinika, Santariškių g. 2, LT-08661 VilniusEl. paštas: [email protected] Įvadas / tikslas: Širdies resinchronizavimo terapijos metodas sumažina širdies nepakankamumo simptomus, pagerina širdies sistolinę funkciją ir išgyvenamumą pacientų, sergančių toli pažengusiu širdies nepakankamumu, atspariu optimaliam medikamentiniam gydymui, ir turinčių elektrinio širdies asinchroniškumo požymį – plačius QRS kompleksus, tačiau vėlyvieji ilgo stebėjimo rezultatai dar nėra iki galo aiškūs ir plačiai tyrinėjami. Darbo tikslas – apžvelgti pagrindines šiuolaikines resinchronizacijos taikymo nuorodas, papildomų atrankos kriterijų paieškų rezultatus; pateikti Vilniaus universitetinės ligoninės Santariškių klinikų Kardiologijos ir angiologijos centro patirties apžvalgą. Ligoniai ir metodai: Analizuojami pacientų, gydytų resinchronizacine terapija nuo 2002 metų vidurio iki 2009 metų pabaigos, atvejai. Klinikinė informacija renkama iš pacientų ligos istorijų, ambulatorinio stebėjimo kortelių. Visi iki šiol gyvenantys pacientai periodiškai kviečiami nuodugniai klinikinei patikrai. Prieš ir po resinchronizacijos procedūros atliekami išplėstiniai širdies echoskopijos tyrimai įvertinant mechaninį asinchroniškumą, spiroergometrijos tyrimai, nustatomas smegenų natriurezinio peptido kiekis kraujyje. Rezultatai: Per aštuonerius metus, nuo 2002 iki 2009 metų pabaigos, implantuoti 92 resinchronizacijos prietaisai. Darbų apimtis gerokai padidėjo per pastaruosius dvejus metus. Šių pacientų, priklausančių III–IV NYHA funkcinei klasei, išgyvenamumo rodikliai yra geri (mirštamumas per 8 metus – tik 10,8 %). Daliai pacientų (4 %) biventrikuliniai stimuliatoriai tapo tiltu į sėkmingą širdies transplantaciją. Išvados: Širdies resinchronizavimo terapija saugiai ir gana veiksmingai pagerina pacientų, sergančių širdies nepakankamumu ir priklausančių III–IV NYHA funkcinei klasei, gyvenimo kokybę. Atrenkant pacientus gydyti šiuo būdu pagal šiuolaikines rekomendacijas, išlieka didelis procentas nepakankamai gerų rezultatų, nors tokios toli pažengusio širdies nepakankamumo grupės ligonių išgyvenamumas yra daug geresnis nei tikėtinas. Reikšminiai žodžiai: resinchronizacija, širdies nepakankamumas, klinikinės studijos Current clinical guidelines for cardiac resynchronization therapy: the experience of vilnius cardiology-angiology center Vytė Maneikienė, Germanas Marinskis, Audrius Aidietis, Sigita Aidietienė, Jelena Čelutkienė, Kęstutis Ručinskas, Vytautas Sirvydis, Aleksandras Laucevičius Vilnius University, Clinic of Cardiovascular Diseases, Santariškių str. 2, LT-08661 Vilnius, LithuaniaEl. paštas: [email protected] Background /objective: Cardiac resynchronisation therapy improves cardiac function and clinical outcomes for patients suffering from congestive heart failure due to systolic dysfunction associated with ventricular dyssinchrony, who are already optimized with medical therapy. The aim of the study was to present the current clinical guidelines of cardiac resynchronization therapy and the results of current clinical trials, as well as to overview the experience of the Vilnius cCardiology-aAngiology Center. Patients and Methods: We analyse patients who underwent cardiac resynchronisation therapy in 2002–2009. Their in- and outpatient histories were studied. The patients were tested before and after the procedure. eEchocardiography was performed to assess mechanical dyssinchrony, cardiopulmonary exercise testing, B-type natriuretic peptide level. Results:Between June 2002 and December 2009 92 resynchronisation devices, were implanted. Cardiac resynchronisation therapy resulted in a higher survival of patients with NYHA III–IV. For four patients, resynchronisation therapy was a bridge to successful transplantation. Conclusions: Cardiac resynchronization therapy safely improved the quality of life in patients with moderate to severe chronic heart failure (New York Heart Association class III–IV). The present criteria for patient selection have some percent age of no responders, but the survival rate in this group of patients is significantly higher than could be expected. Keywords: resynchronization, heart failure, clinical trials

Cardiac Resynchronisation Therapy – Evolving Strategies to Enhance Response

2010 ◽  
Vol 6 (1) ◽  
pp. 83
Author(s):  
Jagmeet P Singh ◽  
Keyword(s):  
Heart Failure ◽  
Systolic Heart Failure ◽  
Cardiac Resynchronisation Therapy ◽  
Left Ventricular ◽  
Patient Specific ◽  
Cardiac Resynchronisation ◽  
Clinical Benefits ◽  
Pacing Lead ◽  
Resynchronisation Therapy ◽  
Physiological Impact

Cardiac resynchronisation therapy (CRT) has gained widespread acceptance as a safe and effective therapeutic strategy for congestive heart failure (CHF) refractory to optimal medical therapy. The use of implantable devices has substantially altered the natural history of systolic heart failure. These devices exert their physiological impact through ventricular remodelling, associated with a reduction in left ventricular (LV) volumes and an improvement in ejection fraction (EF). Several prospective randomised studies have shown that this in turn translates into long-term clinical benefits such as improved quality of life, increased functional capacity and reduction in hospitalisation for heart failure and overall mortality. Despite these obvious benefits, there remain more than a few unresolved concerns, the most important being that up to one-third of patients treated with CRT do not derive any detectable benefit. There are several determinants of successful delivery and response to CRT, including selecting the appropriate patient, patient-specific optimal LV pacing lead placement and appropriate post-implant device care and follow-up. This article highlights the importance of collectively working on all of these aspects of CRT to enhance and maximise response.

Atrial Fibrillation in Heart Failure Patients

2009 ◽  
Vol 5 (1) ◽  
pp. 41
Author(s):  
Michalis Efremidis ◽  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Rate Control ◽  
Clinical Trial Data ◽  
Cardiac Resynchronisation Therapy ◽  
Controlled Clinical Trial ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy ◽  
Randomised Controlled ◽  
Near Future

There is a sinister synergism between atrial fibrillation (AF) and heart failure (HF). These common cardiovascular conditions often co-exist and result in significant morbidity and mortality. Despite the extensive amount of research and literature about each of these disorders separately, randomised controlled clinical trial data concerning the management of AF in patients with HF are lacking. The recently published Atrial Fibrillation and Congestive Heart Failure (AF-CHF) trial elucidated the matter of rhythm versus rate control. In addition, non-pharmacological treatment approaches such as catheter ablation of AF and cardiac resynchronisation therapy are rapidly growing and are likely to alter AF management in HF patients in the near future.

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