P542Cardiac autonomic dysfunction and inflammatory response in heart failure - markers for cardiac resynchronization therapy response?

Abstract Funding Acknowledgements FCP Introduction Cardiac sympathetic activation and inflammatory response are involved in chronic heart failure (HF) pathophysiology. The severity of autonomic dysfunction and inflammation might be responsible for different responses to HF treatment. Aim To evaluate the impact of cardiac autonomic dysfunction, and it´s association with systemic inflammation, on cardiac resynchronization therapy (CRT) response in severe HF patients. Methods Single centre, prospective, longitudinal study, including consecutive patients, referred to CRT. Demographic data, HF aetiology and NYHA class were evaluated. Left ventricular (LV) function data (LV ejection fraction - LVEF) by echocardiography, heart to mediastinum early ratio (HMRe) by 123I-MIBG cardiac scintigraphy, and plasmatic TNF-α levels (pg/mL) were determined, at baseline and 4 months after CRT implantation. CRT response was defined by an absolute increase of at least 5% in LVEF at 4 months evaluation after CRT. Patients were divided in 4 groups according to HMRe and TNF-α cut-points: Group I (TNF-α > 2.0 pg/ml + HMRe ≥ 1.6), Group II (TNF-α > 2.0 pg/ml + HMRe < 1.6), Group III (TNF-α ≤ 2.0 pg/ml + HMRe ≥ 1.6) and Group IV (TNF-α ≤ 2.0 pg/ml + HMRe < 1.6). Data was analyzed using descriptive statistics and groups were compared by Fisher"s exact test. Results A total of 95 patients were included (age 68.6 ± 10.2 years), 67.4% male and 32.6% female, 40% with diabetes mellitus, 30.5% with ischemic cardiomyopathy, 23.2% in NYHA III/IV, baseline LVEF - 26 ± 7%. At 4 months, LVEF was 40 ± 11%. In total, 73.7% were responders and 26.3% were non-responders to CRT. There were 28 patients (29.5%) with HMRe ≥ 1.6, with 25 responders (89.3%) and 48 patients (50.5%) with TNF-α ≤ 2.0 pg/ml, with 38 responders (79.2%). Group I had 16 patients (16.8%), with 81.2% responders; Group II had 31 patients (32.7%), with 61.3% responders; Group III had 12 patients (12.6%), with 100% responders, and Group IV had 36 patients (37.9%), with 72.2% responders. Conclusion: In patients with severe HF submitted to CRT, combining cardiac autonomic dysfunction and inflammation, associated to high rate of CRT non response. Contrarily, those with preserved cardiac autonomic function and no increased levels of inflammation identified most significantly CRT responders. CRT response according to HMRe and TNFα HMRe ≥ 1.6 (n = 28) HMRe < 1.6 (n = 67) Responders NO Respondersn (%) Responders NO Respondersn (%) TNF α > 2 pg/mL (n = 47) G I: 13 (81.2%) 3 (18.8%) GII: 19 (61.3%) 12 (38.7%) * TNF α ≤ 2 pg/mL (n = 48) G III: 12 (100%) 0 (0%)* G IV: 26 (72.2%) 10 (27.8%)

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The prognostic significance of cardiac sympathetic activity and dyssynchrony in cardiac resynchronization therapy in ischemic and non-ischemic heart failure patients

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.335 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

A Mishkina ◽

K Zavadovsky ◽

V Saushkin ◽

D Lebedev ◽

Y Lishmanov

Keyword(s):

Heart Failure ◽

Cardiac Resynchronization Therapy ◽

Sympathetic Activity ◽

Gated Spect ◽

Prognostic Significance ◽

Cardiac Resynchronization ◽

Resynchronization Therapy ◽

Cardiac Sympathetic Activity ◽

Heart Failure Patients ◽

Crt Response

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Russian Foundation for Basic Research Introduction Impaired cardiac sympathetic activity and contractility are associated with poor prognosis in patients with heart failure after cardiac resynchronization therapy (CRT). There are few prognostic data of the cardiac sympathetic activity and dyssynchrony in patients with chronic heart failure of various etiologies. Purpose To examine the prognostic significance of scintigraphic cardiac sympathetic activity and contractility in predicting the response to CRT and to assess the differences between patients with ischemic (IHF) and non-ischemic (NIHF) heart failure. Methods This study included 38 heart failure patients (24 male; mean age of 56 ± 11 years; 16 patients with ischemic etiology), who were submitted to CRT. Before CRT all patients underwent 123I-metaiodobenzylguanidine (123I-MIBG) imaging for cardiac sympathetic activity evaluating: early and delay heart to mediastinum ratio (eH/M and dH/M), summed MIBG Score (eSMS and dSMS). Moreover all patients underwent gated SPECT with the assessments of left ventricle dyssynchrony indexes: standard deviation (SD) and histogram bandwidth (HBW). In addition, all patients underwent gated blood-pool SPECT (GBPS) to assessed ejection fraction (EF) and stroke volume (SV) of both ventricles. Results One year after CRT response defined as LV ESV decreased by≥15% and/or LV EF increase by≥5%. Baseline cardiac sympathetic activity parameters showed significant differences between responders and non-responders only in NIHF patients: eH/M: 2.27 (2.02–2.41) vs. 1.64 (1.32–2.16); dH/M: 2.18 (2.11–2.19) vs. 1.45 (1.23 – 1.61); eSMS: 7 (5-7) vs. 15.5 (10–28.5); dSMS: 10 (10–13) vs. 16.5 (15.5–29). Significant differences in baseline LV dyssynchrony indexes between responders and non-responders were in patients of both group: in NIHF patients - SD: 54.3 (43–58) degree vs. 65 (62–66) degree; HBW: 179.5 (140–198) degree vs. 211 (208-213) degree, p < 0.054 in IHF patients - HBW: 162 (115.2–180) degree vs. 115.2 (79.2–136.8) degree. Contractility of RV was significantly differed between responders and non-responders in IHF patients: RV EF: 54.5 (41-56) % vs. 44.5 (37–49.5) %; RV SV: 80 (69-101) ml vs. 55.5 (50–72.5) ml. According to univariate logistic regression analyses in IHF patients LV dyssynchrony indexes – SD (OR = 1.55; 95% CI 1.09-2.2; p < 0.5) and HBW (OR = 1.13; 95% CI 1.02-1.24; p < 0.5), as well as RV indexes – RV EF (OR = 1.11; 95% CI 1.001-1.23; p < 0.5), RV SV (OR = 1.07; 95% CI 1.003-1.138; p < 0.5) were predictors of CRT response. In the group of NIHF patients, dH/M (OR = 1.47; 95% CI 1.08-2; p < 0.5), SD (OR = 0.83; 95% CI 0.73-0.95; p < 0.5), HBW (OR = 0.96; 95% CI 0.93-0.99; p < 0.5) showed the predictive value in terms of CRT response. Conclusion Scintigraphic methods can be used to select patients for CRT. Cardiac 123I-MIBG scintigraphy and gated SPECT may be used for predicting CRT response in NIHF patients. Whereas in IHF patients ECG-gated SPECT and GBPS may be valuable for predicting the response to CRT.

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Importance of systematic right ventricular assessment in cardiac resynchronization therapy candidates: a machine-learning approach

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.044 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

E Galli ◽

V Le Rolle ◽

OA Smiseth ◽

J Duchenne ◽

JM Aalen ◽

...

Keyword(s):

Machine Learning ◽

Heart Failure ◽

Cardiac Resynchronization Therapy ◽

Right Ventricular ◽

Systolic Heart Failure ◽

Left Ventricular ◽

Supervised Machine Learning ◽

Cardiac Resynchronization ◽

Resynchronization Therapy ◽

Crt Response

Abstract Funding Acknowledgements Type of funding sources: None. Background Despite having all a systolic heart failure and broad QRS, patients proposed for cardiac resynchronization therapy (CRT) are highly heterogeneous and it remains extremely complicated to predict the impact of the device on left ventricular (LV) function and outcomes. Objectives We sought to evaluate the relative impact of clinical, electrocardiographic, and echocardiographic data on the left ventricular (LV) remodeling and prognosis of CRT-candidates by the application of machine learning (ML) approaches. Methods 193 patients with systolic heart failure undergoing CRT according to current recommendations were prospectively included in this multicentre study. We used a combination of the Boruta algorithm and random forest methods to identify features predicting both CRT volumetric response and prognosis (Figure 1). The model performance was tested by the area under the receiver operating curve (AUC). We also applied the K-medoid method to identify clusters of phenotypically-similar patients. Results From 28 clinical, electrocardiographic, and echocardiographic-derived variables, 16 features were predictive of CRT-response; 11 features were predictive of prognosis. Among the predictors of CRT-response, 7 variables (44%) pertained to right ventricular (RV) size or function. Tricuspid annular plane systolic excursion was the main feature associated with prognosis. The selected features were associated with a very good prediction of both CRT response (AUC 0.81, 95% CI: 0.74-0.87) and outcomes (AUC 0.84, 95% CI: 0.75-0.93) (Figure 1, Supervised Machine Learning Panel). An unsupervised ML approach allowed the identifications of two phenogroups of patients who differed significantly in clinical and parameters, biventricular size and RV function. The two phenogroups had significant different prognosis (HR 4.70, 95% CI: 2.1-10.0, p < 0.0001; log –rank p < 0.0001; Figure 1, Unsupervised Machine Learning Panel). Conclusions Machine learning can reliably identify clinical and echocardiographic features associated with CRT-response and prognosis. The evaluation of both RV-size and function parameters has pivotal importance for the risk stratification of CRT-candidates and should be systematically assessed in patients undergoing CRT. Abstract Figure 1

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Epicardial Adipose Tissue Measured From Computed Tomography Predicts Cardiac Resynchronization Therapy Response in Patients With Non-ischemic Systolic Heart Failure

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.678467 ◽

2021 ◽

Vol 8 ◽

Author(s):

Hui-yuan Qin ◽

Cheng Wang ◽

Duo-duo Qian ◽

Chang Cui ◽

Ming-long Chen

Keyword(s):

Heart Failure ◽

Adipose Tissue ◽

Regression Analysis ◽

Epicardial Adipose Tissue ◽

Left Ventricular ◽

Cardiac Resynchronization ◽

Resynchronization Therapy ◽

Qrs Duration ◽

Response Group ◽

Crt Response

Background: Epicardial adipose tissue (EAT) has been linked with the pathogenesis of heart failure (HF). Limited data have been reported about the clinical value of EAT for cardiac resynchronization therapy (CRT) in non-ischemic systolic HF. We aimed to explore the values of EAT measured from CT to predict the response to CRT in patients with non-ischemic systolic HF.Methods: Forty-one patients with CRT were consecutively recruited for our study. All patients received both gated resting Single Photon Emission CT (SPECT) myocardial perfusion imaging (MPI) and dual-source multi-detector row CT scans. EAT thickness was assessed on both the parasternal short and horizontal long-axis views. The area of EAT was calculated at the left main coronary artery level. Left ventricular systolic mechanical dyssynchrony (LVMD) was measured by phase standard deviation (PSD) and phase histogram bandwidth (PBW). The definition of CRT response was an improvement of 5% in left ventricular ejection fraction (LVEF) at 6 months after CRT implantation.Results: After 6 months of follow-up, 58.5% (24 of 41) of patients responded to CRT. A greater total perfusion deficit (TPD) was observed in the left ventricle, and a narrower QRS complex was observed in the nonresponse group than in the response group (p < 0.05). Meanwhile, the systolic PSD and systolic PBW were statistically greater in the CRT group with no response than in the response group (p < 0.05). Meanwhile, the baseline QRS duration, TPD, systolic PSD, systolic PBW, EAT thicknesses of the left ventricular (LV) apex, right atrioventricular (AV) groove, and left AV groove were all significantly related to the CRT response in the univariate logistic regression analysis. Furthermore, the QRS duration and EAT thicknesses of the right AV groove and left AV groove were independent predictors of CRT response in the multivariate logistic regression analysis.Conclusions: The EAT thickness of the left AV groove in patients with non-ischemic systolic HF is associated with the TPD of LV and LV systolic dyssynchrony. The EAT thickness of the AV groove has a good predictive value for the CRT response in patients with non-ischemic systolic HF.

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P3802Electrophysiological and structural heart features in patients with heart failure and response to cardiac resynchronization therapy

European Heart Journal ◽

10.1093/eurheartj/ehz745.0647 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Utsumueva ◽

O Stukalova ◽

N Mironova ◽

S Kashtanova ◽

T Malkina ◽

...

Keyword(s):

Heart Failure ◽

Cardiac Resynchronization Therapy ◽

Cardiac Resynchronization ◽

Resynchronization Therapy ◽

Lead Position ◽

Patients With Heart Failure ◽

Qrs Duration ◽

Response Group ◽

Crt Response ◽

Device Programming

Abstract Introduction As a significant number of patients with heart failure (HF) does not respond to cardiac resynchronization therapy (CRT), a lot of research has deservedly focused on optimization, and better patient selection. The ideal resynchronization depends on different factors, from device programming to heart features and left ventricle (LV) lead position. Analysis of the 12 lead electrocardiogram (ECG) is the most simple method which can provide important information on LV lead location, presence of scar at LV pacing site, and fusion of intrinsic activation or RV pacing with LV pacing. Purpose To analyze the electrophysiological and structural heart features and their correlation with the ECG pattern during biventricular (BV) pacing in patients with HF and CRT devices. Methods The study included 47 patients (mean age 62,3±8,9 yrs) with LBBB, QRS≥130 ms, LV ejection fraction (LVEF) ≤35%, heart failure (HF) NYHA II-IV despite optimal pharmacological therapy during 3 months. All patients had undergone CRT-D implantation. Late-gadolinium enhancement-cardiovascular magnetic resonance, 12 lead ECG, non-invasive cardiac mapping (NICM) (with obtaining the zone of late LV activation were undertaken prior to CRT devices implantation. NICM with cardiac CT and evaluation of LV lead position, ECG pattern during BV pacing (#1 - fusion complex with increased or dominant R wave, independent of QRS duration, #2- QS pattern with QRS duration normalization, and #3- QS pattern with increased QRS duration) were undertaken after CRT devices implantation. Response to CRT was estimated by echo and was defined as decrease in LV end-systolic volume by >15% after 6 months of follow-up. Results CRT was effective in 28 patients (59,5%). According to the results of NICM, zone of late LV activation more often was located at 5,6,11,12 segments, and LV pacing site – at 6,7,12 segments of LV. In the “response” group overlap of scar zone and zone of late LV activation was observed (p=0,005). The presence of scar tissue in the LV pacing site was associated with CRT non-response (p<0.001), and the pacing zone of late LV activation resulted in the best CRT response (p<0.001). The distance from the LV electrode to the zone of late LV activation was less in the “CRT response” group (33 [20; 42] mm vs 83 [55; 100] mm, p<0.001). The most beneficial ECG pattern during BV pacing was #2, which found more often found in case of pacing zone of late LV activation. Configuration #3 was more often observed in the group “CRT non-response”; #1 was intermediate between ECG patterns #2 and #3. Conclusions A comprehensive examination, including the study of the structural and electrophysiological heart features is important for the optimal positioning the LV lead and subsequent CRT device programming. The simple analysis of the QRS pattern during BV pacing can show whether biventricular pacing is adequately performed and can reveal inadequate CRT programming and LV lead positioning.

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Immunohistochemical Inflammation in Histologically Normal Appendices in Patients with Right Iliac Fossa Pain

World Journal of Surgery ◽

10.1007/s00268-021-06288-w ◽

2021 ◽

Author(s):

Emmanouil Psaltis ◽

Abed M. Zaitoun ◽

Keith R. Neal ◽

Dileep N. Lobo

Keyword(s):

Iliac Fossa ◽

Group Iv ◽

Serotonin Content ◽

Group Iii ◽

Immunohistochemical Markers ◽

Markers Of Inflammation ◽

Group I ◽

Tnf Α ◽

Right Iliac Fossa Pain ◽

Elective Colectomy

Abstract Background Histologically normal appendices resected for right iliac fossa pain in children demonstrate immunohistochemical markers of inflammation. We aimed to establish if subclinical inflammation was present in histologically normal appendices resected from adults with right iliac fossa pain. Methods Immunohistochemistry was performed on formalin-fixed paraffin-embedded appendices for tumour necrosis factor (TNF)-α, interleukin (IL)-6, IL-2R and serotonin in four groups: Group I (n = 120): uncomplicated appendicitis, Group II (n = 118): complicated appendicitis (perforation or gangrene), Group III (n = 104): histologically normal appendices resected for right iliac fossa pain and Group IV (n = 106) appendices resected at elective colectomy. Expression was quantified using the H-scoring system. Results Median, interquartile range expression of TNF-α was increased in Groups I (5.9, 3.1–9.8), II (6.8, 3.6–12.1) and III (9.8, 6.2–15.2) when compared with Group IV (3.0, 1.4–4.7, p < 0.01). Epithelial expression of IL-6 in Groups II (44.0, 8.0–97.0) and III (71.0, 18.5–130.0) was increased when compared with Group IV (9.5, 1.0–60.2, p < 0.01). Expression of mucosal IL-2R in Groups I (47.4, 34.8–69.0), II (37.8, 25.4–60.4) and III (18.4, 10.1–34.7) was increased when compared with Group IV (2.8, 1.2–5.7, p < 0.01). Serotonin content in Groups I (3.0, 0–30.0) and II (0, 0–8.5) was decreased when compared with Groups III (49.7, 16.7–107.5) and IV (43.5, 9.5–115.8, p < 0.01). Conclusion Histologically normal appendices resected from symptomatic patients exhibited increased proinflammatory cytokine expression on immunohistochemistry suggesting the presence of an inflammatory process not detected on conventional microscopy.

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Acute heart failure in congenital heart disease in adults: a single-institution study in Latin-America

European Heart Journal ◽

10.1093/eurheartj/ehab724.1886 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

D B Ortega Zhindon ◽

H Gonzalez-Pacheco ◽

J L Cervantes-Salazar ◽

J Calderon-Colmenero ◽

D Manzur-Sandoval ◽

...

Keyword(s):

Heart Failure ◽

Congenital Heart Disease ◽

Heart Disease ◽

Hospital Mortality ◽

Acute Heart Failure ◽

Congenital Heart ◽

Group Iv ◽

Group V ◽

Group Iii ◽

Group I

Abstract Background Heart failure in the adult with adult congenital heart disease (ACHD) is a current topic due to its association with high morbidity and mortality and has been implicated as the leading cause of death in these kinds of patients. Purpose This study reports experience of patients with ACHD and Acute Heart Failure (AHF) hospitalized at a teaching center specialized in cardiovascular disease in Latin America. Methods A retrospective cohort study of patients with AHF who were hospitalized in the coronary care unit of a Latin-American teaching hospital from January 2006 to December 2018. Patients with ACHD were identified and their clinical characteristics and in-hospital evolution were analyzed. Results During the study period, of 7,759 patients admitted with AHF, 181 (2.3%) had ACHD. Their median age was 34 years and 53.6% were men. Patients were grouped as follows: (Group I) left to right shunt 51.4%, (Group II) left ventricular outflow tract obstruction 17.7%, (Group III) outflow tract obstruction of the right ventricle 7.2%, (Group IV) conotronchal anomalies 3.9% and (Group V) miscellaneous group 19.9%. In general, history of previous surgery was in 28.2%, the frequency was higher in Group I and Group III (38.5% and 31.3%, respectively). Overall, all-cause in-hospital mortality was higher among patients with AHF- ACHD compared with patients without ACHD with AHF (23.2% vs. 17.8%; p=0.05). Unadjusted in-hospital mortality was not significant different across the five groups (21.5%, 28.1%, 7.7%, 42.9% and 25.0% for Group I, Group II, Group III, Group IV and Group V, respectively; p=0.41) (Figure 1). Conclusions Adult patients with congenital heart disease and acute heart failure are a challenge in clinical and surgical management that entails a high in-hospital mortality. A high percentage of these patients are candidates for surgical treatment. FUNDunding Acknowledgement Type of funding sources: None. Figure 1

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P5973Regional left ventricular myocardial work and response to cardiac resynchronization therapy

European Heart Journal ◽

10.1093/eurheartj/ehz746.0694 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Cited By ~ 1

Author(s):

M V Kostyukevich ◽

P Van Der Bijl ◽

N M Vo ◽

N Ajmone Marsan ◽

V Delgado ◽

...

Keyword(s):

Heart Failure ◽

Cardiac Resynchronization Therapy ◽

Speckle Tracking ◽

Multivariable Analysis ◽

Lateral Wall ◽

Left Ventricular ◽

Cardiac Resynchronization ◽

Resynchronization Therapy ◽

Constructive Work ◽

Crt Response

Abstract Background Myocardial work, assessed by speckle tracking echocardiography, reflects mechanical efficiency of the left ventricle. In heart failure patients, characterization of acute changes in regional (septal and lateral) left ventricular (LV) myocardial walls after cardiac resynchronization therapy (CRT) may enhance understanding of CRT response. Objective To evaluate the interaction between CRT response and components of myocardial work of the lateral wall and septum in patients with heart failure. Methods Regional LV myocardial work was calculated by integrating non-invasive blood pressure measurements, timing of mitral and aortic valve opening and closure and speckle tracking-derived LV longitudinal strain. From pressure-strain loops, constructive work (CW) and wasted work (WW) were calculated. CRT response was defined as a decrease in LV end-systolic volume ≥15% at 6 months follow-up. Changes in CW and WW of the septal and lateral walls prior to (baseline) and within the first 5 days after CRT implantation were compared between CRT responders and non-responders. Results At baseline, measurement of regional CW and WW was performed in 168 patients treated with CRT (71% men, 66±10 years). At 6 months, 59% of patients were CRT responders. CRT responders more frequently had non-ischemic heart failure than non-responders (54% vs 36%; p=0.027). At baseline, CRT responders were characterized by a significantly higher septal WW (270.5 [160.0; 451.5] mmHg% vs. 210.5 [106.3; 336.5] mmHg%; p=0.038) and lateral CW (989.5 [574.0; 1439.0] mmHg% vs. 689.0 [463,3; 1140.0] mmHg%; p=0.005). On multivariable analysis, only CW of the lateral wall at baseline was independently associated with CRT response (HR 1.001; 95% CI, 1.000–1.001; p=0.048). Immediately after CRT implantation, measurement of regional CW and WW was feasible in 115 patients. CRT responders showed improvement in CW (433.0 [254.5; 686.5] mmHg% to 664.5 [424.5; 977.8] mmHg%; p<0.001) and WW (305.0 [169.0; 461.3] mmHg% to 145.0 [80.0; 306.3] mmHg%; p=0.005) of the septum whereas the lateral wall demonstrated a significant decrease in CW (1036.5 [561.0; 1402.0] to 818.0 [491.0; 1154.3] mmHg%; p=0.005) and increase in WW (132.5 [80.3; 269.3] to 198.5 [107.5; 331.0] mmHg%; p=0.025). Non-responders showed only a decrease in WW of the septum (202.8 [102.9; 332.5] to 168.5 [67.6; 258.4] mmHg%; p=0.049). Conclusion CRT responders are characterized by increased WW of the septum and CW of the lateral wall at baseline, which are corrected immediately after CRT implantation. Constructive work of the LV lateral wall at baseline is independently associated with CRT response. Acknowledgement/Funding Study was supported by ESC Research grant 2018

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Clinical Usefulness of N-terminal Prohormone of Brain Natriuretic Peptide and High Sensitivity Troponin T in Patients with Heart Failure Undergoing Cardiac Resynchronization Therapy

Current Pharmaceutical Design ◽

10.2174/1381612825666190621155718 ◽

2019 ◽

Vol 25 (14) ◽

pp. 1671-1678

Author(s):

Agnieszka Debska-Kozlowska ◽

Marcin Ksiazczyk ◽

Izabela Warchol ◽

Andrzej Lubinski

Keyword(s):

Heart Failure ◽

Cardiac Resynchronization Therapy ◽

Brain Natriuretic Peptide ◽

Troponin T ◽

High Sensitivity ◽

Cardiac Resynchronization ◽

Resynchronization Therapy ◽

High Sensitivity Troponin T ◽

Crt Response

Background: Cardiac resynchronization therapy (CRT) is a valuable intracardiac device-based treatment option for a subgroup of patients with advanced heart failure (HF) and QRS prolongation. However, still a significant proportion of patients do not benefit from CRT implantation, labeled as non-responders. Objectives: The aim of the present study was to evaluate the N-terminal prohormone of brain natriuretic peptide (NT-pro BNP) and high sensitivity troponin T (cTnThs) value as predictors of CRT response in a 12-month observation. Materials and Methods: The study included 46 patients with HF and implanted CRT-D. Levels of NT-pro BNP and cTnThs were assessed during a 12 month follow up. Results: 46 consecutive patients (76% men) with a mean age of 64±8 were observed for 12 months. The CRT response criteria was met by 26 patients (56,5%). A significant decline in the NT-pro BNP concentrations was documented in responders (p=0.001). Moreover, ΔNT-pro BNP by at least 579 pg/ml had high sensitivity and specificity for identifying the CRT responders. There were no statistically significant differences in the results of cTnThs between the two study groups. Conclusion: The relative change in the level of NT-pro BNP by at least 43,5% allows to identify the responders to CRT after 12 months of follow-up. Serial measurements of NT-pro BNP can be a valuable tool for monitoring the effectiveness of CRT.

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The relationship between cardiac resynchronization therapy and serum levels of copeptin in patients with chronic heart failure

EP Europace ◽

10.1093/europace/euab116.429 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

M Kerekanic ◽

M Hudak ◽

M Jakubova ◽

D Kucerova ◽

S Misikova ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Cardiac Resynchronization Therapy ◽

Systolic Dysfunction ◽

Serum Levels ◽

Left Ventricular ◽

Public Institution ◽

Cardiac Resynchronization ◽

Resynchronization Therapy ◽

Crt Response

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): The present study was supported by a grant from Slovak Hearth Rhythm Association (Prognostic value of MR-proANP and MR-proADM in patients undergoing cardiac resynchronization therapy). Background Chronic heart failure (CHF) is a complex syndrome characterized by an abnormal neurohormonal activation, including arginine vasopressin (AVP). Copeptin is an indicator of AVP activation, which levels are elevated in CHF and have prognostic importance. Cardiac resynchronization therapy (CRT) is an important device therapy for patients with advanced CHF, left ventricular (LV) systolic dysfunction and evidence of electromechanical dyssynchrony. The aim of the present study was to determine the possible relationship between CRT and serum copeptin levels. Methods We have included CRT patients with ischemic as well as nonischemic etiology of CHF. The levels of copeptin were measured at baseline and 12 months respectively after CRT implantation. Echocardiography was also performed pre and 12 months post CRT implantation. A CRT response was defined as a ≥ 15 % reduction in LV end-systolic volume (LVESV). Results The study population consisted of 41 patients. The mean copeptin level was 20.50 ± 15.77 pmol/l. Copeptin levels positively correlated with New York Heart Association class, left atrial diameter, creatinine levels and NT-proBNP levels. CRT responders have significant reduction in copeptin levels from baseline to 12 months (from 16.96 ± 12.80 pmol/l to 6.20 ± 6.44 pmol/l, p < 0.001). No significant changes in copeptin levels were observed in CRT nonresponders. Reduction > 45 % in copeptin levels was predictor of CRT-response (OR 6.72, 95 % CI 1.01 - 18.11, p = 0.045). Conclusion The copeptin serum levels can be a useful biomarker in the evaluation of the CRT response.

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Ameliorating Effect of Combined Cinnamon and Ginger Oils against the Neurotoxicity of Nicotine Administration on the Prefrontal Cortex of Adult Albino Rats: Immunohistochemical and Ultrastructural Study

Scientia Pharmaceutica ◽

10.3390/scipharm89030041 ◽

2021 ◽

Vol 89 (3) ◽

pp. 41

Author(s):

Medhat Taha ◽

Mohie Mahmoud Ibrahim ◽

Mamdouh Eldesoqui ◽

Mohamed A. M. Iesa ◽

Tourki A. S. Baokbah ◽

...

Keyword(s):

Oxidative Stress ◽

Prefrontal Cortex ◽

Group Iv ◽

Tissue Homogenate ◽

Control Group ◽

Albino Rats ◽

Group Iii ◽

Group I ◽

Tnf Α ◽

Group Ii

Background: Nicotine is the active alkaloid in cigarettes. It was reported that tobacco smoking has many hazards; one of these hazards is the effect on the cognitive function of the prefrontal cortex. The aim of our study is to investigate the antioxidant effects of ginger, cinnamon oils, and their combination on morphological changes in the prefrontal cortex that were induced by nicotine. Materials and methods: Fifty adult male albino rats were divided into five groups: group I (control group), group II (nicotine), group III (nicotine + cinnamon), group IV (nicotine + ginger), and group V (nicotine + cinnamon + ginger). The coronal sections from the anterior part of the rat brain at the site of prefrontal cortex were examined by light microscope for (H&E and immunohistochemical staining with TNF-α and GFAP), while the ultrastructure morphology was examined by transmission electron microscopy. Levels of the oxidative stress markers (MDA, GSH) in the rats’ brain tissue homogenate were biochemically assessed. Results: Compared to the control group, the rats that were treated with nicotine (group II) showed a significant oxidative stress in the form of marked elevation of MDA and decrease in GSH, apoptotic changes especially in the pyramidal cells in the form of neuronal cell degeneration and pyknosis, and an elevation in the inflammatory marker TNF-α and GFAP expressions. These changes were observed to a lesser degree in rat group (III) and group (IV), while there was a marked improvement achieved by the combined usage of cinnamon and ginger oils, together compared to the nicotine group. Conclusions: Ginger and cinnamon are powerful antioxidants which ameliorate the degenerative and oxidative effects produced by nicotine on a rat’s prefrontal cortex.

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