scholarly journals Automatic Continuous CRT Optimization to Improve Hemodynamic Response: An Italian Single-Center Experience

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Gregorio Covino ◽  
Mario Volpicelli ◽  
Paolo Capogrosso
Keyword(s):  
Heart Failure ◽  
Clinical Response ◽  
Nyha Class ◽  
Hemodynamic Response ◽  
Class Ii ◽  
Response To Therapy ◽  
Single Center ◽  
Heart Failure Patients ◽  
Single Center Experience

Background. Optimization of cardiac resynchronization therapy (CRT) settings after implant can improve response to therapy. In this Italian single-center experience, we investigated the rate of hemodynamic and clinical response in heart failure patients treated with continuously and automatically optimized CRT. Methods. Patients were selected from June 2015 to April 2017 according to the most recent CRT guidelines; all were in sinus rhythm at implant and received a CRT-defibrillator system equipped with SonR, which automatically optimizes AV and VV delays every week. SonR was activated just after implant and remained active during follow-up. The rate of hemodynamic response (R-HR) was defined as ΔLVEF>5%, super-response (R-HSR) as ΔLVEF>15%, and clinical response as a negative transition of NYHA class≥−1 at 6 months follow-up vs. baseline (preimplant). Results. Mean follow-up for the 31 patients (aged 69.9±9.4 years; 61% male; NYHA class II/III 19%/81%; ischemic etiology 65%) was 6±0.7 months. At baseline, LVEF was 29.1%±4.7% and QRS duration 146±13 ms. LBBB morphology was observed in 65%. At 6 months, R-HR was 74% (23/31), R-HSR 32% (10/31), and clinical response rate 77% (24/31). Hemodynamically, patients with ischemic etiology benefited more than those without ischemic etiology, both in terms of response (80% versus 64%) and super-response (35% versus 27%). Conclusions. Continuous automatic weekly optimization of CRT over 6 months consistently improved R-HR, R-HSR, and clinical response in NYHA class II/III heart failure patients versus baseline. Patients with ischemic etiology in particular may benefit hemodynamically from this type of CRT optimization.

scholarly journals Survey of Palliative Sedation at End of Life in Terminally Ill Heart Failure Patients　― A Single-Center Experience of 5-Year Follow-up ―

2019 ◽  
Vol 83 (7) ◽  
pp. 1607-1611 ◽  
Author(s):  
Yasuhiro Hamatani ◽  
Eri Nakai ◽  
Emi Nakamura ◽  
Michi Miyata ◽  
Yukie Kawano ◽  
...  
Keyword(s):  
Heart Failure ◽  
End Of Life ◽  
Terminally Ill ◽  
Palliative Sedation ◽  
Single Center ◽  
Heart Failure Patients ◽  
Single Center Experience

scholarly journals Two-year follow-up of patients with heart failure with reduced ejection fraction receiving cardiac contractility modulation

2020 ◽  
Vol 25 (7) ◽  
pp. 3853
Author(s):  
M. A. Vander ◽  
E. A. Lyasnikova ◽  
L. A. Belyakova ◽  
M. A. Trukshina ◽  
V. L. Galenco ◽  
...  
Keyword(s):  
Heart Failure ◽  
Independent Predictor ◽  
Nyha Class ◽  
Cardiac Contractility ◽  
Composite Endpoint ◽  
Class Ii ◽  
Cardiac Contractility Modulation ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure

Aim. To assess the 2-year prognosis of patients with heart failure with reduced ejection fraction (HFrEF) receiving cardiac contractility modulation (CCM).Material and methods. This single-center observational study included 55 patients (46 men, mean age 53±11 years) with NYHA class II-III HFrEF receiving optimal medical therapy, with sinus rhythm, QRS <130 ms or QRS<150 ms with nonspecific intraventricular conduction delay. NYHA class II and III were established in 76% and 24% of patients, respectively. All patients were implanted with CCM devices between October 2016 and September 2017. Follow-up visits were carried out every 3 months during the 1st year and every 6 months during the 2nd year of observation. The primary composite endpoint was mortality and heart transplantation. Secondary composite endpoints included death, heart transplantation, paroxysmal ventricular tachycardia/ ventricular fibrillation, hospitalizations due decompensated HFResults. The one-year and two-year survival rate was 95% and 80%, respectively. Primary endpoint was observed in 20% of patients. NYHA class III and higher levels of N-terminal pro-brain natriuretic peptide (NTproBNP) were associated with unfavorable prognosis (p=0,014 and p=0,026, respectively). NTproBNP was an independent predictor of survival (p=0,018). CCM contributed to a significant decrease in hospitalizations due to decompensated HF (p<0,0001). The secondary endpoint was observed in 18 (33%) of patients during the 1st year. The predictor for the secondary composite endpoint was NTproBNP (p=0,047).Conclusion. CCM is associated with a significant decrease in hospitalization rate due to decompensated HF. The 2-year survival rate of patients with NYHA class II-III HF receiving CCM was 80%. The NTproBNP level was an independent predictor of survival in patients receiving CMM for 2 years. Further longer-term studies of the CCM efficacy are required.

scholarly journals Prognostic value of global longitudinal strain versus mitral annular plane systolic excursion in patients with ischemic heart failure

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Liu ◽  
C Wagner ◽  
K Hu ◽  
B Lengenfelder ◽  
G Ertl ◽  
...  
Keyword(s):  
Heart Failure ◽  
Longitudinal Strain ◽  
Nyha Class ◽  
Global Longitudinal Strain ◽  
Ischemic Heart ◽  
Ischemic Heart Failure ◽  
Class Iii ◽  
Heart Failure Patients ◽  
All Cause Mortality

Abstract Background Mitral annular plane systolic excursion (MAPSE) derived from M-mode echocardiography is a classical risk factor of clinical outcome in heart failure patients. Two-dimensional-echocardiography (2DE) derived global longitudinal strain (GLS) is also related to outcome in patients with heart failure. This study aimed to compare the prognostic performance between GLS and MAPSE in ischemic heart failure patients with reduced ejection fraction. We sought to test the hypothesis that GLS might be superior to MAPSE as a risk stratification marker in these patients. Methods In total, 1277 ischemic heart failure patients with reduced left ventricular ejection fraction (LVEF&lt;50%), referred to our department between 2009 and 2017, were included in this retrospective study. Offline standard echocardiographic measurements including MAPSE and GLS were performed. Average MAPSE of septal and lateral walls (MAPSE_Avg) was calculated. GLS was derived from the segmental averaging (18-segment) of the three apical views. All patients completed at least one-year clinical follow-up by telephone interview or clinical visit. The primary endpoint was defined as all-cause mortality or heart transplantation (HTx). Results At baseline visit, mean age was 70±11 years and 79.6% were men. NYHA class III-IV were identified in 33.5% of patients. Coronary artery disease was confirmed by coronary angiography. 63.0% patients had a history of myocardial infarction, 32.1% underwent PCI, and 16.8% underwent coronary artery bypass grafting. Over a median follow-up period of 26 (14–39) months, 369 (28.9%) patients died and 5 (0.4%) underwent HTx. Median LVEF was 39% (32–45%), and there were 48.0% patients with LVEF between 40–49%, 32.3% patients with LVEF between 30–49% and 19.7% patients with LVEF &lt;30%. MAPSE_Avg was 8.0 (6.5–10.0) mm and median GLS was −9.9% (−7.7 to −12.3%). Clinical covariates significantly associated with all-cause mortality in this cohort included age (HR=1.048), NYHA class III-IV (HR=1.800), AF (HR=1.567), diabetes (HR=1.262), dyslipidemia (HR=0.657), hyperuricemia (HR=1.861), peripheral vascular disease (HR 1.858), chronic respiratory diseases (HR=1.680), and renal dysfunction (HR=2.705). Multivariable Cox regression analysis showed that reduced MAPSE_Avg (&lt;7mm, HR=1.431, 95% CI 1.146–1.786) and reduced GLS (&lt;8.3%, HR=1.519, 95% CI 1.230–1.875) were independent predictors of all-cause mortality after adjustment of above-mentioned clinical confounders. ROC curves demonstrated that the predictive performance of all-cause mortality among LVEF, MAPSE_Avg, and GLS were similar (AUC=0.608, 0.601, and 0.616, respectively, all P&lt;0.001). Conclusions Both 2DE-guided GLS and MAPSE could provide additional prognostic information in ischemic heart failure patients with reduced LVEF. Prognostic performance of GLS, MAPSE, and LVEF is similar in ischemic heart failure patients with reduced LVEF. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): The German Federal Ministry of Education and Research

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