Usefulness of Pre-Procedural Imaging of the Coronary Venous System With Coronary Angiography Before Cardiac Resynchronization Therapy

Contrast Medium ◽

Radiation Exposure ◽

Coronary Venous System ◽

Group 2 ◽

Cumulative Radiation Exposure ◽

Group 1

Cardiac resynchronization therapy (CRT) is a treatment modality for selected patients with refractory heart failure. We intended to examine the usefulness of coronary venous system imagining with conventional coronary angiogram before the CRT implantation procedure. A total of 180 patients were scheduled for CRT and were prospectively randomized 1:2 into 2 groups. Group 1 (n = 60) received standard CRT procedure without the guidance of selective left coronary angiography. In group 2 (n = 120), CRT implantation was accomplished with the guidance of the preprocedural coronary angiography. We compared the 2 groups in terms of the total implantation time, total fluoroscopy time, the amount of contrast medium used, and cumulative radiation exposure. The total implantation and fluoroscopy times, the amount of contrast medium used, and cumulative radiation exposure were significantly less in group 2 compared with group 1 (53 ± 7 vs 66 ± 9 minutes, 11 ± 3 vs 20 ± 5 minutes, 24 ± 8 vs 42 ± 14 mL, 26 192 ± 6658 vs 37 388± 9064 mGy cm2, and 253 ± 49 vs 392 ± 79 mGy, P < .0001, respectively). We concluded that coronary angiography prior to CRT implantation is useful in simplifying the procedure, saving time, reducing radiation exposure, and reducing contrast use.

P4531Early and late superresponse to cardiac resynchronization therapy

European Heart Journal ◽

10.1093/eurheartj/ehz745.0923 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

V A Kuznetsov ◽

T N Enina ◽

A M Soldatova ◽

T I Petelina ◽

N E Shirokov ◽

...

Keyword(s):

Left Ventricular ◽

Reverse Remodeling ◽

Tnf Α ◽

Echocardiographic Parameters ◽

Group 2 ◽

Group 1

Abstract Background Superresponders to cardiac resynchronization therapy (CRT) demonstrate significant reverse remodeling, improvement in cardiac function, decrease in inflammatory mediators and markers of cardiac fibrosis. It is not clear if superresponse (SR) can be early or late and if the time of SR to CRT is associated with different degree of biochemical improvement. Aim To assess structural and functional heart parameters, sympathetic activity, levels of biomarkers of myocardial fibrosis, inflammatory and neurohormonal mediators in patients with various time of SR to CRT. Methods The study enrolled 82 superresponders to CRT (decrease in left ventricular end-systolic volume (LVESV) >30%) (mean age 60.4±9.3 years; 80.5% men, 19.5% women; 54.9% with ischemic etiology of heart failure). Patients were divided into two groups: group 1 (n=19) – SR was achieved within 24 months (14.0 [8.0; 21.0] months); group 2 (n=63) - SR was achieved after 24 months (59 [43.0; 84.0] months). Echocardiographic parameters, plasma levels of epinephrine, norepinephrine, NT-proBNP, interleukin (IL) 1β, IL-6, IL-10, tumor necrosis factor alpha (TNF-α), metalloproteinase (MMP) 9, tissue inhibitors of metalloproteinase (TIMP) 1 and 4 were evaluated. Results At baseline there were no differences in demographic, clinical and echocardiographic characteristics between the groups. Levels of epinephrine (1.1 [0.1; 2.2] ng/ml vs 2.1 [0.7; 3.4] ng/ml; p=0.049) and IL-10 (1.8 [1.5; 3.5] pg/ml vs 3.9 [2.7; 5.1] pg/ml; p=0.019) were significantly higher in group 2. Both groups demonstrated significant improvement in echocardiographic parameters. On follow-up left ventricular (LV) end-systolic dimension (p=0.041), LV end-diastolic dimension (p=0.049), LVESV (p=0.014), LV end-diastolic volume (p=0.045) were lower in group 2. In group 1 IL-6 (p=0.047), TNF-α (p=0.047) decreased significantly and there was a tendency for IL-1β (p=0.064) and norepinephrine (p=0.069) levels to increase. In group 2 levels of IL-1β (p<0.001), IL-6 (p=0.030), IL-10 (p=0.003), TNF-α (p<0.001), TIMP-1 (p=0.010) and epinephrine (p=0.024) decreased significantly while MMP-9/TIMP-1 (p=0.023) increased as compared to baseline levels. Additionally there was a tendency for NT-proBNP level to decrease in group 2 (p=0.069). Follow-up level of norepinephrine (7.8 [2.9; 17.2] ng/ml vs 1.1 [0.2; 8.7] ng/ml; p=0.011 was lower and MMP-9/TIMP-4 level was higher (0.058 [0.044; 0.091] vs 0.092 [0.064; 0.111]; p=0.013) in group 2. Diverse trends were observed in IL-10 (0.4 [−0.6; 1.2] pg/ml in group 1 vs −2.3 [−3.4; −0.5] pg/ml in group 2; p=0.007) and norepinephrine (4.0 [−5.2; 14.3] ng/ml in the group 1 vs −1.2 [−11.6; 4.0] ng/ml in the group 2; p=0.015) between the groups. Conclusion CRT modulates sympathetic, neurohumoral, immune and fibrotic activity. Late SR to CRT is associated with decrease of sympathetic and inflammatory activity and more pronounced LV reverse remodeling.

Beta Blockers Up-Titration in Patients with Heart Failure Reduced Ejection Fraction and Cardiac Resynchronization Therapy, a Single Center Study

Medical Sciences ◽

10.3390/medsci7060071 ◽

2019 ◽

Vol 7 (6) ◽

pp. 71

Author(s):

Daniele Masarone ◽

Marina Verrengia ◽

Ernesto Ammendola ◽

Rita Gravino ◽

Fabio Valente ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Reduced Ejection Fraction ◽

Patients With Heart Failure ◽

Β Blockers ◽

Group 2 ◽

Group 1

Clinical trials have shown the benefits of β-blockers therapy in patients with heart failure reduced ejection fraction. These benefits include improved survival and a reduced need for hospitalization. Cardiac resynchronization therapy has emerged as an essential device-based therapy for symptomatic patients with heart failure reduced ejection fraction despite optimal pharmacologic treatment. The extent to which β-blockers are being utilized in patients receiving cardiac resynchronization therapy is not well known. In this study, we evaluate the possibility of increasing β-blockers doses in an unselected cohort of heart failure reduced ejection patients after cardiac resynchronization therapy capable defibrillator system implantation and the correlation between β-blockers treatments and clinical outcome. Methods and results: Patients with heart failure reduced ejection fraction in β-blockers therapy that underwent cardiac resynchronization therapy capable defibrillator system implantation between July 2008, and December 2016 were enrolled in the study. The β-blockers dose was determined at the time of discharge and during follow-up. Cardiovascular mortality, hospitalization for worsening heart failure or arrhythmic storm and appropriate intervention of the device, were recorded. The study cohort included 480 patients, 289 patients (60.3%) had β-blockers doses equal to the dose before CRT (Group 1), 191 patients (39.7%) had higher β-blockers doses than those before the CRT implant (Group 2). Comparing the two groups, Group 2 have lower cardiovascular mortality, heart failure-related hospitalization, and arrhythmic events than Group 1. Conclusion: After initiating CRT, β-blockers could be safely up-titrated at higher doses with the reduction in mortality, heart failure-related hospitalization, and arrhythmic events.

Cardiac Resynchronization Therapy Using Left-bundle-branch Area Pacing and Coronary Sinus Pacing

10.21203/rs.3.rs-428239/v1 ◽

2021 ◽

Author(s):

Xiang-Fei Feng ◽

Rui Zhang ◽

Yi-Chi Yu ◽

Bo Liu ◽

Ya-Qin Han ◽

...

Keyword(s):

Heart Failure ◽

Coronary Sinus ◽

Biventricular Pacing ◽

Lv Function ◽

Group 2 ◽

A New Technique ◽

Group 1

Abstract Background: Cardiac resynchronization therapy via biventricular pacing (BVP) is an established therapy for patients with heart failure. Recently, it has been shown that left bundle branch area pacing (LBBAP) is feasible and may also improve clinical outcomes. In this article, we describe a new technique (sequential LBBAP followed by coronary sinus pacing, designated LOT-CRT) and assess the feasibility of LOT-CRT.Methods: The database of all patients from single centre was reviewed retrospectively. The eligible patients were divided into two groups randomly, LOT-CRT and BV-CRT. The LBBAP lead implanted using our methods. The QRS duration (QRSd) was measured at baseline and during LBBAP, BVP, and LOT-CRT.Results: The study enrolled 11 consecutive heart failure patients with LBBB. LBBAP failed in 1 patient, succeed in 5 patients, while CS leads were implanted successfully in all patients. At baseline, the two groups (5 LOT-CRT cases in group 1, 6 BV-CRT cases in group 2) were matched for QRSd and ischemic cardiomyopathy (ICM, 3 cases in group 1, 2 cases in group 2). In group 1, BVP resulted in significant reduction of the QRSd from 158.0 ± 13.0 ms at baseline to 132.0 ± 4.5 ms (P=0.019). Compared with BVP, unipolar LBBAP resulted in further reduction of the QRSd to 123.0 ± 5.7 ms (P < 0.01). However, LOT-CRT resulted in a significantly greater reduction of the QRSd to 117.0 ± 6.7 ms (P < 0.01). In group 2, BVP resulted in significant reduction of the QRSd from 176.7 ±19.7 ms at baseline to 143.3 ±8.2 ms (P=0.011). However, compared with LBBAP, BVP resulted in increase of the QRSd (P >0.05). As compared to the baseline after 3 months of LBBAP, patients in group 1 showed significant improvement in LVEF and NT-proBNP levels (P < 0.01), while patients in group 2 showed non-significant changes in these parameters (P >0.05).Conclusions: The study demonstrates that LOT-CRT is clinically feasible in patients with systolic HF and LBBB. LOT-CRT was associated with significant narrowing of the QRSd and improvement in LV function, especially in patients with ICM.

Anticoagulant therapy in patients with atrial fibrillation and an implanted cardiac resynchronization therapy device

CARDIOVASCULAR THERAPY AND PREVENTION ◽

10.15829/1728-8800-2021-2714 ◽

2021 ◽

Vol 20 (3) ◽

pp. 2714

Author(s):

M. A. Kirgizova ◽

G. M. Savenkova ◽

I. O. Kurlov ◽

S. N. Krivolapov ◽

R. E. Batalov ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Ventricular ◽

Vitamin K Antagonist ◽

Thromboembolic Events ◽

Group 2 ◽

Group 1

Aim. To study the efficacy and safety of direct oral anticoagulant (DOAC) therapy after implantation of cardiac resynchronization therapy (CRT) devices in atrial fibrillation (AF) patients with coronary artery disease (CAD) and dilated cardiomyopathy (DCM).Material and methods. The study included 93 patients followed up from 2014 to 2016 (71 men and 22 women) aged 33-85 years (59,7±10,6) with stable CAD (group 1, n=44) and DCM (group 2, n=49). All patients were diagnosed with AF. The left ventricular ejection fraction (LVEF) was 30,6±3,8%; the left ventricular end-diastolic dimension was 230,9±60,8 mm. All patients received anticoagulants for the prevention of thromboembolic events: a vitamin K antagonist (warfarin) or DOAC. The analysis of medical records, as well as ECG records, echocardiographic, 24-hour ECG monitoring data and information from implanted device was carried out. The follow-up period lasted 24 months.Results. After 24-month follow-up, positive dynamics was noted in all patients — LVEF increased from 30,6±3,7% to 39,5±5,8%). In patients with DCM, a more pronounced increase in myocardial contractile function was noted. Stroke within time interval from 12 to 24 months developed in two patients taking warfarin, from different groups. Transient ischemic attacks were observed in 6 patients: in one patient from group 1 during the period from inclusion and 12-month visit, and in 5 patients from 12 to 24 months. Out of 5 patients, two belonged to group 1 and three — to group 2, while one patient took aspirin and the other 4 — warfarin. One patient from group 1 with persistent AF and vitamin K antagonist therapy had left atrial appendage thrombosis. Hemorrhagic strokes and major bleeding have not been reported.Conclusion. Among patients taking DOAC, regardless of the underlying disease (CAD or DCM) and response to CRT, bleeding events were less often recorded, and there were no thromboembolic events.

Fighting with the invisible: radiation exposure in cardiac resynchronization therapy

EP Europace ◽

10.1093/europace/eup369 ◽

2009 ◽

Vol 11 (12) ◽

pp. 1575-1576 ◽

Cited By ~ 2

Author(s):

G. Z. Duray ◽

S. H. Hohnloser

Keyword(s):

Radiation Exposure ◽

The Invisible

Radiation exposure to patients' skin during cardiac resynchronization therapy

EP Europace ◽

10.1093/europace/eup302 ◽

2009 ◽

Vol 11 (12) ◽

pp. 1683-1688 ◽

Cited By ~ 13

Author(s):

S. Suzuki ◽

S. Furui ◽

T. Yamakawa ◽

T. Isshiki ◽

A. Watanabe ◽

...

Keyword(s):

Radiation Exposure ◽

Radiation Exposure To Patients

The incidence of frailty and its relationship with long-term survival in patients with heart failure and implanted cardiac resynchronization therapy devices

Russian Journal of Cardiology ◽

10.15829/1560-4071-2020-3685 ◽

2020 ◽

Vol 25 (8) ◽

pp. 3685

Author(s):

A. M. Soldatova ◽

V. A. Kuznetsov ◽

D. S. Bogdanova ◽

F. T. Benzineb

Keyword(s):

Left Ventricular ◽

Term Survival ◽

Long Term Survival ◽

Cardiac Resynchronization Therapy Devices ◽

Patients With Heart Failure ◽

Group 2

Aim. To assess long-term survival depending on the presence and severity of frailty in patients with heart failure (HF) and implanted cardiac resynchronization therapy devices.Material and methods. We examined 77 patients (men — 74%, women — 26%, mean age 58,7±10,7 years) with NYHA class II-IV HF. The follow-up period was 42,4±27,1 months. On the basis of 31 parameters (medical history, diagnostic tests, questionnaire survey of physical activity limitations), a frailty index was calculated. Depending on the index value, the patients were divided into 2 groups: group 1 (n=41) — <0,375 (no frailty), group 2 (n=36) — ≥0,375 (patients with frailty).Results. Long-term survival of patients in group 1 was 87,8%, in group 2 — 52,8% (Log rank p<0,001). According to the univariate analysis, the presence of frailty was significantly associated with long-term mortality (odds ratio (OR) 6,108; 95% confidence interval (CI) 2,207-16,907; p<0,001). When sex, age, left ventricular ejection fraction, left bundle branch block, QRS duration, left ventricular volume were included in the multivariate analysis, the presence of frailty remained a significant predictor of long-term mortality (OR 5,763; 95% CI 1,837-18,083; p=0,003).Conclusion. Frailty has an independent effect on the long-term all-cause death risk in patients with HF and implanted cardiac resynchronization therapy devices.