scholarly journals The Short Term Influence of RV Pacing Burden on Numerous Echocardiographic and Spiroergometric Parameter In Patients With Preserved LVEF - The Mechanism of The Worsened Clinical Outcome Due To High RV Pacing Burden Remains Unclear.

2021 ◽  
Author(s):  
Akram Youssef ◽  
Karim Ibrahim ◽  
Michael Günther ◽  
Steffen Kolschmann ◽  
Utz Richter ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Exercise Capacity ◽  
Time Course ◽  
Maximal Oxygen Consumption ◽  
Pacemaker Implantation ◽  
Peak Exercise ◽  
Pacemaker Therapy ◽  
Rv Pacing ◽  
The Impact

Abstract Background: The cause of worsened clinical outcome due to high RV pacing burden remains unclear.Objective: To investigate the impact of RV pacing on several echocardiographic and spiroergometric parameter Methods: In 60 pacemaker patients with preserved LVEF serial echocardiographies and spiroergometries were performed over a time course of 12 months. Additionally in 50 patients retrospective echocardiographic analyses of the LV- and RV function were carried out up to 24 months after pacemaker implantation.Results: The patients were divided into two groups: The high RV pacing burden group (hRVP: ≥ 40%) and the low RV pacing group (lRVP <40%) according to the definitions in previous randomized MOST and DAVID trials. After a period of 12 month pacemaker therapy there could not revealed any changes LVEDD, LVESD, LVEF, E/A-ratio; E/E’-ratio and TAPSE independently of the RV pacing burden. Additionally, after 24 month long term follow-up there were no changes in LVEF and TAPSE in both groups. Accordingly to these echo data no relevant changes of peak exercise capacity, ventilatory anaerobic threshold and maximal oxygen consumption could be revealed independently of the RV pacing. Conclusions: In pacemaker patients with preserved LVEF the burden of RV pacing has no adverse influence, neither to several echocardiographic parameters nor to the clinical exercise capacity after a follow-up of 12 to 24 month. Therefore, the mechanism of the worsened clinical outcome due to high RV pacing burden in patients without a relevant structural heart disease remains unclear.

Abstract MP25: Obesity, Heart Failure Risk & Cardiorespiratory Fitness

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Peter F Kokkinos ◽  
Puneet Narayan ◽  
Charles Faselis ◽  
Jonathan Myers ◽  
Carl Lavie ◽  
...  
Keyword(s):  
Heart Failure ◽  
Exercise Capacity ◽  
Cardiorespiratory Fitness ◽  
Reference Group ◽  
Normal Weight ◽  
Entire Cohort ◽  
Metabolic Equivalents ◽  
Increased Risk ◽  
The Impact

Introduction: Obesity, defined as body mass index (BMI) ≥30 kg/m 2 , is associated with increased incidence of heart failure (HF). Increased cardiorespiratory fitness (CRF), as indicated by increased exercise capacity, is associated with lower risk of cardiovascular disease and HF. However, the CRF-BMI-HF interaction has not been fully explored. Hypothesis: We assessed the hypothesis that the risk of HF associated with increased BMI is moderated by increased CRF. Methods: We identified 19,881 Veterans (mean age: 58.0±11.3 years) who completed an exercise tolerance test (ETT) to assess either CRF status or suspected ischemia at two VA Medical Centers (Washington DC and Palo Alto, CA). None had documented HF at baseline or evidence of ischemia during the ETT. We established four BMI categories: <25 kg/m 2 ; 25-29.9 kg/m 2 ; 30-34.9 kg/m 2 ; and ≥35 kg/m 2 . In addition, we established four CRF categories based on age-stratified quartiles of peak metabolic equivalents (METs) achieved (mean ± SD): Least-Fit (4.5±1.2 METs; n=4,743); Low-Fit (6.6±1.3; n=5,103); Moderate-Fit (8.0±1.3 METs; n=5,084); and High-Fit (11.1±2.4 METs; n=4,951). Multivariable Cox models were used to estimate hazard ratios (HR) and 95% confidence intervals [CI] for incidence of HF across BMI categories for the entire cohort, using BMI 25-29.9 kg/m 2 (lowest HF rate) as the reference group. We then stratified the cohort by the four BMI categories and assessed HF risk across CRF categories within each stratum, using the Least-fit category as the reference group. The models were adjusted for age, race, gender, cardiac risk factors, sleep apnea, alcohol dependence, medications. Results: During follow-up (median=11.8 years), 2,193 developed HF (10.5 per 1,000 person-years of follow-up). The HF risk for normal weight individuals (18.5-24.9 kg/m2) was 10% higher (p=0.93). For obese individuals, the HF risk was 22% higher in those with BMI 30-34.9 kg/m 2 (HR=1.22; 95% CI: 1.09-1.35) and 50% higher (HR=1.50, 95% CI: 1.32-1.72) for those with BMI ≥35 kg/m 2 . When CRF (peak METs achieved) was introduced in the model, the risk for those with BMI 30-34.9 was reduced from 22% to 16% (HR=1.16; 95% CI: 1.04-1.29) and from 50% to 29% (HR=1.29; 95% CI: 1.13-1.48) among those with ≥35 kg/m 2 . For every 1-MET increase in exercise capacity, HF risk was 15% lower (HR=0.85; 95% CI: 0.83-0.87). We then assessed the impact of CRF on the risk of HF within each of the four BMI categories. The HF risk declined progressively (range: 25% to 69%; p<0.01) with increasing fitness within all BMI categories. Conclusions: The obesity-associated increased risk of HF was attenuated by increased CRF. The HF risk was progressively decreased with increased CRF within all BMI categories.

P5472Social economic deprivation and adverse clinical outcomes after acute coronary syndrome

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Y C Lau ◽  
J Latter ◽  
A Jong ◽  
R Weir
Keyword(s):  
Clinical Outcome ◽  
Secondary Prevention ◽  
Clinical Outcomes ◽  
Statistical Difference ◽  
Independent Predictor ◽  
Composite Endpoint ◽  
Socioeconomic Deprivation ◽  
Angiotensin Ii Receptor Blocker ◽  
The Impact

Abstract Background NHS was created in 1948 to redress the healthcare inequality through provision of universal healthcare service in the UK. However even of late, significant health inequality persists. Socioeconomic deprivation is known to result in increased overall morbidity and mortality. Aim To assess the impact of socioeconomic deprivation (as categorised by Scottish Index of Multiple Deprivation, SIMD) on the medical management and clinical outcomes of patients with ACS (NSTEMI/STEMI) who were treated with PCI Methods A retrospective study of NSTEMI/NSTEMI patients after inpatient treatment with coronary angiogram and PCI. The parameters include basic demographics, risk factors, LV EF on echocardiogram, lipid profile and discharge medication. Individual's socioeconomic deprivation index, as described SIMD was also recorded (1 – most deprived and 10 – least deprived), and accordingly placed into quintile (SIMD 1–2, 3–4, 5–6,7 –8, 9–10). Follow-up for 24 months. Clinical outcome assessed was composite endpoint event of MACE. Results 357 from the lowest quintile (SIMD 1–2), 319 from SIMD 3–4, 191 from SIMD 5–6, 120 from SIMD 7–8, and 99 from the highest quintile (SIMD 9–10) were included. No statistical difference exists between age or gender. No difference in past medical history (inclusive of hypertension, diabetes, dyslipidemia, family history. No difference in incidence of nicotine use. Prescription of aspirin, P2Y12 inhibitors (clopidogrel, ticagrelor or prasugrel) as well as secondary prevention medications (such as ace inhibitor/angiotensin II receptor blocker, beta blocker, statin and GTN) were good and not statistically different between all groups. No statistical difference exists between all groups relating to pre-discharge LV ejection fraction on echocardiogram or random cholesterol level check on admission. 24 months follow-up demonstrated composite endpoint of MACE was statistically higher among patients of lowest socioeconomic quintile (Kaplan Meier plot, p<0.001). Step-wise multiple regression analysis also confirmed multiple socioeconomic deprivation as an independent predictor for more adverse clinical outcomes (p<0.001, R2=14.5%). Patients from the least deprived quintile possess survival advantage almost 14-folds as compared to those of most deprived group (Odd-ratio 13.8 (95% CI: 39.4–48.5)). Summary After an ACS event, despite initial coronary intervention and subsequent optimal prescription of prognostically beneficial secondary prevention medications, patients from the lower socioeconomic group (as described by SIMD) are still more likely to experience readmission for cardiovascular death, non-fatal myocardial infarction and non-fatal stroke. Socioeconomic deprivation has been shown to be an independent predictor of adverse clinical outcome for those who survived initial ACS. Acknowledgement/Funding None

Metastatic melanoma in the elderly: Case series of clinical outcome and immune characteristics

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e20018-e20018
Author(s):  
U. P. Hegde ◽  
N. Chakraborty ◽  
A. Chhabra ◽  
S. Ray
Keyword(s):  
Immune System ◽  
Clinical Outcome ◽  
Elderly Patients ◽  
Metastatic Melanoma ◽  
Cutaneous Melanoma ◽  
Proliferative Activity ◽  
The Elderly ◽  
High Dose ◽  
The Impact

e20018 Background: Cutaneous melanoma incidence is rapidly rising in the elderly population. Imbalances of the immune system are described due to aging associated changes between CD4+, CD8+, T helper (Th) 1, Th 2 and T regulatory and T effector lymphocytes (lym). We describe clinical outcome in 10 elderly patients (pts) with cutaneous metastatic melanoma (CMM) and results of the immune studies done in a subgroup. Methods: Between October 2002 and October 2008, 10 elderly pts with treatment naïve CMM, 6 males and 4 female, median ages 76, range 57–84 years were treated at the University of Connecticut Health Center. Metastatic sites included soft tissue in 2 patients (pts), lung and/or liver with lymph node (LN) involvement (6 pts) and distant LN metastasis (2pts). Eight pts opted for treatment and received single or combination chemotherapy (5pts), high dose Interleukin 2 (2 pts), complete tumor resection followed by tumor derived heat shock protein vaccine (1 pt on clinical trial) and bio chemotherapy (1pt). One patient declined treatment (included in follow up). In vitro immune characteristics were studied in HLA-A2 positive subgroup (5pts) and included cytotoxic T lym (CTL) generation against self and non self peptides (Mart-1 27–35 and influenza MP derived peptide flu 58–66), proliferative activity of CD4+ lym in response to anti CD3 antibody under Th1 and Th2 conditions and regulatory T lym activity of CD4+CD25+ lym against CTL. Results: All patients tolerated treatments well resulting in 1 complete response, 4 partial responses, and 4 stable diseases. During 6 year follow up period, 6 patients died while 4 patients are living (one with disease). The median survival of all patients is 28.1 month (mo) while in those surviving (4pts) is 72 mo. Immune studies revealed preserved proliferative activity of CD4+ lym with stronger Th1 induction than Th2. The CTL responses to self and non self antigens were preserved while regulatory T lym showed weak activity against CTL. Conclusions: Some elderly patients with metastatic melanoma demonstrate improved outcomes and favorable immune characteristics. Further studies are needed to understand the impact of aging immune system on cutaneous melanoma. No significant financial relationships to disclose.

scholarly journals Exercise-based cardiac rehabilitation for chronic heart failure: the EXTRAMATCH II individual participant data meta-analysis

2019 ◽  
Vol 23 (25) ◽  
pp. 1-98 ◽  
Author(s):  
Rod S Taylor ◽  
Sarah Walker ◽  
Oriana Ciani ◽  
Fiona Warren ◽  
Neil A Smart ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Exercise Capacity ◽  
Meta Analysis ◽  
Patient Characteristics ◽  
Individual Participant Data ◽  
Significant Difference ◽  
Individual Participant ◽  
The Impact

Background Current national and international guidelines on the management of heart failure (HF) recommend exercise-based cardiac rehabilitation (ExCR), but do not differentiate this recommendation according to patient subgroups. Objectives (1) To obtain definitive estimates of the impact of ExCR interventions compared with no exercise intervention (control) on mortality, hospitalisation, exercise capacity and health-related quality of life (HRQoL) in HF patients; (2) to determine the differential (subgroup) effects of ExCR in HF patients according to their age, sex, left ventricular ejection fraction, HF aetiology, New York Heart Association class and baseline exercise capacity; and (3) to assess whether or not the change in exercise capacity mediates for the impact of the ExCR on final outcomes (mortality, hospitalisation and HRQoL), and determine if this is an acceptable surrogate end point. Design This was an individual participant data (IPD) meta-analysis. Setting An international literature review. Participants HF patients in randomised controlled trials (RCTs) of ExCR. Interventions ExCR for at least 3 weeks compared with a no-exercise control, with 6 months’ follow-up. Main outcome measures All-cause and HF-specific mortality, all-cause and HF-specific hospitalisation, exercise capacity and HRQoL. Data sources IPD from eligible RCTs. Review methods RCTs from the Exercise Training Meta-Analysis of Trials for Chronic Heart Failure (ExTraMATCH/ExTraMATCH II) IPD meta-analysis and a 2014 Cochrane systematic review of ExCR (Taylor RS, Sagar VA, Davies EJ, Briscoe S, Coats AJ, Dalal H, et al. Exercise-based rehabilitation for heart failure. Cochrane Database Syst Rev 2014;4:CD003331). Results Out of the 23 eligible RCTs (4398 patients), 19 RCTs (3990 patients) contributed data to this IPD meta-analysis. There was a wide variation in exercise programme prescriptions across included studies. Compared with control, there was no statistically significant difference in pooled time-to-event estimates in favour of ExCR, although confidence intervals (CIs) were wide: all-cause mortality had a hazard ratio (HR) of 0.83 (95% CI 0.67 to 1.04); HF-related mortality had a HR of 0.84 (95% CI 0.49 to 1.46); all-cause hospitalisation had a HR of 0.90 (95% CI 0.76 to 1.06); and HF-related hospitalisation had a HR of 0.98 (95% CI 0.72 to 1.35). There was a statistically significant difference in favour of ExCR for exercise capacity and HRQoL. Compared with the control, improvements were seen in the 6-minute walk test (6MWT) (mean 21.0 m, 95% CI 1.57 to 40.4 m) and Minnesota Living with Heart Failure Questionnaire score (mean –5.94, 95% CI –1.0 to –10.9; lower scores indicate improved HRQoL) at 12 months’ follow-up. No strong evidence for differential intervention effects across patient characteristics was found for any outcomes. Moderate to good levels of correlation (R 2 trial > 50% and p > 0.50) between peak oxygen uptake (VO2peak) or the 6MWT with mortality and HRQoL were seen. The estimated surrogate threshold effect was an increase of 1.6 to 4.6 ml/kg/minute for VO2peak. Limitations There was a lack of consistency in how included RCTs defined and collected the outcomes: it was not possible to obtain IPD from all includable trials for all outcomes and patient-level data on exercise adherence was not sought. Conclusions In comparison with the no-exercise control, participation in ExCR improved the exercise and HRQoL in HF patients, but appeared to have no effect on their mortality or hospitalisation. No strong evidence was found of differential intervention effects of ExCR across patient characteristics. VO2peak and 6MWT may be suitable surrogate end points for the treatment effect of ExCR on mortality and HRQoL in HF. Future studies should aim to achieve a consensus on the definition of outcomes and promote reporting of a core set of HF data. The research team also seeks to extend current policies to encourage study authors to allow access to RCT data for the purpose of meta-analysis. Study registration This study is registered as PROSPERO CRD42014007170. Funding The National Institute for Health Research Health Technology Assessment programme.

scholarly journals The Impact of Selected Cytokines in the Follow-Up of Normal Pressure Hydrocephalus

2015 ◽  
pp. S283-S290 ◽  
Author(s):  
L. SOSVOROVA ◽  
M. MOHAPL ◽  
J. VCELAK ◽  
M. HILL ◽  
J. VITKU ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Normal Pressure Hydrocephalus ◽  
Neurodegenerative Disorders ◽  
Time Course ◽  
Normal Pressure ◽  
Shunt Insertion ◽  
Mediators Of Inflammation ◽  
The Impact ◽  
Surgical Shunt

Cytokines are widely known mediators of inflammation accompanying many neurodegenerative disorders including normal pressure hydrocephalus (NPH). NPH is caused by impaired cerebrospinal fluid (CSF) reabsorption and treated by surgical shunt insertion. The diagnostics is still complicated and the shunt effect is not durable; after several years, dementia may develop. In the clinical practice, biomarkers support the diagnostics as well as the further time course of many neurodegenerative diseases. Until recently, no reliable biomarker for NPH was evaluated. The attempt of this review was to make a survey concerning cytokines as possible NPH markers. Among all reviewed cytokines, the most promising are CSF IL-10 and IL-33, enabling to follow-up the disease progression and monitoring the effectiveness of the shunt insertion.

scholarly journals Impact of exercise capacity on the long-term incidence of atrial arrhythmias in heart failure

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Tetsuri Sakai ◽  
Atsuhiko Yagishita ◽  
Masahiro Morise ◽  
Susumu Sakama ◽  
Takeshi Ijichi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ventricular Arrhythmias ◽  
Maximal Exercise ◽  
Peak Exercise ◽  
Atrial Arrhythmias ◽  
Patients With Heart Failure ◽  
The Impact ◽  
New Onset

AbstractWe sought to demonstrate the impact of improved peak exercise oxygen consumption (V̇O2) during maximal exercise testing after cardiac rehabilitation (CR) on the incidence of arrhythmias in patients with heart failure (HF). The present study comprised of 220 patients with HF, and peak V̇O2 was examined at 2 and 5 months after CR. Of the 220 patients, 110 (50%) had a low peak V̇O2 of < 14 mL/min/kg at 2 months. The peak V̇O2 improved in 86 of these 110 (78%) patients at 5 months after CR. During a median follow-up of 6 years, the patients with improvement in peak V̇O2, compared to those without peak V̇O2 improvement, had a lower rate of mortality (4% vs. 29%, log-rank, P < 0.001) and HF hospitalization (6 vs. 17%, log-rank, P = 0.044) and a lower incidence of new-onset atrial arrhythmias (9 vs. 27%, log-rank, P = 0.013), with no difference in the incidence of ventricular arrhythmias between groups (1 vs. 4%, log-rank, P = 0.309). The majority of deaths in the patients without an improved peak V̇O2 were because of cardiovascular events (73%), particularly progressive HF (55%). Early detection and management of atrial arrhythmias may improve outcomes in patients without peak V̇O2 improvement after CR.

scholarly journals Do Myocardial Blush Grade Following Chronic Total Occlusion Recanalization Improve Clinical Outcome of Chronic Coronary Syndromes Patients?

2020 ◽  
Vol 1 (3) ◽  
pp. 27-31
Author(s):  
Ikhwan Handirosinyanto ◽  
Mohammad Saifur Rohman ◽  
Dadang Hendrawan ◽  
Djanggan Sargowo ◽  
Yoga Waranugraha ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Chronic Total Occlusion ◽  
Total Occlusion ◽  
Angina Frequency ◽  
Drug Regimens ◽  
Coronary Syndromes ◽  
The Impact ◽  
Myocardial Blush Grade

Background : Myocardial blush grade (MBG) is an angiographic parameter to describe the adequacy of myocardial reperfusion. The correlation between myocardial blush and the clinical outcome following chronic total occlusion (CTO) recanalization is still unclear. Our study aimed to investigate the impact of myocardial blush after CTO recanalization on the clinical outcome of CCS patients. Design : A retrospective cohort study was conducted. Patients who underwent CTO recanalization were divided into two groups based on the myocardial blush. Patients were classified as having good myocardial blush (MBG category 2 to 3 or QUBE 0 to 10.2) and poor myocardial blush (MBG category 0 to 1 or QUBE 10.2 to 36.4). The outcome measured was the improvement of angina measured using the Seattle Angina Questionnaire (SAQ) and the reduction of antianginal drug regimens. Results : The follow-up period was ranging from 2 to 24 months following the CTO recanalization procedure. The SAQ for physical limitation (83.86 ± 16.11 vs. 77.92 ± 3.44; p = 0.247), angina frequency (85.27 ± 17.44 vs. 74.76 ± 22.05; p = 0.105), and quality of life (73.24 ± 3.41 vs. 72.82 ± 3.56; p = 0.932) between the two groups was not significantly different. Good myocardial blush was not correlated with the reduction of antianginal drug regimens (10 (52.6) vs. 8 (40); p = 0.639). Conclusion : Myocardial blush post-CTO recanalization was not associated with the improvement of angina symptoms and the reduction of antianginal drug regimens among patients with CCS.

scholarly journals Conduction disturbances after TAVR: rates of pacemaker implantation, burden of ventricular pacing and prognostic significance

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
S Bricoli ◽  
G Benatti ◽  
L Vignali ◽  
I Tadonio ◽  
MF Notarangelo ◽  
...  
Keyword(s):  
Prognostic Significance ◽  
Pacemaker Implantation ◽  
Av Block ◽  
Ventricular Pacing ◽  
Conduction Disturbances ◽  
Long Term Follow Up ◽  
Rv Pacing ◽  
Complete Av Block

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND The occurrence of conduction disturbances remains frequent after TAVR. However, the effect of PM on mortality is controversial and many patients may recover spontaneous AV conduction during follow-up.  PURPOSE To evaluate the incidence of PM implantation after TAVR, PM dependency and  burden of ventricular pacing during follow-up and their influence on mortality.  METHODS AND RESULTS We performed a retrospective analysis of all consecutive 293 patients who underwent TAVR from 2015 to 2019 at our hospital, regional hub for this procedure. Patients were classified into 3 groups: patients without PM (no-PM), patients with a PM implanted prior to TAVR (pre-PM) and patients requiring a PM following TAVR (post-PM) and their clinical and procedural characteristics are listed in Table 1.  The rate of PM implantation after TAVR was 20,8%, at a median of 3.6 days after the procedure. The most common indication was complete AV block. A VVIR pacemaker was implanted in 28 patients, a DDD/DDDR PM in 27 patients and 2 patients received a CRT device. Among post-PPM patients, only 16% were PM-dependent at 2-month and 1-year follow-up. All of them received a PM for complete AV block (AVB). At 1-year follow-up, RV pacing burden was 60% among AVB patients and 23% in patients with a PM implanted for other reasons. PM implantation after TAVR was not associated with a mortality difference at 30-day, 1-year and long-term follow-up. Pre-PPM patients showed a higher mortality rate at long-term follow-up although not statistically significant. CONCLUSIONS Our data suggest that a single chamber device should be preferred in patients implanted for reasons other than complete AVB; in patients with AVB, the use of dual chamber device with an algorithm to minimize RV pacing should be the most suitable choice. Overall (293)No PPM (216)Pre-PPM (19)Post-PPM (57)p-valueAge, median(IQR)82(80-86)82(80-86)82(79-87)82(80-86)0,53Female, n(%)160(55)129(59)6(32)25(44)0,40NYHA III-IV, n(%)191(65)147(68)15(79)29(51)0,06Logistic Euroscore, mean (IQR)7,53(3,5-8,3)7(3,5-8)9,83(3,6-12)6(3,5-7,4)0,51Right bundle-branch block, n(%)21(7)13(6)na8(14)0,04AVA, mean ± SD0,69 ± 0,190,7 ± 0,190,7 ± 0,160,66 ± 0,180,23Self-expandable valve, n(%)181(62)123(57)12(63)46(81)0,001Balloon-expandable valve, n(%)102(35)86(40)7(37)8(14)0,0003Implant depth, mean ± SD6,87 ± 2,96,32 ± 2,65,71 ± 39,12 ± 30,0001Abstract Figure. Kaplan-Meier survival curve

Abstract 2817: The Impact of Exercise-Induced Changes in Intraventricular Dyssynchrony on the Functional Improvement in Patients with Non-Ischemic Cardiomyopathy

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Soo-Jin Kang ◽  
Hong-Seok Lim ◽  
Un-Jung Choi ◽  
Byung-Joo Choi ◽  
So-Yeon Choi ◽  
...  
Keyword(s):  
Ischemic Cardiomyopathy ◽  
Doppler Imaging ◽  
Functional Improvement ◽  
Peak Exercise ◽  
Lv Function ◽  
Functional Changes ◽  
Exercise Induced ◽  
Induced Changes ◽  
The Impact

Background: We studied whether dynamic changes in LV asynchrony may affect the functional improvement of LV in medically treated patients with non-ischemic cardiomyopathy (CMP). Methods: Supine bicycle exercise was performed in 41 patients (age 51±12 years, EF 33±8%). Using tissue Doppler imaging, the average of peak systolic velocities of 6 basal LV segments were obtained at rest (V b ) and peak exercise (V p ). ΔV was calculated by [V p -V b ], reflecting the contractile reserve. Dyssynchrony index (SD 4 ) was defined as the standard deviation of the time to peak systolic velocities at 4 basal & mid segments of septum and lateral wall on apical 4 chamber view. ΔSD 4 was calculated as [peak exercise SD 4 - resting SD 4 ]. Follow-up echocardiography was done in 35 patients after medication for 11.2±4.2 months. Functional changes of LV was assessed by ΔEF FU and %change of ESV (ΔESV FU ). Results: Baseline SD 4 was 24±17 ms. During exercise, SD 4 increased in 24 patients (ΔSD 4 =+14±12 ms), whereas decreased in 17 patients (ΔSD 4 =-17±14 ms). ΔSD 4 correlated with ΔV (r=-0.36, p=0.021) and exercise-induced increase in MR (ΔJet/LA area (%); r=0.31, p=0.05 and ΔPISA radius at 40cm/s of aliasing v; r=0.46, p=0.003). ΔV and ΔPISA were related to the follow-up change of LV function. Especially, ΔSD 4 independently correlated with ΔEF FU (β= -0.82, p<0.001) and also with ΔESV FU (β= 0.40, p=0.021)(Fig ). However, baseline SD 4 didn’t affect ΔEF FU . On ROC curve analysis, sensitivity and specificity of ΔSD 4 <4.0 ms were 82% and 78% for predicting ΔEF FU >+5% and 70% and 63% for predicting ΔESV FU <-15%. Conclusion : Exercise-induced changes in dyssynchrony (ΔSD 4 ) can predict the functional improvement in non-ischemic CMP.

Abstract 17215: Pacing Burden in Those Undergoing Permanent Pacemaker Implantation After TAVR With Latest Generation Valves

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Amneet Sandhu ◽  
Karen Ream ◽  
Wendy Tzou ◽  
Alexis Tumolo ◽  
Blake Fleeman ◽  
...  
Keyword(s):  
Heart Valves ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
System Disease ◽  
Edwards Sapien ◽  
Conduction System Disease ◽  
Rv Pacing ◽  
New Generation

Background: Risk factors leading to heart block (HB) and need for permanent pacemaker (PPM) implantation post-TAVR using latest generation heart valves have been described. Yet, little is known regarding pacing burden following PPM implantation among such patients. Objective: We sought to determine follow-up RV pacing burden among those undergoing PPM for HB following TAVR. Methods: From July 2016 to July 2017, we reviewed procedural and 3-month follow-up data (including PPM interrogation data) from all patients undergoing implantation of Edwards Sapien 3® and Medtronic Evolut-R® valves at our institution and requiring implantation of a PPM due to HB secondary to the TAVR procedure. Results: Of 132 included patients who underwent TAVR with new generation valves, 25 (19%) required post-TAVR PPM implantation. Of 25 patients, 18 had available follow-up pacemaker data [Table]. Pacing burden post-PPM implantation of 29mm valves was significantly greater compared to non-29mm valves (40.2% vs. 5.4%, p = 0.02). Those with baseline conduction system disease (RBBB or LBBB) had greater pacing burdens, in particular when 29mm Evolut-R® self-expanding valves were deployed (n=3, RV pacing burden 63.3%). Extension of programmed AV delays produced significant reduction in RV pacing burden. Conclusion: In those undergoing TAVR with latest generation valves complicated by HB requiring PPM use, implantation of larger-sized valves (29 mm Evolut-R® in the present series), as well as baseline RBBB or LBBB results in increased follow-up RV pacing burden. This may be mitigated by adjustment of pacing parameters. Further work investigating long-term pacing burden and its consequences is needed to provide additional insight. Table: Demographics, baseline ECG characteristics, procedural characteristics, pacing mode, pacing parameters and follow-up RV pacing burden.

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