Cardiac Resynchronization Therapy
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2021 ◽  
Vol 21 (1) ◽  
Björn Östenson ◽  
Ellen Ostenfeld ◽  
Anna Werther-Evaldsson ◽  
Anders Roijer ◽  
Zoltan Bakos ◽  

Abstract Background Cardiac resynchronization therapy (CRT) restores ventricular synchrony and induces left ventricular (LV) reverse remodeling in patients with heart failure (HF) and dyssynchrony. However, 30% of treated patients are non-responders despite all efforts. Cardiac magnetic resonance imaging (CMR) can be used to quantify regional contributions to stroke volume (SV) as potential CRT predictors. The aim of this study was to determine if LV longitudinal (SVlong%), lateral (SVlat%), and septal (SVsept%) contributions to SV differ from healthy controls and investigate if these parameters can predict CRT response. Methods Sixty-five patients (19 women, 67 ± 9 years) with symptomatic HF (LVEF ≤ 35%) and broadened QRS (≥ 120 ms) underwent CMR. SVlong% was calculated as the volume encompassed by the atrioventricular plane displacement (AVPD) from end diastole (ED) to end systole (ES) divided by total SV. SVlat%, and SVsept% were calculated as the volume encompassed by radial contraction from ED to ES. Twenty age- and sex-matched healthy volunteers were used as controls. The regional measures were compared to outcome response defined as ≥ 15% decrease in echocardiographic LV end-systolic volume (LVESV) from pre- to 6-months post CRT (delta, Δ). Results AVPD and SVlong% were lower in patients compared to controls (8.3 ± 3.2 mm vs 15.3 ± 1.6 mm, P < 0.001; and 53 ± 18% vs 64 ± 8%, P < 0.01). SVsept% was lower (0 ± 15% vs 10 ± 4%, P < 0.01) with a higher SVlat% in the patient group (42 ± 16% vs 29 ± 7%, P < 0.01). There were no differences between responders and non-responders in neither SVlong% (P = 0.87), SVlat% (P = 0.09), nor SVsept% (P = 0.65). In patients with septal net motion towards the right ventricle (n = 28) ΔLVESV was − 18 ± 22% and with septal net motion towards the LV (n = 37) ΔLVESV was − 19 ± 23% (P = 0.96). Conclusions Longitudinal function, expressed as AVPD and longitudinal contribution to SV, is decreased in patients with HF scheduled for CRT. A larger lateral contribution to SV compensates for the abnormal septal systolic net movement. However, LV reverse remodeling could not be predicted by these regional contributors to SV.

2021 ◽  
Vol 28 ◽  
pp. 17-24
V. A. Kuznetsov ◽  
T. N. Enina ◽  
A. M. Soldatova ◽  
T. I. Petelina ◽  
S. M. Dyachkov ◽  

Purpose. To design a mathematical model, that can predict a positive response to cardiac resynchronization therapy (CRT) in patients with congestive heart failure (CHF) and sinus rhythm, according to complex analysis of neurohumoral and immune activation biomarkers, fibrosis, renal dysfunction, echocardiography.Methods. Parameters of echocardiography, plasma levels of NT-proBNP, interleukins-1β, 6, 10, tumor necrosis factor α, С-reactive protein (СRP), matrix metalloproteinase-9 (ММР-9), tissue inhibitors of metalloproteinase 1 and 4, cystatin С (CYSTATIN) were studied in 40 CHF patients with sinus rhythm (65% coronary artery disease patients, 75% males, mean age 54.8±10.6 years old) during the period of maximum decrease of left ventricular end-systolic volume (LVESV) (mean duration 27.5 [11.1; 46.3] months). Responders (decrease in LVESV ≥15%) and non-responders (decrease in LVESV <15%) were identified.Results. The number of responders was 26 (65%). The initial set of variables included: age, left ventricular ejection fraction (EF), pulmonary artery systolic pressure, right ventricle size and NT-proBNP, СRP, ММР-9, CYSTATIN. According to logistic regression analysis, a prediction model of positive CRT response was created. The specificity of the model was 92.9%, sensitivity - 83.3%, AUC=0.952 (р˂0.001).Conclusion. The proposed model, based on the assessment of left ventricle EF and circulating biomarkers of inflammation, fibrosis, and renal function, strongly suggests a higher possibility of response to CRT.

2021 ◽  
Vol 26 (9) ◽  
pp. 4500
L. M. Malishevsky ◽  
V. A. Kuznetsov ◽  
V. V. Todosiychuk ◽  
N. E. Shirokov ◽  
D. S. Lebedev

Aim. To analyze the prognostic value of 18 electrocardiographic (ECG) markers of left bundle branch block (LBBB) in predicting left ventricular (LV) reverse remodeling in patients receiving cardiac resynchronization therapy (CRT).Material and methods. The study included 98 patients. Depending on the presence of reverse remodeling during CRT, defined as a decrease in LV endsystolic volume ≥15%, the patients were divided into two groups: non-responders (n=33) and responders (n=65). We selected and analyzed 18 ECG markers included in 9 LBBB criteria.Results. Among the ECG markers significantly associated with reverse remodeling during CRT, the absence of q wave in leads V5-V6 demonstrated the highest sensitivity (92,31%), a negative predictive value (70,59%) and overall accuracy (73,47%). Normal internal deviation interval of the R wave in leads V1-V3 was also associated with the best sensitivity (92.31%), while QS with a positive T in lead aVR — the best specificity (69,7%). Discordant T wave demonstrated the highest positive predictive value (80,33%). Multivariate analysis revealed following ECG signs independently associated with reverse remodeling during CRT: QRS complex duration (odds ratio (OR)=1,022; 95% confidence interval (CI): 1,001-1,043; p=0,040); absence of q wave in leads V5-V6 (OR=4,076; 95% CI: 1,071-15,51; p=0,039); discordant T wave (OR=4,565; 95% CI: 1,708-12,202; p=0,002). These ECG findings were combined into a mathematical model that demonstrated high predictive power (AUC=0,81 [0,722-0,898], p<0,001). Once the cut-off point was determined, a binary variable was obtained that showed higher sensitivity, negative predictive value, and overall accuracy when compared with the actual LBBB criteria. The 5-year survival rate among patients with a model value above the cut-off point was 84,4%, while in patients with a value below the cut-off point — 50% (Log-rank test, p=0,001). To improve usability of the model, a mobile application was developed.Conclusion. For the first time, the diagnostic value of ECG markers of LBBB were analyzed and a mathematical model with ECG signs was proposed to predict reverse remodeling in patients receiving CRT.

2021 ◽  
Vol 17 ◽  
Tuoyo O Mene-Afejuku ◽  
Abayomi O Bamgboje ◽  
Modele O Ogunniyi ◽  
Ola Akinboboye ◽  
Uzoma N Ibebuogu

Background: Heart failure (HF) is a global public health problem which affects over 23 million people worldwide. The prevalence of HF is higher among seniors in the USA and other developed countries. Ventricular arrhythmias (VAs) account for 50% of deaths among patients with HF. We aim to elucidate on the factors associated with VAs among seniors with HF, as well as therapies that may improve outcomes. Methods: PubMed, Web of Science, Scopus, Cochrane Library databases, Science Direct, and Google Scholar were searched using specific key words. The reference lists of relevant articles were searched for additional studies related to HF and VAs among seniors as well as associated outcomes. Results: The prevalence of VAs increases with worsening HF. 24-hour Holter electrocardiogram may be useful in risk stratifying patients for device therapy if they do not meet the criterion of low ventricular ejection fraction. Implantable cardiac defibrillators (ICDs) are superior to anti-arrhythmic drugs in reducing mortality in patients with HF. Guideline directed medical therapy (GDMT) together with device therapy to reduce symptoms may be required. In general, the proportion of seniors on GDMT is low. A combination of ICDs and cardiac resynchronization therapy may improve outcomes in select patients. Conclusion: Seniors with HF and VAs have a high mortality even with the use device therapy and GDMT. The holistic effect of device therapy on outcomes among seniors with HF is equivocal. More studies focused on seniors with advanced HF as well as therapeutic options is therefore required.

2021 ◽  
Vol 27 (3) ◽  
pp. 7-15
Svetoslav Iovev ◽  
Peyo Zhivkov ◽  
Mariana Konteva

Cardiac resynchronization therapy (CRT) using coronary sinus (CS) leads is an established method for the therapy of congestive heart failure (CHF) in the case of asynchronous ventricular contractions. Successful therapy depends on the placement of left ventricular leads usually via the coronary sinus (CS), a technically more challenging procedure than regular pacemaker implantations. Without specifi c precautions CRT implantation can be the gateway to a time-consuming nightmare. Therefore, CS lead implantation methods, with a focus on complications, were reviewed according to the literature and our own experience with approximately 4500 procedures from 2002-2021.

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