Merits of Different Ventricular Lead Locations on Left Ventricular Myocardial Strain and Dyssynchrony in Patients with Cardiac Resynchronization Therapy.
- 作者列表："Algazzar AS","Elbably MM","Katta AA","Elmeligy N","Elrabbat K","Qutub MA
BACKGROUND:The idea behind cardiac resynchronization therapy (CRT) is to pace both ventricles resulting in a synchronized electro-mechanical coupling of the left ventricle (LV), meaning every effort should be made to improve the percentage of CRT responders. OBJECTIVES:This study aimed at demonstrating the short-term effect of right ventricular apical (RVA) and mid-septal (RVS) lead locations combined with different LV lead positions on LV myocardial strain, dyssynchrony, and clinical outcomes. METHODS:We examined 60 patients with indication for CRT before and after 6 months of implantation for clinical outcome and CRT response (6-min walk test [6MWT], NYHA class, decrease in left ventricular end systolic volume [LVESV] by >15%), dyssynchrony, and myocardial strain. RESULTS:After 6 months of follow-up, the two RV lead locations represented a significant improvement in 6MWT, left ventricular ejection fraction, and LVESV in comparison to baseline values, but no significant difference was found between both groups. With regards to NYHA class improvement, p values were insignificant between the groups (0.44 and 0.88) at baseline and 6 months after implantation, respectively. The mean 6MWT was 273.8 m in the RVA group compared to 279.0 m in the RVS group (p = 0.84) at baseline. After 6 months of CRT implantation, the 6MWT mean was 326.5 m in the RVA group compared to 316.2 m in the RVS group (p = 0.74). The posterolateral cardiac vein site showed a significant improvement when combined with RVS location in interventricular and intraventricular dyssynchrony, global longitudinal strain, global circumferential strain, and apical circumferential strain (p = 0.01 0.032, 0.02, 0.005, and 0.049), respectively. CONCLUSION:RVS is not inferior and provides a good alternative to RVA pacing in short-term follow-up. However, the QRS duration, myocardial strain, and dyssynchrony varies depending on RV and LV stimulation sites. Long-term morbidity and mortality outcomes according to LV lead location in coronary sinus need more assessment.
背景: 心脏再同步化治疗 (CRT) 背后的想法是起搏两个心室，导致左心室 (LV) 的同步电-机械耦合，这意味着应该尽一切努力提高CRT应答者的百分比。 目的: 本研究旨在证明右心室心尖 (RVA) 和中间隔 (RVS) 导联位置联合不同LV导联位置对LV心肌应变、不同步和临床结果的短期影响。 方法: 我们检查了60例植入前和植入6个月后有CRT指征的患者的临床结果和CRT反应 (6分钟步行试验 [6MWT]，NYHA分级，左心室收缩末期容积 [LVESV] 减少> 15%)，不同步和心肌应变。 结果: 随访6个月后，与基线值相比，两种RV导联位置代表6MWT、左心室射血分数和LVESV的显著改善，但两组之间没有发现显著差异。关于NYHA分级改善，在基线和植入后6个月，两组之间的p值 (0.44和0.88) 分别不显著。在基线时，RVA组的平均6MWT为273.8 m，而RVS组为279.0 m (p = 0.84)。CRT植入6个月后，RVA组6MWT平均值为326.5 m，而RVS组为316.2 m (p = 0.74)。心脏后外侧静脉部位与RVS位置联合使用时，在室间隔和室室内不同步、整体纵向应变、整体圆周应变和心尖圆周应变方面显示出显著改善 (分别为p = 0.01 0.032、0.02、0.005和0.049)。 结论: RVS并不劣于RVA起搏，在短期随访中提供了一种良好的替代RVA起搏的方法。然而，QRS时限、心肌应变和不同步取决于RV和LV刺激部位。根据冠状静脉窦LV导联位置的长期发病率和死亡率结果需要更多的评估。
METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.