Figure 2 - uploaded by Daniel Patrick Morin
Content may be subject to copyright.
Source publication
Systolic heart failure is a major problem for Americans today, with 550,000 new cases diagnosed per year, and ultimately contributes to 287,000 deaths annually. While pharmacologic therapy has drastically improved outcomes in patients with systolic heart failure, hospitalizations from systolic heart failure continue to increase and remain a major c...
Similar publications
Takotsubo cardiomyopathy (TC) is a unique transient nonischemic cardiomyopathy that mimics acute myocardial infarction (MI). The aim of our study was to evaluate electrocardiographic changes in patients with TC, including the frequency of ST elevation and other abnormalities.
Eleven patients were retrospectively identified from echocardiography d...
To determine the characteristics and outcomes of young adults with heart failure (HF).
Few studies have focused on young and very young adults with HF.
Patients were categorized into 5 age groups: 20-39, 40-49, 50-59, 60-69, and ≥70 years.
The youngest patients with HF were more likely to be obese (youngest vs. oldest: BMI≥35kg/m2: 23% vs. 6%), of...
Citations
... CRT has had a major favourable impact on the care of patients with heart failure, left ventricular (LV) systolic dysfunction, and mechanical dyssynchrony, routinely identified by electrocardiography (ECG) as abnormal electrical activation. 5,6 CRT devices can modify the electrical activation patterns of the ventricles and result in improvements in both intra-ventricular and interventricular synchrony, in turn leading to an improvement in overall hemodynamic function. 7 The major mechanism of action of CRT is believed to be reversal of the abnormal ventricular activation pattern seen in patients with LBBB conduction delay. ...
... This principle finds application in cardiac resynchronization therapy (CRT), one of the major types of CIEDs that has revolutionized the treatment of drug-resistant advanced congestive heart failure. The aim of CRT is to achieve mechanical synchrony of the heart via activating electrical impulses in a synchronized fashion [14]. Although CRTs are usually used in the treatment of systolic dysfunction, there has been evidence that they improve the diastolic outcomes of the heart as well [15]. ...
Heart Failure is a major public health problem globally, affecting about 5.1 million patients in the US, almost 40% of whom have predominantly diastolic left ventricular (LV) dysfunction. Pulsed doppler echocardiography of the mitral inflow, in terms of E-A ratio, is used in the assessment of diastolic function. Besides E-A ratio, optimization of E-A wave synchrony and morphology has also been shown to improve diastolic filling and cardiac hemodynamics in patients with cardiac implantable electronic devices (CIED). In this case report, we applied the principles of echocardiographic AV optimization in CIED patients to patients without CIEDs by pharmacological intervention to improve LV diastolic function.
... Among various heart diseases, heart failure, a condition in which the heart muscle is unable to pump su cient blood to meet the body's demands, continues to increase in prevalence and severity. Heart failure affects over 26 million people globally, contributing to approximately 287,000 deaths in the United States alone each year (Ponikowski et al. 2014; Owen et al. 2009). Despite the varied environmental factors associated with heart failure, recent studies have revealed that genetic factors may play a critical role in the formation of this disease (Czepluch et al. 2018). ...
Background
Heart failure is a complex syndrome that hinders the heart's ability to provide oxygen to the tissues and is a significant cause of death globally. Given that left ventricular failure is more common than left atrial failure, this study utilizes single-cell RNA-sequencing data to detect differentially expressed genes (DEGs) between the endothelial cells of the two chambers and examines whether these DEGs are related to heart failure development.
Method
The analysis of a healthy human dataset was performed using Seurat, an R package, to identify differentially expressed genes (DEGs) between endothelial cells from the left ventricle and the left atrium of the heart. These findings were validated using two datasets that included both humans and mice with and without heart disease. The overlapped DEGs from the datasets were then utilized to develop a risk prediction model by using linear regression, which can determine an individual's risk for heart failure based on the expression levels of the overlapped DEGs.
Results
Seven genes, including MYL3, MYH6, TNNC1, FN1, B2M, MYL2, and SAT1, were identified with a significant p-value in all three datasets. Enrichment analysis has shown that these genes play a critical role in muscle contraction and heart regulation, and mutations in these genes have been linked to cardiomyopathy. The risk prediction model had a high accuracy rate of 85% in an independent validation dataset.
Conclusion
This study has successfully identified significant genes in endothelial cells that are associated with heart failure and may explain the difference in morbidity between the left ventricle and left atrium.
... The therapeutic arsenal for HF has advanced within the past 20 years. Cardiac resynchronization therapy (CRT) is now commonly used in patients whose etiology involves desynchronization of ventricular contractions, leading to the pathogenesis of the disease [4]. CRT is indicated for patients who do not respond satisfactorily to drug therapy to improve the hemodynamic aspects of these patients [5]. ...
... CRT has achieved significant benefits for patients, leading to improved quality of life and a decreased number of hospital admissions; consequently, HF-related morbidity and mortality [4,6]. However, approximately one-third of patients undergoing CRT respond inadequately to this therapy due to anatomical difficulties, phrenic nerve stimulation, and inadequate position, among others [6,7]. ...
... The main criterion is meeting the classical criteria of indication for CRT (extended QRS, LVEF < 35%, NYHA functional class II-IV). Among the population studied, a predominance of men, totaling 77% of patients randomized in the studies [4], was observed. ...
Background
Cardiac resynchronization therapy is an important validated technique for patients with dyssynchrony and heart failure. However, the response rate to conventional resynchronization is approximately 50%; therefore, new techniques and schedules have emerged. This study aimed to evaluate the different clinical and echocardiographic variables of conventional versus multipoint cardiac resynchronization therapy.
Research design and method
A systematic review was conducted of randomized clinical trials in the PubMed, Cochrane, and Embase databases on cardiac resynchronization intervention with multipoint stimulation and clinical and echocardiographic outcomes evaluated before and 3 months after the intervention.
Results
Three studies (N = 139) were ultimately selected, and 100% of patients had a New York Heart Association functional class of II–IV, QRS > 120 ms, and left ventricular ejection fraction < 35%. Significantly greater improvement was observed in the functional class of patients who underwent multipoint versus conventional therapy. Final systolic volume and ejection fraction improved in the multipoint group, but the difference was not statistically significant.
Conclusions
The literature lacks sufficient randomized controlled multicenter studies to enable conclusions regarding cardiac resynchronization therapy responses using different strategies. Moreover, the improvement in functional class in the multipoint pacing group involved few patients and had slight statistical relevance.
... CRT improves cardiac performance, patients symptoms and reduces morbidity and mortality in appropriately selected patients [5] by producing reverse remodeling, improving EF and reducing mitral regurgitation and in LV volumes. [6] For patients with moderate-to-severe HF (New York Heart Association [NYHA] Class III-IV), CRT has been shown in multiple trials (MUSTIC SR, MIRACLE, CONTAK-CD, MIRACLEICD) to provide very consistent improvements in NYHA functional class ranking, exercise capacity, peak oxygen consumption, and quality of life. ...
... 1. We recommend use of postimplantation QRS duration as a simple method for CRT optimization 2. Prediction of response to CRT could be assessed by either postimplantation QRS duration or LVOT VTI 3. Postimplantation cut off values can be used for identification of patients with optimum response to CRT 4. Postimplantation cut off value of QRS duration (<130) predict higher LVOT VTI and also the postimplantation benefit for the patient with CRT implanted 5. Our results raise the importance of using tools to reduce QRS duration e.g., either quadripolar leads or his bundle pacing in optimizing the response to CRT as both of them achieve a shorter QRS duration 6. CRT response is more in female with non-ICM, lower BSA and longer time since CRT implantation 7. Further studies are needed to verify the similarity with our cut off values for CRT response prediction. ...
Background:
Cardiac resynchronization therapy (CRT) has a morbidity and mortality benefits in moderate to severe heart failure. It reduces mortality and hospitalization and improves cardiac function. It can be used according to the European guidelines in severely depressed left ventricular ejection fraction (i.e., ≤35%) and complete left bundle branch block. However, 30% of patients may show no benefit from CRT therapy. Therefore, prediction of CRT response seems to be an important subject for study in the current researches. We aimed to study the correlation between Surface ECG QRS complex duration (QRS) duration and cardiac output measured by ventricular outflow tract velocity time integral (LVOT VTI) as a predictor of response in patients with CRT implantation.
Methods:
We studied 100 consecutive patients prospectively with biventricular pacing system. The patients were studied at the pacemaker follow-up clinic. Each patient was subjected to: Full medical history, general and local examination, a 12 lead electrocardiogram and QRS duration in ms was measured. All patients were subjected to a focused transthoracic echocardiographic examination in which a parasternal long axis view was obtained to measure the diameter of the LVOT diameter in mid-systole. The LVOT VTI was measured by pulsed-wave Doppler in the LVOT using a 2-mm sample volume positioned just proximal to the aortic valve in the apical five chamber view.
Results:
We found a statistically significant difference between CRT responders and nonresponders as regards age, body surface area (BSA), time since CRT implantation and smoking status (P = 0.018, 0.039, 0.002, <0.001). There was negative significant correlation between QRS duration and LVOT VTI and stroke volume index. The optimal cut off values for optimal response to CRT using receiver operating characteristics curves were 130 ms for postimplant QRS duration and 17.1 cm for LVOT VTI. We also found a significant difference between responders and nonresponders as regard CO. It was higher in responders (5.97 vs. 3.34, P < 0.001).
Conclusion:
CRT response is more in patients with lower BSA, and without previous history of ischemic heart disease or smoking. There is a significant negative correlation between QRS duration and LVOT VTI.
... Most of the pulse generators had scratches; however, with the naked eye it was not possible to quantify how deep they were. With the use of the microscope, the coils were examined for cut, stretches and other damage modes [9]. [11,12]. ...
... Most of the pulse generators had scratches; however, with the naked eye it was not possible to quantify how deep they were. With the use of the microscope, the coils were examined for cut, stretches and other damage modes [9]. [11,12]. ...
Damage assessment of lead and pulse generator with various exposure times is
important in the development of cardiac devices. Approximately, 92.1 million patients
in the US suffer from cardiovascular diseases with an estimated healthcare cost of over
$300 billion and at least one million with implantable cardiac devices. These devices
are complex and composed on multiple levels and present challenges while assessing
the damage. However, the study on the analysis of cardiac devices may lend insight into
common damage patterns and improve future cardiac devices design. The objective of
this work is to perform a thorough in vivo damage assessment of retrieved 65 cardiac
devices and 136 leads from different manufacturers (Medtronic, St. Jude Medical-Abbott
and Boston Scientific). The examined damage features were surface deformation,
burnishing, pitting, scratching, discoloration, delamination, insulation defects, coil
damage, and abrasion. Methods to collect and compile data were performed, and
statistical models were used to assess the sensitivity of measured parameters with
in vivo performance. The devices from Medtronic and Boston Scientific were affected
by the damage modes but these damages could not have affected the functionality of
the devices and the therapy. The main damage mode observed was scratching, and the
anterior side was more exposed to damage than the posterior side. Medtronic leads
showed significant resistant to different damage modes when compared to Boston
Scientific and St. Jude Medical, and the middle part was more exposed to damage than
the proximal part. Medtronic leads showed failure rates lower than other manufacturers
based on the 65 devices that were examined in this paper.
... In the past two decades, CRT has been increasingly employed for the treatment of selected HF patients with electrical dyssynchrony. CRT aims to restore mechanical synchrony by electrically pacing the heart in a synchronised manner (Owen et al., 2009). Standard selection criteria for CRT are a New York Heart Association functional class of II to IV, a QRS duration ≥ 120ms, and a LV ejection fraction (EF)≤ 35% (Owen et al., 2009). ...
... CRT aims to restore mechanical synchrony by electrically pacing the heart in a synchronised manner (Owen et al., 2009). Standard selection criteria for CRT are a New York Heart Association functional class of II to IV, a QRS duration ≥ 120ms, and a LV ejection fraction (EF)≤ 35% (Owen et al., 2009). However, when applying such criteria, approximately 30% and 44% of eligible patients do not show, respectively, clinical (i.e. ...
We present a framework for combining a cardiac motion atlas with non- motion data. The atlas represents cardiac cycle motion across a number of subjects in a common space based on rich motion descriptors capturing 3D displacement, velocity, strain and strain rate. The non-motion data are derived from a variety of sources such as imaging, electrocardiogram (ECG) and clinical reports. Once in the atlas space, we apply a novel supervised learning approach based on random projections and ensemble learning to learn the relationship between the atlas data and some desired clinical output. We apply our framework to the problem of predicting response to Cardiac Resynchronisation Therapy (CRT). Using a cohort of 34 patients selected for CRT using conventional criteria, results show that the combination of motion and non-motion data enables CRT response to be predicted with 91.2% accuracy (100% sensitivity and 62.5% specificity), which compares favourably with the current state-of-the-art in CRT response prediction.
... Cardiac resynchronization therapy (CRT) is an established treatment option for heart failure patients with a widened QRS complex who are resistant to optimal medical therapy (14)(15)(16). CRT device implan tation may lead to left ventricular (LV) reverse remodeling, systolic and diastolic function improvement and reduction of mitral regurgitation (17)(18). Left ventricular remodeling contributes to reduction of symptoms and improvement of exercise tolerance, quality of life and overall survival (19)(20)(21). ...
In the majority of patients with a wide QRS complex and heart failure resistant to optimal medical therapy, cardiac resynchronization therapy (CRT) leads to reverse ventricular remodeling and possibly to changes in cardiac collagen synthesis and degradation. We investigated the relationship of biomarkers of myocardial collagen metabolism and volumetric response to CRT.
We prospectively studied 46 heart failure patients (mean age 61±9 years, 87% male) who underwent CRT im plantation. Plasma concentrations of amino-terminal propeptide type I (PINP), a marker of collagen synthesis, and carboxy-terminal collagen telopeptide (CITP), a marker of collagen degradation, were measured before and 6 months after CRT. Response to CRT was defined as 15% or greater reduction in left ventricular end-systolic volume at 6-month follow-up.
Baseline PINP levels showed a negative correlation with both left ventricular end-diastolic volume (r=−0.51; p=0.032), and end-systolic diameter (r=−0.47; p=0.049). After 6 months of device implantation, 28 patients (61%) responded to CRT. No significant differences in the baseline levels of PINP and CITP between responders and non-responders were observed (p>0.05 for both). During follow-up, responders demonstrated a significant increase in serum PINP level from 31.37±18.40 to 39.2±19.19 μg/L (p=0.049), whereas in non-responders serum PINP levels did not significantly change (from 28.12±21.55 to 34.47±18.64 μg/L; p=0.125). There were no significant changes in CITP levels in both responders and non-responders (p>0.05).
Left ventricular reverse remodeling induced by CRT is associated with an increased collagen synthesis in the first 6 months of CRT implantation.
... X-ray of patient receiving cardiac resynchronization therapy. Adapted with permission from Owen et al.6 Authorization for this adaptation has been obtained both from the owner of the copyright in the original work and from the owner of copyright in the translation or adaptation.Regional and global pathophysiology of cardiac dyssynchrony. A, Left, Strain plots vs time for control dogs and dyssynchronous dogs in both the early-and the late-activated regions. ...
Patients with heart failure and decreased function frequently develop discoordinate contraction because of electric activation delay. Often termed dyssynchrony, this further decreases systolic function and chamber efficiency and worsens morbidity and mortality. In the mid- 1990s, a pacemaker-based treatment termed cardiac resynchronization therapy (CRT) was developed to restore mechanical synchrony by electrically activating both right and left sides of the heart. It is a major therapeutic advance for the new millennium. Acute chamber effects of CRT include increased cardiac output and mechanical efficiency and reduced mitral regurgitation, whereas reduction in chamber volumes ensues more chronically. Patient candidates for CRT have a prolonged QRS duration and discoordinate wall motion, although other factors may also be important because ≈30% of such selected subjects do not respond to the treatment. In contrast to existing pharmacological inotropes, CRT both acutely and chronically increases cardiac systolic function and work, yet it also reduces long-term mortality. Recent studies reveal unique molecular and cellular changes from CRT that may also contribute to this success. Heart failure with dyssynchrony displays decreased myocyte and myofilament function, calcium handling, β-adrenergic responsiveness, mitochondrial ATP synthase activity, cell survival signaling, and other changes. CRT reverses many of these abnormalities often by triggering entirely new pathways. In this review, we discuss chamber, circulatory, and basic myocardial effects of dyssynchrony and CRT in the failing heart, and we highlight new research aiming to better target and implement CRT, as well as leverage its molecular effects.
