The effectiveness of the cardiac resynchronization in a patient with ischemic cardiomyopathy

Cardiac resynchronization therapy (CRT) in multiple and large trials has been demonstrated to improve symptoms and decrease hospitalization and mortality of patients when used in addition to optimal medical therapy. The global mechanical performance of the heart is affected in subjects with heart failure by atrio-ventricular, interventricular, or intraventricular conduction disorders, which lead to the desynchronization of electrical activity. Cardiac resynchronization therapy can effectively improve the clinical and haemodynamic status of these patients. According to literature data, CRT is performed only on well-selected patients (who qualify for CRT based on current indications), and approximately 70% of those patients respond favorably. We present the case of a patient responsive to cardiac resynchronization therapy which led to lowering of his NYHA classification and to improvement of left ventricle hemodynamics. The benefits of cardiac resynchronization therapy were multiple in this case, including improved tolerance to physical exercise and a decreased rate of hospitalization, which overall led to improved quality of life

The effectiveness of the cardiac resynchronization in a patient with ischemic cardiomyopathy

Cardiac resynchronization therapy (CRT) in multiple and large trials has been demonstrated to improve symptoms and decrease hospitalization and mortality of patients when used in addition to optimal medical therapy. The global mechanical performance of the heart is affected in subjects with heart failure by atrio-ventricular, interventricular, or intraventricular conduction disorders, which lead to the desynchronization of electrical activity. Cardiac resynchronization therapy can effectively improve the clinical and haemodynamic status of these patients. According to literature data, CRT is performed only on well-selected patients (who qualify for CRT based on current indications), and approximately 70% of those patients respond favorably. We present the case of a patient responsive to cardiac resynchronization therapy which led to lowering of his NYHA classification and to improvement of left ventricle hemodynamics. The benefits of cardiac resynchronization therapy were multiple in this case, including improved tolerance to physical exercise and a decreased rate of hospitalization, which overall led to improved quality of life

The effectiveness of the cardiac resynchronization in a patient with ischemic cardiomyopathy

Cardiac resynchronization therapy (CRT) in multiple and large trials has been demonstrated to improve symptoms and decrease hospitalization and mortality of patients when used in addition to optimal medical therapy. The global mechanical performance of the heart is affected in subjects with heart failure by atrio-ventricular, interventricular, or intraventricular conduction disorders, which lead to the desynchronization of electrical activity. Cardiac resynchronization therapy can effectively improve the clinical and haemodynamic status of these patients. According to literature data, CRT is performed only on well-selected patients (who qualify for CRT based on current indications), and approximately 70% of those patients respond favorably. We present the case of a patient responsive to cardiac resynchronization therapy which led to lowering of his NYHA classification and to improvement of left ventricle hemodynamics. The benefits of cardiac resynchronization therapy were multiple in this case, including improved tolerance to physical exercise and a decreased rate of hospitalization, which overall led to improved quality of life

Retinal Microvascular Alterations in a Patient with Type 1 Diabetes Mellitus, Hemoglobin D Hemoglobinopathy, and High Myopia—Case Report and Review of the Literature

Type 1 diabetes mellitus (type 1 DM) is one of the most prevalent endocrinological diseases among children and young adults, with a growing incidence rate reaching up to 2.9 new cases per year per 100,000 persons below 15 years of age. We report a rare case of a 20-year-old female patient with type 1 DM, hemoglobin D (HbD) heterozygote variant and high myopia of −10.00 spheric diopters, and describe the retinal microvascular alterations visible on OCT angiography (angio-OCT). The patient also presented with a severe stature deficit (less than three standard deviations) and delayed puberty, which could not be explained only by suboptimal glycemic control and indicated possible hypopituitarism. HbA1c level evaluated with the high-performance liquid chromatography (HPLC) method was 6.5%, a falsely low value due to HbD hemoglobinopathy. On ophthalmic evaluation, the angio-OCT scan showed the following retinal microvascular alterations in the right eye (RE): the FAZ (Foveal Avascular Zone) area was 0.39 mm2, the FAZ perimeter was 2.88 mm, and the circularity index was 0.58. The following alterations were shown in the left eye (LE): the FAZ area was 0.34 mm2, the FAZ perimeter was 3.21 mm, and the circularity index was 0.41. Clinicians should consider high-performance retinal screening methods such as angio-OCT evaluation for young type 1 DM patients, especially for those with associated pathologies like high myopia and hemoglobinopathies. Moreover, multiple evaluation methods of HbA1c values are mandatory as hemoglobinopathies can interfere with the accuracy of HbA1c assay methods

Early Retinal Microvascular Alterations in Young Type 1 Diabetic Patients without Clinical Retinopathy

The purpose of this study is to identify and quantify preclinical changes with the help of optical coherence tomography angiography (OCTA) within the retinal microcirculation of young type 1 diabetes (T1D) patients without clinical signs of diabetic retinopathy (DR) and to compare these results with those obtained from healthy age-matched subjects. OCTA is currently used for monitoring diabetic retinopathy; however, there is no current consensus on which OCTA parameter alterations predict the first clinical signs of diabetic retinopathy. The main challenge that young patients with T1D face during the course of the disease is that they can rapidly progress to the development of DR, especially during adolescence. Moreover, they also present an increased risk of rapid progression toward advanced stages of DR and vision loss compared to type 2 diabetes patients, indicating the importance of early diagnosis and intervention. The limitations of the currently used screening procedures that led to the conceptualization of our study are the difficulties in performing fluorescein angiography tests for diagnosing the clinical signs of DR on young patients, namely the invasive procedure of dye injection, the risk of allergic reactions and the long duration of the examination. Moreover, given the long life expectancy of young T1D patients, it is essential to identify the preclinical changes in retinal microvasculature before reaching the first clinical signs quantifiable by FFA. The clinical study enrolled 119 subjects aged between 4 and 30 years old with a mean age of 13 years old, comprising 61 T1D patients with a mean duration of the disease of 4 years and 8 months and 58 healthy age-matched subjects for the control group. OCTA scans were performed using the RevoNX 130 OCTA device (Optopol) to evaluate the following retinal parameters: foveal avascular zone (FAZ) area, perimeter and circularity, overall foveal thickness, and superficial and deep vessel densities. Statistically significant differences between the two groups were identified for the following parameters: the FAZ area in the T1D group (0.42 ± 0.17) was larger than the control group (0.26 ± 0.080), the FAZ circularity (0.41 ± 0.11) was decreased compared to the control group (0.61 ± 0.08) and the FAZ perimeter was larger (3.63 ± 0.97) compared to the control group (2.30 ± 0.50). The overall foveal thickness was decreased in the T1D group (222.98 ± 17.33) compared to the control group (230.64 ± 20.82). The total vessel density of the superficial capillary plexus (SCP) on an investigated area of 6 X 6 mm centered around the fovea was decreased in the T1D group (37.4164 ± 2.14) compared to the control group (38.0241 ± 2.44). Our data suggest that specific imaging biomarkers such as FAZ perimeter, area and circularity, decreased overall foveal thickness and decreased vessel density in the SCP precede the clinical diagnosis of DR in young T1D patients and represent useful parameters in quantifying capillary nonperfusion in T1D patients without clinical signs of DR