Optimizing Cardiac Resynchronization Therapy Device Programming

Cardiac resynchronization therapy (CRT) improves symptoms and cardiac function, reduces hospitalizations and increases survival in selected patients with heart failure. It is mandatory to maximize mechanical and electrical synchronicity. Atrio-ventricular and ventriculo-ventricular intervals optimization have a substantial impact on the hemodynamic response to pacing. The number of patients with an implanted CRT system is increasing and many issues have not yet been answered about who and how will benefit the most

Left Ventricle to Right Atrium Shunt Secondary to Blunt Chest Trauma. A Case Report

Intracardiac shunts are rarely encountered as sequelae of non-penetrating heart trauma and their clinical manifestations may often be unrecognized in the multi-injured patient. However, they are serious complications and their diagnostic approach is not always feasible.

Pre-procedural Transesophageal Echocardiography Underestimates Atrial Septal Defect Size Compared to the Balloon Sizing Technique

Background: Secundum-type atrial septal defects (ASD) are increasingly being treated with percutaneous placement of occluding devices. Accurate sizing of the ASD is mandatory for subsequent optimal selection of the device. We sought to compare the two most commonly used methods, 2 – dimensional transesophageal echocardiography (2D-TEE) and stretched- balloon sizing . Methods: Sixteen patients (8 men and 8 women) aged 53.8±9.8 years with ASD were scheduled for implantation of an Amplatzer septal occluder device. The procedure was performed with the use of local only anesthesia via the right femoral vein with fluoroscopic guidance alone and without the intra-procedural use of 2D-TEE. The size of the defect was measured with 2D-TEE prior to the procedure. In the catheterization laboratory the ASD size was measured again with the insertion of a sizing ballon inflated with diluted contrast agent until a waist appeared. Waist dimensions were measured using cineangiographic  quantitation (QCA) software. Results: All ASDs were successfully closed with Amplatzer occluders. A significant correlation was found between echocardiographic and fluoroscopic measurements of the ASD size (r=0.863, p=0.000). However, most of the echocardiographic measurements underestimated ASD diameters compared with conventional QCA balloon sizing by a mean of 3 mm (16.46±5.93 mm vs 19.83 ±6.3 mm, t= 4.18, p= 0.001). Conclusions: Atrial septal defects can be treated safely and effectively with the percutaneous placement of an Amplatzer septal occluder device via a simple percutaneous technique with use of local anesthesia and fluoroscopy alone without a need for intra-procedural 2D-TEE. Although the use of pre-procedural 2D-TEE has been a common practice for establishing the diagnosis and offering an initial assessment of the size of the defect, it largely underestimates the latter. The single-plane fluoroscopic balloon sizing performed during the procedure seems indispensable for choosing an occluding device of appropriate size. &nbsp

Simultaneous "traumatic Gerbode" and aortic rupture due to blunt chest trauma

The Gerbode defect is characterized by a perimembranous ventricular septal defect between the left ventricle and the right atrium. This intracardiac shunt is a congenital defect but may be iatrogenic after valve surgery or atrioventricular node ablation, may be the result of endocarditis or may be traumatic. It is really rarely encountered as sequelae of non-penetrating heart trauma, and their clinical manifestations may often be unrecognized in the multi-injured patient. However, they are serious complications, and their diagnostic approach is not always feasible. We hereby present a case of a young man with the left ventricle to the right atrium communication after blunt thoracic trauma due to a car accident and concomitant rupture of the thoracic aorta. We present also the case and the ways of treatment according to the international bibliography

Additive benefit of rehabilitation on physical status, symptoms and mental health after hospitalisation for severe COVID-19 pneumonia

Introduction The potential additive benefits of rehabilitation beyond spontaneous recovery post-COVID-19 currently remain unknown.Methods In this prospective, interventional, non-randomised parallel assignment two-arm study, we investigated the effects of an 8-week rehabilitation programme (Rehab, n=25) added to usual care (UC) versus UC (n=27) on respiratory symptoms, fatigue, functional capacity, mental health and health-related quality of life in patients with COVID-19 pneumonia, 6–8 weeks post-hospital discharge. The rehabilitation programme included exercise, education, dietary and psychological support. Patients with chronic obstructive pulmonary disease, respiratory and heart failure were excluded from the study.Results At baseline, groups were not different in mean age (56 years), gender (53% female), intensive care unit admission (61%), intubation (39%), days of hospitalisation (25), number of symptoms (9) and number of comorbidities (1.4). Baseline evaluation was conducted at median (IQR) 76 (27) days after symptoms onset. Groups were not different regarding baseline evaluation outcomes. At 8 weeks, Rehab showed significantly greater improvement in COPD Assessment Test by a mean±SEM (95% CI) 7.07±1.36 (4.29–9.84), p <0.001 and all three fatigue questionnaires: Chalder-Likert: 5.65±1.27 (3.04–8.25), p <0.001; bimodal: 3.04±0.86 (1.28–4.79), p=0.001; Functional Assessment of Chronic Illness Therapy: 6.37±2.09 (2.08–10.65), p=0.005 and Fatigue Severity Scale: 1.36±0.433 (0.47–2.25), p=0.004. At 8 weeks rehab also showed significantly greater improvment in Short Physical Performance Battery: 1.13±0.33 (0.46–1.79), p=0.002; Hospital Anxiety and Depression Scale (HADS) Anxiety: 2.93±1.01 (0.67–5.18), p=0.013; Beck Depression Inventory: 7.81±3.07 (1.52–14.09), p=0.017; Montreal Cognitive Assessment: 2.83±0.63 (1.5–4.14), p <0.001; EuroQol (EQ-5D-5L) Utility Index: 0.21±0.05 (0.1–0.32), p=0.001 and Visual Analogue Scale: 6.57±3.21 (0.2–13.16), p=0.043. Both groups significantly improved 6-min walking distance by approximately 60 m and pulmonary function measures, whereas post-traumatic stress disorder measurement IES-R (Impact of Event Scale, Revised) and HADS-Depression score were not different between groups at 8 weeks. A 16% attrition rate was observed in the rehabilitation group exhibiting a threefold increase in training workload. There were no adverse effects reported during exercise training.Discussion These findings highlight the added value of rehabilitation post-COVID-19 to amplify the natural course of physical and mental recovery that otherwise would remain incomplete with UC

The role of late gadolinium enhancement in predicting arrhythmic events in cardiac sarcoidosis patients – a mini-review

Sarcoidosis is a multisystem inflammatory disorder with an unknown origin. Symptomatic cardiac involvement is rare and occurs in about 5% of patients with sarcoidosis. Fatal ventricular arrhythmias are the most severe clinical presentation of the disease. Cardiac magnetic resonance (CMR) is a useful non-invasive tool for the risk stratification of ventricular arrhythmias and sudden cardiac death (SCD) in patients with cardiac sarcoidosis (CS). More specifically, late gadolinium enhancement (LGE), a CMR tool for scar detection, has been found to be significantly associated with arrhythmic events in CS patients. This review aims to present the existing evidence regarding the association of LGE with adverse events and especially with fatal ventricular arrhythmias

The role of late gadolinium enhancement in predicting arrhythmic events in cardiac sarcoidosis patients – A mini-review

Sarcoidosis is a multisystem inflammatory disorder with an unknown origin. Symptomatic cardiac involvement is rare and occurs in about 5% of patients with sarcoidosis. Fatal ventricular arrhythmias are the most severe clinical presentation of the disease. Cardiac magnetic resonance (CMR) is a useful non-invasive tool for the risk stratification of ventricular arrhythmias and sudden cardiac death (SCD) in patients with cardiac sarcoidosis (CS). More specifically, late gadolinium enhancement (LGE), a CMR tool for scar detection, has been found to be significantly associated with arrhythmic events in CS patients. This review aims to present the existing evidence regarding the association of LGE with adverse events and especially with fatal ventricular arrhythmias

The Greek Collaborative Long COVID Study: Non-Hospitalized and Hospitalized Patients Share Similar Symptom Patterns

Long COVID-19 syndrome refers to persisting symptoms (>12 weeks) after the initial coronavirus infection and is estimated to affect 3% to 12% of people diagnosed with the disease globally. Aim: We conducted a collaborative study with the Long COVID patient organization in Greece, in order to estimate the characteristics, symptoms, and challenges these patients confront. Methods: Data were collected from 208 patients using unstructured qualitative free-text entries in an anonymized online questionnaire. Results: The majority of respondents (68.8%) were not hospitalized and reported lingering symptoms (66.8%) for more than six months. Eighteen different symptoms (fatigue, palpitations, shortness of breath, parosmia, etc.) were mentioned in both hospitalized and community patients. Awareness of Long COVID sequelae seems to be low even among medical doctors. Treatment options incorporating targeted rehabilitation programs are either not available or still not included inthe management plan of Long COVID patients. Conclusions: Patients infected with coronavirus with initial mild symptoms suffer from the same persistent symptoms as those who were hospitalized. Long COVID syndrome appears to be a multi-systemic entity and a multidisciplinary medical approach should be adopted in order to correctly diagnose and successfully manage these patients