Distinct trajectories of disease-specific health status in heart failure patients undergoing cardiac resynchronization therapy

Purpose: It is well known that a significant proportion of heart failure patients (10–44 %) do not show improvement in symptoms or functioning from cardiac resynchronization therapy (CRT), yet no study has examined patient-reported health status trajectories after implantation. Methods: A cohort of 139 patients with a CRT-defibrillator (70 % men; age 65.7 ± 10.1 years) completed the Kansas City Cardiomyopathy Questionnaire (KCCQ) prior to implantation (baseline) and at 2, 6, and 12–14 months post-implantation. Latent class analyses were used to identify trajectories and associates of disease-specific health status over time. Results: All health status trajectories showed an initial small to large improvement from baseline to 2-month follow-up, whereafter most trajectories displayed a stable pattern between short- and long-term follow-up. Low educational level, NYHA class III/IV, smoking, no use of beta-blockers, use of psychotropic medication, anxiety, depression, and type D personality were found to be associated with poorer health status in unadjusted analyses. Interestingly, subgroups of patients (12–20 %) who experienced poor health status at baseline improved to stable good health status levels after implantation. Conclusions: Levels of disease-specific health status vary considerably across subgroups of CRT-D patients. Classification into poorer disease-specific health status trajectories was particularly associated with patients’ psychological profile and NYHA classification. The timely identification of CRT-D patients who present with poor disease-specific health status (i.e., KCCQ score < 50) and a distressed psychological profile (i.e., anxiety, depression, and/or type D personality) is paramount, as they may benefit from cardiac rehabilitation in combination with psychological intervention

Elasticity, viscosity, and deformation of orbital fat

PURPOSE. For development of a finite element analysis model of orbital mechanics, it was necessary to determine the material properties of orbital fat and its degree of deformation in eye rotation. METHODS. Elasticity and viscosity of orbital fat of eight orbits of four calves and two orbits of one rhesus monkey were measured with a parallel-plate rheometer. The degree of deformation of orbital fat was studied in two human subjects by magnetic resonance imaging (MRI) through the optic nerve in seven (first subject) or fourteen positions of gaze from left to right. Bifurcations of veins in the fat were used as markers for displacement of the fat. RESULTS. The elastic shear modulus (G′) of calf orbital fat was between 250 Pa and 500 Pa, and of monkey orbital fat it was between 500 Pa and 900 Pa. The viscous shear modulus (G″) of calf orbital fat was between 80 Pa and 150 Pa, and for monkey orbital fat it was between 300 Pa and 500 Pa. In the MRI scans, it was found that markers in the fat, 1 to 5 mm posterior to t