Myocardial Scar on Surface ECG: Selvester Score, but Not Fragmentation, Predicts Response to CRT

Purpose. Myocardial scar is directly related to the response to CRT after implantation. The extent of myocardial scar can be detected not only by cardiac magnetic resonance but also by two electrocardiographic scores: fragmented QRS (fQRS) and Selvester score (SSc). The aim of our study is to compare the role of baseline SSc and fQRS in predicting response to CRT in a cohort of heart failure patients with true left bundle branch block (LBBB). As a secondary endpoint, we assessed the association of both scores with overall and cardiac mortality, heart failure hospitalizations, ventricular arrhythmias requiring ICD intervention, and major adverse cardiovascular event (MACE). Methods. We evaluated fQRS and SSc of 178 consecutive HF patients with severe systolic dysfunction (LVEF ≤ 35%), NYHA class II-III despite optimal medical treatment, and true-LBBB. Response to CRT was defined as the improvement of LVEF of at least 10% or as the reduction of LVESV of at least 15% at a 6-month follow-up. Each endpoint was related to fQRS and SSc. Results. SSc ≥7 was significantly associated with the absence of echocardiographic response to CRT (OR: 0.327; 95% C.I. 0.155-0.689; p=0.003), while the presence of fQRS at baseline ECG was not (OR: 1.133; 95% C.I. 0.539-2.381; p=0.742). No correlation was found between SSc and overall mortality, cardiac death, ventricular arrhythmias, hospitalizations due to heart failure, or for MACE. Similar results were observed between fQRS and all secondary endpoints. Conclusion. In HF patients with true-LBBB and LVEF ≤35% eligible for CRT, myocardial scar assessed by calculating the SSc on preimplant ECG is an independent predictor of nonresponse after multiple adjustments. Neither SSc nor fQRS is associated with overall and cardiac death, ventricular arrhythmias, or hospitalization for heart failure at a 24-month follow-up

Effectiveness of cardiac resynchronization therapy in heart failure patients with valvular heart disease: comparison with patients affected by ischaemic heart disease or dilated cardiomyopathy. The InSync/InSync ICD Italian Registry

AimsTo analyse the effectiveness of cardiac resynchronization therapy (CRT) in patients with valvular heart disease (a subset not specifically investigated in randomized controlled trials) in comparison with ischaemic heart disease or dilated cardiomyopathy patients.Methods and resultsPatients enrolled in a national registry were evaluated during a median follow-up of 16 months after CRT implant. Patients with valvular heart disease treated with CRT (n = 108) in comparison with ischaemic heart disease (n = 737) and dilated cardiomyopathy (n = 635) patients presented: (i) a higher prevalence of chronic atrial fibrillation, with atrioventricular node ablation performed in around half of the cases; (ii) a similar clinical and echocardiographic profile at baseline; (iii) a similar improvement of LVEF and a similar reduction in ventricular volumes at 6-12 months; (iv) a favourable clinical response at 12 months with an improvement of the clinical composite score similar to that occurring in patients with dilated cardiomyopathy and more pronounced than that observed in patients with ischaemic heart disease; (v) a long-term outcome, in term of freedom from death or heart transplantation, similar to patients affected by ischaemic heart disease and basically more severe than that of patients affected by dilated cardiomyopathy.ConclusionIn 'real world' clinical practice, CRT appears to be effective also in patients with valvular heart disease. However, in this group of patients the outcome after CRT does not precisely overlap any of the two other groups of patients, for which much more data are currently available

Incidence of ventricular arrhythmias after biventricular defibrillator replacement. Impact on safety of downgrading from CRT-D to CRT-P

Background: Cardiac resynchronization therapy (CRT) reduces mortality and hospitalizations. It is debated whether CRT alone (CRT-P) or CRT plus defibrillator (CRT-D) is preferable, and still guidelines are not exhaustive. The aim of the study was to investigate whether to implant CRT-P or CRT-D in CRT-D patients who did not experience malignant arrhythmias at the moment of replacement. Methods: Out of 451 heart failure patients undergoing CRT-D according to guidelines, 103 (67±10 years, 80% men) underwent device replacement with CRT-D. Every 6 months patients underwent to clinical evaluation and device interrogation and episodes of ventricular arrhythmias (VA) stored. At baseline and before replacement echocardiogram was performed. Patients were defined responders if left ventricular (LV) end-systolic volume decreased ≥15% and super-responders if LV ejection fraction increased ≥40% or ≥50%. Results: Mean follow-up was 75±24 months after implantation and 26±10 months after replacement. First VAs incidence per year did not decrease over time (P=0.619). Before replacement, 27 patients (26.2%, 15 responders/12 non-responders) experienced VA. After replacement, 8 patients (7.7%, 4 responders/4 non-responders) experienced VA for the first time. Super-responder condition was not associated with lower VA incidence before (0.499) and after (P=0.339) replacement. At multivariate analysis, age was the only independent predictor of electrical appropriate therapy after substitution (ORper year=1.17; 95% CI: 1.03-1.34; P=0.003). Conclusions: Freedom from VA before device replacement does not correlate with freedom from VA after replacement, so downgrade from CRT-D to CRT-P is not feasible at replacement, in particular in the elderlies, independently of responder and super-responder condition

PuCrO3_3 compound synthesis, structural and thermodynamic studies

International audienceThe synthesis of PuCrO$_3$ compound starting from metallic and/or sesquioxide chromium and PuO2 powder mixtures in stoichiometric ratios has been studied at different temperatures under atmospheres with a varying oxygen potential (Ar, Ar + 5% H2, Ar + 5% H$_2$ + 850 ppm H$_2$O). The structure of the polycrystalline perovskite compound PuCrO$_3$ was investigated by means of an X ray powder pattern fitting. A Rietveld analysis was performed using the computer program JANA2000. PuCrO$_3$ crystallizes in the orthorhombic space group Pbnm with a = 549.58(3) pm, b = 771.99(3) pm and c = 543.97(3) pm. A XAS study gave oxidation states +III for both chromium and plutonium. The heat capacity of PuCrO3 was measured by means of a differential scanning calorimeter (DSC) in the temperature range of 373-1373 K. Debye temperature as well as electronic defect energies have been fitted from these measurements. Enthalpy increment, entropy and free energy function of PuCrO$_3$ have been calculated from the measured heat capacity and estimated data as a function of temperature