Wpływ stopnia nawodnienia oraz zmienności ciśnienia tętniczego krwi i częstości rytmu serca w czasie hemodializy na śróddializacyjne zmiany stężeń wysokoczułej troponiny T

Introduction. High sensitivity troponin T (TnT-hs) is biomarker of myocardial damage and ischemia. Despite its elevation troponin still preserve its usefulness as a marker of the cardiovascular risk and mortality in chronic kidney disease. Variations of hydration status between and during hemodialysis exert significant hemodynamic effects, which may negatively affect cardiovascular system and blood pressure and lead to myocardial damage. The aim of the study was to access the effect of hydration status and variability of blood pressure and heart rate induced by hemodialysis on intradialytic changes of TnT-hs, in chronic hemodialysis patients. Material and methods. In 50 chronic hemodialysis patients (35M, 15F, mean age 64 ± 12 years) blood pressure and heart rate were monitored noninvasively during HD session. Serum concentration of TnT-hs and hydration status were assessed before and after hemodialysis. Results. TnT-hs concentration was above normal range in 98% patients before, and in all after hemodialysis. Median TnT-hs level was 82 ng/L before and 84 ng/L after hemodialysis, which comprised 586% and 600% of the upper limit of normal range. There was a small 2.4%, intradialytic increase of TnT-hs (p = 0.004). TnT-hs levels correlated positively with mean interdialytic weigh gain, before HD (r = 0.43, p = 0.02) and after HD (r = 0.5, p = 0.003). There was also a positive correlation between TnT-hs concentration and mean heart rate (r = 0.37, p = 0.008) and with mean systolic blood pressure during HD, before HD (r = 0.3, p = 0.026) and after HD (r = 0.3, p = 0.031). Conclusions. Hemodialysis can be a risk factor of myocardial injury, especially in overhydrated patients.Wstęp. Wysokoczuła troponina T (TnT-hs) jest przydatnym klinicznie wskaźnikiem uszkodzenia komórek mięśnia sercowego. Stężenia TnT-hs u pacjentów z przewlekłą chorobą nerek są wyższe niż w populacji ogólnej, co wiąże się ze zwiększonym ryzykiem incydentów sercowo-naczyniowych oraz zgonu. Znaczne zmiany stopnia nawodnienia w czasie zabiegu hemodializy mogą niekorzystnie oddziaływać na układ sercowo-naczyniowy i ciśnienie tętnicze, co w efekcie może prowadzić do uszkodzenia kardiomiocytów. Celem pracy była ocena wpływu stanu nawodnienia, zmian częstości rytmu serca (HR) i ciśnienia tętniczego (BP) w trakcie hemodializy (HD) na zmiany stężeń TnT-hs powodowane zabiegiem hemodializy u pacjentów długotrwale hemodializowanych. Materiał i metody. U 50 pacjentów (35M, 15K, średnia wieku 64 ± 12 lat) z rozpoznaniem schyłkowej niewydolności nerek, długotrwale hemodializowanych, nieinwazyjnie monitorowano BP oraz HR podczas HD. Przed i po HD dokonano oceny stanu nawodnienia pacjenta oraz pobrano próbki krwi w celu oznaczenia stężenia TnT-hs. Wyniki. Zwiększone stężenie w surowicy TnT-hs stwierdzono u 98% pacjentów przed zabiegiem HD oraz u 100% pacjentów po zabiegu. Mediana TnT-hs wynosiła 82ng/l przed HD i 84 ng/l po zabiegu, co wyniosło odpowiednio 586% oraz 600% wartości górnego zakresu referencyjnego. Stężenie TnT-hs podczas HD wzrastało nieznacznie o 2,4% (p = 0,04). Stężenie TnT-hs przed HD i po zabiegu korelowało ze średnim HR (r = 0,37; p = 0,008) oraz średnim skurczowym BP podczas zabiegu HD (przed HD r = 0,32; p = 0,026 i po HD r = 0,3; p = 0,031). Wykazano dodatnią korelację między przewodnieniem pomiędzy dializami a stężeniem TnT-hs przed HD (r = 0,43, p = 0,02) i po HD (r = 0,5, p = 0,003). Wnioski. Zabieg hemodializy może zwiększać ryzyko uszkodzenia mięśnia sercowego, w szczególności w przypadku znacznego stopnia przewodnienia

The usefulness of His bundle pacing in a heterogeneous population of patients with impaired left ventricular systolic function

Background: His bundle pacing (HBP) maintains a physiological activation pattern of ventricular activation, and in patients with intraventricular conduction delay (IVCD) it can normalize wide QRS duration. Methods: A total of 181 patients from the HBP registry were enrolled into a the study, which was conducted at the Department of Electrocardiology in Katowice, Poland. The patients had left ventricular ejection fraction (LVEF) < 50% and were implanted between November 2015 and April 2019. The HBP indications were as follows: 1) bradycardia and atrioventricular conduction disturbances with expected high pacing burden, 2) IVCD, LVEF ≤ 35%, with an indication for resynchronization therapy, 3) the need to upgrade to resynchronization therapy due to pacing-induced cardiomyopathy. Pacing parameters and echocardiographic and clinical data were assessed for up to 2 years of follow-up (FU). Results: His bundle pacing was successful in 154 (85.1%) patients. Eighty-two patients completed a 6-month FU. The mean age was 70.6 ± 9.23 years, and 79% were males. At 6 months FU LVEF improved from 35.3 ± 8.22% to 43.1 ± 10.14% (p < 0.0001), and indexed left ventricular end-systolic volume (LVESVi) decreased from 63.1 ± 25.21 mL/m2 to 51.9 ± 22.79 mL/m2 (p < 0.0001). In 53.1%, the LVESVi reduction was greater than 15%. The improvement in LVEF and LVESVi was also observed after 24 months of FU. Conclusions: His bundle pacing in permanently paced patients when LVEF is reduced below 50% is associated with improvement in LVEF and reverse left ventricle remodeling

The Effects of His Bundle Pacing Compared to Classic Resynchronization Therapy in Patients with Pacing-Induced Cardiomyopathy

Pacing-induced cardiomyopathy (PICM) is among the most common right ventricular pacing complications. Upgrading to cardiac resynchronization therapy (CRT) is the recommended treatment option. Conduction system pacing with His bundle pacing (HBP) has the potential to restore synchronous ventricular activation and can be an alternative to biventricular pacing (BVP). Patients with PICM scheduled for a system upgrade to CRT were included in the prospective cohort study. Either HBP or BVP was used for CRT. Electrocardiographic, clinical, and echocardiographic measurements were recorded at baseline and six-month follow-up. HBP was successful in 44 of 53 patients (83%). Thirty-nine patients with HBP and 22 with BVP completed a 6-month follow-up. HBP led to a higher reduction in QRS duration than BVP, 118.3 ± 14.20 ms vs. 150.5 ± 18.64 ms, p p = 0.04). Left ventricular ejection fraction (LVEF) improved in BVP patients from 32.9 ± 7.93% to 43.9 ± 8.07%, p p p = 0.019. The improvement in clinical outcomes and left ventricle reverse remodeling was more significant with HBP than BVP. HBP can be a valid alternative to BVP for upgrade procedures in PICM patients