Impact of inter-ventricular lead distance on cardiac resynchronization therapy outcomes

Cardiac resynchronization therapy (CRT) has been shown as an essential treatment of patients with heart failure, leading to improvements in symptoms, left ventricular (LV) function, and survival. However, up to 30% of appropriately selected patients remain non-responders to CRT. The aim of our study was to test a hypothesis on the impact of lead positioning in the ventricular walls on CRT response in patients with advanced chronic heart failure with and without pre-operative inter and intra-ventricular myocardial dyssynchrony. We examined 53 guideline-selected CRT candidates. Response to CRT was defined in 6 months after implantation of CRT devices. All patients underwent standard and Doppler echocardiography for assessment of LV function and mechanical dyssynchrony. Individual right ventricular (RV) and LV lead tip position, inter-lead distance, and the horizontal and vertical components were measured on the radiograph images with using an automated custom made software Our results showed that the RLV inter-lead distance is an essential parameter correlated with the CRT outcomes. A logistic model comprising the RLV inter-lead distance with parameters of dyssynchrony demonstrated a high predictive power for odds of CRT success. © 2017 IEEE Computer Society. All rights reserved.Research was supported by Act 211 Government of the Russian Federation, agreement № 02.A03.21.0006 and Program of the RAS Presidium #I.33П

Management of heart failure patients in Russia: perspectives and realities of the second decade of the XXI century

The article highlights the central components of Russian heart failure (HF) management programs in actual clinical practice. The experience of the Competence Center of Almazov National Medical Research Center, as well as opportunities and prospects for improving the monitoring of decompensated HF

RELATION OF THE LATE ACTIVATION ZONE WITH THE LEFT VENTRICLE MYOCARIDUM CHANGES IN CANDIDATES FOR RESYNCHRONIZING THERAPY

Aim. By non-invasive methods, to assess relations of the zone of late electrical activation with changes in the left ventricle (LV) myocardium structure in patients — candidates for cardiac resynchronizing therapy. Material and methods. Totally, 37 patients included, with III functional class of chronic heart failure (CHF). In all patients, there was complete His left bundle branch block (LBBB) with QRS width 205 (190; 215) ms. Non-invasive electrophysiological mapping (NEM) was done with the “Amycard01C EP LAB” (EP Solutions SA,Switzerland), and magnetic-resonance imaging (MRI). At the first step, multichannel electrocardiography (ECG) was done. At the second step, MRI was done (MAGNETOM Trio A Tim 3 T, Siemens AG,Germany) with intravenous contrast “Gadovist” load. Changes inLV myocardium structure (post-inflammatory fibrosis or scar tissue) were evaluated by segments, within the delayed MRI contrasting. At the third stage, individual models of ventricles were built up. Activation ofLV epicardium in LBBB was evaluated by NEM.Results. Most oftenly the zone of late activation by NEM was found in the basal region on the border of posterior and lateral LV segments — 17 patients (46%) and in basal lateral LV segment — 8 (21%). By MRI, only post inflammatory fibrosis was found in 21 patient, among them in 5 the area of fibrosis was located on LV epicardium and overlapped the zone of late activation by NEM. Among 12 patients with ischemic heart disease 2 had scar onLV epicardium overlapping with the late activation zone. No one of 4 patients with combination of post-inflammatory fibrosis and ischemic scar did not show overlap of structural changes on the epicardium with the late activation zone.Conclusion. Combination of NEM and MRI in pre-operational period of patients investigation make it to relate structural changes inLV myocardium with the zone of its late electrical activation

Two-year follow-up of patients with heart failure with reduced ejection fraction receiving cardiac contractility modulation

Aim. To assess the 2-year prognosis of patients with heart failure with reduced ejection fraction (HFrEF) receiving cardiac contractility modulation (CCM).Material and methods. This single-center observational study included 55 patients (46 men, mean age 53±11 years) with NYHA class II-III HFrEF receiving optimal medical therapy, with sinus rhythm, QRS <130 ms or QRS<150 ms with nonspecific intraventricular conduction delay. NYHA class II and III were established in 76% and 24% of patients, respectively. All patients were implanted with CCM devices between October 2016 and September 2017. Follow-up visits were carried out every 3 months during the 1st year and every 6 months during the 2nd year of observation. The primary composite endpoint was mortality and heart transplantation. Secondary composite endpoints included death, heart transplantation, paroxysmal ventricular tachycardia/ ventricular fibrillation, hospitalizations due decompensated HFResults. The one-year and two-year survival rate was 95% and 80%, respectively. Primary endpoint was observed in 20% of patients. NYHA class III and higher levels of N-terminal pro-brain natriuretic peptide (NTproBNP) were associated with unfavorable prognosis (p=0,014 and p=0,026, respectively). NTproBNP was an independent predictor of survival (p=0,018). CCM contributed to a significant decrease in hospitalizations due to decompensated HF (p<0,0001). The secondary endpoint was observed in 18 (33%) of patients during the 1st year. The predictor for the secondary composite endpoint was NTproBNP (p=0,047).Conclusion. CCM is associated with a significant decrease in hospitalization rate due to decompensated HF. The 2-year survival rate of patients with NYHA class II-III HF receiving CCM was 80%. The NTproBNP level was an independent predictor of survival in patients receiving CMM for 2 years. Further longer-term studies of the CCM efficacy are required

Dynamics of heart failure markers and cardiac reverse remodeling in patients receiving cardiac contractility modulation therapy

Aim. To assess the clinical course and cardiac reverse remodeling in patients with heart failure (HF) with reduced ejection fraction (HFrEF) receiving cardiac contractility modulation (CCM) therapy.Material and methods. Fifty-five patients (mean age, 53±11 years, 46 males) with NYHA class II-III HFrEF (ischemic etiology in 73% of patients), sinus rhythm, QRS<130 ms or QRS<150 ms of non-LBBB morphology receiving optimal medical therapy were enrolled into the study. CCM devices were implanted to all patients between October 2016 and September 2017. We assessed the following parameters: hospitalizations and mortality due to decompensated HF; changes in HF class, NTproBNP concentration, peak oxygen consumption, six-minute walk test, left ventricular end-systolic and end-diastolic volumes and ejection fraction (EF), atrial and ventricular arrhythmias. A comparative analysis of the studied parameters was carried out depending on the pacing with one and two ventricular leads, on LVEF value (>25% and <25%) and HF etiology.Results. CCM therapy was associated with a decrease in HF class (p<0,00004001), HF-related hospitalization rate (p<0,0001001), blood NTproBNP concentration (p<0,018), an increase in peak oxygen consumption during the first year (p<0,006011), as well as a decrease in LV volumes and a LVEF increase (p<0,0001001). The direction of these changes did not depend on the number of ventricular leads and LVEF. The presence of ischemic cardiomyopathy and old myocardial infarction did not affect the disease prognosis, but was associated with a lower change in LV volumes and NTproBNP during 24 months of CCM therapy. LVEF values were significantly higher in the group of patients with HFrEF not associated with coronary artery disease after 12 and 24 months of follow-up.Conclusion. In the group of patients with class II-III HFrEF, CCM therapy in most patients was associated with improved clinical and hemodynamic status, increased exercise tolerance, decreased HF-related hospitalization rate, positive echocardiographic and NTproBNP changes

Guidelines for the diagnosis and treatment of circulatory diseases in the context of the COVID-19 pandemic

Guidelines for the diagnosis and treatment of circulatory diseases in the context of the COVID-19 pandemi