ABSTRACT
Cardiac resynchronization therapy [CRT] has been introduced as a promising therapeutic choice in heart failure [HF] patients with ventricular dyssynchrony, shown with a wide QRS. In previous study, we showed a positive effect of CRT on ejection fraction. This study aimed to evaluate the effect of CRT on the severity of mitral regurgitation [MR] quantitatively using the volumetric Doppler method in HF patients. In this prospective before-after survey, 22 HF patients with wide QRS [>/=120 ms] and NYHA class III who were included. All patients were evaluated initially for QRS width, NYHA class, MR volume, MR fraction and mitral valve area [MV area]. Biventricular pacing was done through cardiac-resynchronization device along with three pacing leads and same evaluations were done after CRT. The mean [SD] QRS width and NYHA class were significantly decreased after CRT in HF patients [p<0.001]. Also MR volume [46.9 +/- 30.2 mL vs. 27.0 +/- 26.4 mL, p<0.001] and fraction [40.1 +/- 25.5% vs. 26.8 +/- 22.7%, p=0.002] were improved following CRT. The decrease of MV area after CRT was also significant [10.6 +/- 3.0 cm[2] vs. 8.6 +/- 2.6 cm[2], p<0.001]. As MR is associated with morbidity and mortality in HF patients and the standard surgical therapy may not be practical for a majority of them, this novel treatment may improve their disease condition significantly
ABSTRACT
QT interval parameters have been suggested as a predictor of lethal arrhythmia and mortality in patients with myocardial infarction. The aim of the present study was to compare the value of QT interval indices in patients presenting with non-ST-segment elevation myocardial infarction [NSTEMI] between a group of patients with type 2 diabetes mellitus and a nondiabetic group of patients. This case-control study evaluated QT interval parameters in 115 patients [47 diabetic and 68 nondiabetic patients] diagnosed with NSTEMI between September 2011 and July 2012. The following QT interval indices were analyzed: maximum [max] and minimum [min] QT interval; max and min corrected QT interval [QTc]; QT dispersion [QTd]; and corrected QT dispersion [QTcd]. All the patients were observed for ventricular arrhythmia during their hospital course and underwent coronary angiography. They were selected to undergo coronary artery bypass surgery [CABG] or percutaneous coronary angioplasty [PCI] based on their coronary anatomy. The mean age of the patients was 60.8 +/- 11.4 years. The patients were 40.0% female and 60.0% male. There were no significant differences in clinical characters between type 2 diabetic and nondiabetic patients with NSTEMI. Compared with post-myocardial infarction patients without diabetes, those with type 2 diabetes had higher QTc max, QTd and QTcd [p value < 0.05]. There was a significant difference in QTd and QTcd in the patients needing coronary revascularization with diabetes as opposed to the nondiabetics [p value = 0.035 and p value = 0.025, respectively] as well as those who had ventricular arrhythmia with diabetes [p value = 0.018 and p value = 0.003, respectively]. QTcd was higher in the patients who had higher in-hospital mortality [p value = 0.047]. The QTc max, QTd and QTcd were significantly [all p values < 0.05] associated with ventricular arrhythmia, QTcd with need for revascularization and QTc max with in-hospital mortality in the diabetic patients. Based on the findings of this study, it seems that type 2 diabetics with NSTEMI have greater QTc max, QTd, and QTcd and these QT parameters may have a relationship with worse cardiac outcomes and poorer prognoses
ABSTRACT
Cardiac resynchronization therapy [CRT] has introduced as new treatment strategy in heart failure [HF] patients and some of its effects have been investigated. The aim of this study was to study the effectiveness of CRT in the improvement of left ventricular systolic function indicated by left ventricular ejection fraction [LVEF] in HF patients. In our prospective study 22 HF patients with NYHA class III and above, QRS duration>120 ms and EF [ejection fraction] =35% who were candidates for CRT enrolled. Patients were evaluated for NYHA class, QRS width, left ventricular end-systolic volume [LVESV], left ventricular end-diastolic volume [LVEDV] and LVEF before and two months after the CRT procedure. Paired-t test analysis used to compare the before and post-CRT data statistically. Initial evaluation showed that all of the patients were in NYHA class III before CRT. Two months after CRT, all of the patients improved their NYHA class in a way that 18 patients [82%] were in NYHA class I and the other 4 [18%] were in NYHA class II. The mean [SD] QRS width decreased significantly after biventricular [BiV] pacing [p<0.001]. Also a significant decrease in LVESV, LVEDV and increase in LVEF was shown in HF patients after CRT [p<0.001]. The present study showed the efficacy of CRT in improvement of LVEF in HF patients with wide QRS after two months from CRT
ABSTRACT
The signal-averaged electrocardiograph is a noninvasive method to evaluate the presence of the potentials generated by tissues activated later than their usual timing in the cardiac cycle. The purpose of this study was to demonstrate the correlation between the filtered QRS duration obtained via the signal-averaged electrocardiography and left ventricular dimensions and volumes and then to compare it with the standard electrocardiography. We included patients with advanced systolic left ventricular dysfunction [ejection fraction = 35%]. All the patients underwent surface twelve-lead electrocardiography, signal-averaged electrocardiography, and echocardiography. The study included 86 patients with a mean age of 54.66 +/- 13.23 years. The mean left ventricular ejection fraction was 18.31 +/- 5.49%; the mean QRS duration was 0.14 +/- 0.02 sec; and 52% of the patients had left bundle branch block. The mean filtered QRS duration was 145.87 +/- 24.89 ms. Our data showed a significant linear relation between the filtered QRS duration and left ventricular end-systolic volume, left ventricular end-diastolic volume, left ventricular end-systolic diameter, and left ventricular end-diastolic diameter; the correlation coefficient was, however, not good. There was no significant correlation between the QRS duration and left ventricular diameters and volumes. The filtered QRS duration has a better correlation with left ventricular dimensions and volumes than does the QRS duration in the standard electrocardiography