ABSTRACT
Background: Cardiac Resynchronization Therapy [CRT] is now a well-established treatment for patients with advanced heart failure through biventricular pacing. Optimizing the left ventricular [LV] lead position via echocardiographic speckle tracking guidance could reduce the rate of non-responders to CRT
Objectives: to assess the role of speckle tracking echocardiography in determining the proper position of the left ventricular lead in patients undergoing CRT
Methods: the study population comprised 50 patients who were indicated for CRT according to the ESC 2012 guidelines. Speckle tracking echocardiography was done to all patients before CRT implantation or shortly after implantation while switching off pacing to determine the latest activated myocardial wall of the LV. The patients were classified after CRT implantation into two groups; the first group [group A] included 20 patients and represented those with concordance between the most mechanically delayed myocardial wall derived from speckle tracking echocardiography and the coronary sinus lead position, and the second group [group B] included 30 patients that showed discordance between them. Both groups were recruited for follow-up after a period of 6 months to assess clinical response, echocardiographic response and mortality
Results: Significant correlation was observed between echocardiographic response and the LV lead concordance [p value=0.041], and between combined clinical and echocardiographic response and LV lead concordance. There was a nearly significant difference between clinical response and the LV lead concordance [p value=0.057], and there was a trend towards less mortality in the group with concordant LV lead [10.5% in the concordant group versus 24.1% in the discordant group] with no statistical significance [p value=0.286]
Conclusions: we demonstrated an increased benefit with an echocardiographically optimized LV lead position targeting the most delayed myocardial wall by 2D speckle tracking echocardiography
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Echocardiography , Heart Ventricles , Heart FailureABSTRACT
Inflammation plays an important role in all stages of inflammation and it appears to be a pivotal component of the process the transform stable to unstable disease because an augmentation of the inflammatory activity takes place during ACS. To study benefits of statins in treatment of unstable angina and non ST segment elevation myocardial infarction during the early days of hospital admission through its anti-inflammatory effect regardless cholesterol level. This study included 50 patients who were divided into two groups, atorvastatin group [group I] [25 patients] and control group [group II] [25 patients]. All patients were subjected to 12 lead electrocardiography, routine laboratory investigations including total cholesterol, LDL-C, HDL-C, triglycerides ,CRP and titre on admission, at the 6[th] and 14[th] day ,also, CPK and CKMB were measured on admission, after 6, 24 and 48 hours respectively. All patients received the traditional treatment of unstable angina and non ST segment elevation myocardial infarction, Atorvastatin 20 mg/day was administered to group I from the first day and continued during the period of follow up. CRP levels decreased significantly at the 6[th]day and 14[th] day in group [I] and increased significantly at the 6[th] day in group [II].Atorvastatin lowered the level of T.C, HDL-C, TO and this decrease was significant as regards LDL-C and TO and increased HDL-C significantly by the end of 14 days. There was no correlation between CRP changes and lipid profile changes. The result of the current study showed that atorvastatin 20 mg had anti- inflammatory effect in addition to its lipid lowering effect appeared in the early days after anti-inflammatory effect appeared in the early days after administration so starting of atorvastatin therapy immediately on admission in patients with UA or NSTEMI, regardless their lipid levels is recommended