ABSTRACT
Objective To investigate the application effects of cardiac resynchronization therapy(CRT)of[left bundle optimization(LOT)]and biventricular pacing(BiV)in the patients with chronic heart failure complicating left bundle branch block.Methods The single center,prospective and non-randomized controlled study method was used.Forty-two patients with heart failure meeting CRT in this center from April 2020 to April 2022 were consecutively included.Among them,32 cases adopted the BiV-CRT(BiV-CRT group)and 10 cases adopted LOT-CRT(LOT-CRT group).The pacing-making parameters,quality of life scale(SF-36)score,6-min walk test(6-MWT),ECG QRS width(QRSd),left ventricular end-diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF)and New York cardiac function grade(NYHA)situation were collected before surgery,after surgery immediately and in postoperative 3,6,12 months.Their complica-tions and clinical outcomes were evaluated.Results The pacing threshold value in the LOT-CRT group was stable and lower than that in the BiV-CRT group(P＜0.05);QRSd in postoperative 12 months in the LOT-CRT group was shorter than that in the BiV-CRT group[(115.0±14.3)ms vs.(133.0±14.0)ms,P＜0.05]and 6-MWT was longer than that in the BiV-CRT group[(327.0±52.8)m vs.(274.0±52.8)m,P＜0.05],and the differences were statistically significant(P＜0.05);LVEF,LVEDD,NYHA cardiac grade and SF-36 score in postoperative 12 months were improved compared with those before implantation.The rehospitaliza-tion rate of heart failure in the LOT-CRT group was lower.Conclusion LOT-CRT could obtain a narrower QRS wave and longer 6-MWT than BiV-CRT.
ABSTRACT
Objective To assess the differences in carotid artery stiffness properties and endothelium-independent dilation (EID)between elderly and young patients,and evaluate the echotracking (ET)system for vascular stiffness at different ages.Methods A total of 79 outpatients with multiple cardiovascular risks were recruited.Clinical data including medical history,height,weight,blood pressure,fasting blood glucose and blood lipid were collected.We evaluated the arterial stiffness parameters of carotid artery and EID using an ultrasonic ET system in 46 elderly subjects,compared with 33 sex-matched non-elderly subjects.The impaired EID function was defined as brachial artery nitroglycerin mediated dilation (NMD)below 4％.Results All stiffness parameters including pressure-strain elasticity modulus stiffness index β (Ep),pulse wave velocity β (PWVβ)and augmentation index (AI)were significantly increased in elderly group compared with the non-elderly group [(138.9±64.7)kPa vs.(100.6±30.8)kPa,(10.9±4.7)vs.(8.2±2.3),and (6.9±1.4)m/s vs.(6.1±0.9)m/s,P＜0.05 respectively],while the exception of arterial compliance (AC)was reduced (0.9±0.3)mm2/kPa vs.(1.0±0.5)mm2/kPa(P＜0.05).The incidence of impaired EID in elderly group was higher than in non-elderly group [56.5％ (26 cases) vs.33.3％ (11 cases),P＜0.05].ET parameters including Ep,stiffness index β,PWVβ,AC and AI were related to age (r=-0.44,-0.45,-0.40,-0.40,0.34,all P＜0.01)； Ep,stiffness index β,PWVβ and AC were also related to impaired EDI (r=-0.38,-0.40,-0.34,-0.29,all P＜0.01).Conclusions Arterial stiffness properties and EID measured by ET system was more serious in elderly with multiple cardiovascular risks than in non-elderly subjects.As a convenient and accurate assessment of stiffness parameters,ET system is optimal option for measuring arterial stiffness and EID in elderly people.