Evaluation of in-hospital NT-proBNP changes in heart failure patients to identify the six-month clinical response following cardiac resynchronization therapy

N-terminal pro beta-type natriuretic peptide [NT-proBNP] is a valuable marker for monitoring the response to treatment in patients with heart failure. Based on the clinically observed improvement of heart failure symptoms early after cardiac resynchronization therapy [CRT], we sought to investigate whether CRT induce any significant reduction in the plasma level of NT-proBNP in three days after implantation and whether it is correlated with patients' response at six months. In this prospective study, 21 consecutive patients with severe heart failure [New York Heart Association class 3.19 +/- 0.40] who underwent CRT were enrolled. Being alive, no hospitalization due to decompensated heart failure, and improvement of at least one NYHA functional class at six months were classified as clinical responsiveness. The plasma level of NTproBNP was measured before, three days, and six months after CRT. Clinical evaluation, echocardiographic study, and six-minute walking test were performed before and six months after the procedure. At six months' follow-up, 16 [76.2%] patients were responders. The plasma level of NT-proBNP at three days after CRT increased almost equally in both responder and non-responder groups of patients [Delta NT-proBNP was 40.94 +/- 135.74 vs. 54.80 +/- 88.98]; however, at six months' follow-up, the NT-proBNP changes statistically differed across the two groups of patients [P=0.005]. According to our findings, NT-proBNP percent deviation from baseline to three days after CRT appears to be not correlated with the patients' clinical response after six months, which was incongruent to the patients' clinical improvement after CRT

Association between androgenic hormone levels and left ventricular ejection fraction

Androgens have been shown to have diverse effects on the cardiovascular system. The aim of this study was to compare androgenic hormone levels in patients with different left ventricular ejection fractions [EF]. The study population consisted of 515 consecutive men who were referred for angiographic studies and whose results of echocardiography and coronary angiography were available. The patients were classified into four groups: EF < 35%, EF=35-45%, EF=45-54%, and EF >/= 55% to evaluate the trends of baseline characteristics and serum androgens, including free testosterone [fT], total testosterone [tT], and dehydroepiandrosterone sulfate [DHEAS]. To better elucidate the difference in the patients with severe heart failure, the patients were divided into two groups according to their EF level, and comparisons were repeated between those with EF < 35% and the ones with EF >/= 35%. There were statistically significant trends in some characteristics in the patients with different levels of EF. The subjects with higher EF levels were less likely to have diabetes [p value < 0.001], coronary artery lesion [p value < 0.001], or high levels of C-reactive protein [CRP] [p value < 0.001]. As regards the patients with severe heart failure, our regression analysis revealed that the fT level was significantly lower in those with EF < 35% than in the ones with EF >/= 35% [5.82 +/- 2.73 pg/mL vs. 6.88 +/- 3.34 pg/mL, p value < 0.05]. A significant association was found between the level of fT and EF < 35%. There is a need for further controlled prospective studies to delineate any possible causal relationship accurately

Ablation of focal right upper pulmonary vein tachycardia using retrograde aortic approach

The use of diagnostic and therapeutic methods for assessing pulmonary vein due to its status as a main source of ectopic beats for the initiation of atrial dysrrythmias is strongly recommended. We report the case of a 13-year-old girl who was admitted to our hospital with the electrocardiogram manifestation of an ectopic atrial tachycardia. The focus of arrhythmia was inside the right upper pulmonary vein. The patient underwent successful ablation with a conventional electrophysiology catheter via the retrograde aortic approach. We showed that when the origin of atrial tachycardia is in the right upper pulmonary vein, it is possible to advance the catheter into this vein via the retrograde aortic approach and find the focus of arrhythmia. This case demonstrates that right upper pulmonary vein mapping is feasible through the retrograde aortic approach and it is also possible to ablate the arrhythmia using the same catheter and approach

Significant improvement in severely stunned left ventricle after percutaneous coronary intervention

This is a case of severely stunned left ventricle which occurred after a non-ST elevation myocardial infarction in a 76-year-old woman who was a known case of three-vessel disease. Her symptoms and cardiac function responded well to revascularization

Percutaneous Repositioning of Dislodged Pacing Lead

The overall rate of atrial pacing lead dislodgement is estimated to be about 3%. These leads are generally repositioned via a second operation through opening the pacemaker pocket. Some operators have introduced percutaneous techniques using snare system or deflectable catheters for this purpose. In this article we present our experience with five cases of percutaneous lead repositioning. Three cases were performed using deflectable ablation catheters and in two cases we used a specially designed urologic basket. The procedural success rate was 100% at the beginning but the long term success rate was 60%