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Objective To evaluate the efficacy and safety of double lumen microcatheters in chronic coronary artery total occlusion(CTO)lesions at bifurcation during percutaneous coronary intervention(PCI).Methods From October 2013 to March 2015,we retrospectively analysed the application of double lumen microcatheter with bifurcation CTO lesions and reviewed the patients' clinical features,coronary angiography,intervention operation success rate,complications rates and incidence of major adverse cardiac events(including all-cause death,nonfatal myocardial infarction and target vascular remodeling).Results Twenty-three CTO lesions at bifurcation were treated with double lumen microcatheters,stenting were performed in 21 lesions and 2 lesions only received PTCA due to small blood vessel size.The operation success rate was 100％.All the 11 right coronary lesions and 3 left coronary lesions were managed using single stenting technique.Double stenting strategy was used in 9 left coronary lesions including 4 cases with mini-crush technique,4 cases with modified culottes technique and one case with modified T technique.All double stenting procedures were completed by kissing balloon expansion.There was no major adverse cardiac event occured during and after operation.Conclusion Double lumen microcatheters are useful in PCI treatment of bifurcation CTO lesions.
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<p><b>OBJECTIVE</b>To evaluate the incidence of super-response and the potential predictors related to super-response after cardiac resynchronization therapy (CRT) in patients with congestive heart failure.</p><p><b>METHODS</b>190 patients [145 men and 45 women;age: (60.48 ± 11.91) years] underwent CRT between March 2001 and March 2012 were enrolled in this multi-center trial, of which, 54 patients with ischemic cardiomyopathy and 136 patients with non-ischemic cardiomyopathy. These patients were followed up from 6 months to 11 years (mean 58 months) post CRT.</p><p><b>RESULTS</b>Ten patients died within 6 months post CRT, the others were followed up for more than 6 months. At 6-month follow-up, 51 patients were identified as CRT super-responders (28.33%), 75 patients were CRT responders (41.67%) and 29 patients were CRT non-responders (16.11%), and 25 patients were CRT negative responders (13.89%). Super-response occurred more frequently in non-ischemic cardiomyopathy patients, while non-response most commonly occurred in ischemic cardiomyopathy patients (P < 0.05); patients in the negative response group had higher serum creatinine level than other groups (P < 0.05) , and patients in the non-response group and negative response group had higher pulmonary artery pressure than patients in the super-response group (P < 0.05); the average QRS duration was ≥ 160 ms before CRT, and the mean decrease was around 30 ms after CRT in the super-response group while the average QRS duration was 139 ms before CRT, and the mean reduction was around 8 ms after CRT in the negative response group (P < 0.05). LV lead position in the super-response group was usually in the middle and base of the heart, while in the negative response group it was more commonly located in the apex of the heart (P < 0.01) .</p><p><b>CONCLUSIONS</b>LV lead located at the middle and pre-CRT ORS duration ≥ 160 ms are associated with super-response post CRT procedure in this patient cohort.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Cardiac Resynchronization Therapy , Follow-Up Studies , Heart Failure , Therapeutics , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To evaluate the long-term effects and analyze causes of non-response to cardiac resynchronization therapy (CRT) in heart failure (HF) patients with permanent atrial fibrillation (AF).</p><p><b>METHODS</b>Thirty-three patients with HF and AF [29 men, mean age (61 ± 10) years, NYHA class III or IV, left ventricular ejection fraction (LVEF) ≤ 35%, QRS ≥ 120 ms in 31 cases] underwent bi-ventricular pacing (n = 26) or bi-ventricular pacing and atrioventricular node ablation (AVN-ablation, n = 7) were included in this study. Non-response was defined: the increase of left ventricular ejection fraction (LVEF) was less than 15%. Patients were followed-up for 4 years.</p><p><b>RESULTS</b>Six patients died during follow up. Non-responder to CRT was observed in 6 out of 27 survived patients (22.22%). Six out of 7 patients underwent AVN-ablation were in responder group and 1 in non-responder group. Comparing with responder group, the baseline LVEF was significantly higher (37% vs. 32%, P = 0.003), and the history of HF was significantly longer (6.3 years vs. 4.1 years, P = 0.039), pulmonary artery pressure was significantly higher (53 vs. 32 mm Hg, P = 0.027), bi-ventricular pacing percentage (BIVP%) was significantly lower (75.86% vs. 91.73%, P = 0.007) in non-responder group.</p><p><b>CONCLUSIONS</b>Higher LVEF, longer HF history, higher pulmonary artery pressure and lower BIVP% are factors linked with non-responses to CRT in this patient cohort. CRT plus AVN-ablation is associated with high response rate to CRT in this patient cohort.</p>