Analyses of super-response to cardiac resynchronization therapy in patients with congestive heart failure: a multiple center trial / 中华心血管病杂志

<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>

Causes of non-response to cardiac resynchronization therapy in heart failure patients with permanent atrial fibrillation / 中华心血管病杂志

<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>

Anatomy variation of coronary vein system in patients with ischemic heart disease and non-ischemic / 中华心血管病杂志

<p><b>OBJECTIVE</b>The purpose of this study was to analyze the anatomy variation of coronary vein system in patients with ischemic heart disease (IHD) and non-ischemic heart disease (NIHD).</p><p><b>METHOD</b>Forty-one patients with IHD and 87 patients with NIHD [101 men, mean age (63.5 +/- 10.6) years] were included in this study.</p><p><b>RESULTS</b>Coronary sinuses were successfully cannulated and venographies were obtained in 127 cases. Transvenous LV pacing leads were successfully placed in optimal coronary vein in 123 cases (96.09%). The majority (76.38%) patients had at least one or more vessel abnormalities (thinness, stenosis, tortuousity, lack of lateral marginal vein or postero-lateral vein). The incidence of thin and tortuousity was significantly higher in lateral marginal vein than that in postero-lateral vein (P < 0.05-0.01). The incidence of lack of postero-lateral marginal vein was more frequent than the lack of lateral vein (P < 0.05). The rate of abnormality in both vessels was 25.2%. Incidence of vein lack in male was more frequent than in female (P < 0.05). The thin and tortuousity of vessels in female were more frequent than in male (P < 0.05). The incidence of thin and tortuousity of postero-lateral and abnormality of both vessels was significantly higher in IHD than in NIHD patients (P < 0.05). All coronary sinus myocardial bridges occurred in NIHD. Stenoses of left anterior descending (LAD) and left circumflex (LCX) were mostly associated with abnormality of lateral vessels.</p><p><b>CONCLUSIONS</b>The anatomic variations of lateral and postero-lateral coronary vein were more frequent in this patient cohort. Vein lack in male was more frequent and the thin and tortuousity of vessels were less in male than in female patients. The ratio of vessel abnormality is higher in patients with IHD. Coronary arteries stenosis and position of infarction are associated with anatomic variations of coronary vein system.</p>

Incidence and causes of nonresponse to cardiac resynchronization therapy in patients with congestive heart failure / 中华心血管病杂志

<p><b>OBJECTIVE</b>To observe the incidence and explore the potential factors of nonresponse to cardiac resynchronization therapy(CRT)in patients with severe chronic congestive heart failure.</p><p><b>METHOD</b>CRT was performed in 119 patients with NYHA function class III-IV and left ventricular ejection fraction ≤ 35% [96 men and 23 women, age (60.5 ± 11.3) years].</p><p><b>RESULTS</b>Seven patients died for different reasons between 1 - 6 months post CRT and clinical and echocardiographic (Echo) data at 6 months post CRT were analyzed from the remaining 112 patients. The incidence of nonresponse to CRT was 28.57%. Compared to the response group, complete right bundle branch block, longer course of congestive heart failure, higher pulmonary systolic pressure and serum creatinine level and non-optimal target vessels positioning of the left ventricle lead (the great cardiac vein and the middle cardiac vein) were the independent predictors for nonresponse after CRT (all P < 0.05). Compared with nonresponse group, the dosages of digoxin and diuretics used for heart failure were significantly reduced in response group (P < 0.01).</p><p><b>CONCLUSIONS</b>The incidence of nonresponse after CRT was 28.57% in this patient cohort. Higher pulmonary systolic pressure and serum creatinine level and non-optimal target vessels positioning of the left ventricle lead (the great cardiac vein and the middle cardiac vein) were the independent predictors for nonresponse after CRT.</p>

Long-term effects and mortality of biventricular pacing therapy in patients with congestive heart failure / 中华心血管病杂志

<p><b>OBJECTIVE</b>To study the long-term effects and mortality of biventricular pacing therapy in patients with congestive heart failure.</p><p><b>METHODS</b>Twenty-five patients, 18 men and 7 women, aged 34-75 [mean aged of (61.42 +/- 10.36)] years, with a cardiac function of New York Heart Association (NYHA) class III (n = 10) or IV (n = 15) received biventricular pacing therapy from Mar. 2001 to Feb. 2005. The etiologies of heart failure were idiopathic dilated cardiomyopathy (16 cases), hypertensive heart disease (3 cases) and ischemic heart disease (6 cases). Left ventricular end-diastolic dimension (LVEDD) was > 60 mm, Left ventricular ejection fraction (LVEF) was < 0.40 and QRS duration was > 130 ms in all the patients. Heart function parameters were repeatedly measured before and 3 months, 6 months, 1 year, 2 years and 3 years after pacemaker implantation. Mortality was also determined. The average follow up period was (20.88 +/- 11.51) months.</p><p><b>RESULTS</b>(1) Mortality: 5 patients died during follow-up (3 non-cardiac and 1 cardiac sudden death and 1 acute myocardial infarction). (2) The mean 6-min walking distance was increased significantly (P < 0.05) at 3 months to 3 years of follow-up. (3) NYHA class: The cardiac function of all patients improved significantly, with a reduction of mean NYHA class of more than one grade at 3 months to 3 years follow-up. (4) LVEDD: LVEDD reduced significantly (P < 0.05) at 3 months to 3 years follow-up. (5) LVEF: LVEF increased significantly (P < 0.05) at 3 months to 2 years follow-up. LVEF also improved at third year's follow-up, but the difference was not significant statistically.</p><p><b>CONCLUSIONS</b>Cardiac resynchronization, a pacemaker-based therapy for heart failure, may enhance quality of life and heart function and reverse LV remodeling. The long-term effects of treatment were stable, leading to the reduction of mortality from advanced heart failure.</p>

Percutaneous coronary intervention combined cardiac resynchronization therapy for refractory heart failure secondary to ischemic cardiomyopathy / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of percutaneous coronary intervention (PCI) combined cardiac resynchronization therapy (CRT) for refractory heart failure secondary to ischemic cardiomyopathy (ICM).</p><p><b>METHODS</b>PCI and CRT were performed in 7 ICM patients confirmed by angiography with NYHA class IV, QRS duration >/= 130 ms in 6 of them, III degrees AVB in 1 patient, fast ventricular heart rate Af in 1 patient, ventricular fibrillation history in 2 patient. All of them had their LVEDD >/= 55 mm, and LVEF </= 0.40 detected by UCG. PCI was performed first in 5 patients, and their follow-up angiography showed no restenosis 6 months after PCI, then CRT was given. CRT was performed first in 2 patients and 2 weeks later PCI was combined.</p><p><b>RESULTS</b>The procedures of PCI and CRT were performed successfully in all patients. Five patients received right atrial and biventricular pacing, one patient with Af received biventricular pacing and atrial-ventricular node radiofrequency ablation at the same procedure, and the another one patient received CRTD. One out of seven patients died of re-AMI 4 months after the combination therapy, and the other 6 patients had been alive 5 - 41 (23.2 +/- 13.8) months during the follow-up period. The heart function of the 7 patients had further improved after PCI and CRT combined therapy compared to that of PCI or CRT only. Their NYHA class decreased from IV to II, 6-minute walking distance increased steadily, and mitral regurgitation reduced and QRS duration shortened significantly. The LVEDD decreased and LVEF increased significantly in 2 patients without ventricular aneurysm, and slight improvement or no change were in the other 5 patients.</p><p><b>CONCLUSION</b>For patients with refractory heart failure secondary to ICM, the combination of PCI and CRT could obviously improve their heart function, quality of life and prognosis, which also very safe in perforation.</p>