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BMC Cardiovascular Disorders - Latest Articles
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The latest research articles published by BMC Cardiovascular Disorders
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Local electrogram delay recorded from left ventricular lead at implant predicts response to cardiac resynchronization therapy: Retrospective study with 1 year follow up
Background:
Considerable proportion of patients does not respond to the cardiac resynchronization therapy(CRT). This study investigated clinical relevance of left ventricular electrode localelectrogram delay from the beginning of QRS (QLV). We hypothesized that longer QLVindicating more optimal lead placement in the late activated regions is associated with thehigher probability of positive CRT response.
Methods:
We conducted a retrospective, single-centre analysis of 161 consecutive patients with heartfailure and LBBB or nonspecific intraventricular conduction delay (IVCD) treated with CRT.We routinely intend to implant the LV lead in a region with long QLV. Clinical response toCRT, left ventricular (LV) reverse remodelling (i.e. decrease in LV end-systolic diameter -LVESD [greater than or equal to]10%) and reduction in plasma level of NT-proBNP >30% at 12-month post-implantwere the study endpoints. We analyzed association between pre-implant variables and thestudy endpoints.
Results:
Clinical CRT response rate reached 58%, 84% and 92% in the lowest ([less than or equal to]105 ms), middle(106-130 ms) and the highest (>130 ms) QLV tertile (p < 0.0001), respectively. Longer QRSduration (p = 0.002), smaller LVESD and a non-ischemic cardiomyopathy (both p = 0.02)were also univariately associated with positive clinical CRT response. In a multivariateanalysis, QLV remained the strongest predictor of clinical CRT response (p < 0.00001),followed by LVESD (p = 0.01) and etiology of LV dysfunction (p = 0.04). Comparablepredictive power of QLV for LV reverse remodelling and NT-proBNP response rates wasobserved.
Conclusion:
LV lead position assessed by duration of the QLV interval was found the strongestindependent predictor of beneficial clinical response to CRT.
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Effectiveness of two intensive treatment methods for
smoking cessation and relapse prevention in patients
with coronary heart disease: study protocol and
baseline description
Background:
There is no more effective intervention for secondary prevention of coronary heart diseasethan smoking cessation. Yet, evidence about the (cost-)effectiveness of smoking cessationtreatment methods for cardiac inpatients that also suit nursing practice is scarce. This protocoldescribes the design of a study on the (cost-)effectiveness of two intensive smoking cessationinterventions for hospitalised cardiac patients as well as first results on the inclusion rates andthe characteristics of the study population.
Methods:
A quasi-experimental study design is used in eight cardiac wards of hospitals throughout theNetherlands to assess the (cost-)effectiveness of two intensive smoking cessation counsellingmethods both combined with nicotine replacement therapy. Randomization was conducted atthe ward level (cross-over). Baseline and follow-up measurements after six and 12 monthsare obtained. Upon admission to the cardiac ward, nurses assess patients' smoking behaviour,provide a quit advice and subsequently refer patients for either telephone counselling or faceto-face counselling. The counselling interventions have a comparable structure and contentbut differ in provider and delivery method, and in duration. Both counselling interventionsare compared with a control group receiving no additional treatment beyond the usual care.Between December 2009 and June 2011, 245 cardiac patients who smoked prior tohospitalisation were included in the usual care group, 223 in the telephone counselling groupand 157 in the face-to-face counselling group. Patients are predominantly male and have amean age of 57 years. Acute coronary syndrome is the most frequently reported admissiondiagnosis. The ultimate goal of the study is to assess the effects of the interventions onsmoking abstinence and their cost-effectiveness. Telephone counselling is expected to bemore (cost-)effective in highly motivated patients and patients with high SES, whereas faceto-face counselling is expected to be more (cost-)effective in less motivated patients andpatients with low SES.DiscussionThis study examines two intensive smoking cessation interventions for cardiac patients byusing a multi-centre trial with eight cardiac wards. Although not all eligible patients could beincluded and the distribution of patients is skewed in the different groups, the results will beable to provide valuable insight into effects and costs of counselling interventions varying indelivery mode and intensity.Trial registrationDutch Trial Register NTR2144
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Idiopathic premature ventricular contractions and
ventricular tachycardias originating from the
vicinity of tricuspid annulus: Results of
radiofrequency catheter ablation in thirty-five
patients
Background:
In recent years, catheter ablation has increasingly been used for ablation of idiopathicpremature ventricular complexes (PVCs) or ventricular tachycardias (IVTs). However, themapping and catheter ablation of the arrhythmias originating from the vicinity of tricuspidannulus (TA) may not be fully understood. This study aimed to investigate electrophysiologiccharacteristics and effects of radiofrequency catheter ablation (RFCA) for patients withsymptomatic PVCs and IVTs originating from the vicinity of TA.
Methods:
Characteristics of body surface electrocardiogram (ECG) and electrophysiologic recordingswere analyzed in 35 patients with symptomatic PVCs/ IVTs originating from the vicinity ofTA. RFCA was performed using pace mapping and activation mapping.
Results:
Among the 35 patients with PVCs/IVTs arising from the vicinity of TA, complete eliminationof PVCs/IVTs could be achieved by RFCA in 32 patients (success rate 91.43%) during amedian follow-up period of 21 months. PVCs/IVTs originating from the vicinity of TA haddistinctive ECG characteristics that were useful for identifying the precise origin. An rSpattern was recorded in lead V1 in 93.1% of patients with PVCs/IVTs from the free wall ofTA, vs 16.7% of patients with PVCs/IVTs from the septal TA, whereas a QS pattern in leadV1 occurred in 83.3% of patients with PVCs/IVTs from the septal TA vs 6.9% of patientswith PVCs from the free wall of the TA. The precordial R wave transition occurred by leadV3 or earlier in all patients with PVCs/IVTs originating from the septal portion of the TA, ascompared to transition beyond V3 in all patients with PVCs/IVTs from the free wall of theTA.
Conclusions:
RFCA is an effective curative therapy for symptomatic PVCs/IVTs originating from thevicinity of TA. There are specific characteristics in ECG and the ablation site could belocated by ECG analysis.
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Age - related treatment strategy and long-term
outcome in acute myocardial infarction patients in
the PCI era
Background:
Older age, as a factor we cannot affect, is consistently one of the main negative prognosticvalues in patients with acute myocardial infarction. One of the most powerful factors thatimproves outcomes in patients with acute coronary syndromes is the revascularizationpreferably performed by percutaneous coronary intervention. No data is currently availablefor the role of age in large groups of consecutive patients with PCI as the nearly sole methodof revascularization in AMI patients. The aim of this study was to analyze age-relateddifferences in treatment strategies, results of PCI procedures and both in-hospital and longtermoutcomes of consecutive patients with acute myocardial infarction.
Methods:
Retrospective multicenter analysis of 3814 consecutive acute myocardial infarction patientsdivided into two groups according to age (1800 patients [less than or equal to] 65 years and 2014 patients > 65years). Significantly more older patients had a history of diabetes mellitus and previousmyocardial infarctions.
Results:
The older population had a significantly lower rate of coronary angiographies (1726; 95.9%vs. 1860; 92.4%, p < 0.0001), PCI (1541; 85.6% vs. 1505; 74.7%, p < 0.001), achievement ofoptimal final TIMI flow 3 (1434; 79.7% vs. 1343; 66.7%, p < 0.001) and higher rate ofunsuccessful reperfusion with final TIMI flow 0-1 (46; 2.6% vs. 78; 3.9%, p = 0.022). A totalof 217 patients (5.7%) died during hospitalization, significantly more often in the olderpopulation (46; 2.6% vs. 171; 8.5%, p < 0.001). The long-term mortality (data for 2847patients from 2 centers) was higher in the older population as well (5 years survival: 86.1%vs. 59.8%). Though not significantly different and in contrast with PCI, the presence ofdiabetes mellitus, previous MI, final TIMI flow and LAD, as the infarct-related artery, hadrelatively lower impact on the older patients. Severe heart failure on admission (Killip III-IV)was associated with the worst prognosis in the whole group of patients, though itssignificance was higher in the youngers (HR 6.04 vs. 3.14, p = 0.051 for Killip III and 12.24vs. 5.65, p = 0.030 for Killip IV). We clearly demonstrated age as a strong discriminator forthe whole population of AMI patients.
Conclusions:
In a consecutive AMI population, the older group (>65 years) was associated with a lesspronounced impact of risk factors on long-term outcome. To ascertain the coronary anatomyby coronary angiography and proceed to PCI if suitable regardless of age is crucial in allpatients, though the primary success rate of PCI in the older age is lower. Age, when viewedas a risk factor, was a dominant discriminating factor in all patients.
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The prognostic importance of a history of
hypertension in patients with symptomatic heart
failure is substantially worsened by a short mitral
inflow deceleration time
Background:
Hypertension is a common comorbidity in patients with heart failure and may contribute todevelopment and course of disease, but the importance of a history of hypertension inpatients with prevalent heart failure remains uncertain.
Methods:
3078 consecutively hospitalized heart failure patients (NYHA classes II-IV) were screenedfor the EchoCardiography and Heart Outcome Study (ECHOS). The left ventricular ejectionfraction (LVEF) was estimated by 2 dimensional transthoracic echocardiography in allpatients and a subgroup of 878 patients had additional data on pulsed wave Dopplerassessment of transmitral flow available. A restrictive filling (RF) was defined as a mitralinflow deceleration time [less than or equal to]140 ms. Patients were followed for a median of 6.8 (Inter QuartileRange 6.6-7.0) years and multivariable Cox regression models were used to assess the risk ofall-cause mortality associated with hypertension.
Results:
The study population had a mean age of 73 +/- 11 years. 39% were female, 27% had a historyof hypertension and 48% had a RF. Over the study period, 64% of the population died.Hypertension was not associated with increased risk of mortality, hazard ratio (HR) 0.95(0.85-1.05). LVEF did not modify this relationship (p for interaction = 0.7), but RF patternsubstantially influenced the outcomes associated with hypertension (p forinteraction < 0.001); HR 0.75 (0.57-0.99) and 1.41 (1.08-1.84) in patients without and withRF, respectively.
Conclusions:
In patients with symptomatic heart failure, a history of hypertension is associated with asubstantially increased relative risk of mortality among patients with a restrictive transmitralfilling pattern.
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