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Trends in Cardiovascular Medicine Aug 2019His bundle pacing (HBP) has continued to evolve over the past decade and has started to become a global phenomenon. Evidence is mounting of its clinical benefits as... (Review)
Review
His bundle pacing (HBP) has continued to evolve over the past decade and has started to become a global phenomenon. Evidence is mounting of its clinical benefits as compared to both right ventricular and left ventricular pacing. In this paper, we review recent data in support of His bundle pacing and some of the challenges facing us as we advocate its increasing role in clinical practice.
Topics: Action Potentials; Adult; Animals; Bundle of His; Cardiac Pacing, Artificial; Electrocardiography; Female; Heart Block; Heart Failure; Heart Rate; Humans; Male; Middle Aged; Recovery of Function; Risk Factors; Treatment Outcome; Ventricular Dysfunction; Ventricular Function
PubMed: 30344079
DOI: 10.1016/j.tcm.2018.09.018 -
Revue Medicale de Liege Jan 2021Even though, it has long been considered as a passive channel allowing communication between the systemic and pulmonary circulations, it is now clearly established that...
Even though, it has long been considered as a passive channel allowing communication between the systemic and pulmonary circulations, it is now clearly established that the right ventricle plays an essential role in cardio-pulmonary couple physiology. Its failure results in a clinical presentation that reflects the systemic congestion and reduced cardiac output. It is the consequence of two pathological situations frequently encountered in intensive care including pulmonary vascular resistance increase and right ventricle contraction alteration. Mechanical ventilation, certain drugs and volume overload can also participate. The management of the acute right heart failure is based on the combination of supportive treatment and causal treatment, specific to the etiology. Supportive therapy aims to optimize filling pressures, reduce afterload and support cardiac contractibility. With the growing number of therapeutic options used according to co-morbidities, decision-making by a multidisciplinary heart team seems essential.
Topics: Critical Care; Heart Failure; Heart Ventricles; Humans; Respiration, Artificial; Ventricular Dysfunction, Right
PubMed: 33443325
DOI: No ID Found -
The Journal of Thoracic and... May 2020
Topics: Coronary Artery Bypass; Humans; Magnetic Resonance Imaging; Ventricular Dysfunction, Left
PubMed: 31230812
DOI: 10.1016/j.jtcvs.2019.05.047 -
The Thoracic and Cardiovascular Surgeon Oct 2022Controversy exists about left ventricular systolic function recovery after coronary artery bypass grafting in patients with ischemic cardiomyopathy. The aim of this...
BACKGROUND
Controversy exists about left ventricular systolic function recovery after coronary artery bypass grafting in patients with ischemic cardiomyopathy. The aim of this study is to evaluate the temporal evolvement of left ventricular systolic function after coronary artery bypass surgery in patients with ischemic cardiomyopathy.
PATIENTS AND METHODS
A total of 50 patients with coronary artery disease and left ventricular ejection fraction (LVEF) ≤35% underwent isolated coronary artery bypass grafting in a single center in the period 2017 to 2019. We performed a retrospective analysis of the echocardiographic and clinical follow-up data at 3 months and 1 year postoperatively.
RESULTS
Median LVEF preoperatively was 25% (20-33%), mean patient age was 66 ± 8.2 years, 33 (66%) patients were operated off-pump, and 22 (44%) procedures were non-elective. There was no in-hospital myocardial infarction, stroke, and repeat revascularization. Three (6%) patients underwent re-exploration for bleeding or tamponade. In-hospital mortality was 8% and 1-year mortality was 12%. At 1 year postoperatively, there was no repeat revascularization, no myocardial infarction, 1 (2.6%) patient had a transient ischemic attack, and 10 (20%) patients required an implantable defibrillator. There was a statistically significant median ejection fraction increase at 3 months (15% [5-22%], < 0.0001) and 1 year (23% [13-25%], < 0.0001) postoperatively, with an absolute increase ≥10% in 32 (74.4%) and 30 (78.9%) patients at 3 months and 1 year, respectively.
CONCLUSION
Patients with ischemic cardiomyopathy undergoing coronary artery bypass surgery show continuous recovery of left ventricular systolic function in the first postoperative year.
Topics: Aged; Cardiomyopathies; Coronary Artery Bypass; Humans; Middle Aged; Myocardial Infarction; Myocardial Ischemia; Retrospective Studies; Stroke Volume; Treatment Outcome; Ventricular Dysfunction, Left; Ventricular Function, Left
PubMed: 34894634
DOI: 10.1055/s-0041-1736246 -
American Journal of Physiology. Heart... Feb 2020Right ventricle (RV) pressure loading can lead to RV fibrosis and dysfunction. We previously found increased RV, septal hinge-point and left ventricle (LV) fibrosis in...
Right ventricle (RV) pressure loading can lead to RV fibrosis and dysfunction. We previously found increased RV, septal hinge-point and left ventricle (LV) fibrosis in experimental RV pressure loading. However, the relation of RV wall stress to biventricular fibrosis and dysfunction is incompletely defined. Rabbits underwent progressive pulmonary artery banding (PAB) over 3 wk with hemodynamics, echocardiography, and myocardial samples obtained at a terminal experiment at 6 wk. An additional group received PAB and treatment with an endothelin receptor antagonist. The endocardial and epicardial borders of short-axis echo images were traced and analyzed with invasive pressures to yield regional end-diastolic (ED) and end-systolic (ES) wall stress. To increase clinical translation, computer model-derived wall stress was compared with Laplace wall stress. The relation of wall stress with fibrosis (picrosirius red staining) and ventricular function was analyzed. ED wall stress in all regions and RV and LV free-wall ES wall stress were increased in PAB rabbits versus sham animals. Laplace wall stress correlated well with computational models. In PAB, fibrosis was highest in the RV free wall, then septal hinge regions, and lowest in the septum and LV free wall. Fibrosis was moderately related to ED ( = 0.47, = 0.0011), but not ES wall stress. RV ED wall stress was strongly related to echo indexes of function (strain rate: = 0.71, = 0.048; ', = -0.75, = 0.0077; tricuspid annular plane systolic excursion: = 0.85, = 0.0038) and RV fractional area change ( = 0.77, = 0.027). ED, more than ES, wall stress is related moderately to fibrosis and strongly to function in experimental RV pressure loading, especially at the septal hinge-point regions, where fibrosis is prominent. This suggests that wall stress partially links RV pressure loading, fibrosis, and dysfunction and may be useful to follow clinically. Biventricular fibrosis and dysfunction impact outcomes in RV pressure loading, but their relation to wall stress is poorly defined. Using a pulmonary artery band rabbit model, we entered echocardiography and catheter data into a computer model to yield regional end-diastolic (EDWS) and end-systolic (ESWS) wall stress. EDWS, more than ESWS, correlated with fibrosis and dysfunction, especially at the fibrosis-intense septal hinge-point regions. Thus, wall stress may be clinically useful in linking RV pressure loading to regional fibrosis and dysfunction.
Topics: Algorithms; Animals; Computer Simulation; Echocardiography; Fibrosis; Hemodynamics; Male; Myocardium; Pressure; Rabbits; Stroke Volume; Ventricular Dysfunction, Left; Ventricular Dysfunction, Right; Ventricular Function, Right; Ventricular Pressure; Ventricular Remodeling
PubMed: 31886720
DOI: 10.1152/ajpheart.00343.2019 -
Cardiovascular Ultrasound Aug 2022Recognition of congestion and hypoperfusion in patients with chronic left ventricular dysfunction (LVD) has therapeutic and prognostic implications. In the present study...
PURPOSE
Recognition of congestion and hypoperfusion in patients with chronic left ventricular dysfunction (LVD) has therapeutic and prognostic implications. In the present study we hypothesized that a multiparameter echocardiographic grading of right ventricular dysfunction (RVD) can facilitate the characterization of hemodynamic profiles.
METHODS
Consecutive patients (n = 105, age 53 ± 14 years, males 77%, LV ejection fraction 28 ± 11%) referred for heart transplant or heart failure work-up, with catheterization and echocardiography within 48 h, were reviewed retrospectively. Three hemodynamic profiles were defined: compensated LVD (cLVD, normal pulmonary capillary wedge pressure (PCWP < 15 mmHg) and normal mixed venous saturation (SvO ≥ 60%)); decompensated LVD (dLVD, with increased PCWP) and LV failure (LVF, increased PCWP and reduced SvO). We established a 5-point RVD score including pulmonary hypertension, reduced tricuspid annular plane systolic excursion, RV dilatation, ≥ moderate tricuspid regurgitation and increased right atrial pressure.
RESULTS
The RVD score [median (IQR 25%;75%)] showed significant in-between the three groups differences with 1 (0;1), 1 (0.5;2) and 3.0 (2;3.5) in patients with cLVD, dLVD and LVF, respectively. The finding of RVD score ≥ 2 or ≥ 4 increased the likelihood of decompensation or LVF 5.2-fold and 6.7-fold, respectively. On the contrary, RVD score < 1 and < 2 reduced the likelihood 11.1-fold and 25-fold, respectively. The RVD score was more helpful than standard echocardiography regarding identification of hemodynamic profiles.
CONCLUSIONS
In this proof of concept study an echocardiographic RVD score identified different hemodynamic severity profiles in patients with chronic LVD and reduced ejection fraction. Further studies are needed to validate its general applicability.
Topics: Adult; Aged; Echocardiography; Heart Failure; Hemodynamics; Humans; Male; Middle Aged; Retrospective Studies; Stroke Volume; Ventricular Dysfunction, Left; Ventricular Dysfunction, Right; Ventricular Function, Right
PubMed: 35915497
DOI: 10.1186/s12947-022-00290-5 -
JACC. Cardiovascular Imaging Apr 2022
Topics: Congenitally Corrected Transposition of the Great Arteries; Heart Ventricles; Humans; Predictive Value of Tests; Transposition of Great Vessels; Ventricular Dysfunction, Right
PubMed: 35393062
DOI: 10.1016/j.jcmg.2021.12.002 -
Cardiovascular Diabetology May 2024The association between the triglyceride-glucose (TyG) index and subclinical left ventricular (LV) systolic dysfunction in obese patients remains unclear. This study...
BACKGROUND
The association between the triglyceride-glucose (TyG) index and subclinical left ventricular (LV) systolic dysfunction in obese patients remains unclear. This study aimed to investigate the relationship between the TyG index and LV global longitudinal strain (GLS) in obese patients.
METHODS
A total of 1028 obese patients from January 2019 to January 2024 were included in the present study. Clinical parameters and biochemical and echocardiographic data were obtained from the participants. LV GLS was obtained from the GE EchoPAC workstation for evaluating subclinical LV function. The TyG index was calculated as Ln (fasting TG [mg/dL] × fasting glucose [mg/dL]/2). LV GLS was compared between obese patients with a high TyG index and those with a low TyG index.
RESULTS
Obese patients with a high TyG index had greater incidences of hypertension, diabetes mellitus and hyperlipidaemia. The LV GLS was significantly lower in the high TyG index group than in the low TyG index group (P = 0.01). After adjusting for sex, age, body mass index, heart rate, hypertension, diabetes mellitus, dyslipidaemia, blood urea nitrogen, serum creatinine, LV mass and LV hypertrophy, the TyG index remained an independent risk indicator related to an LV GLS < 20% (OR: 1.520, 95% CI: 1.040 to 2.221; P = 0.031).
CONCLUSIONS
We concluded that an increase in the TyG index is independently associated with subclinical LV systolic dysfunction in obese patients.
Topics: Humans; Male; Female; Ventricular Dysfunction, Left; Obesity; Middle Aged; Triglycerides; Ventricular Function, Left; Blood Glucose; Biomarkers; Adult; Risk Factors; Asymptomatic Diseases; Risk Assessment; Systole; Aged; Cross-Sectional Studies; Predictive Value of Tests; Retrospective Studies
PubMed: 38715070
DOI: 10.1186/s12933-024-02253-8 -
JACC. Cardiovascular Imaging Jan 2020Heart failure with preserved ejection fraction presents a challenging diagnosis given a heterogeneous patient population and limited therapeutic options. Diastolic... (Review)
Review
Heart failure with preserved ejection fraction presents a challenging diagnosis given a heterogeneous patient population and limited therapeutic options. Diastolic function assessment using echocardiography has been a cornerstone in the work-up and is as important as systolic functional assessment. There has been increased awareness to the potential utility of cardiac magnetic resonance (CMR) imaging over the past decade as a promising, radiation-free, robust imaging modality providing an unrestricted field of view and high-resolution images for global and regional functional assessment. CMR provides early markers for detecting myocardial disease using tissue characterization imaging, which might prove useful to improve diagnosis and management. Over the years, several studies have examined CMR-derived diastolic functional indices, including transmitral and pulmonary venous velocities, left ventricular and left atrial strain using myocardial tagging, and, more recently, feature tracking. The relevance of imaging-based diastolic function indices and their clinical application across different modalities is increasingly recognized.
Topics: Atrial Function, Left; Diastole; Heart Failure; Humans; Magnetic Resonance Imaging, Cine; Phenotype; Predictive Value of Tests; Prognosis; Stroke Volume; Ventricular Dysfunction, Left; Ventricular Function, Left
PubMed: 31202753
DOI: 10.1016/j.jcmg.2019.02.031 -
Pacing and Clinical Electrophysiology :... Sep 2022It is unknown whether His-Purkinje conduction system pacing (HPCSP), as either His bundle or left bundle branch pacing, could be an alternative to cardiac...
BACKGROUND
It is unknown whether His-Purkinje conduction system pacing (HPCSP), as either His bundle or left bundle branch pacing, could be an alternative to cardiac resynchronization therapy (BiVCRT) for patients with left ventricular dysfunction needing ventricular pacing due to atrioventricular block. The aim of the study is to compare the echocardiographic response and clinical improvement between HPCSP and BiVCRT.
METHODS
Consecutive patients who successfully received HPCSP were compared with a historical cohort of BiVCRT patients. Patients were 1:1 matched by age, LVEF, atrial fibrillation, renal function and cardiomyopathy type. Responders were defined as patients who survived, did not require heart transplantation and increased LVEF ≥5 points at 6-month follow-up.
RESULTS
HPCSP was successfully achieved in 92.5% (25/27) of patients. During follow-up, 8% (2/25) of HPCSP patients died and 4% (1/25) received a heart transplant, whereas 4% (1/25) of those in the BiVCRT cohort died. LVEF improvement was 10% ± 8% HPCSP versus 7% ± 5% BiVCRT (p = .24), and the percentage of responders was 76% (19/25) HPCSP versus 64% (16/25) BiVCRT (p = .33). Among survivors, the percentage of patients who improved from baseline II-IV mitral regurgitation (MR) to 0-I MR was 9/11 (82%) versus 2/8 (25%) (p = .02). Compared to those with BiVCRT, patients with HPCSP achieved better NYHA improvement: 1 point versus 0.5 (OR 0.34; p = .02).
CONCLUSION
HPCSP in patients with LVEF ≤45% and atrioventricular block improved the LVEF and induced a response similar to that of BiVCRT. HPCSP significantly improved MR and NYHA functional class. HPCSP may be an alternative to BiVCRT in these patients. (Figure 1. Central Illustration). [Figure: see text].
Topics: Atrioventricular Block; Bundle of His; Cardiac Conduction System Disease; Cardiac Pacing, Artificial; Cardiac Resynchronization Therapy; Heart Failure; Humans; Stroke Volume; Treatment Outcome; Ventricular Dysfunction; Ventricular Function, Left
PubMed: 35583311
DOI: 10.1111/pace.14535