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Elliott MK, Mehta V, Wijesuriya N, Sidhu BS, Gould J, Niederer S, Rinaldi CA. Multi-lead pacing for cardiac resynchronization therapy in heart failure: a meta-analysis of randomized controlled trials. EUROPEAN HEART JOURNAL OPEN 2022; 2:oeac013. [PMID: 35919119 PMCID: PMC9242027 DOI: 10.1093/ehjopen/oeac013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/25/2022] [Accepted: 02/25/2022] [Indexed: 11/13/2022]
Abstract
Aims Multi-lead pacing is a potential therapy to improve response to cardiac resynchronization therapy (CRT) by providing rapid activation of the myocardium from multiple sites. Here, we perform a meta-analysis of randomized controlled trials to assess the efficacy of multi-lead pacing. Methods and results A literature search was performed which identified 251 unique records. After screening, 6 studies were found to meet inclusion criteria, with 415 patients included in the meta-analysis. Four studies performed multi-lead pacing with two left ventricular (LV) leads and one right ventricular (RV) lead. One study used two RV leads and one LV lead, and one study used both configurations. There was no difference between multi-lead pacing and conventional CRT in LV end-systolic volume [mean difference (MD) -0.54 mL, P = 0.93] or LV ejection fraction (MD 1.42%, P = 0.40). There was a borderline significant improvement in Minnesota Living With Heart Failure Questionnaire score for multi-lead pacing vs. conventional CRT (MD -4.46, P = 0.05), but the difference was not significant when only patients receiving LV-only multi-lead pacing were included (MD -3.59, P = 0.25). There was also no difference between groups for 6-min walk test (MD 15.06 m, P = 0.38) or New York Heart Association class at follow-up [odds ratio (OR) 1.49, P = 0.24]. There was no difference in mortality between groups (OR 1.11, P = 0.77). Conclusion This meta-analysis does not support the use of multi-lead pacing for CRT delivery. However, significant variation between studies was noted, and therefore a benefit for multi-lead pacing in select patients cannot be excluded, and further investigation may be warranted.
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Affiliation(s)
- Mark K Elliott
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Vishal Mehta
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Nadeev Wijesuriya
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Baldeep S Sidhu
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Justin Gould
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Christopher A Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
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2
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Cardiac resynchronization therapy with multipoint pacing via quadripolar lead versus traditional biventricular pacing: A systematic review and meta-analysis of clinical studies on hemodynamic, clinical, and prognostic parameters. Heart Rhythm O2 2021; 2:682-690. [PMID: 34988517 PMCID: PMC8710588 DOI: 10.1016/j.hroo.2021.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Cardiac resynchronization therapy (CRT) is one of the cornerstones of heart failure (HF) therapy, as it has reduced mortality and morbidity and has shown improvement in functional capacity. Multipoint pacing (MPP) is a way of configuring CRT with the aim to improve the percentage of patients who respond to CRT. Objective To demonstrate the effectiveness of the MPP compared to traditional biventricular pacing (BiV). Methods We performed a systematic review and meta-analysis according to PRISMA guidelines of studies in which MPP vs BiV strategy were compared. Results MPP use is associated with a higher rate of patients experiencing functional improvement (odds ratio: 2.51, 95% confidence interval [CI], 1.56–4.06; P = .0002) and with higher delta LV dP/dtmax (mean difference, 1.82; 95% CI, 0.24–3.39; P = .0240) with respect to BiV. MPP and BiV have no significantly different effect on left ventricular end-systolic volume (LVESV) (mean difference, 0.39; 95% CI, -11.12 to 11.89; P = .9475); moreover, there is no significant difference between the 2 treatments regarding hospitalization for HF (odds ratio, 0.70; 95% CI, 0.32 to 1.54; P = .3816) and all-cause death (odds ratio, 0.81; 95% CI, 0.40 to 1.62; P = .5460). MPP is associated with a significantly lower projected battery longevity (mean difference -8.66 months; 95% CI, -13.67 to -3.66; P = .00007) with respect to BiV. Conclusion MPP significantly improves functional class and acute hemodynamic parameters with respect to BiV. Prognostic indices and LVESV are not significantly influenced by MPP. MPP is associated with a significant reduction in projected battery longevity.
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3
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Dell'Era G, Gravellone M, Scacchi S, Franzone PC, Pavarino LF, Boggio E, Prenna E, De Vecchi F, Occhetta E, Devecchi C, Patti G. A clinical-in silico study on the effectiveness of multipoint bicathodic and cathodic-anodal pacing in cardiac resynchronization therapy. Comput Biol Med 2021; 136:104661. [PMID: 34332350 DOI: 10.1016/j.compbiomed.2021.104661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/16/2021] [Accepted: 07/16/2021] [Indexed: 11/18/2022]
Abstract
Up to one-third of patients undergoing cardiac resynchronization therapy (CRT) are nonresponders. Multipoint bicathodic and cathodic-anodal left ventricle (LV) stimulations could overcome this clinical challenge, but their effectiveness remains controversial. Here we evaluate the performance of such stimulations through both in vivo and in silico experiments, the latter based on computer electromechanical modeling. Seven patients, all candidates for CRT, received a quadripolar LV lead. Four stimulations were tested: right ventricular (RVS); conventional single point biventricular (S-BS); multipoint biventricular bicathodic (CC-BS) and multipoint biventricular cathodic-anodal (CA-BS). The following parameters were processed: QRS duration; maximal time derivative of arterial pressure (dPdtmax); systolic arterial pressure (Psys); and stroke volume (SV). Echocardiographic data of each patient were then obtained to create an LV geometric model. Numerical simulations were based on a strongly coupled Bidomain electromechanical coupling model. Considering the in vivo parameters, when comparing S-BS to RVS, there was no significant decrease in SV (from 45 ± 11 to 44 ± 20 ml) and 6% and 4% increases of dPdtmax and Psys, respectively. Focusing on in silico parameters, with respect to RVS, S-BS exhibited a significant increase of SV, dPdtmax and Psys. Neither the in vivo nor in silico results showed any significant hemodynamic and electrical difference among S-BS, CC-BS and CA-BS configurations. These results show that CC-BS and CA-BS yield a comparable CRT performance, but they do not always yield improvement in terms of hemodynamic parameters with respect to S-BS. The computational results confirmed the in vivo observations, thus providing theoretical support to the clinical experiments.
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Affiliation(s)
- G Dell'Era
- Cardiologia 1, Azienda Ospedaliera Universitaria "Maggiore Della Carità", Novara, Italy
| | - M Gravellone
- Divisione di Cardiologia, Ospedale Degli Infermi, Biella, Italy
| | - S Scacchi
- Dipartimento di Matematica, Università Degli Studi di Milano, Via Saldini 50, 20133, Milano, Italy.
| | - P Colli Franzone
- Dipartimento di Matematica, Università Degli Studi di Pavia, Via Ferrata 1, 27100, Pavia, Italy
| | - L F Pavarino
- Dipartimento di Matematica, Università Degli Studi di Pavia, Via Ferrata 1, 27100, Pavia, Italy
| | - E Boggio
- Divisione di Cardiologia, Ospedale Degli Infermi, Biella, Italy
| | - E Prenna
- Cardiologia 1, Azienda Ospedaliera Universitaria "Maggiore Della Carità", Novara, Italy
| | - F De Vecchi
- Divisione di Cardiologia, Ospedale Sant'Andrea, Vercelli, Italy
| | - E Occhetta
- Divisione di Cardiologia, Ospedale Sant'Andrea, Vercelli, Italy
| | - C Devecchi
- Divisione di Cardiologia, Ospedale Sant'Andrea, Vercelli, Italy
| | - G Patti
- Cardiologia 1, Azienda Ospedaliera Universitaria "Maggiore Della Carità", Novara, Italy; Dipartimento di Medicina Traslazionale, Università Del Piemonte Orientale, Novara, Italy
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4
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Albatat M, Arevalo H, Bergsland J, Strøm V, Balasingham I, Odland HH. Optimal pacing sites in cardiac resynchronization by left ventricular activation front analysis. Comput Biol Med 2020; 128:104159. [PMID: 33301952 DOI: 10.1016/j.compbiomed.2020.104159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/14/2020] [Accepted: 11/29/2020] [Indexed: 10/22/2022]
Abstract
Cardiac resynchronization therapy (CRT) can substantially improve dyssynchronous heart failure and reduce mortality. However, about one-third of patients who are implanted, derive no measurable benefit from CRT. Non-response may partly be due to suboptimal activation of the left ventricle (LV) caused by electrophysiological heterogeneities. The goal of this study is to investigate the performance of a newly developed method used to analyze electrical wavefront propagation in a heart model including myocardial scar and compare this to clinical benchmark studies. We used computational models to measure the maximum activation front (MAF) in the LV during different pacing scenarios. Different heart geometries and scars were created based on cardiac MR images of three patients. The right ventricle (RV) was paced from the apex and the LV was paced from 12 different sites, single site, dual-site and triple site. Our results showed that for single LV site pacing, the pacing site with the largest MAF corresponded with the latest activated regions of the LV demonstrated during RV pacing, which also agrees with previous markers used for predicting optimal single-site pacing location. We then demonstrated the utility of MAF in predicting optimal electrode placements in more complex scenarios including scar and multi-site LV pacing. This study demonstrates the potential value of computational simulations in understanding and planning CRT.
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Affiliation(s)
- Mohammad Albatat
- Intervention Centre, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Hermenegild Arevalo
- Department of Computational Physiology, Simula Research Laboratory, Fornebu, Norway
| | | | - Vilde Strøm
- Department of Computational Physiology, Simula Research Laboratory, Fornebu, Norway
| | - Ilangko Balasingham
- Intervention Centre, Oslo University Hospital, Oslo, Norway; Department of Electronic Systems, Norwegian University of Science and Technology, Trondheim, Norway
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5
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Niederer S, Porter B, Rinaldi CA. To the Editor - Multisite pacing strategies: Solutions looking for a problem? Heart Rhythm O2 2020; 1:315. [PMID: 34113886 PMCID: PMC8183811 DOI: 10.1016/j.hroo.2020.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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6
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Pérez-Gutiérrez MF, Sánchez-Muñoz JJ, Erazo-Rodas M, Guerrero-Curieses A, Everss E, Quesada-Dorador A, Ruiz-Granell R, Ibáñez-Criado A, Bellver-Navarro A, Rojo-Álvarez JL, García-Alberola A. Spectral Analysis and Mutual Information Estimation of Left and Right Intracardiac Electrograms during Ventricular Fibrillation. SENSORS (BASEL, SWITZERLAND) 2020; 20:s20154162. [PMID: 32726931 PMCID: PMC7435921 DOI: 10.3390/s20154162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 07/19/2020] [Accepted: 07/22/2020] [Indexed: 06/11/2023]
Abstract
Ventricular fibrillation (VF) signals are characterized by highly volatile and erratic electrical impulses, the analysis of which is difficult given the complex behavior of the heart rhythms in the left (LV) and right ventricles (RV), as sometimes shown in intracardiac recorded Electrograms (EGM). However, there are few studies that analyze VF in humans according to the simultaneous behavior of heart signals in the two ventricles. The objective of this work was to perform a spectral and a non-linear analysis of the recordings of 22 patients with Congestive Heart Failure (CHF) and clinical indication for a cardiac resynchronization device, simultaneously obtained in LV and RV during induced VF in patients with a Biventricular Implantable Cardioverter Defibrillator (BICD) Contak Renewal IVTM (Boston Sci.). The Fourier Transform was used to identify the spectral content of the first six seconds of signals recorded in the RV and LV simultaneously. In addition, measurements that were based on Information Theory were scrutinized, including Entropy and Mutual Information. The results showed that in most patients the spectral envelopes of the EGM sources of RV and LV were complex, different, and with several frequency peaks. In addition, the Dominant Frequency (DF) in the LV was higher than in the RV, while the Organization Index (OI) had the opposite trend. The entropy measurements were more regular in the RV than in the LV, thus supporting the spectral findings. We can conclude that basic stochastic processing techniques should be scrutinized with caution and from basic to elaborated techniques, but they can provide us with useful information on the biosignals from both ventricles during VF.
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Affiliation(s)
- Milton Fabricio Pérez-Gutiérrez
- Departamento de Eléctrica y Electrónica, Universidad de las Fuerzas Armadas ESPE, Av. General Rumiñahui s/n, Sangolquí 171-5-231B, Ecuador;
| | - Juan José Sánchez-Muñoz
- Arrhythmia Unit and Electrophysiology, Department of Cardiology, Virgen de la Arrixaca University Hospital, Instituto Murciano de Investigación Biosanitaria, 30120 Murcia, Spain; (J.J.S.-M.); (A.G.-A.)
| | - Mayra Erazo-Rodas
- Departamento de Eléctrica y Electrónica, Universidad de las Fuerzas Armadas ESPE, Av. General Rumiñahui s/n, Sangolquí 171-5-231B, Ecuador;
| | - Alicia Guerrero-Curieses
- Departamento de Teoría de la Señal y Comunicaciones, Sistemas Telemáticos y Computación, Universidad Rey Juan Carlos, 28943 Fuenlabrada, Spain; (A.G.-C.); (E.E.); (J.L.R.-Á.)
| | - Estrella Everss
- Departamento de Teoría de la Señal y Comunicaciones, Sistemas Telemáticos y Computación, Universidad Rey Juan Carlos, 28943 Fuenlabrada, Spain; (A.G.-C.); (E.E.); (J.L.R.-Á.)
| | - Aurelio Quesada-Dorador
- Arrhythmia Unit, Department of Cardiology, Hospital General de Valencia, 46014 Valencia, Spain;
| | - Ricardo Ruiz-Granell
- Arrhythmia Unit, Department of Cardiology, Hospital Clínico Universitario, Av. Blasco Ibañez, 17, 46010 Valencia, Spain;
| | - Alicia Ibáñez-Criado
- Arrhythmia Unit, Department of Cardiology, Hospital Clínico de Alicante, 03010 Alicante, Spain;
| | | | - José Luis Rojo-Álvarez
- Departamento de Teoría de la Señal y Comunicaciones, Sistemas Telemáticos y Computación, Universidad Rey Juan Carlos, 28943 Fuenlabrada, Spain; (A.G.-C.); (E.E.); (J.L.R.-Á.)
| | - Arcadi García-Alberola
- Arrhythmia Unit and Electrophysiology, Department of Cardiology, Virgen de la Arrixaca University Hospital, Instituto Murciano de Investigación Biosanitaria, 30120 Murcia, Spain; (J.J.S.-M.); (A.G.-A.)
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7
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Albatat M, Bergsland J, Arevalo H, Odland HH, Wall S, Sundnes J, Balasingham I. Multisite pacing and myocardial scars: a computational study. Comput Methods Biomech Biomed Engin 2020; 23:248-260. [PMID: 31958019 DOI: 10.1080/10255842.2020.1711885] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Cardiac resynchronization therapy (CRT) is a frequently effective treatment modality for dyssynchronous heart failure, however, 30% of patients do not respond, usually due to suboptimal activation of the left ventricle (LV). Multisite pacing (MSP) may increase the response rate, but its effect in the presence of myocardial scars is not fully understood. We use a computational model to study the outcome of MSP in an LV with scars in two different locations and of two different sizes. The LV was stimulated from anterior, posterior and lateral locations individually and in pairs, while a septal stimulation site represented right ventricular (RV) pacing. Intraventricular pressures were measured, and outcomes evaluated in terms of maximum LV pressure gradient (dP/dtmax)- change compared to isolated RV pacing. The best result obtained using various LV pacing locations included a combination of sites remote from scars and the septum. The highest dP/dtmax increase was achieved, regardless of scar size, using MSP with one pacing site located on the LV free wall opposite to the scar and one site opposite to the septum. These in silico modelling results suggest that making placement of pacing electrodes dependent on location of scarring, may alter acute haemodynamics and that such modelling may contribute to future CRT optimization.
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Affiliation(s)
| | | | - Hermenegild Arevalo
- Department of Computational Physiology, Simula Research Laboratory, Fornebu, Norway
| | | | - Samuel Wall
- Department of Computational Physiology, Simula Research Laboratory, Fornebu, Norway
| | - Joakim Sundnes
- Department of Computational Physiology, Simula Research Laboratory, Fornebu, Norway
| | - Ilangko Balasingham
- Intervention Centre, Oslo University Hospital, Oslo, Norway.,Department of Electronic Systems, Norwegian University of Science and Technology, Trondheim, Norway
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8
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Noheria A, Sodhi S, Orme GJ. The Evolving Role of Electrocardiography in Cardiac Resynchronization Therapy. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:91. [DOI: 10.1007/s11936-019-0784-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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9
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Technological and Clinical Challenges in Lead Placement for Cardiac Rhythm Management Devices. Ann Biomed Eng 2019; 48:26-46. [DOI: 10.1007/s10439-019-02376-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 09/25/2019] [Indexed: 01/29/2023]
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10
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He L, Wang T, Chen BW, Lu FM, Xu J. Puerarin inhibits apoptosis and inflammation in myocardial cells via PPARα expression in rats with chronic heart failure. Exp Ther Med 2019; 18:3347-3356. [PMID: 31602208 PMCID: PMC6777288 DOI: 10.3892/etm.2019.7984] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 07/12/2019] [Indexed: 12/15/2022] Open
Abstract
Chronic heart failure affects myocardial energy metabolism and cardiac function. Puerarin has been reported to improve cardiac function through regulation of energy metabolism in mice with myocardial infarction. The aim of the current study was to determine whether puerarin can improve body weight and reduce inflammation and apoptosis in rats with chronic heart failure. Rats were divided into three groups: Puerarin, PBS and sham group. Transverse aortic constriction was performed to induce chronic heart failure in the puerarin an PBS groups. Cardiac function, apoptosis and inflammation were evaluated following a 4-week treatment in rats with chronic heart failure. The results demonstrated that puerarin significantly increased the survival rate of rats and improved cardiac function compared with the PBS group. In addition, puerarin decreased lactate dehydrogenase and succinate dehydrogenase activity compared with the PBS group. Puerarin treatment increased the expression levels of glucose transporter type 4 and decreased the expression levels of CD36. Additionally, puerarin decreased the levels inflammatory factors, including tumor necrosis factor α, interleukin (IL)-1β and IL-6 in serum and myocardial tissue compared with the PBS group. Puerarin upregulated peroxisome proliferator-activated receptor α (PPARα) and its downstream target genes nuclear respiratory factor 1, FOS proto-oncogene, YY1 transcription factor, acetyl-coenzyme A carboxylase a, Fas cell surface death receptor, L-type pyruvate kinase and acetyl-coenzyme A dehydrogenase medium chain in myocardial cells from rats with chronic heart failure. These results demonstrated that puerarin inhibited apoptosis and inflammation in myocardial cells via the PPARα pathway. In conclusion, the present study indicated that puerarin may exhibit antiapoptotic and anti-inflammatory activity through the PPARα pathway in rats with chronic heart failure.
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Affiliation(s)
- Le He
- Department of Cardiology, Tianjin Chest Hospital, Tianjin 300222, P.R. China
| | - Tong Wang
- Department of Endocrinology, Tianjin Yellow River Hospital, Tianjin 300110, P.R. China
| | - Bing-Wei Chen
- Department of Cardiology, Tianjin Chest Hospital, Tianjin 300222, P.R. China
| | - Feng-Min Lu
- Department of Cardiology, Tianjin Chest Hospital, Tianjin 300222, P.R. China
| | - Jing Xu
- Department of Cardiology, Tianjin Chest Hospital, Tianjin 300222, P.R. China
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11
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Katbeh A, Van Camp G, Barbato E, Galderisi M, Trimarco B, Bartunek J, Vanderheyden M, Penicka M. Cardiac Resynchronization Therapy Optimization: A Comprehensive Approach. Cardiology 2019; 142:116-128. [PMID: 31117077 DOI: 10.1159/000499192] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 02/26/2019] [Indexed: 11/19/2022]
Abstract
Since the first report on biventricular pacing in 1994, cardiac resynchronization therapy (CRT) has become standard for patients with advanced heart failure (HF) and ventricular conduction delay. CRT improves myocardial function by resynchronizing myocardial contraction, which results in reverse left ventricular remodeling and improves symptoms and clinical outcomes. Despite the accelerated development of CRT device technology and its increased application in treating HF patients, almost one-third of these patients do not respond to the therapy or gain any clinical benefit from device implantation. Over the last decade, multiple cardiac imaging modalities have provided a deeper understanding of myocardial pathophysiology, thereby improving HF treatment management. However, the optimal strategy for improving the CRT response remains debatable. This article provides an updated overview of the electropathophysiology of myocardial dysfunction in ventricular conduction delay and the diagnostic approaches involving the use of multiple modalities.
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Affiliation(s)
- Asim Katbeh
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Guy Van Camp
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | | | - Martin Penicka
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium,
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12
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Hill AC, Silka MJ, Bar-Cohen Y. Cardiac Resynchronization Therapy in Pediatrics. J Innov Card Rhythm Manag 2018; 9:3256-3264. [PMID: 32477817 PMCID: PMC7252792 DOI: 10.19102/icrm.2018.090804] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 12/27/2017] [Indexed: 12/24/2022] Open
Abstract
Cardiac resynchronization therapy (CRT) has proven to be a powerful and effective tool in the treatment of adults with severe dilated or ischemic cardiomyopathy. A substantial portion of the adult heart failure population has severely depressed systolic function, heart failure symptoms, QRS prolongation, and left bundle branch block. Indications for CRT in adults are commonly focused on these characteristics. However, pediatric patients represent a heterogeneous group with many etiologies of heart failure and anatomic variants, with most of them not fitting the typical adult CRT criteria. The heterogeneity of the pediatric population has hindered the identification of ideal candidates for CRT, but initial experience with CRT in various groups of pediatric patients has been encouraging. This article reviews indications for and outcomes of CRT in pediatric and congenital heart disease patients.
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Affiliation(s)
- Allison C Hill
- Division of Cardiology, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michael J Silka
- Division of Cardiology, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Yaniv Bar-Cohen
- Division of Cardiology, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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