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Abrignani MG, Lucà F, Abrignani V, Pelaggi G, Aiello A, Colivicchi F, Fattirolli F, Gulizia MM, Nardi F, Pino PG, Parrini I, Rao CM. A Look at Primary and Secondary Prevention in the Elderly: The Two Sides of the Same Coin. J Clin Med 2024; 13:4350. [PMID: 39124617 DOI: 10.3390/jcm13154350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 07/16/2024] [Accepted: 07/18/2024] [Indexed: 08/12/2024] Open
Abstract
The global population is experiencing an aging trend; however, this increased longevity is not necessarily accompanied by improved health in older age. A significant consequence of this demographic shift is the rising prevalence of multiple chronic illnesses, posing challenges to healthcare systems worldwide. Aging is a major risk factor for multimorbidity, which marks a progressive decline in resilience and a dysregulation of multisystem homeostasis. Cardiovascular risk factors, along with aging and comorbidities, play a critical role in the development of heart disease. Among comorbidities, age itself stands out as one of the most significant risk factors for cardiovascular disease, with its prevalence and incidence notably increasing in the elderly population. However, elderly individuals, especially those who are frail and have multiple comorbidities, are under-represented in primary and secondary prevention trials aimed at addressing traditional cardiovascular risk factors, such as hypercholesterolemia, diabetes mellitus, and hypertension. There are concerns regarding the optimal intensity of treatment, taking into account tolerability and the risk of drug interactions. Additionally, uncertainty persists regarding therapeutic targets across different age groups. This article provides an overview of the relationship between aging and cardiovascular disease, highlighting various cardiovascular prevention issues in the elderly population.
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Affiliation(s)
| | - Fabiana Lucà
- O.U. Interventional Cardiology, Bianchi Melacrino Morelli Hospital, 89124 Reggio Calabria, Italy
| | - Vincenzo Abrignani
- Internal Medicine and Stroke Care Ward, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90141 Palermo, Italy
| | - Giuseppe Pelaggi
- O.U. Interventional Cardiology, Bianchi Melacrino Morelli Hospital, 89124 Reggio Calabria, Italy
| | | | - Furio Colivicchi
- Cardiology Division, San Filippo Neri Hospital, 00135 Rome, Italy
| | - Francesco Fattirolli
- Department of Experimental and Clinical Medicine, Careggi University Hospital, University of Florence, 50121 Firenze, Italy
| | | | - Federico Nardi
- O.U. Cardiology, Santo Spirito Hospital, 15033 Casale Monferrato, Italy
| | | | - Iris Parrini
- Cardiology Department, Mauriziano Umberto I Hospital, 10128 Turin, Italy
| | - Carmelo Massimiliano Rao
- O.U. Interventional Cardiology, Bianchi Melacrino Morelli Hospital, 89124 Reggio Calabria, Italy
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Antoniou N, Kalaitzoglou M, Tsigkriki L, Baroutidou A, Tsaousidis A, Koulaouzidis G, Giannakoulas G, Charisopoulou D. Speckle Tracking Echocardiography in Patients with Non-Ischemic Dilated Cardiomyopathy Who Undergo Cardiac Resynchronization Therapy: A Narrative Review. Diagnostics (Basel) 2024; 14:1178. [PMID: 38893704 PMCID: PMC11171556 DOI: 10.3390/diagnostics14111178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/20/2024] [Accepted: 05/30/2024] [Indexed: 06/21/2024] Open
Abstract
Non-ischemic dilated cardiomyopathy (DCM) represents a significant cause of heart failure, defined as the presence of left ventricular (LV) dilatation and systolic dysfunction unexplained solely by abnormal loading conditions or coronary artery disease. Cardiac resynchronization therapy (CRT) has emerged as a cornerstone in the management of heart failure, particularly in patients with DCM. However, identifying patients who will benefit the most from CRT remains challenging. Speckle tracking echocardiography (STE) has garnered attention as a non-invasive imaging modality that allows for the quantitative assessment of myocardial mechanics, offering insights into LV function beyond traditional echocardiographic parameters. This comprehensive review explores the role of STE in guiding patient selection and optimizing outcomes in CRT for DCM. By assessing parameters such as LV strain, strain rate, and dyssynchrony, STE enables a more precise evaluation of myocardial function and mechanical dyssynchrony, aiding in the identification of patients who are most likely to benefit from CRT. Furthermore, STE provides valuable prognostic information and facilitates post-CRT optimization by guiding lead placement and assessing response to therapy. Through an integration of STE with CRT, clinicians can enhance patient selection, improve procedural success rates, and ultimately, optimize clinical outcomes in patients with DCM. This review underscores the pivotal role of STE in advancing personalized management strategies for DCM patients undergoing CRT.
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Affiliation(s)
- Nikolaos Antoniou
- Cardiology Department, General Hospital G. Papanikolaou, 57010 Thessaloniki, Greece; (N.A.); (M.K.); (L.T.); (A.T.)
| | - Maria Kalaitzoglou
- Cardiology Department, General Hospital G. Papanikolaou, 57010 Thessaloniki, Greece; (N.A.); (M.K.); (L.T.); (A.T.)
| | - Lamprini Tsigkriki
- Cardiology Department, General Hospital G. Papanikolaou, 57010 Thessaloniki, Greece; (N.A.); (M.K.); (L.T.); (A.T.)
| | - Amalia Baroutidou
- Cardiology Department, AHEPA University General Hospital, 54636 Thessaloniki, Greece; (A.B.); (G.G.)
| | - Adam Tsaousidis
- Cardiology Department, General Hospital G. Papanikolaou, 57010 Thessaloniki, Greece; (N.A.); (M.K.); (L.T.); (A.T.)
| | - George Koulaouzidis
- Department of Biochemical Sciences, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - George Giannakoulas
- Cardiology Department, AHEPA University General Hospital, 54636 Thessaloniki, Greece; (A.B.); (G.G.)
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Al-Khatib SM. We have come a long way on the appropriateness of implantable cardioverter-defibrillator implantation: What have we learned from this journey? Heart Rhythm 2024; 21:408-409. [PMID: 38199319 DOI: 10.1016/j.hrthm.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 01/12/2024]
Affiliation(s)
- Sana M Al-Khatib
- Division of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
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Franczyk B, Rysz J, Olszewski R, Gluba-Sagr A. Do Implantable Cardioverter-Defibrillators Prevent Sudden Cardiac Death in End-Stage Renal Disease Patients on Dialysis? J Clin Med 2024; 13:1176. [PMID: 38398488 PMCID: PMC10889557 DOI: 10.3390/jcm13041176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/23/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
Chronic kidney disease patients appear to be predisposed to heart rhythm disorders, including atrial fibrillation/atrial flutter, ventricular arrhythmias, and supraventricular tachycardias, which increase the risk of sudden cardiac death. The pathophysiological factors underlying arrhythmia and sudden cardiac death in patients with end-stage renal disease are unique and include timing and frequency of dialysis and dialysate composition, vulnerable myocardium, and acute proarrhythmic factors triggering asystole. The high incidence of sudden cardiac deaths suggests that this population could benefit from implantable cardioverter-defibrillator therapy. The introduction of implantable cardioverter-defibrillators significantly decreased the rate of all-cause mortality; however, the benefits of this therapy among patients with chronic kidney disease remain controversial since the studies provide conflicting results. Electrolyte imbalances in haemodialysis patients may result in ineffective shock therapy or the appearance of non-shockable underlying arrhythmic sudden cardiac death. Moreover, the implantation of such devices is associated with a risk of infections and central venous stenosis. Therefore, in the population of patients with heart failure and severe renal impairment, periprocedural risk and life expectancy must be considered when deciding on potential device implantation. Harmonised management of rhythm disorders and renal disease can potentially minimise risks and improve patients' outcomes and prognosis.
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Affiliation(s)
- Beata Franczyk
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, 90-419 Lodz, Poland; (B.F.); (J.R.)
| | - Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, 90-419 Lodz, Poland; (B.F.); (J.R.)
| | - Robert Olszewski
- Department of Gerontology, Public Health and Didactics, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland;
| | - Anna Gluba-Sagr
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, 90-419 Lodz, Poland; (B.F.); (J.R.)
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Gómez-Mesa JE, Márquez-Murillo M, Figueiredo M, Berni A, Jerez AM, Núñez-Ayala E, Pow-Chon F, Sáenz-Morales LC, Pava-Molano LF, Montes MC, Garillo R, Galindo-Coral S, Reyes-Caorsi W, Speranza M, Romero A. Inter-American Society of Cardiology (CIFACAH-ELECTROSIAC) and Latin-American Heart Rhythm Society (LAHRS): multidisciplinary review on the appropriate use of implantable cardiodefibrillator in heart failure with reduced ejection fraction. J Interv Card Electrophysiol 2023; 66:1211-1229. [PMID: 36469237 PMCID: PMC10333140 DOI: 10.1007/s10840-022-01425-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 11/10/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND Our main objective was to present a multidisciplinary review on the epidemiology of sudden cardiac death (SCD) and the tools that could be used to identify malignant ventricular arrhythmias (VAs) and to perform risk stratification. In addition, indications and contraindications for the use of implantable cardioverter defibrillator (ICD) in general and in special populations including the elderly and patients with chronic kidney disease (CKD) are also given. METHODS An expert group from the Inter American Society of Cardiology (IASC), through their HF Council (CIFACAH) and Electrocardiology Council (ElectroSIAC), together with the Latin American Heart Rhythm Society (LAHRS), reviewed and discussed the literature regarding the appropriate use of an ICD in people with heart failure (HF) with reduced ejection fraction (HFpEF). Indications and contraindications for the use of ICD are presented in this multidisciplinary review. RESULTS Numerous clinical studies have demonstrated the usefulness of ICD in both primary and secondary prevention of SCD in HFpEF. There are currently precise indications and contraindications for the use of these devices. CONCLUSIONS In some Latin American countries, a low rate of implantation is correlated with low incomes, but this is not the case for all Latin America. Determinants of the low rates of ICD implantation in many Latin American countries are still a matter of research. VA remains one of the most common causes of cardiovascular death associated with HFrEF and different tools are available for stratifying the risk of SCD in this population.
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Affiliation(s)
- Juan Esteban Gómez-Mesa
- Cardiology Department, Fundación Valle del Lili, Cali, Colombia.
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia.
- Inter-American Council of Heart Failure and Pulmonary Hypertension/CIFACAH, Mexico City, Mexico.
- Inter-American Society of Cardiology/IASC, Mexico City, Mexico.
| | - Manlio Márquez-Murillo
- Inter-American Society of Cardiology/IASC, Mexico City, Mexico
- Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
- Inter-American Council of Electrocardiography and Arrhythmias/ELECTROSIAC, Mexico City, Mexico
| | - Marcio Figueiredo
- University of Campinas (UNICAMP) Hospital, Campinas, Brazil
- Latin American Heart Rhythm Society/LAHRS, Montevideo, Uruguay
| | - Ana Berni
- Inter-American Society of Cardiology/IASC, Mexico City, Mexico
- Inter-American Council of Electrocardiography and Arrhythmias/ELECTROSIAC, Mexico City, Mexico
- Hospital Angeles Pedregal, Mexico City, Mexico
| | - Ana Margarita Jerez
- Inter-American Council of Heart Failure and Pulmonary Hypertension/CIFACAH, Mexico City, Mexico
- Inter-American Society of Cardiology/IASC, Mexico City, Mexico
- Instituto de Cardiología Y Cirugía Cardiovascular, La Habana, Cuba
| | - Elaine Núñez-Ayala
- Inter-American Council of Heart Failure and Pulmonary Hypertension/CIFACAH, Mexico City, Mexico
- Inter-American Society of Cardiology/IASC, Mexico City, Mexico
- Electrophysiology, Arrhythmias and Pacemaker Unit, CEDIMAT, Centro Cardiovascular, Santo Domingo, Dominican Republic
| | - Freddy Pow-Chon
- Inter-American Council of Heart Failure and Pulmonary Hypertension/CIFACAH, Mexico City, Mexico
- Inter-American Society of Cardiology/IASC, Mexico City, Mexico
- Hospital Luis Vernaza, Guayaquil, Ecuador
| | - Luis Carlos Sáenz-Morales
- Latin American Heart Rhythm Society/LAHRS, Montevideo, Uruguay
- Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
| | - Luis Fernando Pava-Molano
- Cardiology Department, Fundación Valle del Lili, Cali, Colombia
- Latin American Heart Rhythm Society/LAHRS, Montevideo, Uruguay
| | - María Claudia Montes
- Cardiology Department, Fundación Valle del Lili, Cali, Colombia
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
| | - Raúl Garillo
- Inter-American Society of Cardiology/IASC, Mexico City, Mexico
- Inter-American Council of Electrocardiography and Arrhythmias/ELECTROSIAC, Mexico City, Mexico
- Facultad de Ciencias Médicas, Pontificia Universidad Católica Argentina, Buenos Aires, Argentina
| | - Stephania Galindo-Coral
- Cardiology Department, Fundación Valle del Lili, Cali, Colombia
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
| | - Walter Reyes-Caorsi
- Inter-American Council of Electrocardiography and Arrhythmias/ELECTROSIAC, Mexico City, Mexico
- Latin American Heart Rhythm Society/LAHRS, Montevideo, Uruguay
- Comisión Honoraria Para La Salud Cardiovascular, Montevideo, Uruguay
| | - Mario Speranza
- Inter-American Council of Heart Failure and Pulmonary Hypertension/CIFACAH, Mexico City, Mexico
- Inter-American Society of Cardiology/IASC, Mexico City, Mexico
- Hospital Clínica Bíblica, Ciudad de Costa Rica, Costa Rica
| | - Alexander Romero
- Inter-American Council of Heart Failure and Pulmonary Hypertension/CIFACAH, Mexico City, Mexico
- Inter-American Society of Cardiology/IASC, Mexico City, Mexico
- Hospital Santo Tomas, Ciudad de Panama, Panama
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Andresen H, Pagonas N, Eisert M, Patschan D, Nordbeck P, Buschmann I, Sasko B, Ritter O. Defibrillator exchange in the elderly. Heart Rhythm O2 2023; 4:382-390. [PMID: 37361620 PMCID: PMC10288028 DOI: 10.1016/j.hroo.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
Background Implantable cardioverter-defibrillator (ICD) therapy in elderly patients is controversial because survival benefits might be attenuated by nonarrhythmic causes of death. Objective The purpose of this study was to investigate the outcome of septuagenarians and octogenarians after ICD generator exchange (GE). Methods A total of 506 patients undergoing elective GE were analyzed to determine the incidence of ICD shocks and/or survival after GE. Patients were divided into a septuagenarian group (age 70-79 years) and an octogenarian group (age ≥80 years). The primary endpoint was death from any cause. Secondary endpoints were survival after appropriate ICD shock and death without experiencing ICD shocks after GE ("prior death"). Results The association of the ICD with all-cause mortality and arrhythmic death was determined for septuagenarians and octogenarians. Comparing both groups, similar left ventricular ejection fraction (35.6% ± 11.2% vs 32.4% ± 8.9%) and baseline prevalence of New York Heart Association functional class III or IV heart failure (17.1% vs 14.7%) were found. During the entire follow-up period of the study, 42.5% of patients in the septuagenarian group died compared to 79% in the octogenarian group (P <.01). Prior death was significantly more frequent in both age groups than were appropriate ICD shocks. Predictors of mortality were common in both groups and included advanced heart failure, peripheral arterial disease, and renal failure. Conclusion In clinical practice, decision-making for ICD GE among the elderly should be considered carefully for individual patients.
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Affiliation(s)
- Henrike Andresen
- Department of Internal Medicine I, Klinikum Brandenburg, Brandenburg/Havel, Germany
| | - Nikolaos Pagonas
- Department of Internal Medicine I, Klinikum Brandenburg, Brandenburg/Havel, Germany
- Brandenburg Medical School Theodor Fontane, Brandenburg/Havel, Germany
| | - Marius Eisert
- Brandenburg Medical School Theodor Fontane, Brandenburg/Havel, Germany
| | - Daniel Patschan
- Department of Internal Medicine I, Klinikum Brandenburg, Brandenburg/Havel, Germany
- Brandenburg Medical School Theodor Fontane, Brandenburg/Havel, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg/Havel, Germany
| | - Peter Nordbeck
- Department of Internal Medicine I, University Hospital of Würzburg, Würzburg, Germany
| | - Ivo Buschmann
- Department of Internal Medicine I, Klinikum Brandenburg, Brandenburg/Havel, Germany
- Brandenburg Medical School Theodor Fontane, Brandenburg/Havel, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg/Havel, Germany
| | - Benjamin Sasko
- Department of Internal Medicine I, Klinikum Brandenburg, Brandenburg/Havel, Germany
- Brandenburg Medical School Theodor Fontane, Brandenburg/Havel, Germany
- Department of Internal Medicine IV–Cardiology, Knappschaftskrankenhaus Bottrop, Bottrop, Germany
| | - Oliver Ritter
- Department of Internal Medicine I, Klinikum Brandenburg, Brandenburg/Havel, Germany
- Brandenburg Medical School Theodor Fontane, Brandenburg/Havel, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg/Havel, Germany
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Kawahara Y, Kanazawa H, Takashio S, Tsuruta Y, Sumi H, Kiyama T, Kaneko S, Ito M, Hoshiyama T, Hirakawa K, Ishii M, Tabata N, Yamanaga K, Fujisue K, Hanatani S, Sueta D, Arima Y, Araki S, Usuku H, Nakamura T, Yamamoto E, Soejima H, Matsushita K, Kawano H, Tsujita K. Clinical, electrocardiographic, and echocardiographic parameters associated with the development of pacing and implantable cardioverter-defibrillator indication in patients with transthyretin amyloid cardiomyopathy. Europace 2023; 25:euad105. [PMID: 37099643 PMCID: PMC10228612 DOI: 10.1093/europace/euad105] [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: 08/19/2022] [Accepted: 03/30/2023] [Indexed: 04/28/2023] Open
Abstract
AIMS This study aimed to identify factors for attention leading to future pacing device implantation (PDI) and reveal the necessity of prophylactic PDI or implantable cardioverter-defibrillator (ICD) implantation in transthyretin amyloid cardiomyopathy (ATTR-CM) patients. METHODS AND RESULTS This retrospective single-center observational study included consecutive 114 wild-type ATTR-CM (ATTRwt-CM) and 50 hereditary ATTR-CM (ATTRv-CM) patients, neither implanted with a pacing device nor fulfilling indications for PDI at diagnosis. As a study outcome, patient backgrounds were compared with and without future PDI, and the incidence of PDI in each conduction disturbance was examined. Furthermore, appropriate ICD therapies were investigated in all 19 patients with ICD implantation. PR-interval ≥220 msec, interventricular septum (IVS) thickness ≥16.9 mm, and bifascicular block were significantly associated with future PDI in ATTRwt-CM patients, and brain natriuretic peptide ≥35.7 pg/mL, IVS thickness ≥11.3 mm, and bifascicular block in ATTRv-CM patients. The incidence of subsequent PDI in patients with bifascicular block at diagnosis was significantly higher than that of normal atrioventricular (AV) conduction in both ATTRwt-CM [hazard ratio (HR): 13.70, P = 0.019] and ATTRv-CM (HR: 12.94, P = 0.002), whereas that of patients with first-degree AV block was neither (ATTRwt-CM: HR: 2.14, P = 0.511, ATTRv-CM: HR: 1.57, P = 0.701). Regarding ICD, only 2 of 16 ATTRwt-CM and 1 of 3 ATTRv-CM patients received appropriate anti-tachycardia pacing or shock therapy, under the number of intervals to detect for ventricular tachycardia of 16-32. CONCLUSIONS According to our retrospective single-center observational study, prophylactic PDI did not require first-degree AV block in both ATTRwt-CM and ATTRv-CM patients, and prophylactic ICD implantation was also controversial in both ATTR-CM. Larger prospective, multi-center studies are necessary to confirm these results.
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Affiliation(s)
- Yusei Kawahara
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Hisanori Kanazawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
- Department of Cardiac Arrhythmias, Kumamoto University, Kumamoto, Japan, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Seiji Takashio
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Yuichiro Tsuruta
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Hitoshi Sumi
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Takuya Kiyama
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Shozo Kaneko
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
- Department of Cardiac Arrhythmias, Kumamoto University, Kumamoto, Japan, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Miwa Ito
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Tadashi Hoshiyama
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Kyoko Hirakawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Masanobu Ishii
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Noriaki Tabata
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Kenshi Yamanaga
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Koichiro Fujisue
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Shinsuke Hanatani
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Daisuke Sueta
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Yuichiro Arima
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Satoshi Araki
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Hiroki Usuku
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Taishi Nakamura
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Eiichiro Yamamoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Hirofumi Soejima
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Kenichi Matsushita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Hiroaki Kawano
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
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Brazile TL, Saul M, Nouraie SM, Gibson K. Characteristics and survival of patients diagnosed with cardiac sarcoidosis: A case series. Front Med (Lausanne) 2022; 9:1051412. [PMID: 36582282 PMCID: PMC9792839 DOI: 10.3389/fmed.2022.1051412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/22/2022] [Indexed: 12/15/2022] Open
Abstract
Background Sarcoidosis is a multiorgan system granulomatous disease of unknown etiology. It is hypothesized that a combination of environmental, occupational, and/or infectious factors provoke an immunological response in genetically susceptible individuals, resulting in a diversity of manifestations throughout the body. In the United States, cardiac sarcoidosis (CS) is diagnosed in 5% of patients with systemic sarcoidosis, however, autopsy results suggest that cardiac involvement may be present in > 50% of patients. CS is debilitating and significantly decreases quality of life and survival. Currently, there are no gold-standard clinical diagnostic or monitoring criteria for CS. Methods We identified patients with a diagnosis of sarcoidosis who were seen at the Simmons Center from 2007 to 2020 who had a positive finding of CS documented with cardiovascular magnetic resonance (CMR) and/or endomyocardial biopsy as found in the electronic health record. Medical records were independently reviewed for interpretation and diagnostic features of CS including late gadolinium enhancement (LGE) patterns, increased signal on T2-weighted imaging, and non-caseating granulomas, respectively. Extracardiac organ involvement, cardiac manifestations, comorbid conditions, treatment history, and vital status were also abstracted. Results We identified 44 unique patients with evidence of CS out of 246 CMR reports and 9 endomyocardial biopsy pathology reports. The first eligible case was diagnosed in 2007. The majority of patients (73%) had pulmonary manifestations, followed by hepatic manifestations (23%), cutaneous involvement (23%), and urolithiasis (20%). Heart failure was the most common cardiac manifestation affecting 59% of patients. Of these, 39% had a documented left ventricular ejection fraction of < 50% on CMR. Fifty eight percent of patients had a conduction disease and 44% of patients had documented ventricular arrhythmias. Pharmacotherapy was usually initiated for extracardiac manifestations and 93% of patients had been prescribed prednisone. ICD implantation occurred in 43% of patients. Patients were followed up for a median of 5.4 (IQR: 2.4-8.5) years. The 10-year survival was 70%. In addition to age, cutaneous involvement was associated with an increased risk of death (age-adjusted OR 8.47, 95% CI = 1.11-64.73). Conclusion CMR is an important tool in the non-invasive diagnosis of CS. The presence of LGE on CMR in a pattern consistent with CS has been shown to be a predictor of mortality and likely contributed to a high proportion of patients undergoing ICD implantation to decrease risk of sudden cardiac death. Clinical implications Additional studies are necessary to develop robust criteria for the diagnosis of CS with CMR, assess the benefit of serial imaging for disease monitoring, and evaluate the effect of immunosuppression on disease progression.
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Affiliation(s)
- Tiffany L. Brazile
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States,University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Melissa Saul
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Seyed Mehdi Nouraie
- University of Pittsburgh and The Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease, Pittsburgh, PA, United States
| | - Kevin Gibson
- University of Pittsburgh and The Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease, Pittsburgh, PA, United States,*Correspondence: Kevin Gibson,
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9
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Wang S, Lyu Y, Cheng S, Zhang Y, Gu X, Gong M, Liu J. Smaller left ventricular end-systolic diameter and lower ejection fraction at baseline associated with greater ejection fraction improvement after revascularization among patients with left ventricular dysfunction. Front Cardiovasc Med 2022; 9:967039. [PMID: 36247459 PMCID: PMC9559822 DOI: 10.3389/fcvm.2022.967039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 09/13/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives To investigate the predictive roles of pre-operative left ventricular (LV) size and ejection fraction (EF) in EF improvement and outcome following revascularization in patients with coronary artery disease (CAD) and LV dysfunction. Background Revascularization may improve EF and long-term outcomes of patients with LV dysfunction. However, the determinants of EF improvement have not yet been investigated comprehensively. Materials and methods Patients with EF measurements before and 3 months after revascularization were enrolled in a cohort study (No. ChiCTR2100044378). All patients had baseline EF ≤ 40%. EF improvement was defined as absolute increase in EF > 5%. According to LV end-systolic diameter (LVESD) (severely enlarged or not) and EF (≤35% or of 36–40%) at baseline, patients were categorized into four groups. Results A total of 939 patients were identified. A total of 549 (58.5%) had EF improved. Both LVESD [odds ratio (OR) per 1 mm decrease, 1.05; 95% CI, 1.04–1.07; P < 0.001] and EF (OR per 1% decrease, 1.06; 95% CI, 1.03–1.10; P < 0.001) at baseline were predictive of EF improvement after revascularization. Patients with LVESD not severely enlarged and EF ≤ 35% had higher odds of being in the EF improved group in comparison with other three groups both in unadjusted and adjusted analysis (all P < 0.001). The median follow-up time was 3.5 years. Patients with LVESD not severely enlarged and EF ≤ 35% had significantly lower risk of all-cause death in comparison with patients with LVESD severely enlarged and EF ≤ 35% [hazard ratio (HR), 2.73; 95% CI, 1.28–5.82; P = 0.009], and tended to have lower risk in comparison with patients with LVESD severely enlarged and EF of 36–40% (HR, 2.00; 95% CI, 0.93–4.27; P = 0.074). Conclusion Among CAD patients with reduced EF (≤ 40%) who underwent revascularization, smaller pre-operative LVESD and lower EF had greatest potential to have EF improvement and better outcome. Our findings imply the indication for revascularization in patients with LV dysfunction who presented with lower EF but smaller LV size.
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Affiliation(s)
- Shaoping Wang
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China
| | - Yi Lyu
- Department of Anesthesiology, Minhang Hospital, Fudan University, Shanghai, China
| | - Shujuan Cheng
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China
| | - Yuchao Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China
| | - Xiaoyan Gu
- Department of Echocardiography, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China
| | - Ming Gong
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China
| | - Jinghua Liu
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China
- *Correspondence: Jinghua Liu,
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10
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Wang S, Cheng S, Zhang Y, Lyu Y, Liu J. Extent of Ejection Fraction Improvement After Revascularization Associated with Outcomes Among Patients with Ischemic Left Ventricular Dysfunction. Int J Gen Med 2022; 15:7219-7228. [PMID: 36124105 PMCID: PMC9482409 DOI: 10.2147/ijgm.s380276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/29/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Ejection fraction (EF) has been reported to be a major predictor of improved survival in patients with heart failure. However, it is largely unknown whether the extent of improvement in EF affects the subsequent risk of mortality. This study sought to investigate change in EF after revascularization and the implication of these changes on clinical outcomes among patients with ischemic left ventricular dysfunction. Patients and Methods We conducted a cohort study (No. ChiCTR2100044378) of patients with reduced EF (≤40%) who received revascularization and had EF reassessment by echocardiography 3 months after revascularization. Patients were categorized according to the absolute change in EF: 1) EF worsened group (absolute decrease in EF >5%); 2) EF unchanged group (absolute change in EF −5% to 5%); 3) EF improved group (absolute increase in EF >5%). Results Of 974 patients, 84 (8.6%) had EF worsened, 317 (32.5%) had EF unchanged and 573 (58.8%) had EF improved. The median follow-up time was 3.5 years, during which 143 patients died. For each 5-unit increments in EF, the risk of death decreased by 20% (hazard ratio, HR, per 5% increases, 0.80; 95% CI, 0.73–0.86; P<0.001). Compared with EF improvement group, patients with EF worsened (HR, 3.35; 95% CI, 2.07–5.42; P<0.001) and patients with EF unchanged (HR, 2.05; 95% CI, 1.40–3.01; P<0.001) had significantly higher risk of all-cause death. Conclusion Changes in EF were inversely associated with the risk of mortality. The extent of EF improvement after revascularization might be a potential factor which defines clinical outcomes.
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Affiliation(s)
- Shaoping Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, People’s Republic of China
| | - Shujuan Cheng
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, People’s Republic of China
| | - Yuchao Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, People’s Republic of China
| | - Yi Lyu
- Department of Anesthesiology, Minhang Hospital, Fudan University, Shanghai, People’s Republic of China
- Yi Lyu, Department of Anesthesiology, Minhang Hospital, Fudan University, No. 180 Xinsong Road, Minhang District, Shanghai, 201199, People’s Republic of China, Email
| | - Jinghua Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, People’s Republic of China
- Correspondence: Jinghua Liu, Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, People’s Republic of China, Tel +86 10 64456998, Fax +86 1064456998, Email
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11
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Barmore W, Patel H, Voong C, Tarallo C, Calkins Jr JB. Effects of medically generated electromagnetic interference from medical devices on cardiac implantable electronic devices: A review. World J Cardiol 2022; 14:446-453. [PMID: 36160813 PMCID: PMC9453256 DOI: 10.4330/wjc.v14.i8.446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 06/15/2022] [Accepted: 08/16/2022] [Indexed: 02/05/2023] Open
Abstract
As cardiac implantable electronic devices (CIED) become more prevalent, it is important to acknowledge potential electromagnetic interference (EMI) from other sources, such as internal and external electronic devices and procedures and its effect on these devices. EMI from other sources can potentially inhibit pacing and trigger shocks in permanent pacemakers (PPM) and implantable cardioverter defibrillators (ICD), respectively. This review analyzes potential EMI amongst CIED and left ventricular assist device, deep brain stimulators, spinal cord stimulators, transcutaneous electrical nerve stimulators, and throughout an array of procedures, such as endoscopy, bronchoscopy, and procedures involving electrocautery. Although there is evidence to support EMI from internal and external devices and during procedures, there is a lack of large multicenter studies, and, as a result, current management guidelines are based primarily on expert opinion and anecdotal experience. We aim to provide a general overview of PPM/ICD function, review documented EMI effect on these devices, and acknowledge current management of CIED interference.
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Affiliation(s)
- Walker Barmore
- Department of Cardiology, Augusta University Medical Center, Augusta, GA 30912, United States
| | - Himax Patel
- Department of Internal Medicine, Augusta University Medical Center, Augusta, GA 30912, United States
| | - Cassandra Voong
- Department of Internal Medicine, Augusta University Medical Center, Augusta, GA 30912, United States
| | - Caroline Tarallo
- Medical College of Georgia, Medical College of Georgia, Augusta, GA 30912, United States
| | - Joe B Calkins Jr
- Department of Cardiology, Augusta University Medical Center, Augusta, GA 30912, United States
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12
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Popescu DM, Shade JK, Lai C, Aronis KN, Ouyang D, Moorthy MV, Cook NR, Lee DC, Kadish A, Albert CM, Wu KC, Maggioni M, Trayanova NA. Arrhythmic sudden death survival prediction using deep learning analysis of scarring in the heart. NATURE CARDIOVASCULAR RESEARCH 2022; 1:334-343. [PMID: 35464150 DOI: 10.1038/s44161-022-00041-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Sudden cardiac death from arrhythmia is a major cause of mortality worldwide. Here, we develop a novel deep learning (DL) approach that blends neural networks and survival analysis to predict patient-specific survival curves from contrast-enhanced cardiac magnetic resonance images and clinical covariates for patients with ischemic heart disease. The DL-predicted survival curves offer accurate predictions at times up to 10 years and allow for estimation of uncertainty in predictions. The performance of this learning architecture was evaluated on multi-center internal validation data and tested on an independent test set, achieving concordance index of 0.83 and 0.74, and 10-year integrated Brier score of 0.12 and 0.14. We demonstrate that our DL approach with only raw cardiac images as input outperforms standard survival models constructed using clinical covariates. This technology has the potential to transform clinical decision-making by offering accurate and generalizable predictions of patient-specific survival probabilities of arrhythmic death over time.
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Affiliation(s)
- Dan M Popescu
- Alliance for Cardiovascular Diagnostic and Treatment Innovation (ADVANCE), Johns Hopkins University, Baltimore, 21224, USA
| | - Julie K Shade
- Alliance for Cardiovascular Diagnostic and Treatment Innovation (ADVANCE), Johns Hopkins University, Baltimore, 21224, USA
| | - Changxin Lai
- Johns Hopkins University School of Medicine, Department of Biomedical Engineering, Baltimore, 21224, USA
| | - Konstantinos N Aronis
- University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, 15237, USA
| | - David Ouyang
- Cedar-Sinai Medical Center, Department of Cardiology, Los Angeles, 90048, USA
| | - M Vinayaga Moorthy
- Brigham and Women's Hospital, Harvard Medical School, Boston, 02115, USA
| | - Nancy R Cook
- Brigham and Women's Hospital, Harvard Medical School, Boston, 02115, USA
| | - Daniel C Lee
- Northwestern University, Feinberg School of Medicine, Chicago, 60611, USA
| | - Alan Kadish
- Touro College and University System, Valhalla, 10595, USA
| | - Christine M Albert
- Cedar-Sinai Medical Center, Department of Cardiology, Los Angeles, 90048, USA
| | - Katherine C Wu
- Alliance for Cardiovascular Diagnostic and Treatment Innovation (ADVANCE), Johns Hopkins University, Baltimore, 21224, USA.,Johns Hopkins University School of Medicine, Department of Medicine, Division of Cardiology, Baltimore, 21224, USA
| | - Mauro Maggioni
- Alliance for Cardiovascular Diagnostic and Treatment Innovation (ADVANCE), Johns Hopkins University, Baltimore, 21224, USA.,Johns Hopkins University, Department of Applied Mathematics and Statistics, Baltimore, 21224, USA
| | - Natalia A Trayanova
- Alliance for Cardiovascular Diagnostic and Treatment Innovation (ADVANCE), Johns Hopkins University, Baltimore, 21224, USA.,Johns Hopkins University School of Medicine, Department of Biomedical Engineering, Baltimore, 21224, USA
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13
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Borne RT, Varosy P, Lan Z, Masoudi FA, Curtis JP, Matlock DD, Peterson PN. Trends in Use of Single- vs Dual-Chamber Implantable Cardioverter-Defibrillators Among Patients Without a Pacing Indication, 2010-2018. JAMA Netw Open 2022; 5:e223429. [PMID: 35315917 PMCID: PMC8941353 DOI: 10.1001/jamanetworkopen.2022.3429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Use of dual-chamber implantable cardioverter-defibrillator (ICD) systems among patients without a pacing indication is an example of low-value care given higher procedural risks, higher costs, and little evidence for benefit from an atrial lead. However, variation in the use of dual-chamber systems was present among patients without a pacing indication. OBJECTIVE To examine the temporal trends and hospital variation in use of single- and dual-chamber ICD implantation among patients without a pacing indication undergoing first-time ICD implantation. DESIGN, SETTING, AND PARTICIPANTS A multicenter cross-sectional study was conducted using the US National Cardiovascular Data Registry ICD Registry. A total of 266 182 patients undergoing initial implantation of a single- or dual-chamber transvenous ICD without a bradycardia pacing indication, class I or II cardiac resynchronization therapy indication, or history of atrial fibrillation or atrial flutter were included. The study was conducted from April 1, 2010, to December 31, 2018; data analysis was performed from October 19, 2020, to January 5, 2022. EXPOSURES Implantation of a single- or dual-chamber ICD. MAIN OUTCOMES AND MEASURES Temporal trends among patients undergoing single- vs dual-chamber ICDs were determined using the Cochran-Armitage trend test, and hospital-level variation using adjusted hospital median odds ratios was examined. RESULTS A total of 266 182 patients (single-chamber ICD, 134 925; dual-chamber ICD, 131 257) were included in this analysis; mean (SD) age was 58.0 (14.0) years and 91 990 patients (68.2%) were men. The use of dual-chamber ICDs decreased from 64.7% (n = 15 694) in 2010 to 42.2% (n = 9762) in 2018 (P < .001). Adjusted for patient characteristics, the median hospital-level proportion of single-chamber ICDs increased from 42.9% (95% CI, 42.6%-45.0%) in 2010 to 50.0% (95% CI, 47.8%-51.0%) in 2018. The median odds ratio for the use of dual-chamber ICDs, adjusted for patient characteristics, was 1.6 (95% CI, 1.6-1.8) in 2010 and 1.5 (95% CI, 1.5-1.8) in 2018, indicating decreasing but persistent variation in use. CONCLUSIONS AND RELEVANCE In this national study of US patients undergoing first-time ICD implantation without a clinical indication for an atrial lead, the use of dual-chamber devices decreased. However, institutional variability in the use of atrial leads persists, suggesting differences in individual or institutional cultures of real-world practice and opportunity to reduce this low-value practice.
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Affiliation(s)
- Ryan T. Borne
- Division of Cardiology, University of Colorado Health, Colorado Springs
| | - Paul Varosy
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora
- Cardiology Section, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado
| | - Zhou Lan
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, Connecticut
| | - Frederick A. Masoudi
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora
- Research and Analytics, Ascension Health, St Louis, Missouri
| | - Jeptha P. Curtis
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, Connecticut
- Division of Cardiology, Yale University School of Medicine, New Haven, Connecticut
| | - Daniel D. Matlock
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora
- Veterans Affairs Eastern Colorado Geriatric Research Education and Clinical Center, Denver
| | - Pamela N. Peterson
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora
- Division of Cardiology, Denver Health Hospital, Denver, Colorado
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14
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Bolt L, Wertli MM, Haynes AG, Rodondi N, Chiolero A, Panczak R, Aujesky D. Variation in regional implantation patterns of cardiac implantable electronic device in Switzerland. PLoS One 2022; 17:e0262959. [PMID: 35171922 PMCID: PMC8849475 DOI: 10.1371/journal.pone.0262959] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 01/04/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction There is a substantial geographical variation in the rates of pacemaker (PM), implantable cardioverter defibrillator (ICD), and cardiac resynchronization therapy (CRT) device implantation across European countries. We assessed the extent of regional variation and potential determinants of such variation. Methods We conducted a population-based analysis using discharge data for PM/ICD/CRT implantations from all Swiss acute care hospitals during 2013–2016. We derived hospital service areas (HSA) by analyzing patient flows. We calculated age- and sex-standardized rates and quantified variation using the extremal quotient (EQ) and the systemic component of variation (SCV). We estimated the reduction in variance of crude implantation rates across HSAs using multilevel regression models, with incremental adjustment for age and sex, language, socioeconomic factors, population health, diabetes mellitus, and the density of cardiologists on the HSA level. Results We analyzed implantations of 8129 PM, 1461 ICD, and 1411 CRT from 25 Swiss HSAs. The mean age- and sex-standardized implantation rate was 29 (range 8–57) per 100,000 persons for PM, 5 (1–9) for ICD, and 5 (2–8) for CRT. There was a very high variation in PM (EQ 7.0; SCV 12.6) and ICD (EQ 7.2; SCV 11.3) and a high variation in CRT implantation rates (EQ 3.9; SCV 7.1) across HSAs. Adjustments for age and sex, language, socioeconomic factors, population health, diabetes mellitus, and density of cardiologists explained 94% of the variance in ICD and 87.5% of the variance in CRT implantation rates, but only 36.3% of the variance in PM implantation rates. Women had substantially lower PM/ICD/CRT implantation rates than men. Conclusion Switzerland has a very high regional variation in PM/ICD implantation and a high variation in CRT implantation rates. Women had substantially lower implantation rates than men. A large share of the variation in PM procedure rates remained unexplained which might reflect variations in physicians’ preferences and practices.
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Affiliation(s)
- Lucy Bolt
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Maria M. Wertli
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- * E-mail:
| | | | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Arnaud Chiolero
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
- School of Population and Global Health, McGill University, Montreal, Canada
| | - Radoslaw Panczak
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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15
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Electrocardiographic markers of cardiac resynchronization therapy response: delayed time to intrinsicoid deflection onset in lateral leads. J Geriatr Cardiol 2022; 19:21-30. [PMID: 35233220 PMCID: PMC8832045 DOI: 10.11909/j.issn.1671-5411.2022.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Cardiac resynchronization therapy (CRT) has emerged as an important intervention for patients with heart failure (HF) with reduced ejection fraction and delayed ventricular activation. In these patients, CRT has demonstrated to improve quality of life, promote reverse left ventricular (LV) remodeling, reduce HF hospitalizations, and extend survival. However, despite advancements in our understanding of CRT, a significant number of patients do not respond to this therapy. Several invasive and non-invasive parameters have been assessed to predict response to CRT, but the electrocardiogram (ECG) has remained as the prevailing screening method albeit with limitations. Ideally, an accurate, simple, and reproducible ECG marker or set of markers would dramatically overcome the current limitations. We describe the clinical utility of an old ECG parameter that can estimate ventricular activation delay: the onset to intrinsicoid deflection (ID). Based on the concept of direct measurement of ventricular activation time (intrinsic deflection onset), time to ID onset measures on the surface ECG the time that the electrical activation time takes to reach the area subtended by the corresponding surface ECG lead. Based on this principle, the time to ID on the lateral leads can estimate the delay activation to the lateral LV wall and can be used as a predictor for CRT response, particularly in patients with non-specific intraventricular conduction delay or in patients with left bundle branch block and QRS < 150 ms. The aim of this review is to present the current evidence and potential use of this ECG parameter to estimate LV activation and predict CRT response.
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16
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Sandhu M, Abuzuaiter B, Dhand R, Rao S, Chaudhuri D. Displaced AICD Lead Presenting as Hiccups: A Rare Complication. J Investig Med High Impact Case Rep 2022; 10:23247096221103380. [PMID: 35699232 PMCID: PMC9201358 DOI: 10.1177/23247096221103380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Ventricular fibrillation can lead to sudden cardiac death. Automatic implantable
cardioverter defibrillator (AICD) devices have shown to be highly successful in the
termination of these arrhythmias and are a first-line modality of treatment for the
prevention of sudden cardiac death. We present the case of a 69-year-old female with a
history of paroxysmal atrial fibrillation on anticoagulation with apixaban and rate
controlled with metoprolol who presented from home with a chief complaint of hiccups. She
had a prior admission to the hospital after she was found to have monomorphic ventricular
tachycardia during a nuclear stress test. A cardiac work-up including cardiac
catheterization and cardiac magnetic resonance imaging did not show any evidence of
significant coronary artery disease or reversible cardiomyopathy. The patient underwent
successful placement of a single chamber ICD and was discharged home. Twelve weeks after
placement of the AICD, the patient was lifting furniture and experienced sudden onset of
hiccups. A chest X-ray showed displacement of the AICD lead from the right ventricular
apex to the superior vena cava. The patient underwent lead repositioning with complete
resolution of her hiccups. The etiology hiccups was suspected to be secondary to
irritation of the right phrenic nerve which travels along the anterolateral border of the
superior vena cava. We present the case of hiccups following ICD lead displacement. This
serves to highlight a rare complication of ICD displacement that healthcare providers
should consider when patients with recently placed ICD devices complain of hiccups.
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Affiliation(s)
- Michael Sandhu
- State University of New York Upstate Medical University, Syracuse, USA
| | - Basel Abuzuaiter
- State University of New York Upstate Medical University, Syracuse, USA
| | - Rajat Dhand
- State University of New York Upstate Medical University, Syracuse, USA
| | - Suman Rao
- State University of New York Upstate Medical University, Syracuse, USA
| | - Debanik Chaudhuri
- State University of New York Upstate Medical University, Syracuse, USA
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Zaffalon D, Pagura L, Cannatà A, Barbati G, Gregorio C, Finocchiaro G, Serdoz LV, Zecchin M, Fabris E, Merlo M, Sinagra G. Supraventricular Tachycardia Causing Left Ventricular Dysfunction. Am J Cardiol 2021; 159:72-78. [PMID: 34656315 DOI: 10.1016/j.amjcard.2021.08.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 07/27/2021] [Accepted: 08/03/2021] [Indexed: 11/27/2022]
Abstract
There is limited evidence on characterization and natural history of supraventricular tachycardia (SVT)-induced left ventricular (LV) dysfunction. The aim of this work was to characterize clinical features and long-term evolution of SVT-induced LV dysfunction. Patients consecutively admitted with sustained SVT and heart rate >100 bpm as the only known cause of a new onset LV systolic dysfunction (i.e., LV ejection fraction [EF] <50%) were analyzed. Patients were then revaluated periodically. Recovered LVEF (i.e., ≥50%) and a composite of death, heart transplant or first episode of major ventricular arrhythmias were evaluated as study end-points. We enrolled 83 patients. After SVT therapy, 56 (67%) showed a recovered LVEF at the last follow-up of median 54 (interquartile range 36 to 87) months. Seventeen (30%) of those patients had a temporary new drop in LVEF during follow-up associated to high-rate SVT relapse. At presentation, patients with recovered LVEF were younger (52 vs 67 years respectively, p <0.001) and had higher LVEF (34% vs 27% respectively, p = 0.005) compared to non-recovered LVEF patients. Finally, 4% of recovered LVEF patients vs 26% of nonrecovered LVEF patients experienced death/heart transplant/major ventricular arrhythmias during follow-up (p = 0.004). In conclusion, after almost 5 years of follow-up, two-thirds of patients with high-rate SVT causing a newly diagnosed LV systolic dysfunction recovered and maintained normal LV function after SVT control, with a subsequent benign outcome. Long term individual surveillance is required in those patients, as arrhythmic recurrences and new drops in LVEF are common in the long term.
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Ibrahim SH, Bilchick KC, Miller MS, Blazek OJ, Strickling JE, Elumogo C, Wharton RC, Patel P, Ondigi O, Brady WJ, Kwon Y, Mazimba S. Increased left and right atrial volume indices are associated with decreased survival times post-cardiac arrest. Resuscitation 2021; 170:306-313. [PMID: 34695443 DOI: 10.1016/j.resuscitation.2021.10.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/14/2021] [Accepted: 10/13/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Left and right atrial volume indices (LAVI and RAVI) are markers of cardiac remodeling. LAVI and RAVI are associated with worse outcomes in other cardiac conditions. This study aimed to determine the associations of these atrial volume indices with survival time post-cardiac arrest. METHODS This was a single center, retrospective study of patients with a sudden cardiac arrest event during index hospitalization from 2014-2018 based on pre-arrest parameters. The analysis was stratified based on whether a pulseless ventricular tachycardia/ventricular fibrillation (pVT/VF) event or a pulseless electrical activity (PEA)/asystole event occurred. Cox proportional hazards regression and model selection with best subsets approach evaluated the association of atrial volume parameters with survival times in the context of other covariates. RESULTS Of 305 patients studied (64 ± 14 years, 37% female), the mean LAVI was 34.0 ± 15.8 mL/m2 (based on 162 reliable measurements), and mean RAVI was 25.0 ± 15.6 mL/m2 (based on 163 measurements). Increased atrial volume indices were most strongly associated with survival in patients who had sustained pVT/VF (LAVI HR 0.47, 95% CI 0.25-0.90, p = 0.020; RAVI HR 0.57, 95% CI 0.30-1.05, p = 0.074). In multivariable best subsets Cox regression with LAVI, RAVI, and 13 other scaled covariates, LAVI < 34 ml/m2 was by far the best single predictor of survival (p < 0.0001), and the next best predictor was the absence of pulmonary hypertension. CONCLUSION Among patients with cardiac arrest from ventricular arrhythmias, those with no more than mild left atrial enlargement pre-arrest by LAVI measurement had the best prognosis. Additional studies are indicated to validate the importance of this finding for clinical management decisions. CONDENSED ABSTRACT In patients with sudden cardiac arrest associated with ventricular arrhythmias, a left atrial volume index (LAVI) < 34 mL/m2 prior to the arrest had the strongest association with survival among fifteen candidate predictors. Pulmonary hypertension was more common in patients with an elevated right atrial volume index (RAVI), and the absence of pulmonary hypertension was the next best pre-arrest parameter predictive of survival. Larger studies are indicated to validate the use of LAVI for clinical management decisions in this condition.
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Affiliation(s)
- Sami H Ibrahim
- Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, United States.
| | - Kenneth C Bilchick
- Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, United States.
| | - Matthew S Miller
- Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, United States.
| | - Olivia J Blazek
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States.
| | - Jarred E Strickling
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States.
| | - Comfort Elumogo
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States.
| | - Robert C Wharton
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States.
| | - Paras Patel
- Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, United States.
| | - Olivia Ondigi
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States.
| | - William J Brady
- Department of Emergency Medicine, University of Virginia Health System, Charlottesville, VA, United States.
| | - Younghoon Kwon
- Division of Cardiovascular Medicine, University of Washington, Seattle, WA, United States.
| | - Sula Mazimba
- Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, United States.
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19
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Wang S, Borah BJ, Cheng S, Li S, Zheng Z, Gu X, Gong M, Lyu Y, Liu J. Diabetes Associated With Greater Ejection Fraction Improvement After Revascularization in Patients With Reduced Ejection Fraction. Front Cardiovasc Med 2021; 8:751474. [PMID: 34646874 PMCID: PMC8502963 DOI: 10.3389/fcvm.2021.751474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 09/01/2021] [Indexed: 11/14/2022] Open
Abstract
Objectives: To investigate the association between diabetes mellitus (DM) and ejection fraction (EF) improvement following revascularization in patients with coronary artery disease (CAD) and left ventricular (LV) dysfunction. Background: Revascularization may improve outcomes of patients with LV dysfunction by improvement of EF. However, the determinants of EF improvement have not yet been investigated comprehensively. Method: A cohort study (No. ChiCTR2100044378) of patient with repeated EF measurements after revascularization was performed. All patients had baseline EF ≤40%. Patients who had EF reassessment 3 months after revascularization were enrolled. Patients were categorized into EF unimproved (absolute increase in EF ≤5%) and improved group (absolute increase in EF >5%). Results: A total of 974 patients were identified. 573 (58.8%) had EF improved. Patients with DM had greater odds of being in the improved group (odds ratio [OR], 1.42; 95% CI, 1.07–1.89; P = 0.014). 333 (34.2%) patients with DM had a greater extent of EF improvement after revascularization (10.5 ± 10.4 vs. 8.1 ± 11.2%; P = 0.002) compared with non-diabetic patients. The median follow-up time was 3.5 years. DM was associated with higher risk of overall mortality (hazard ratio [HR], 1.46; 95% CI, 1.02–2.08; P = 0.037). However, in EF improved group, the risk was similar between diabetic and non-diabetic patients (HR, 1.36; 95% CI, 0.80–2.32; P = 0.257). Conclusions: Among patients with reduced EF, DM was associated with greater EF improvement after revascularization. Revascularization in diabetic patients might partially attenuate the impact of DM on adverse outcomes. Our findings imply the indication for revascularization in patients with LV dysfunction who present with DM.
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Affiliation(s)
- Shaoping Wang
- Department of Cardiology, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - Bijan J Borah
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States.,Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
| | - Shujuan Cheng
- Department of Cardiology, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shiying Li
- Department of Cardiology, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ze Zheng
- Department of Cardiology, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaoyan Gu
- Department of Echocardiography, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ming Gong
- Department of Cardiovascular Surgery, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yi Lyu
- Department of Anesthesiology, Minhang Hospital, Fudan University, Shanghai, China
| | - Jinghua Liu
- Department of Cardiology, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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20
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Rabah H, Khalaf Z, Rabah A. Dopamine in Idiopathic Polymorphic Ventricular Tachycardia/Ventricular Fibrillation. J Innov Card Rhythm Manag 2021; 12:4699-4703. [PMID: 34595055 PMCID: PMC8476091 DOI: 10.19102/icrm.2021.120908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/12/2021] [Indexed: 11/13/2022] Open
Abstract
The role of medical therapy in the treatment of idiopathic polymorphic ventricular tachycardia (IPMVT) and idiopathic ventricular fibrillation (IVF) is not well established. Current medications in use include amiodarone, lidocaine, isoproterenol, verapamil, and quinidine. However, the use of dopamine for controlling such arrhythmias has never been described. We present an interesting case of IPMVT/IVF storm induced by short-coupled premature ventricular contractions. The arrhythmia was terminated acutely using dopamine infusion and was suppressed chronically using verapamil.
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Affiliation(s)
- Hussein Rabah
- Department of Internal Medicine, Staten Island University Hospital, New York, NY, USA
| | - Zaynab Khalaf
- Department of Internal Medicine, Faculty of Medical Sciences, Lebanese University, Al Hadath, Lebanon
| | - Ali Rabah
- Division of Electrophysiology, Beirut Cardiac Institute (BCI), Beirut, Lebanon
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21
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Schuger CD, Ando K, Cantillon DJ, Lambiase PD, Mont L, Joung BY, Peress D, Yong P, Wold N, Daubert JP. Assessment of primary prevention patients receiving an ICD - Systematic evaluation of ATP: APPRAISE ATP. Heart Rhythm O2 2021; 2:405-411. [PMID: 34430946 PMCID: PMC8369290 DOI: 10.1016/j.hroo.2021.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background The value of antitachycardia pacing (ATP) in the overall cohort of primary prevention patients who receive implantable cardioverter-defibrillators (ICDs) remains uncertain. ATP success reported in prior trials potentially included a large number of patients receiving unnecessary ATP for arrhythmias that may have self-terminated owing to the prematurity of the intervention. Although some patients derive benefit from initial ATP in terminating rapid ventricular arrhythmias and thereby preventing shocks, there are limited data allowing us to identify those patients a priori. Objective The purpose of APPRAISE ATP is to understand the role of ATP in primary prevention patients currently indicated for ICD therapy in a large prospective randomized controlled trial with modern programming parameters. Methods The study is a global, prospective, randomized, multicenter clinical trial conducted at up to 150 sites globally, enrolling approximately 2600 subjects The primary endpoint of the trial is time to first all-cause shock in a 2-arm study with an equivalent study design in which the incidence of all-cause shocks will be compared between primary prevention subjects programmed with shocks only vs subjects programmed to standard therapy (ATP and shock). Results An Electrogram and Device Interrogation Core Laboratory will review interrogation data to determine primary endpoints that occur in APPRAISE ATP. Their decisions are based on independent physician review of the data from device interrogation. Conclusion The ultimate purpose of the study is to aid clinicians in the selection of ICD technologies based on hard endpoint evidence across the spectrum of indications for primary prevention implantation.
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Affiliation(s)
| | - Kenji Ando
- Kokura Memorial Hospital, Kitakyushu, Japan
| | - Daniel J Cantillon
- Cleveland Clinic, Heart and Vascular Institute, Cardiac Electrophysiology and Pacing, Cleveland, Ohio
| | | | - Lluis Mont
- Department of Cardiology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | | | - Patrick Yong
- Boston Scientific Corporation, St. Paul, Minnesota
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22
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Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto S, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 guideline on non-pharmacotherapy of cardiac arrhythmias. J Arrhythm 2021; 37:709-870. [PMID: 34386109 PMCID: PMC8339126 DOI: 10.1002/joa3.12491] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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23
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Adam RD, Coriu D, Jercan A, Bădeliţă S, Popescu BA, Damy T, Jurcuţ R. Progress and challenges in the treatment of cardiac amyloidosis: a review of the literature. ESC Heart Fail 2021; 8:2380-2396. [PMID: 34089308 PMCID: PMC8318516 DOI: 10.1002/ehf2.13443] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/04/2021] [Accepted: 05/12/2021] [Indexed: 12/19/2022] Open
Abstract
Cardiac amyloidosis is a restrictive cardiomyopathy determined by the accumulation of amyloid, which is represented by misfolded protein fragments in the cardiac extracellular space. The main classification of systemic amyloidosis is determined by the amyloid precursor proteins causing a very heterogeneous disease spectrum, but the main types of amyloidosis involving the heart are light chain (AL) and transthyretin amyloidosis (ATTR). AL, in which the amyloid precursor is represented by misfolded immunoglobulin light chains, can involve almost any system carrying the worst prognosis among amyloidosis patients. This has however dramatically improved in the last few years with the increased usage of the novel therapies such as proteasome inhibitors and haematopoietic cell transplantation, in the case of timely diagnosis and initiation of treatment. The treatment for AL is directed by the haematologist working closely with the cardiologist when there is a significant cardiac involvement. Transthyretin (TTR) is a protein that is produced by the liver and is involved in the transportation of thyroid hormones, especially thyroxine and retinol binding protein. ATTR results from the accumulation of transthyretin amyloid in the extracellular space of different organs and systems, especially the heart and the nervous system. Specific therapies for ATTR act at various levels of TTR, from synthesis to deposition: TTR tetramer stabilization, oligomer aggregation inhibition, genetic therapy, amyloid fibre degradation, antiserum amyloid P antibodies, and antiserum TTR antibodies. Treatment of systemic amyloidosis has dramatically evolved over the last few years in both AL and ATTR, improving disease prognosis. Moreover, recent studies revealed that timely treatment can lead to an improvement in clinical status and in a regression of amyloid myocardial infiltration showed by imaging, especially by cardiac magnetic resonance, in both AL and ATTR. However, treating cardiac amyloidosis is a complex task due to the frequent association between systemic congestion and low blood pressure, thrombo-embolic and haemorrhagic risk balance, patient frailty, and generally poor prognosis. The aim of this review is to describe the current state of knowledge regarding cardiac amyloidosis therapy in this constantly evolving field, classified as treatment of the cardiac complications of amyloidosis (heart failure, rhythm and conduction disturbances, and thrombo-embolic risk) and the disease-modifying therapy.
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Affiliation(s)
- Robert Daniel Adam
- Department of CardiologyEmergency Institute for Cardiovascular Diseases ‘Prof. Dr. C. C. Iliescu’3rd Cardiology Department, 258 Fundeni StreetBucharest022328Romania
- University of Medicine and Pharmacy ‘Carol Davila’BucharestRomania
| | - Daniel Coriu
- University of Medicine and Pharmacy ‘Carol Davila’BucharestRomania
- Department of HematologyFundeni Clinical InstituteBucharestRomania
| | - Andreea Jercan
- University of Medicine and Pharmacy ‘Carol Davila’BucharestRomania
| | - Sorina Bădeliţă
- Department of HematologyFundeni Clinical InstituteBucharestRomania
| | - Bogdan A. Popescu
- Department of CardiologyEmergency Institute for Cardiovascular Diseases ‘Prof. Dr. C. C. Iliescu’3rd Cardiology Department, 258 Fundeni StreetBucharest022328Romania
- University of Medicine and Pharmacy ‘Carol Davila’BucharestRomania
| | - Thibaud Damy
- French Referral Center for Cardiac AmyloidosisAmyloidosis Mondor NetworkCréteilFrance
- Department of CardiologyHenri Mondor Hospital/AP‐HPCréteilFrance
| | - Ruxandra Jurcuţ
- Department of CardiologyEmergency Institute for Cardiovascular Diseases ‘Prof. Dr. C. C. Iliescu’3rd Cardiology Department, 258 Fundeni StreetBucharest022328Romania
- University of Medicine and Pharmacy ‘Carol Davila’BucharestRomania
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24
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Marini M, Martin M, Strazzanti M, Quintarelli S, Guarracini F, Coser A, Valsecchi S, Bonmassari R. Implantable cardioverter-defibrillators in elderly patients: outcome and predictors of mortality. J Interv Card Electrophysiol 2021; 64:573-580. [PMID: 34212276 DOI: 10.1007/s10840-021-01017-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/30/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE The implantable cardioverter-defibrillator (ICD) is the therapy of choice for the prevention of sudden cardiac death. The number of elderly patients receiving ICDs is increasing. This study aimed to assess the outcome of patients according to their age at the time of implantation, and to identify variables potentially associated with patient survival. METHODS Between June 2009 and December 2019, we retrospectively enrolled all consecutive patients in whom ICD implantation had been performed for primary or secondary prevention at our center. RESULTS During the study period, 670 patients underwent ICD implantation. We stratified the population into four age-classes: Class 1 (23%) (pts aged less than 60 years), Class 2 (28%) (pts aged between 60 and 70 years), Class 3 (39%) (pts aged between 70 and 80 years) and Class 4 (9%) (pts aged 80 years or older). Over a median follow-up of 42 months, the rate of deaths in Class 4 was higher than in Classes 1 and 2 (log-rank test, P < 0.01), but was comparable to that in Class 3 (P = 0.407). With increasing age, we observed more complications at the time of implantation and during follow-up. On multivariate analysis, higher NYHA class, creatinine level and CHA2DS2-VASc score were identified as independent predictors of death, while age was not associated with worse prognosis. Higher body mass index, higher NYHA class and CHA2DS2-VASc score were also confirmed as independent predictors of hospitalizations or death due to any cause. CONCLUSION This study showed good survival in ICD patients in all age-groups, including those aged ≥80 years. The CHA2DS2-VASc score seems to be a stronger predictor of death than age.
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Affiliation(s)
| | - Marta Martin
- Department of Cardiology, S. Chiara Hospital, Trento, Italy
| | | | | | | | - Alessio Coser
- Department of Cardiology, S. Chiara Hospital, Trento, Italy
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25
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Sawano M, Kohsaka S, Ishii H, Numasawa Y, Yamaji K, Inohara T, Amano T, Ikari Y, Nakamura M. One-Year Outcome After Percutaneous Coronary Intervention for Acute Coronary Syndrome - An Analysis of 20,042 Patients From a Japanese Nationwide Registry. Circ J 2021; 85:1756-1767. [PMID: 34162778 DOI: 10.1253/circj.cj-21-0098] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Acute coronary syndrome (ACS) hospital survivors experience a wide array of late adverse cardiac events, despite considerable advances in the quality of care. We investigated 30-day and 1-year outcomes of ACS hospital survivors using a Japanese nationwide cohort.Methods and Results:We studied 20,042 ACS patients who underwent percutaneous coronary intervention (PCI) in 2017: 10,242 (51%) with ST-elevation myocardial infarction (STEMI), 3,027 (15%) with non-ST-elevation myocardial infarction (NSTEMI), and 6,773 (34%) with unstable angina (UA). The mean (±SD) age was 69.6±12.4 years, 77% of the patients were men, and 20% had a previous history of PCI. The overall 30-day all-cause, cardiac, and non-cardiac mortality rates were 3.0%, 2.4%, and 0.6%, respectively. The overall 1-year incidence of all-cause, cardiac, and non-cardiac death was 7.1%, 4.2%, and 2.8%, respectively. Compared with UA patients, STEMI patients had a higher risk of all fatal events, non-fatal ischemic stroke, and acute heart failure, and NSTEMI patients had a higher risk of heart failure. CONCLUSIONS The results from our ACS hospital survivor PCI database suggest the need to improve care for the acute myocardial infarction population to lessen the burden of 30-day mortality due to ACS, heart failure, and sudden cardiac death, as well as 1-year ischemic stroke and heart failure events.
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Affiliation(s)
- Mitsuaki Sawano
- Department of Cardiology, Keio University School of Medicine
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Hideki Ishii
- Department of Cardiology, Fujita Health University Bantane Hospital
| | - Yohei Numasawa
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital
| | | | - Taku Inohara
- Department of Cardiology, Keio University School of Medicine
| | | | - Yuji Ikari
- Department of Cardiovascular Medicine, Tokai University
| | - Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
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26
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Laczay B, Patel D, Grimm R, Xu B. State-of-the-art narrative review: multimodality imaging in electrophysiology and cardiac device therapies. Cardiovasc Diagn Ther 2021; 11:881-895. [PMID: 34295711 DOI: 10.21037/cdt-20-724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/30/2020] [Indexed: 12/07/2022]
Abstract
Cardiac electrophysiology procedures have evolved to provide improvement in morbidity and mortality for many patients. Cardiac resynchronization therapy (CRT), implantable cardioverter/defibrillator (ICD) placement and lead extraction procedures are proven procedures, associated with significant reductions in patient morbidity and mortality as well as improved quality of life. The applications and optimization of these therapies are an evolving field. The optimal use and outcomes of cardiac electrophysiology procedures require a multidisciplinary approach to patient selection, device selection, and procedural planning. Cardiac imaging using echocardiography plays a key role in selection of patients for CRT therapy, for guidance of left ventricular (LV) lead placement, and for optimization of atrioventricular pacing delays in patients with CRT. Cardiac computed tomography (CT) is an important tool in assessment of lead perforation, as well as assessing risk of lead extraction and procedural planning. Cardiac magnetic resonance imaging (MRI) is an important adjunct to transthoracic echocardiography for patient selection and risk stratification for defibrillator therapy for multiple disease states including ischemic cardiomyopathy, hypertrophic cardiomyopathy, cardiac sarcoidosis, and arrhythmogenic right ventricular cardiomyopathy (ARVC). Cardiac positron emission tomography (PET) is a useful adjunct to the diagnosis of device infections as well as inflammatory conditions including cardiac sarcoidosis. Our review attempts to summarize the contemporary roles of multimodality imaging in CRT therapy, ICD therapy and lead extraction therapy.
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Affiliation(s)
- Balint Laczay
- Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Divyang Patel
- Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Richard Grimm
- Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Bo Xu
- Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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27
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Kewcharoen J, Kanitsoraphan C, Thangjui S, Leesutipornchai T, Saowapa S, Pokawattana A, Navaravong L. Postimplantation pocket hematoma increases risk of cardiac implantable electronic device infection: A meta-analysis. J Arrhythm 2021; 37:635-644. [PMID: 34141016 PMCID: PMC8207394 DOI: 10.1002/joa3.12516] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/31/2020] [Accepted: 01/21/2021] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Several studies have shown an inconsistent relationship between postimplantation pocket hematoma and cardiac implantable electronic device (CIED) infection. In this study, we performed a systematic review and meta-analysis to explore the effect of postimplantation hematoma and the risk of CIED infection. METHODS We searched the databases of MEDLINE and EMBASE from inception to March 2020. Included studies were cohort studies, case-control studies, cross-sectional studies, and randomized controlled trials that reported incidence of postimplantation pocket hematoma and CIED infection during the follow-up period. CIED infection was defined as either a device-related local or systemic infection. Data from each study were combined using the random effects, generic inverse variance method of Der Simonian and Laird to calculate odds ratios (OR) and 95% confidence intervals (CI). RESULTS Fourteen studies were included in final analysis, involving a total of 28 319 participants. In random-effect model, we found that postimplantation pocket hematoma significantly increases the risk of overall CIED infection (OR = 6.30, 95% CI: 3.87-10.24, I 2 = 49.3%). There was no publication bias observed in the funnel plot as well as no small-study effect observed in Egger's test. CONCLUSIONS Our meta-analysis demonstrated that postimplantation pocket hematoma significantly increases the risk of CIED infection. Precaution should be taken during device implantation to reduce postimplantation hematoma and subsequent CIED infection.
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Affiliation(s)
- Jakrin Kewcharoen
- University of Hawaii Internal Medicine Residency ProgramHonoluluHIUSA
| | | | | | | | - Sakditad Saowapa
- Faculty of MedicineRamathibodi HospitalMahidol UniversityBangkokThailand
| | | | - Leenhapong Navaravong
- Division of Cardiovascular MedicineUniversity of Utah School of MedicineSalt Lake CityUTUSA
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28
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Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto SI, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 Guideline on Non-Pharmacotherapy of Cardiac Arrhythmias. Circ J 2021; 85:1104-1244. [PMID: 34078838 DOI: 10.1253/circj.cj-20-0637] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Haruhiko Abe
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital
| | - Toshiyuki Ishikawa
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University
| | - Katsuhiko Imai
- Department of Cardiovascular Surgery, Kure Medical Center and Chugoku Cancer Center
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kaoru Okishige
- Department of Cardiology, Yokohama City Minato Red Cross Hospital
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | | | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Morio Shoda
- Department of Cardiology, Tokyo Women's Medical University
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | - Yoshihiro Seo
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | | | - Yuji Nakazato
- Department of Cardiovascular Medicine, Juntendo University Urayasu Hospital
| | - Takashi Nishimura
- Department of Cardiac Surgery, Tokyo Metropolitan Geriatric Hospital
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | | | - Yuji Murakawa
- Fourth Department of Internal Medicine, Teikyo University Hospital Mizonokuchi
| | - Teiichi Yamane
- Department of Cardiology, Jikei University School of Medicine
| | - Takeshi Aiba
- Division of Arrhythmia, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Koichi Inoue
- Division of Arrhythmia, Cardiovascular Center, Sakurabashi Watanabe Hospital
| | - Yuki Iwasaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kikuya Uno
- Arrhythmia Center, Chiba Nishi General Hospital
| | - Michio Ogano
- Department of Cardiovascular Medicine, Shizuoka Medical Center
| | - Masaomi Kimura
- Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine
| | | | - Shingo Sasaki
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
| | | | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women's Medical University
| | - Tsugutoshi Suzuki
- Departments of Pediatric Electrophysiology, Osaka City General Hospital
| | - Yukio Sekiguchi
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Kyoko Soejima
- Arrhythmia Center, Second Department of Internal Medicine, Kyorin University Hospital
| | - Masahiko Takagi
- Division of Cardiac Arrhythmia, Department of Internal Medicine II, Kansai Medical University
| | - Masaomi Chinushi
- School of Health Sciences, Faculty of Medicine, Niigata University
| | - Nobuhiro Nishi
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hitoshi Hachiya
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | | | | | - Yasushi Miyauchi
- Department of Cardiovascular Medicine, Nippon Medical School Chiba-Hokusoh Hospital
| | - Aya Miyazaki
- Department of Pediatric Cardiology, Congenital Heart Disease Center, Tenri Hospital
| | - Tomoshige Morimoto
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Hiro Yamasaki
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | | | - Takeshi Kimura
- Department of Cardiology, Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
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Eboh O, Mao Y, Lee E, Okunrintemi V, Derbal O, Maxwell Hill S, Sears SF, Pursell I, Mounsey JP, Burch A. Out of Hospital Sudden Death in a Rural Population: Low Rates of ICD Underutilization Among Decedents. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:980-985. [PMID: 33913184 DOI: 10.1111/pace.14248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/11/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Implantable cardioverter defibrillators (ICDs) reduce mortality in patients at risk for life-threatening arrhythmias. Implantation of ICDs in rural or economically disadvantaged populations is suspected to be low. This study examined Out of Hospital Premature Natural Death (OHPND) and electronic medical record (EMR) data to identify rates of non-implantation of ICDs among decedents in eastern North Carolina. METHODS OHPND cases in 2016 were identified using mortality data and matched with EMRs. Those meeting criteria for ICD implantation based on chart review were adjudicated by two electrophysiologists to determine whether they qualified for implantation. Comorbidity burden was established using Charlson's Comorbidity Index (CCI). RESULTS Out of 1316 OHPND cases, 967 (73.4%) had EMR records. Chart review identified 70 (7.2%) potential ICD candidates with a LVEF ≤35 of which 5 (7.1%) did not meet criteria because LVEF subsequently improved. Of the remaining 65 patients, 32 (49.2%) already received an ICD, and 33 patients (50.7%) met criteria but had not received one. Reasons for non-implantation included: limited life expectancy secondary to comorbidities, principally chronic kidney disease (CKD) (N = 11, 17%), physician non-adherence to guidelines (N = 9, 14%), loss to follow-up (N = 7, 11%), patient refusal (N = 5, 8%), and death before commencing medical therapy (N = 1, 2%). Among our cohort of 967 individuals who died unexpectedly, nine (0.9%) patients may have avoided death with an ICD. CONCLUSION This study using decedent data shows low rates of ICD-underutilization in a rural population and emphasizes the role of advanced comorbidities such as CKD in ICD-underutilization.
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Affiliation(s)
- Oghenesuvwe Eboh
- Department of Internal Medicine, Vidant Medical Center, East Carolina University, Greenville, North Carolina, USA
| | - Yuxuan Mao
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
| | - Elisabeth Lee
- Department of Internal Medicine, Vidant Medical Center, East Carolina University, Greenville, North Carolina, USA
| | - Victor Okunrintemi
- Department of Internal Medicine, Vidant Medical Center, East Carolina University, Greenville, North Carolina, USA
| | - Ouassim Derbal
- Department of Internal Medicine, Vidant Medical Center, East Carolina University, Greenville, North Carolina, USA
| | | | - Samuel F Sears
- Department of Psychology, Department of Cardiovascular Sciences, East Carolina University, Greenville, North Carolina, USA
| | - Irion Pursell
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - John P Mounsey
- Department of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Ashley Burch
- Department of Health Services and Information Management, East Carolina University, Greenville, North Carolina, USA
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Pannag J, Martin L, Yost J, McGillion M, Carroll SL. Testing a nurse-led, pre-implantation educational intervention for primary prevention implantable cardioverter-defibrillator candidates: a randomized feasibility trial. Eur J Cardiovasc Nurs 2021; 20:367-375. [PMID: 33620480 DOI: 10.1093/eurjcn/zvaa009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/18/2020] [Accepted: 10/02/2020] [Indexed: 11/14/2022]
Abstract
AIMS Implantable cardioverter-defibrillators (ICDs) deliver therapy for life-threatening arrhythmias. Evidence suggests that ICD candidates have misconceptions regarding ICD therapy and unmet information needs. We undertook a pilot feasibility trial comparing a nurse-led educational intervention plus standard care, vs. standard pre-ICD implantation care. Secondary aims included examination of anxiety, quality of life, and shock anxiety. METHODS AND RESULTS Implantable cardioverter-defibrillator candidates were consented and randomized to standard pre-ICD implantation care vs. standard care plus a nurse-led educational intervention. The primary feasibility outcomes included: recruitment rate, consent rate, randomization rate, proportion of participants able to complete all questionnaires, time to deliver intervention, and intervention topics completion. At baseline, demographic and Patient-Reported Outcomes Measurement Information System (PROMIS) anxiety scores were collected. Four weeks post-ICD implantation, participants completed the PROMIS, Florida Patient Acceptance Survey (FPAS), and Florida Shock Anxiety Scale (FSAS). Twenty patients consented (10 per group). Feasibility targets were achieved for all but two outcomes: consent rate was 87% vs. 95% target, and completion of data collection measures was 85% vs. 90% target. Consent rate was lower than expected as one patient declined, and two could not be approached. Completion rate was lower than expected as two patients were lost to follow-up, and one did not receive an ICD during the study period, leading to incomplete post-implantation survey collections. CONCLUSION The results demonstrate the feasibility of conducting a trial comparing a nurse-led pre-implantation educational intervention to standard care in an outpatient setting. Further study to evaluate the effectiveness of this intervention on patient-reported outcomes is warranted.
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Affiliation(s)
- Jasprit Pannag
- School of Nursing, McMaster University, 1280 Main Street West, HSC 2J17, Hamilton, ON L8S 4K1, Canada
| | - Lynn Martin
- School of Nursing, McMaster University, 1280 Main Street West, HSC 2J17, Hamilton, ON L8S 4K1, Canada
| | - Jennifer Yost
- M. Louise Fitzpatrick College of Nursing, Villanova University, Driscoll Hall #330, Villanova, PA 19096, USA
| | - Michael McGillion
- School of Nursing, McMaster University, 1280 Main Street West, HSC 2J17, Hamilton, ON L8S 4K1, Canada
| | - Sandra L Carroll
- School of Nursing, McMaster University, 1280 Main Street West, HSC 2J17, Hamilton, ON L8S 4K1, Canada
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Long-term prognostic value of myocardin expression levels in non-ischemic dilated cardiomyopathy. Heart Vessels 2021; 36:1841-1847. [PMID: 33983455 DOI: 10.1007/s00380-021-01869-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
The mortality of patients with non-ischemic dilated cardiomyopathy (NIDCM) remains substantial. We evaluated gene expression levels of myocardin, an early cardiac gene, in the peripheral blood cells of NIDCM patients as a prognostic biomarker in their long-term outcome and mortality from congestive HF (CHF). We retrospectively analyzed 101 consecutives optimally treated NIDCM patients of Cretan origin who were enrolled from the HF clinic of our hospital from November 2005 to December 2008. Our patient data were either taken from their medical files or recorded during visits to the HF unit or hospitalizations. Follow-up was carried out by telephone interview and by accessing information from general practitioners and cardiologists in private practice. The median follow-up period was 8 years (mean follow-up 7 ± 3.4 years). The overall mortality during follow-up was 61.4%, while mortality due to congestive heart failure (CHF) was 49.5%. Higher CHF and all-cause mortality were observed in patients with myocardin levels < 14.26 (p < 0.001 for both CHF and all-cause mortality). A multivariate Cox regression analysis showed that myocardin level of expression had independent significant prognostic value for the risk of death from CHF (HR 14.5, 95% confidence interval (CI) 5.3-39) in those patients. Peripheral blood cells gene expression of myocardin, an early myocardial marker, may serve as prognostic biomarkers of the long-term outcome of patients with NIDCM. Our findings open new prospects in the risk stratification of these patients.
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Shah NH, Ross SJ, Njapo SAN, Merritt J, Kolarich A, Kaufmann M, Miles WM, Winchester DE, Burkart TA, McKillop M. Better Than You Think—Appropriate Use of Implantable Cardioverter-Defibrillators at a Single Academic Center: A Retrospective Review. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2021. [DOI: 10.15212/cvia.2021.0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Implantable cardioverter-defibrillators (ICDs) can be life-saving devices, although they are expensive and may cause complications. In 2013, several professional societies published joint appropriate use criteria (AUC) assessing indications for ICD implantation. Data
evaluating the clinical application of AUC are limited. Previous registry-based studies estimated that 22.5% of primary prevention ICD implantations were “non-evidence-based” implantations. On the basis of AUC, we aimed to determine the prevalence of “rarely appropriate”
ICD implantation at our institution for comparison with previous estimates.Methods: We reviewed 286 patients who underwent ICD implantation between 2013 and 2016. Appropriateness of each ICD implantation was assessed by independent review and rated on the basis of AUC.Results:
Of 286 ICD implantations, two independent reviewers found that 89.5% and 89.2%, respectively, were appropriate, 5.6% and 7.3% may be appropriate, and 1.8% and 2.1% were rarely appropriate. No AUC indication was found for 3.5% and 3.4% of ICD implantations, respectively. Secondary prevention
ICD implantations were more likely rarely appropriate (2.6% vs. 1.2% and 3.6% vs. 1.1%) or unrated (6.0% vs. 1.2% and 2.7% vs. 0.6%). The reviewers found 3.5% and 3.4% of ICD implantations, respectively, were non-evidence-based implantations. The difference in rates between reviewers was not
statistically significant.Conclusion: Compared with prior reports, our prevalence of rarely appropriate ICD implantation was very low. The high appropriate use rate could be explained by the fact that AUC are based on current clinical practice. The AUC could benefit from additional
secondary prevention indications. Most importantly, clinical judgement and individualized care should determine which patients receive ICDs irrespective of guidelines or criteria.
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Affiliation(s)
- Nikhil H. Shah
- UF Division of Cardiovascular Medicine, 1600 SW Archer Rd, PO Box 100277, Gainesville, FL 32610, USA
| | - Steven J. Ross
- UF Division of Cardiovascular Medicine, 1600 SW Archer Rd, PO Box 100277, Gainesville, FL 32610, USA
| | - Steve A. Noutong Njapo
- UVA Division of Cardiovascular Medicine, PO Box 800158 1215 Lee St. Charlottesville, VA 22908-0158, USA
| | - Justin Merritt
- UF Division of Cardiovascular Medicine, 1600 SW Archer Rd, PO Box 100277, Gainesville, FL 32610, USA
| | - Andrew Kolarich
- The Johns Hopkins Hospital Department of Radiology, 601 N Caroline St, Baltimore, MD 21287, USA
| | - Michael Kaufmann
- The Heart Center, 930 Franklin Street SE, Huntsville, AL, 358015, USA
| | - William M. Miles
- UF Division of Cardiovascular Medicine, 1600 SW Archer Rd, PO Box 100277, Gainesville, FL 32610, USA
| | - David E. Winchester
- UF Division of Cardiovascular Medicine, 1600 SW Archer Rd, PO Box 100277, Gainesville, FL 32610, USA
| | - Thomas A. Burkart
- Intermountain Medical Center, 1380 E Medical Center Dr, Ste 1500, St. George, UT 847906, USA
| | - Matthew McKillop
- Carolina Cardiology Consultants, Prisma Health, 1005 Grove Road, Greenville, SC 29605, USA
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Elgara M, Khalil MO, Raza T. Hyperthyroidism precipitating cardiac arrest in a patient with Brugada pattern. BMJ Case Rep 2021; 14:14/4/e240038. [PMID: 33858885 PMCID: PMC8054039 DOI: 10.1136/bcr-2020-240038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
A 38-year-old man previously healthy suffered an out-of-hospital cardiac arrest; he was resuscitated successfully and admitted to the intensive care unit. His initial ECG suggested a Brugada pattern; other laboratory tests revealed low potassium level, low Thyroid Stimulating Hormone (TSH) and high FT4. He was started on carbimazole for hyperthyroidism, along with other supportive care. A comprehensive cardiac evaluation was done, including ajmaline and flecainide tests, results were inconclusive. An implantable cardioverter defibrillator device (ICD) was inserted to prevent such catastrophic events in the future. After discharge and on follow-up, our patient was doing well. His thyroid function test (TFT) was normal; moreover, a follow-up ICD interrogation did not record any arrhythmias. This case report highlighted asymptomatic hyperthyroidism as a precipitant for Brugada pattern resulting in sudden cardiac arrest.
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Affiliation(s)
- Mohamed Elgara
- Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - Tasleem Raza
- Critical care, Hamad Medical Corporation, Doha, Qatar
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Jing R, Sun XX, Hua W, Chen L, Yang SW, Hu YR, Zhang NX, Cai MS, Gu M, Niu HX, Zhang S. Global and regional cardiac dysfunction quantified by 18F-FDG PET scans can predict ventricular arrhythmia in patients with implantable cardioverter defibrillator. J Nucl Cardiol 2021; 28:464-477. [PMID: 33751472 DOI: 10.1007/s12350-020-02515-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 12/14/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND A low appropriate therapy rate indicates that a minority of patients will benefit from their implantable cardioverter defibrillator (ICD). Quantitative measurements from 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) may predict ventricular arrhythmia (VA) occurrence after ICD placement. METHODS We performed a prospective observational study and recruited patients who required ICD placement. Pre-procedure image scans were performed. Patients were followed up for VA occurrence. Associations between image results and VA were analyzed. RESULTS In 51 patients (33 males, 53.9 ± 17.2 years) analyzed, 17 (33.3%) developed VA. Compared with patients without VA, patients with VA had significantly larger values in scar area (17.7 ± 12.4% vs. 7.0 ± 7.9%), phase standard deviation (51.4° ± 14.0° vs. 34.0° ± 15.0°), bandwidth (172.9° ± 39.8° vs. 128.7° ± 49.9°), sum thickening score (STS, 29.5 ± 11.1 vs. 17.8 ± 13.2), and sum motion score (42.9 ± 11.5 vs. 33.0 ± 19.0). Cox regression analysis and receiver operating characteristic curve analysis showed that scar size, dyssynchrony, and STS were associated with VA occurrence (HR, 4.956, 95% CI 1.70-14.46). CONCLUSION Larger left ventricular scar burden, increased dyssynchrony, and higher STS quantified by 18F-FDG PET may indicate a higher VA incidence after ICD placement.
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Affiliation(s)
- Ran Jing
- State Key Laboratory of Cardiovascular Disease, The Cardiac Arrhythmia Center, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, People's Republic of China
| | - Xiao-Xin Sun
- Department of Nuclear Medicine, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Wei Hua
- State Key Laboratory of Cardiovascular Disease, The Cardiac Arrhythmia Center, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, People's Republic of China.
| | - Liang Chen
- State Key Laboratory of Cardiovascular Disease, The Cardiac Arrhythmia Center, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, People's Republic of China
| | - Sheng-Wen Yang
- State Key Laboratory of Cardiovascular Disease, The Cardiac Arrhythmia Center, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, People's Republic of China
| | - Yi-Ran Hu
- State Key Laboratory of Cardiovascular Disease, The Cardiac Arrhythmia Center, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, People's Republic of China
| | - Ni-Xiao Zhang
- State Key Laboratory of Cardiovascular Disease, The Cardiac Arrhythmia Center, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, People's Republic of China
| | - Min-Si Cai
- State Key Laboratory of Cardiovascular Disease, The Cardiac Arrhythmia Center, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, People's Republic of China
| | - Min Gu
- State Key Laboratory of Cardiovascular Disease, The Cardiac Arrhythmia Center, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, People's Republic of China
| | - Hong-Xia Niu
- State Key Laboratory of Cardiovascular Disease, The Cardiac Arrhythmia Center, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, People's Republic of China
| | - Shu Zhang
- State Key Laboratory of Cardiovascular Disease, The Cardiac Arrhythmia Center, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, People's Republic of China
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Salatzki J, Fischer T, Riffel J, André F, Hirschberg K, Ochs A, Hund H, Müller-Hennessen M, Giannitsis E, Friedrich MG, Scholz E, Frey N, Katus HA, Ochs M. Presence of contractile impairment appears crucial for structural remodeling in idiopathic left bundle-branch block. J Cardiovasc Magn Reson 2021; 23:39. [PMID: 33789682 PMCID: PMC8015193 DOI: 10.1186/s12968-021-00731-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 02/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To differentiate effects of ventricular asynchrony from an underlying hypocontractile cardiomyopathy this study aimed to enhance the understanding of functional impairment and structural remodeling in idiopathic left bundle-branch block (LBBB). We hypothesize, that functional asynchrony with septal flash volume effects alone might not entirely explain the degree of functional impairment. Hence, we suggest the presence of a superimposed contractile cardiomyopathy. METHODS In this retrospective study, 53 patients with idiopathic LBBB were identified and matched to controls with and without cardiovascular risk factors. Cardiovascular magnetic resonance (CMR) was used to evaluate cardiac function, volumes and myocardial fibrosis using native T1 mapping and late gadolinium enhancement (LGE). Septal flash volume was assessed by CMR volumetric measurements and allowed to stratify patients with systolic dysfunction solely due to isolated ventricular asynchrony or superimposed contractile impairment. RESULTS Reduced systolic LV-function, increased LV-volumes and septal myocardial fibrosis were found in patients with idiopathic LBBB compared to healthy controls. LV-volumes increased and systolic LV-function declined with prolonged QRS duration. Fibrosis was typically located at the right ventricular insertion points. Subgroups with superimposed contractile impairment appeared with pronounced LV dilation and increased fibrotic remodeling compared to individuals with isolated ventricular asynchrony. CONCLUSIONS The presence of superimposed contractile impairment in idiopathic LBBB is crucial to identify patients with enhanced structural remodeling. This finding suggests an underlying cardiomyopathy. Future studies are needed to assess a possible prognostic impact of this entity and the development of heart failure. TRIAL REGISTRATION This study was retrospectively registered.
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Affiliation(s)
- Janek Salatzki
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
- DZHK (German Centre for Cardiovascular Research), Partner site Heidelberg, Heidelberg, Germany.
| | - Theresa Fischer
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Johannes Riffel
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Heidelberg, Heidelberg, Germany
| | - Florian André
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Heidelberg, Heidelberg, Germany
| | - Kristóf Hirschberg
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - Andreas Ochs
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Heidelberg, Heidelberg, Germany
| | - Hauke Hund
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Matthias Müller-Hennessen
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Heidelberg, Heidelberg, Germany
| | - Evangelos Giannitsis
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Heidelberg, Heidelberg, Germany
| | - Matthias G Friedrich
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Heidelberg, Heidelberg, Germany
- Division of Cardiology, Departments of Medicine and Diagnostic Radiology, Mc-Gill University Health Centre, Montreal, Canada
| | - Eberhard Scholz
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Heidelberg, Heidelberg, Germany
| | - Norbert Frey
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Heidelberg, Heidelberg, Germany
| | - Hugo A Katus
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Heidelberg, Heidelberg, Germany
| | - Marco Ochs
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Heidelberg, Heidelberg, Germany
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Bisognano J, Schneider JE, Davies S, Ohsfeldt RL, Galle E, Stojanovic I, Deering TF, Lindenfeld J, Zile MR. Cost-impact analysis of baroreflex activation therapy in chronic heart failure patients in the United States. BMC Cardiovasc Disord 2021; 21:155. [PMID: 33771104 PMCID: PMC7995802 DOI: 10.1186/s12872-021-01958-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 03/17/2021] [Indexed: 01/08/2023] Open
Abstract
Background The study evaluated the cost of baroreflex activation therapy plus guideline directed therapy (BAT + GDT) compared to GDT alone for HF patients with reduced ejection fraction and New York Heart Association Class III or II (with a recent history of III). Baroreflex activation therapy (BAT) is delivered by an implantable device that stimulates the baroreceptors through an electrode attached to the outside of the carotid artery, which rebalances the autonomic nervous system to regain cardiovascular (CV) homeostasis. The BeAT-HF trial evaluated the safety and effectiveness of BAT. Methods A cost impact model was developed from a U.S. health care payer or integrated delivery network perspective over a 3-year period for BAT + GDT versus GDT alone. Expected costs were calculated by utilizing 6-month data from the BeAT-HF trial and existing literature. HF hospitalization rates were extrapolated based on improvement in NT-proBNP. Results At baseline the expected cost of BAT + GDT were $29,526 per patient more than GDT alone due to BAT device and implantation costs. After 3 years, the predicted cost per patient was $9521 less expensive for BAT + GDT versus GDT alone due to lower rates of significant HF hospitalizations, CV non-HF hospitalizations, and resource intensive late-stage procedures (LVADs and heart transplants) among the BAT + GDT group. Conclusions BAT + GDT treatment becomes less costly than GDT alone beginning between years 1 and 2 and becomes less costly cumulatively between years 2 and 3, potentially providing significant savings over time. As additional BeAT-HF trial data become available, the model can be updated to show longer term effects.
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Affiliation(s)
- John Bisognano
- University of Rochester Medical Center, Rochester, NY, USA
| | | | | | | | | | | | | | | | - Michael R Zile
- Medical University of South Carolina, Charleston, SC, USA
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Romero J, Velasco A, Pisani CF, Alviz I, Briceno D, Díaz JC, Della Rocca DG, Natale A, de Lourdes Higuchi M, Scanavacca M, Di Biase L. Advanced Therapies for Ventricular Arrhythmias in Patients With Chagasic Cardiomyopathy: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 77:1225-1242. [PMID: 33663741 DOI: 10.1016/j.jacc.2020.12.056] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/30/2020] [Accepted: 12/07/2020] [Indexed: 11/24/2022]
Abstract
Chagas disease is caused by infection from the protozoan parasite Trypanosoma cruzi. Although it is endemic to Latin America, global migration has led to an increased incidence of Chagas in Europe, Asia, Australia, and North America. Following acute infection, up to 30% of patients will develop chronic Chagas disease, with most patients developing Chagasic cardiomyopathy. Chronic Chagas cardiomyopathy is highly arrhythmogenic, with estimated annual rates of appropriate implantable cardioverter-defibrillator therapies and electrical storm of 25% and 9.1%, respectively. Managing arrhythmias in patients with Chagasic cardiomyopathy is a major challenge for the clinical electrophysiologist, requiring intimate knowledge of cardiac anatomy, advanced training, and expertise. Endocardial-epicardial mapping and ablation strategy is needed to treat arrhythmias in this patient population, owing to the suboptimal long-term success rate of endocardial mapping and ablation alone. We also describe innovative approaches to improve acute and long-term clinical outcomes in patients with refractory ventricular arrhythmias following catheter ablation, such as bilateral cervicothoracic sympathectomy and bilateral renal denervation, among others.
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Affiliation(s)
- Jorge Romero
- Cardiac Arrhythmia Center, Montefiore-Einstein Center for Heart and Vascular Care, Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, New York, New York, USA
| | - Alejandro Velasco
- Cardiac Arrhythmia Center, Montefiore-Einstein Center for Heart and Vascular Care, Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, New York, New York, USA
| | - Cristiano F Pisani
- Arrhythmia Unit, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Isabella Alviz
- Cardiac Arrhythmia Center, Montefiore-Einstein Center for Heart and Vascular Care, Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, New York, New York, USA
| | - David Briceno
- Cardiac Arrhythmia Center, Montefiore-Einstein Center for Heart and Vascular Care, Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, New York, New York, USA
| | - Juan Carlos Díaz
- Cardiac Arrhythmia Center, Montefiore-Einstein Center for Heart and Vascular Care, Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, New York, New York, USA
| | | | - Andrea Natale
- Cardiac Arrhythmia Center, Montefiore-Einstein Center for Heart and Vascular Care, Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, New York, New York, USA; Texas Cardiac Arrhythmia Institute at St David's Medical Center, Austin, Texas, USA
| | - Maria de Lourdes Higuchi
- Arrhythmia Unit, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Mauricio Scanavacca
- Arrhythmia Unit, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Luigi Di Biase
- Cardiac Arrhythmia Center, Montefiore-Einstein Center for Heart and Vascular Care, Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, New York, New York, USA; Texas Cardiac Arrhythmia Institute at St David's Medical Center, Austin, Texas, USA.
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38
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Wilcox JE, Fang JC, Margulies KB, Mann DL. Heart Failure With Recovered Left Ventricular Ejection Fraction: JACC Scientific Expert Panel. J Am Coll Cardiol 2021; 76:719-734. [PMID: 32762907 DOI: 10.1016/j.jacc.2020.05.075] [Citation(s) in RCA: 141] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/07/2020] [Accepted: 05/14/2020] [Indexed: 12/25/2022]
Abstract
Reverse left ventricular (LV) remodeling and recovery of LV function are associated with improved clinical outcomes in patients with heart failure with reduced ejection fraction. A growing body of evidence suggests that even among patients who experience a complete normalization of LV ejection fraction, a significant proportion will develop recurrent LV dysfunction accompanied by recurrent heart failure events. This has led to intense interest in understanding how to manage patients with heart failure with recovered ejection fraction (HFrecEF). Because of the lack of a standard definition for HFrecEF, and the paucity of clinical data with respect to the natural history of HFrecEF patients, there are no current guidelines on how these patients should be followed up and managed. Accordingly, this JACC Scientific Expert Panel reviews the biology of reverse LV remodeling and the clinical course of patients with HFrecEF, as well as provides guidelines for defining, diagnosing, and managing patients with HFrecEF.
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Affiliation(s)
- Jane E Wilcox
- Division of Cardiovascular Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - James C Fang
- Division of Cardiology, Department of Medicine, University of Utah, Salt Lake City, Utah
| | - Kenneth B Margulies
- Translational Research Center, Department of Medicine, University of Pennsylvania Pearlman School of Medicine, Philadelphia, Pennsylvania
| | - Douglas L Mann
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
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Titus Ngeno G, Borges-Neto S, Fudim M. Mechanical dyssynchrony in acute heart failure: A marker and a target? J Nucl Cardiol 2021; 28:150-152. [PMID: 33386536 DOI: 10.1007/s12350-020-02468-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 11/30/2020] [Indexed: 11/29/2022]
Affiliation(s)
- G Titus Ngeno
- Duke Department of Medicine and Division of Cardiology, Durham, NC, USA
| | - Salvador Borges-Neto
- Duke Department of Medicine and Division of Cardiology, Durham, NC, USA.
- Duke Department of Radiology and Division of Nuclear Medicine, 2301 Erwin Road, Durham, NC, 27710, USA.
- Duke Heart Center, Durham, NC, USA.
| | - Marat Fudim
- Duke Department of Medicine and Division of Cardiology, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
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40
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Affiliation(s)
- Natalia A Trayanova
- Department of Biomedical Engineering and Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, MD
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41
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Yilmaz A, Bauersachs J, Bengel F, Büchel R, Kindermann I, Klingel K, Knebel F, Meder B, Morbach C, Nagel E, Schulze-Bahr E, Aus dem Siepen F, Frey N. Diagnosis and treatment of cardiac amyloidosis: position statement of the German Cardiac Society (DGK). Clin Res Cardiol 2021; 110:479-506. [PMID: 33459839 PMCID: PMC8055575 DOI: 10.1007/s00392-020-01799-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 12/21/2020] [Indexed: 12/15/2022]
Abstract
Systemic forms of amyloidosis affecting the heart are mostly light-chain (AL) and transthyretin (ATTR) amyloidoses. The latter is caused by deposition of misfolded transthyretin, either in wild-type (ATTRwt) or mutant (ATTRv) conformation. For diagnostics, specific serum biomarkers and modern non-invasive imaging techniques, such as cardiovascular magnetic resonance imaging (CMR) and scintigraphic methods, are available today. These imaging techniques do not only complement conventional echocardiography, but also allow for accurate assessment of the extent of cardiac involvement, in addition to diagnosing cardiac amyloidosis. Endomyocardial biopsy still plays a major role in the histopathological diagnosis and subtyping of cardiac amyloidosis. The main objective of the diagnostic algorithm outlined in this position statement is to detect cardiac amyloidosis as reliably and early as possible, to accurately determine its extent, and to reliably identify the underlying subtype of amyloidosis, thereby enabling subsequent targeted treatment.
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Affiliation(s)
- A Yilmaz
- Sektion für Herzbildgebung, Klinik für Kardiologie, Universitätsklinikum Münster, Von-Esmarch-Str. 48, 48149, Münster, Germany.
| | - J Bauersachs
- Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - F Bengel
- Klinik für Nuklearmedizin, Medizinische Hochschule Hannover, Hannover, Germany
| | - R Büchel
- Klinik für Nuklearmedizin, Universitätsspital Zürich, Zurich, Switzerland
| | - I Kindermann
- Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Germany
| | - K Klingel
- Institut für Pathologie und Neuropathologie, Universität Tübingen, Tübingen, Germany
| | - F Knebel
- Medizinische Klinik m.S. Kardiologie und Angiologie, Charite Universitätsmedizin Berlin Campus Mitte, Berlin, Germany
| | - B Meder
- Klinik für Innere Medizin III, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - C Morbach
- Klinik für Innere Medizin III, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - E Nagel
- Interdisziplinäres Amyloidosezentrum Nordbayern, Deutsches Zentrum für Herzinsuffizienz, Medizinische Klinik I der Universität Würzburg, Würzburg, Germany
| | - E Schulze-Bahr
- Institut für Experimentelle und translationale kardiovaskuläre Bildgebung, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - F Aus dem Siepen
- Institut für Genetik von Herzerkrankungen (IfGH), Universitätsklinikum Münster, Münster, Germany
| | - N Frey
- Klinik für Innere Medizin III, Schwerpunkt Kardiologie und Angiologie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany.,Kommission für Klinische Kardiovaskuläre Medizin, Deutsche Gesellschaft für Kardiologie, Düsseldorf, Germany
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Kabutoya T, Mitsuhashi T, Shimizu A, Nitta T, Mitamura H, Kurita T, Abe H, Nakazato Y, Sumitomo N, Kadota K, Kimura K, Okumura K. Prognosis of Japanese Patients With Coronary Artery Disease Who Underwent Implantable Cardioverter Defibrillator Implantation - The JID-CAD Study. Circ Rep 2021; 3:69-76. [PMID: 33693292 PMCID: PMC7939950 DOI: 10.1253/circrep.cr-20-0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background:
There has been no large multicenter clinical trial on the prognosis of implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy with a defibrillator (CRT-D) in Japanese patients with coronary artery disease (CAD). The aim of the present study was to compare differences in the prognoses of Japanese patients with CAD between primary and secondary prevention, and to identify potential predictors of prognosis. Methods and Results:
We investigated 392 CAD patients (median age 69 years, 90% male) treated with ICD/CRT-D enrolled in the Japan Implantable Devices in CAD (JID-CAD) Registry. The primary endpoint was all-cause death, and the secondary endpoint was appropriate ICD therapies. Endpoints were assessed by dividing patients into primary prevention (n=165) and secondary prevention (n=227) groups. The mean (±SD) follow-up period was 2.1±0.9 years. The primary endpoint was similar in the 2 groups (P=0.350). Conclusions:
The mortality rate in Japanese patients with CAD who underwent ICD/CRT-D implantation as primary prevention was not lower than that of patients who underwent ICD/CRT-D implantation as secondary prevention, despite the lower cardiac function in the patients undergoing ICD/CRT-D implantation as primary prevention.
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Affiliation(s)
- Tomoyuki Kabutoya
- Department of Medicine, Division of Cardiovascular Medicine, Jichi Medical University Shimotsuke Japan
| | | | | | - Takashi Nitta
- Cardiovascular Surgery, Nippon Medical School Tokyo Japan
| | | | - Takashi Kurita
- Cardiology, Kindai University School of Medicine Osaka-Sayama Japan
| | - Haruhiko Abe
- Department of Heart Rhythm Management, University of Occupational and Environmental Health Kitakyushu Japan
| | - Yuji Nakazato
- Cardiology, Juntendo University Urayasu Hospital Urayasu Japan
| | - Naokata Sumitomo
- Pediatric Cardiology, Saitama Medical University International Medical Center Hidaka Japan
| | | | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center Yokohama Japan
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital Kumamoto Japan
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Guo F, Krahn PRP, Escartin T, Roifman I, Wright G. Cine and late gadolinium enhancement MRI registration and automated myocardial infarct heterogeneity quantification. Magn Reson Med 2020; 85:2842-2855. [PMID: 33226667 DOI: 10.1002/mrm.28596] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 09/29/2020] [Accepted: 10/22/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE To develop an approach for automated quantification of myocardial infarct heterogeneity in late gadolinium enhancement (LGE) cardiac MRI. METHODS We acquired 2D short-axis cine and 3D LGE in 10 pigs with myocardial infarct. The 2D cine myocardium was segmented and registered to the LGE images. LGE image signal intensities within the warped cine myocardium masks were analyzed to determine the thresholds of infarct core (IC) and gray zone (GZ) for the standard-deviation (SD) and full-width-at-halfmaximum (FWHM) methods. The initial IC, GZ, and IC + GZ segmentations were postprocessed using a normalized cut approach. Cine segmentation and cine-LGE registration accuracies were evaluated using dice similarity coefficient and average symmetric surface distance. Automated IC, GZ, and IC + GZ volumes were compared with manual results using Pearson correlation coefficient (r), Bland-Altman analyses, and intraclass correlation coefficient. RESULTS For n = 87 slices containing scar, we achieved cine segmentation dice similarity coefficient = 0.87 ± 0.12, average symmetric surface distance = 0.94 ± 0.74 mm (epicardium), and 1.03 ± 0.82 mm (endocardium) in the scar region. For cine-LGE registration, dice similarity coefficient was 0.90 ± 0.06 and average symmetric surface distance was 0.72 ± 0.39 mm (epicardium) and 0.86 ± 0.53 mm (endocardium) in the scar region. For both SD and FWHM methods, automated IC, GZ, and IC + GZ volumes were strongly (r > 0.70) correlated with manual measurements, and the correlations were not significantly different from interobserver correlations (P > .05). The agreement between automated and manual scar volumes (intraclass correlation coefficient = 0.85-0.96) was similar to that between two observers (intraclass correlation coefficient = 0.81-0.99); automated scar segmentation errors were not significantly different from interobserver segmentation differences (P > .05). CONCLUSIONS Our approach provides fully automated cine-LGE MRI registration and LGE myocardial infarct heterogeneity quantification in preclinical studies.
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Affiliation(s)
- Fumin Guo
- Sunnybrook Research Institute, University of Toronto, Toronto, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Philippa R P Krahn
- Sunnybrook Research Institute, University of Toronto, Toronto, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Terenz Escartin
- Sunnybrook Research Institute, University of Toronto, Toronto, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Idan Roifman
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - Graham Wright
- Sunnybrook Research Institute, University of Toronto, Toronto, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Canada
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44
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Giovanni S, Stefano M, Teresa SM, Margherita C, Giovanni B, Umberto P, Paola P, Giacomo C, Pierfranco D, Alfonso G, Riccardo C, Claudio M. Incremental prognostic value of myocardial neuroadrenergic damage in patients with chronic congestive heart failure: An iodine-123 meta-iodobenzylguanidine scintigraphy study. J Nucl Cardiol 2020; 27:1787-1797. [PMID: 30377997 DOI: 10.1007/s12350-018-01467-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 09/17/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND ICD in primary prevention reduced mortality in patients with heart failure (HF); however, in about 80% of the ICD recipients an event requiring a device intervention will never occur. Thus, a reliable screening test included in a multiparametric approach to appropriately select patients to ICD implantation is increasingly required. Aim of the work was to assess if the Iodine-123 Meta-Iodobenzylguanidine scintigraphy (123I-mIBG) could be useful to identify patients with HF who would not benefit from the ICD implantation because at low risk of arrhythmias. METHODS AND RESULTS This is a retrospective multicentre study on patients undergoing 123I-mIBG from February 2012 to December 2015. Inclusion criteria where: age ≥ 18 years old, LVEF ≤ 35% with idiopathic or ischemic heart disease, no previous malignant ventricular arrhythmias. Patients were divided in two groups based on of late H/M < or ≥ 1.60 on 123I-mIBG. Primary end-point was occurrence of malignant arrhythmias. Secondary end-point was occurrence of cardiac death and hospitalization for worsening HF. MACE were mortality and malignant arrhythmias. Eighty-one patients were enrolled (mean age: 69 years). On 123I-mIBG, 54 patients had late H/M < 1.6 and 27 patients had late H/M ≥ 1.60. After a mean follow-up of 13.3 (± 9.7) months, the primary end-point occurred in 13 patients out of 81. No arrhythmias occurred in patients with H/M late ≥ 1.6. Nineteen patients out of 20 with MACE showed an H/M late < 1.6. Death in group with H/M ≥ 1.6 occurred for worsening HF. A late H/M ≥ 1.60 showed a very high NPV for arrhythmia (100%) and for death (96.3%). CONCLUSION 123I-mIBG imaging has the capability to identify patients at low risk of events.
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Affiliation(s)
- Scrima Giovanni
- Cardiology Department, Ospedale Santa Croce Moncalieri, Moncalieri, Italy.
| | - Maffè Stefano
- Division of Cardiology, SS Trinita' Hospital, ASL No, Borgomanero, NO, Italy
| | | | | | - Bertuccio Giovanni
- Nuclear Medicine Department, Ospedale Santa Croce Moncalieri, Moncalieri, Italy
| | - Parravicini Umberto
- Division of Cardiology, SS Trinita' Hospital, ASL No, Borgomanero, NO, Italy
| | - Paffoni Paola
- Division of Cardiology, SS Trinita' Hospital, ASL No, Borgomanero, NO, Italy
| | - Canavese Giacomo
- Nuclear Medicine Department, Ospedale Santa Croce Moncalieri, Moncalieri, Italy
| | | | - Gambino Alfonso
- Cardiology Department, Ospedale Santa Croce Moncalieri, Moncalieri, Italy
| | - Campini Riccardo
- IRCCS Nuclear Medicine Department, Maugeri Clinical Scientific Institute, Veruno, Italy
| | - Marcassa Claudio
- IRCCS Cardiology Department, Maugeri Clinical Scientific Institute, Veruno, Italy
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Böttcher B, Beller E, Busse A, Cantré D, Yücel S, Öner A, Ince H, Weber MA, Meinel FG. Fully automated quantification of left ventricular volumes and function in cardiac MRI: clinical evaluation of a deep learning-based algorithm. Int J Cardiovasc Imaging 2020; 36:2239-2247. [PMID: 32677023 PMCID: PMC7568707 DOI: 10.1007/s10554-020-01935-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/06/2020] [Indexed: 12/18/2022]
Abstract
To investigate the performance of a deep learning-based algorithm for fully automated quantification of left ventricular (LV) volumes and function in cardiac MRI. We retrospectively analysed MR examinations of 50 patients (74% men, median age 57 years). The most common indications were known or suspected ischemic heart disease, cardiomyopathies or myocarditis. Fully automated analysis of LV volumes and function was performed using a deep learning-based algorithm. The analysis was subsequently corrected by a senior cardiovascular radiologist. Manual volumetric analysis was performed by two radiology trainees. Volumetric results were compared using Bland–Altman statistics and intra-class correlation coefficient. The frequency of clinically relevant differences was analysed using re-classification rates. The fully automated volumetric analysis was completed in a median of 8 s. With expert review and corrections, the analysis required a median of 110 s. Median time required for manual analysis was 3.5 min for a cardiovascular imaging fellow and 9 min for a radiology resident (p < 0.0001 for all comparisons). The correlation between fully automated results and expert-corrected results was very strong with intra-class correlation coefficients of 0.998 for end-diastolic volume, 0.997 for end-systolic volume, 0.899 for stroke volume, 0.972 for ejection fraction and 0.991 for myocardial mass (all p < 0.001). Clinically meaningful differences between fully automated and expert corrected results occurred in 18% of cases, comparable to the rate between the two manual readers (20%). Deep learning-based fully automated analysis of LV volumes and function is feasible, time-efficient and highly accurate. Clinically relevant corrections are required in a minority of cases.
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Affiliation(s)
- Benjamin Böttcher
- Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Ebba Beller
- Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Anke Busse
- Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Daniel Cantré
- Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Seyrani Yücel
- Department of Internal Medicine, Divison of Cardiology, University Medical Center Rostock, Rostock, Germany
| | - Alper Öner
- Department of Internal Medicine, Divison of Cardiology, University Medical Center Rostock, Rostock, Germany
| | - Hüseyin Ince
- Department of Internal Medicine, Divison of Cardiology, University Medical Center Rostock, Rostock, Germany
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Felix G Meinel
- Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany.
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Nakamori S, Ngo LH, Rodriguez J, Neisius U, Manning WJ, Nezafat R. T 1 Mapping Tissue Heterogeneity Provides Improved Risk Stratification for ICDs Without Needing Gadolinium in Patients With Dilated Cardiomyopathy. JACC Cardiovasc Imaging 2020; 13:1917-1930. [PMID: 32653543 DOI: 10.1016/j.jcmg.2020.03.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/27/2020] [Accepted: 03/27/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVES This study sought to determine whether myocardial tissue heterogeneity scanned by native T1 mapping could improve risk stratification in patients with nonischemic dilated cardiomyopathy (NICM) evaluated for primary prevention by ICD. BACKGROUND The benefit of insertable cardiac-defibrillator (ICD) as primary prevention ICD in patients with NICM remains to be fully clarified. METHODS A total of 115 NICM candidates for primary prevention and 55 healthy controls with similar distributions of age and sex were prospectively enrolled. Imaging was performed at 1.5-T using a protocol that included cine magnetic resonance for left ventricular function, late gadolinium enhancement (LGE) for focal scarring, and 5-slice native T1 mapping for diffuse fibrosis and heterogeneity. The last method was assessed by mean absolute deviation of the segmental pixel-SD from the average pixel-SD (Mad-SD). The primary endpoint was a composite of appropriate ICD therapy and sudden cardiac death. RESULTS During a median follow-up of 24 months, 13 patients (11%) experienced the primary endpoint. Dichotomized Mad-SD >0.24 provided a comparable outcome to the presence of LGE for the primary endpoint (annual event rate: 9.8% vs. 10.9%). The integration of Mad-SD to global native T1 showed excellent arrhythmic event-free survival (annual event rate: 0%), and high sensitivity of 85% (95% confidence interval [CI]: 55% to 98%) and moderate specificity of 72% (95% CI: 62% to 80%), with a C-statistic of 0.76 (95% CI: 0.64 to 0.87), which was comparable to the presence, location, or extent of LGE in its ability to predict arrhythmic events. CONCLUSIONS Combined myocardium tissue heterogeneity and interstitial fibrosis assessment by native T1 mapping is an important predictor of ventricular tachycardia and ventricular fibrillation and provides additive risk stratification for primary prevention ICD in NICM patients without the need for gadolinium contrast.
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Affiliation(s)
- Shiro Nakamori
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Long H Ngo
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Jennifer Rodriguez
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Ulf Neisius
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Warren J Manning
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts; Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Reza Nezafat
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
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Almahameed ST, Kaufman ES. Idiopathic Ventricular Fibrillation: Diagnosis, Ablation of Triggers, Gaps in Knowledge, and Future Directions. J Innov Card Rhythm Manag 2020; 11:4135-4146. [PMID: 32596029 PMCID: PMC7313628 DOI: 10.19102/icrm.2020.110604] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 03/12/2020] [Indexed: 01/14/2023] Open
Abstract
Idiopathic ventricular fibrillation (IVF) is a diagnosis of exclusion made when no underlying cause is identified in a cardiac arrest survivor. Although the frequency of this diagnosis has declined over time due to advances in diagnostic techniques, it remains a substantial cause of sudden cardiac arrest. Further, IVF tends to recur. This article reviews the criteria for diagnosis, patient characteristics, the two primary arrhythmic phenotypes—short-coupled variant of torsades de pointes and recurrent paroxysmal IVF—and the electrophysiologic features, treatment, and ablation of premature ventricular complexes that can trigger IVF.
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Affiliation(s)
- Soufian T Almahameed
- Heart and Vascular Center, MetroHealth Campus of Case Western Reserve University, Cleveland, OH, USA
| | - Elizabeth S Kaufman
- Heart and Vascular Center, MetroHealth Campus of Case Western Reserve University, Cleveland, OH, USA
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Zhang ZH, Meng FQ, Hou XF, Qian ZY, Wang Y, Qiu YH, Jiang ZY, Du AJ, Qin CT, Zou JG. Clinical characteristics and long-term prognosis of ischemic and non-ischemic cardiomyopathy. Indian Heart J 2020; 72:93-100. [PMID: 32534695 PMCID: PMC7296233 DOI: 10.1016/j.ihj.2020.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/22/2020] [Accepted: 04/19/2020] [Indexed: 11/16/2022] Open
Abstract
Objectives The different etiology of HF has different prognostic risk factors. Prognosis assessment of ICM and NICM has important clinical value. This study is aimed to explore the predicting factors for ICM and NICM. Methods 1082 HFrEF patients were retrospectively enrolled from Jan. 01, 2016 to Dec. 31, 2017. On Jan. 31, 2019, 873 patients were enrolled for analysis excluding incomplete, unfollowed, and unexplained data. The patients were divided into ischemic and non-ischemic group. The differences in clinical characteristics and long-term prognosis between the two groups were analyzed, and multivariate Cox analysis was used to predict the respective all-cause mortality, SCD and rehospitalization of CHF. Results 873 patients aged 64(53,73) were divided into two groups: ICM (403, 46.16%) and NICM. At the end, 203 died (111 in ICM, 54.68%), of whom 87 had SCD (53 in ICM, 60.92%) and 269 had rehospitalization for HF(134 in ICM, 49.81%). Independent risk factors affecting all-cause mortality in ICM: DM, previous hospitalization of HF, age, eGFR, LVEF; for SCD: PVB, eGFR, Hb, revascularization; for readmission of HF: low T3 syndrome, PVB, DM, previous hospitalization of HF, eGFR. Otherwise; factors affecting all-cause mortality in NICM: NYHA III-IV, paroxysmal AF/AFL, previous hospitalization of HF, β-blocker; for SCD: low T3 syndrome, PVB, nitrates, sodium, β-blocker; for rehospitalization of HF: paroxysmal AF/AFL, previous admission of HF, LVEF. Conclusions Both all-cause mortality and SCD in ICM is higher than that in NICM. Different etiologies of CHF have different risk factors affecting the prognosis.
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Affiliation(s)
- Zhi-Hua Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu, China; Department of Cardiology, Jiangning Hospital Affiliated to Nanjing Medical University, Jiangsu, China
| | - Fan-Qi Meng
- Department of Cardiology, Xiamen Cardiovascular Disease Hospital, Xiamen, China
| | - Xiao-Feng Hou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu, China
| | - Zhi-Yong Qian
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu, China
| | - Yao Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu, China
| | - Yuan-Hao Qiu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu, China
| | - Zhe-Yu Jiang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu, China
| | - An-Jie Du
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu, China
| | - Chao-Tong Qin
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu, China
| | - Jian-Gang Zou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu, China.
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Kiage JN, Latif Z, Craig MA, Mansour N, Khouzam RN. Implantable Cardioverter Defibrillators and Chronic Kidney Disease. Curr Probl Cardiol 2020; 46:100639. [PMID: 32624194 DOI: 10.1016/j.cpcardiol.2020.100639] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 05/27/2020] [Indexed: 01/02/2023]
Abstract
Use of implantable cardioverter defibrillators (ICDs) is the treatment of choice for heart failure patients with ejection fraction <35% to prevent sudden cardiac death. Whether this benefit remains among patients with chronic kidney disease (CKD) or end stage renal disease (ESRD) is yet to be elucidated. We conducted a systematic review of studies in PubMed that have investigated the use of ICDs among patients with CKD or ESRD. From the 470 studies identified, we selected 42 for the current review. Patients with CKD/ESRD were more likely to get antitachycardia pacing or shocks and had higher cardiac and/or all-cause mortality compared to patients without CKD/ESRD. These associations had an inverse dose-response effect with worse outcomes with decreasing kidney function. In conclusion, use of ICDs in CKD/ESRD is associated with increased antitachycardia pacing/shocks and mortality suggesting that their routine use in this patient population may be associated with more adverse outcomes than benefits.
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50
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Outcomes following implantable cardioverter–defibrillator generator replacement in adults: A systematic review. Heart Rhythm 2020; 17:1036-1042. [DOI: 10.1016/j.hrthm.2020.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 01/01/2020] [Indexed: 11/20/2022]
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