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Egorova AD, van Erven L, Beeres SLMA, Tops LF. Fusion cardiac resynchronization therapy in an left ventricular assist device patient from two devices and crossing leads: a case report. Eur Heart J Case Rep 2021; 5:ytab335. [PMID: 34671715 PMCID: PMC8523028 DOI: 10.1093/ehjcr/ytab335] [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: 02/11/2021] [Revised: 04/26/2021] [Accepted: 08/05/2021] [Indexed: 12/04/2022]
Abstract
Background Cardiac implanted electronic devices (CIED) have significantly improved the
survival and quality of life in heart failure patients. Although implantable
cardioverter-defibrillators (ICD) and cardiac resynchronization therapy
(CRT) have a major role in patients with moderate to severe heart failure
symptoms, the role of these devices in patients with a left ventricular
assist device (LVAD) is not yet well defined. The burden of CIED-related
procedures in patients with an LVAD is high. The price of lead malfunctions
and pocket complications requires creative approaches to tackle CIED-related
issues in this patient population. Case summary Here, we describe the clinical course of a 67-year-old ventricular pacing
dependent LVAD patient with an ICD indication based on recurrent monomorphic
ventricular tachycardias and a CRT indication due to previous deterioration
of (right-sided) heart failure in the absence of biventricular pacing. We
were confronted with impending right ventricular lead failure and bilateral
venous access problems due to chronic subclavian vein occlusion in a patient
with a total of five transvenous leads, therapeutic anticoagulation, and
pronounced thoracic collaterals. We sought for a creative solution to be
able to deliver effective biventricular fusion pacing with the existing
leads from two contralateral pulse generators resulting in biventricular
fusion pacing. This provided the solution to deliver effective CRT. Discussion This case illustrates the complexity of care and CIED-related decision-making
in pacing dependent LVAD patients, in particularly those with an ICD and CRT
indication.
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Affiliation(s)
- Anastasia D Egorova
- Department of Cardiology, Leiden Heart-Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Lieselot van Erven
- Department of Cardiology, Leiden Heart-Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Saskia L M A Beeres
- Department of Cardiology, Leiden Heart-Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Laurens F Tops
- Department of Cardiology, Leiden Heart-Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
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Ren X, Johns RA, Gao WD. EXPRESS: Right Heart in Pulmonary Hypertension: From Adaptation to Failure. Pulm Circ 2019; 9:2045894019845611. [PMID: 30942134 PMCID: PMC6681271 DOI: 10.1177/2045894019845611] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 03/27/2019] [Indexed: 01/24/2023] Open
Abstract
Right ventricular (RV) failure (RVF) has garnered significant attention in recent years because of its negative impact on clinical outcomes in patients with pulmonary hypertension (PH). PH triggers a series of events, including activation of several signaling pathways that regulate cell growth, metabolism, extracellular matrix remodeling, and energy production. These processes render the RV adaptive to PH. However, RVF develops when PH persists, accompanied by RV ischemia, alterations in substrate and mitochondrial energy metabolism, increased free oxygen radicals, increased cell loss, downregulation of adrenergic receptors, increased inflammation and fibrosis, and pathologic microRNAs. Diastolic dysfunction is also an integral part of RVF. Emerging non-invasive technologies such as molecular or metallic imaging, cardiac MRI, and ultrafast Doppler coronary flow mapping will be valuable tools to monitor RVF, especially the transition to RVF. Most PH therapies cannot treat RVF once it has occurred. A variety of therapies are available to treat acute and chronic RVF, but they are mainly supportive, and no effective therapy directly targets the failing RV. Therapies that target cell growth, cellular metabolism, oxidative stress, and myocyte regeneration are being tested preclinically. Future research should include establishing novel RVF models based on existing models, increasing use of human samples, creating human stem cell-based in vitro models, and characterizing alterations in cardiac excitation–contraction coupling during transition from adaptive RV to RVF. More successful strategies to manage RVF will likely be developed as we learn more about the transition from adaptive remodeling to maladaptive RVF in the future.
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Affiliation(s)
- Xianfeng Ren
- Department of Anesthesiology,
China-Japan
Friendship Hospital, Beijing, China
| | - Roger A. Johns
- Department of Anesthesiology and
Critical Care Medicine,
Johns
Hopkins University School of Medicine,
Baltimore, MD, USA
| | - Wei Dong Gao
- Department of Anesthesiology and
Critical Care Medicine,
Johns
Hopkins University School of Medicine,
Baltimore, MD, USA
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Cirulis MM, Ryan JJ, Archer SL. Pathophysiology, incidence, management, and consequences of cardiac arrhythmia in pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension. Pulm Circ 2019; 9:2045894019834890. [PMID: 30747032 PMCID: PMC6410395 DOI: 10.1177/2045894019834890] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Arrhythmias are increasingly recognized as serious, end-stage complications of pre-capillary pulmonary hypertension, including pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). Although arrhythmias contribute to symptoms, morbidity, in-hospital mortality, and possibly sudden death in PAH/CTEPH, there remains a paucity of epidemiologic, pathophysiologic, and outcome data to guide management of these patients. This review summarizes the most current evidence on the topic: from the molecular mechanisms driving arrhythmia in the hypertrophied or failing right heart, to the clinical aspects of epidemiology, diagnosis, and management.
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Affiliation(s)
- Meghan M Cirulis
- 1 Division of Pulmonary Medicine, Department of Medicine, University of Utah, Salt Lake City, UT, USA
- 2 Division of Cardiovascular Medicine, Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - John J Ryan
- 2 Division of Cardiovascular Medicine, Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Stephen L Archer
- 3 Department of Medicine, Queen's University, Kingston, ON, Canada
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Yin J, Liu H, Huan L, Song S, Han L, Ren F, Zhang Z, Zang Z, Zhang J, Wang S. Role of miR-128 in hypertension-induced myocardial injury. Exp Ther Med 2017; 14:2751-2756. [PMID: 28928797 PMCID: PMC5590046 DOI: 10.3892/etm.2017.4886] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 01/13/2017] [Indexed: 12/14/2022] Open
Abstract
The present study aimed to investigate the role and mechanism of micro RNA (miR)-128 in hypertension-induced myocardial injury. The peripheral blood of patients with hypertension was collected and the expression of miR-128 was detected using fluorescence reverse transcription-quantitative polymerase chain reaction (RT-qPCR). Primary myocardial cells isolated from rat in vitro were cultured under conditions of hypoxia and glucose deprivation, and miR-128 expression was measured by RT-qPCR. The expression of c-Met protein was measured using western blot analysis and the apoptosis of transfected cells was measured by flow cytometry in rat myocardial cells following transfection with miR-128 mimics or c-Met siRNA. A luciferase assay was applied to assess the binding of miR-128 to c-Met mRNA. miR-128 expression was significantly higher in hypertension patients compared with controls (P<0.05). miR-128 expression was higher in patients with stage III/IV hypertension compared with patients with stage II hypertension. Similarly, miR-128 expression in primary cardiomyocytes cultured under deprivation of oxygen and glucose increased with the culture time and reached a peak at 12 h. c-Met expression decreased significantly (P<0.05) and the ratio of apoptotic cells increased significantly (P<0.05), following transfection of miR-128 mimics. The number of apoptotic cells also increased when c-Met expression was knocked down by siRNA. The dual luciferase assay indicated that fluorescence intensity decreased significantly in miR-128 mimics and wild type c-Met group (P<0.05), indicating that miR-128 can directly target c-Met. Therefore, the results of the current study suggest that miR-128 may promote myocardial cell injury by regulating c-Met expression.
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Affiliation(s)
- Jie Yin
- Department of Cardiology, Laiwu People's Hospital, Laiwu, Shangdong 271100, P.R. China
| | - Hongyan Liu
- Department of Cardiology, Laiwu People's Hospital, Laiwu, Shangdong 271100, P.R. China
| | - Lei Huan
- Department of Cardiology, Laiwu People's Hospital, Laiwu, Shangdong 271100, P.R. China
| | - Suping Song
- Department of The Second Medicine, Laiwu People's Hospital, Laiwu, Shangdong 271100, P.R. China
| | - Liying Han
- Ordance Industrial 521 Hospital, Xi'an, Shanxi 710000, P.R. China
| | - Faxin Ren
- Department of Cardiology, Yuhangding Hospital of Yantai, Yantai, Shangdong 264000, P.R. China
| | - Zengtang Zhang
- Department of Cardiology, Laiwu People's Hospital, Laiwu, Shangdong 271100, P.R. China
| | - Zhiqiang Zang
- Department of Cardiology, Laiwu People's Hospital, Laiwu, Shangdong 271100, P.R. China
| | - Junye Zhang
- Laboratory of Cardiac Function, Qilu Hospital of Shangdong University, Jinan, Shandong 250012, P.R. China
| | - Shu Wang
- Sino German Laboratory, Fuwai Hospital, Beijing 100037, P.R. China
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Ricci F, Mele D, Bianco F, Bucciarelli V, De Caterina R, Gallina S. Right heart-pulmonary circulation unit and cardiac resynchronization therapy. Am Heart J 2017; 185:1-16. [PMID: 28267462 DOI: 10.1016/j.ahj.2016.11.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 11/07/2016] [Indexed: 11/15/2022]
Abstract
Clinical response to cardiac resynchronization therapy (CRT) has been known for years to be highly variable, with a spectrum of responses from no change or even deterioration of cardiac function to spectacular improvements. In the plethora of clinical, echocardiographic, biohumoral, and electrophysiological predictors of response to CRT and postimplant issues besides patient selection, the role of right ventricular (RV) function has been largely overlooked. In reviewing current evidence, we noticed conflicting results between observational studies and randomized trials not only concerning the impact of baseline RV function on CRT efficacy but also on the effects of CRT on RV size and function. Hence, we aimed to provide a critical reappraisal of current knowledge and unresolved issues on the reciprocal interactions between RV function and CRT, shifting the spotlight on the concept of right heart pulmonary circulation unit and on the clinical and prognostic significance of impaired ventricular-arterial coupling reserve. In this viewpoint, we propose that (1) CRT should not be denied to potential candidate because of "isolated" RV dysfunction and (2) assessment of baseline right heart pulmonary circulation unit and its dynamic response to pharmacological stress should be considered in future studies, as well as in the preimplant evaluation of individual candidates among other clinical factors.
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Affiliation(s)
- Fabrizio Ricci
- Institute of Cardiology, "G.d'Annunzio" University, Chieti, Italy; Department of Neuroscience and Imaging and ITAB-Institute for Advanced Biomedical Technologies, University "G. d'Annunzio", Chieti, Italy.
| | - Donato Mele
- Noninvasive Cardiac Unit, University Hospital of Ferrara, Ferrara, Italy
| | - Francesco Bianco
- Institute of Cardiology, "G.d'Annunzio" University, Chieti, Italy
| | | | | | - Sabina Gallina
- Institute of Cardiology, "G.d'Annunzio" University, Chieti, Italy
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Wang L, Zhou W, Liang Y, Yang Y, Garcia EV, Chen J, Fang W. Right ventricular dyssynchrony in pulmonary hypertension: Phase analysis using FDG-PET imaging. J Nucl Cardiol 2017; 24:69-78. [PMID: 26715598 PMCID: PMC10959236 DOI: 10.1007/s12350-015-0341-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 11/06/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Right ventricular (RV) performance in patients of pulmonary hypertension (PH) requires optimal assessment. The objective of this study is to develop phase analysis using 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) imaging as a feasible tool for evaluation of RV dyssynchrony in PH. METHODS AND RESULTS Fifty-four PH patients with well-characterized hemodynamic parameters were enrolled. All subjects performed FDG-PET imaging for RV phase analysis and RV function evaluation. Two-dimensional echocardiography with speckle tracking analysis was conducted to obtain RV time to peak systolic strain (PSST) as a comparison. The median contraction delay difference between RV middle free wall and septum measured by PET phase analysis (RVPDPET) was 20.12° (interquartile range, 4.99°-30.10°). The median difference of PSST between RV middle free wall and middle septal wall (RVPDEcho) measured by echocardiography was 43.98° (interquartile range, 6.25°-72.00°). RVPDPET was well correlated with RVPDEcho (r = 0.685, P < .001). RV phase standard deviation (RVSD) and histogram bandwidth (RVBW) derived from PET phase histogram were significantly correlated with cardiac index, RV ejection fraction, 6-minute walking distance, and serum N-terminal pro B-type natriuretic peptide (NT-proBNP) (RVSD: r = -0.532, P < .001; r = -0.551, P < .001; r = -0.544, P < .001; r = 0.404, P < .01; respectively, RVBW: r = -0.492, P < .001; r = -0.466, P < .001; r = -0.544, P < .001; r = 0.349, P = .01, respectively), while there were no significant correlations between RVSD and RVBW with hemodynamic parameters (right atrial pressure, right ventricular systolic pressure, right ventricular end-diastolic pressure, mean pulmonary artery pressure, and total pulmonary resistance). CONCLUSIONS Contraction delays between RV free wall and septum in PH measured by phase analysis and speckle tracking echocardiography were well correlated. RV dyssynchrony measured by phase analysis of FDG-PET was significantly related to RV dysfunction. Phase analysis of FDG-PET is feasible to evaluate RV mechanical dyssynchrony in patients of PH.
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Affiliation(s)
- Lei Wang
- Department of Nuclear Medicine, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, China
- Centre for Pharmacology and Therapeutics, Experimental Medicine, Imperial College London, London, United Kingdom
| | - Weihua Zhou
- School of Computing, University of Southern Mississippi, 730 East Beach Blvd, Long Beach, MS, 39560, USA.
| | - Yu Liang
- Department of Echocardiography, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Yong Yang
- Department of Nuclear Medicine, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, China
| | - Ernest V Garcia
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Ji Chen
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Wei Fang
- Department of Nuclear Medicine, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, China.
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Wang JJ, Zuo XR, Xu J, Zhou JY, Kong H, Zeng XN, Xie WP, Cao Q. Evaluation and Treatment of Endoplasmic Reticulum (ER) Stress in Right Ventricular Dysfunction during Monocrotaline-Induced Rat Pulmonary Arterial Hypertension. Cardiovasc Drugs Ther 2016; 30:587-598. [DOI: 10.1007/s10557-016-6702-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Mandras SA, Oleck S, Ventura HO. Pulmonary Arterial Hypertension and the Failing Ventricle: Getting It Right. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2015. [DOI: 10.15212/cvia.2015.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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