Predictors of long-term survival in Japanese patients with heart failure with reduced ejection fraction (HFrEF) treated with cardiac resynchronization therapy-defibrillators (CRT-D)

BACKGROUND

Reports on the factors predicting long-term survival of CRT-D cases from Western countries are increasing, however, those from Asia including Japan are still sparse. We aimed to clarify the factors predicting long-term survival of Japanese CRT-D cases.

METHODS

We retrospectively analyzed consecutive 133 patients who underwent CRT-D implantation between 2006 and 2021. We compared clinical factors between patients who died within 5 years after implantation (short-survival group: n = 31) and who had survived for more than 5 years (long-survival group: n = 36) after implantation.

RESULTS

Major underlying heart diseases were dilated cardiomyopathy (45%) and ischemic heart disease (12%). There was no difference between the short-survival group and the long-survival group in incidence of CLBBB (32% vs. 30%), whereas CRBBB was more common in the short-survival group (26% vs. 0%, p = .004). Mechanical dyssynchrony at implantation was more frequent in the long-survival group (48% vs. 78%, p = .02). The incidence of response to CRT at 1 year after implantation was higher in long-survival group (19% vs. 50%, p = .02). Multiple logistic regression analysis identified NYHA class, mechanical dyssynchrony at implantation, and response at one year as predictors of long-term survival.

CONCLUSIONS

In Japanese CRT-D cases, lower NHYA class, preexisting mechanical dyssynchrony, and 1-year response to CRT predict long-term survival.

Modulation of a motor evoked response to transcranial magnetic stimulation by the activity level of the first dorsal interosseous muscle in humans when grasping a stationary object with different grip widths

A relation between corticospinal excitability and background voluntary muscular activity was investigated at low and high transcranial magnetic stimulation (TMS) intensities while grasping a stationary object with different widths (2 and 8 cm) using a precision grip. The muscle activity was recorded from the first dorsal interosseous muscle. Regression analysis revealed that there was a linear relation between the motor evoked potential (MEP) and background muscular activity for both grip widths at each of the TMS intensities. At the low TMS intensity, the slope of the regression lines was similar for the 2 and 8 cm grip widths. It was, however, different when the TMS intensity was high. The results suggested that sensitivity modulation of bias level (input) facilitation occurred with wider grip width. The results of this study would reflect to quantitative aspects of the relation between the synaptic drive to the motoneuron pool and the resulting efferent activity characterized, i.e. input-output relations of the human corticospinal pathway dependent on the occasion demand.