The response to cardiac resynchronization therapy (CRT) is suboptimal in one-third of patients.The study aimed to evaluate the impact of sleep-disordered breathing (SDB) on the CRT-induced left ventricular (LV) reverse remodeling and response for CRT in patients with ischemic congestive heart failure (CHF).A total of 37 patients aged 65.43 years (SD 6.05), seven of whom were females, were treated with CRT according to class I European Society of Cardiology recommendations. Clinical evaluation, polysomnography, and contrast echocardiography were performed twice during the six-month follow-up (6M-FU) to assess the effect of CRT.In 33 patients (89.1%), sleep-disordered breathing (SDB), predominantly central sleep apnea (70.3%) was observed. This include nine patients (24.3%) with an apnea-hypopnea index (AHI) of >30 events/hour. During the 6M-FU, 16 patients (47.1%) responded to CRT by reducing LV end-systolic volume index (LVESVi) by ≥15%. We stated a directly proportional linear relationship between AHI value and LV volume: LVESVi p = 0.004, and LV end-diastolic volume index p = 0.006.Pre-existing severe SDB can impair the LV volumetric response to CRT even in an optimally selected group with class I indications for resynchronization, which may have an impact on long-term prognosis.
Electromechanical coupling in patients receiving cardiac resynchronization therapy (CRT) is not fully understood. Our aim was to determine the best combination of electrical and mechanical substrates associated with effective CRT.Sixty-two patients were prospectively enrolled from two centres. Patients underwent 12-lead electrocardiogram (ECG), cardiovascular magnetic resonance (CMR), echocardiography, and anatomo-electromechanical mapping (AEMM). Remodelling was measured as the end-systolic volume (ΔESV) decrease at 6 months. CRT was defined effective with ΔESV ≤ -15%. QRS duration (QRSd) was measured from ECG. Area strain was obtained from AEMM and used to derive systolic stretch index (SSI) and total left-ventricular mechanical time. Total left-ventricular activation time (TLVAT) and transeptal time (TST) were derived from AEMM and ECG. Scar was measured from CMR. Significant correlations were observed between ΔESV and TST [rho = 0.42; responder: 50 (20-58) vs. non-responder: 33 (8-44) ms], TLVAT [-0.68; 81 (73-97) vs. 112 (96-127) ms], scar [-0.27; 0.0 (0.0-1.2) vs. 8.7 (0.0-19.1)%], and SSI [0.41; 10.7 (7.1-16.8) vs. 4.2 (2.9-5.5)], but not QRSd [-0.13; 155 (140-176) vs. 167 (155-177) ms]. TLVAT and SSI were highly accurate in identifying CRT response [area under the curve (AUC) > 0.80], followed by scar (AUC > 0.70). Total left-ventricular activation time (odds ratio = 0.91), scar (0.94), and SSI (1.29) were independent factors associated with effective CRT. Subjects with SSI >7.9% and TLVAT <91 ms all responded to CRT with a median ΔESV ≈ -50%, while low SSI and prolonged TLVAT were more common in non-responders (ΔESV ≈ -5%).Electromechanical measurements are better associated with CRT response than conventional ECG variables. The absence of scar combined with high SSI and low TLVAT ensures effectiveness of CRT.
Abstract Background Right ventricular pacing (RVP) can be harmful and in a number of patients leads to deterioration of left ventricle function. The deleterious effect of RVP is particularly visible in patients with reduced ejection fraction. His bundle pacing (HBP) allows ventricular stimulation without electrical and mechanical dyssynchrony and should not be associated with deterioration of left ventricle function. In some patients HBP restores electrical and mechanical synchrony. Objective The aim of the study is to evaluate effect of HBP on left ventricle function in patient with reduced left ventricle ejection fraction (LVEF. Methods Twenty-one patients with indication for permanent pacing and with (LVEF) between 35 and 50% were included into the study. Age 71,9±10,44. Men 76,2%. 13 (61,9%) patients with permanent atrial fibrillation. In 33,3% of patients there were intraventricular conduction delay (IVCD), 3 (14,3%) with LBBB, 3 (14,3%) with RBBB and 1 (4,8%) with nonspecific IVCD. 6 patients were upgraded from previously implanted pacemaker. Mean QRS duration 133,6±37,85. Baseline ejection fraction (EF) 42,6±3,21%. Clinical and echocardiographic evaluation were performed at baseline and after 6–12 months of follow up. Results QRS duration narrowed from 133,6±37,85ms to 114,3±16,90ms (p=0,033) with HBP. HBP was associated with reduction of end systolic left ventricular volume (LVES) from 91,5±31,10ml to 75,9±38,56ml (p=0,0058). EF improved from 42,6±3,21% to 48,3±7,39% (p=0,0006). Improvement in EF in patients without myocardial infarction (MI) was better (42,6±3,23% to 49,5±8,04%, p=0,0053) than in patients with MI (42,6±3,37% to 47,0±6,79%, p=0,062). Increase in EF was also better in patients with atrial fibrillation (42,7±3,19% to 49,9±8,20%, p=0,0017) than int patients with sinus rhythm (42,4±3,46% to 45,6±5,28%, p=0,17). Functional capacity assessed by NYHA class improved significantly from 2,4±0,59 to 1,7±0,58. Ejection Fraction Conclusion His bundle pacing is associated with th significant clinical and echocardiographic improvement in patients with mildly reduced left ventricular ejection fraction and indication for permanent pacing. After 6–12 moths of HBP pacing the improvement in EF is greater in patients with atrial fibrillation and without myocardial infarction.
There is no research that evaluates the relationship between the severity of the symptoms of atrial fibrillation (AF), the presence of frailty syndrome and acceptance of the illness.The study included 132 patients aged 72.7 ± 6.73 with diagnosed AF. The severity of the symptoms of AF was determined according to European Heart Rhythm Association (EHRA) guidelines, frailty syndrome was assessed using the Tilburg frailty indicator (TFI) and the acceptance of the illness was assessed using the acceptance of illness scale (AIS). A standard statistical comparison and multiple regression analysis using the stepwise method were performed.In patients with AF, frailty was 5.31 ± 2.69 (TFI). Frailty syndrome was diagnosed in 59.8% of the AF patients who had a score of 7.17 ± 1.72. A higher level of EHRA score was connected with a smaller degree of the acceptance of the illness p = 0.0000. The multiple regression model indicated that age (p = 0.0009) and the severity of the symptoms (p = 0.0001) are important predictors of frailty syndrome.There is a relationship between the presence of frailty syndrome and the intensity of the symptoms and the acceptance of AF. Age and the EHRA score permitted higher levels of frailty syndrome to be predicted.
Patients with a history of COVID‑19 are characterized by a deteriorated level of cardiorespiratory fitness (CRF). The COVID‑19 rehabilitation program of the National Health Fund (NHF) was developed and financed by the public insurer in Poland to help convalescents return to full health.We aimed to evaluate the effectiveness of cardiopulmonary rehabilitation (CR) after COVID‑19, carried out under the NHF program.The study included 553 convalescents at a mean age of 63.5 years (SD, 10.26; 316 women [57.1%]), hospitalized at the Cardiac Rehabilitation Department of the Ustroń Health Resort, Poland, after a median of 23.10 weeks (interquartile range [IQR], 16.25-29.00) following COVID‑19. The mean duration of CR was 21 days (IQR, 21-28). The effectiveness of CR was assessed based on the improvement in spirometry and clinical parameters, as well as indicators of CRF and exercise tolerance.The mean baseline CRF level, as assessed by the 6‑minute walk test (6MWT), was reduced to 76.32% of the predicted value (SD, 15.87) in men and 85.83% of the predicted value (SD, 15.60) in women, while the mean values of the spirometry parameters were normal. During CR, there was an improvement in the median 6MWT distance by 42.5 m (95% CI, 37.50-45.00; P <0.001), and in the median exercise tolerance assessed on the Borg scale (fatigue, by -1 point; 95% CI, -1.0 to -1.0; P <0.001; dyspnea, by -1.5 points; 95% CI, -1.5 to -1.0; P <0.001). We observed a decrease in the mean resting blood pressure by 8.57 mm Hg (95% CI, -11.30 to -5.84; P <0.001) for systolic and by 3.38 mm Hg (95% CI, -4.53 to -2.23; P <0.001) for diastolic values. The most pronounced improvement was seen in the patients with low CRF level at baseline, who were eligible for lower‑intensity rehabilitation models. The CR effectiveness was not dependent on the severity of COVID‑19 or the time from the disease onset to the commencement of rehabilitation.CR is a safe and effective intervention that can accelerate recovery from COVID‑19, including an increase in exercise capacity and exercise tolerance.
