Additional benefit of exercise training in patients with cardiac resynchronization therapy
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Exercise therapy
Haemodynamic response
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Cardiac resynchronization therapy is a treatment modality developed in the early 2000s that targets the mechanical and electrical dyssynchrony in heart failure with reduced ejection fraction patients. Appropriate patient selection conditions specified in the guidelines include measurement of left ventricular systolic dysfunction, QRS width, and assessment of functional classification. Despite consistent and increasing evidence sup-porting the use of cardiac resynchronization therapy in eligible patients, proportion of patients with the device is still not at the desired level. In addition, studies conducted in recent years have shown that the cardiac resynchronization therapy response of patients is quite heterogeneous and in echocardiographic follow-up, it was observed that reverse remodeling was not at the supposed level in approximately one-third of the patients. In order to change this result, which is due to many reasons, solutions such as using assistive imaging methods, providing optimal patient selection, trying different pacing techniques and post-procedural programming strategies (AV-delay and VV-delay optimization) have been the subject of debate. In this article, we aim to review the mechanisms that have been revealed regarding the differences in cardiac resynchronization therapy response and new pacing techniques-especially conduction system pacing-that may be preferred to resolve poor cardiac resynchronization therapy response.
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What is heart failure? what causes heart failure? the public health problem of heart failure pathophysiology of the heart failure syndrome the symptoms and signs of heart failure investigation of the patient with heart failure treatment of heart failure - diuretics treatment for heart failure - ace inhibitors treatment of heart failure - digoxin management of heart failure - non-pharmacological therapy management of concomitant problems in patients with heart failure patients who do not respond to treatment preventions of heart failure.
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Congestive Heart Failure: Trends in Epidemiology and Therapy Heart Failure and Sudden Cardiac Death Resuscitation Issues in Patients with Severe Congestive Heart Failure Pulmonary Abnormalities in Congestive Heart Failure: A Therapeutic Opportunity? Exercise Gas Exchange in Heart Failure: A Brief Review Exercise Capacity and Prognosis in Congestive Heart Failure Assessment of Physical Activity in the Patient with Heart Failure Pharmacological Enhancement of the Exercise Performance of Patients with Heart Failure Evaluating Quality of Life in Congestive Heart Failure: Issues, Progress and Recommendations Social Support and Congestive Heart Failure Patients Depression in Heart Failure Patients Sexual Functioning in Congestive Heart Failure Patients Clinical Practice Guidelines for Outpatient Management of Patients with Left Ventricular Systolic Dysfunction
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Background— Recent studies have demonstrated that a positive response to cardiac resynchronization therapy (CRT) is related to the presence of preimplantation left ventricular (LV) dyssynchrony. The time course and the extent of LV resynchronization after CRT implantation and their relationship to response are currently unknown. Methods and Results— One hundred consecutive patients scheduled for implantation of a CRT device were prospectively included if they met the following criteria: New York Heart Association class III to IV, LV ejection fraction ≤35%, QRS duration >120 ms, and LV dyssynchrony (≥65 ms) on color-coded tissue Doppler imaging. Immediately after CRT implantation, LV dyssynchrony was reduced from 114±36 to 40±33 ms ( P <0.001), which persisted at the 6-month follow-up (35±31 ms; P <0.001 versus baseline; P =0.14 versus immediately after implantation). At the 6-month follow-up, 85% of patients were classified as responders to CRT (defined as >10% reduction in LV end-systolic volume). Immediately after implantation, the responders to CRT demonstrated a significant reduction in LV dyssynchrony from 115±37 to 32±23 ms ( P <0.001). The nonresponders, however, did not show a significant reduction in LV dyssynchrony (106±29 versus 79±44 ms; P =0.08). If the extent of acute LV resynchronization was <20%, response to CRT at the 6-month follow-up was never observed. Conversely, 93% of patients with LV resynchronization ≥20% responded to CRT. Conclusions— LV resynchronization after CRT is an acute phenomenon and predicts response to CRT at 6-month follow-up in patients with echocardiographic evidence of LV dyssynchrony at baseline.
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Objective To discuss the clinical effect of heart failure mixture in congestive heart failure.Methods Retrospective analysed clinical data of 30 cases patients with congestive heart failure accepted the treatment of heart failure mixture,and evaluated its efficacy.Results The original Western Medicine following the service on 21 cases of heart failure count not control,plus service with heart failure mixture,all effective;Nine cases with Western,the simple used of heart failure mixture,effective 7 cases,invalid 2 cases.Conclusion Heart failure mixture in congestive heart failure has significant clinical effect,without obvious adverse reaction.
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Although cardiac resynchronization therapy is currently used for treatment of refractory heart failure in patients with low ejection fraction and cardiac dyssynchrony, there is a substantial number of non-responders. This indicates that, in addition to cardiac dyssynchrony, there are other factors affecting response to cardiac resynchronization therapy. Pre-implant identification of these factors appears of crucial importance in order to finalize the resynchronization treatment to those patients who have the highest probability of a positive response. In this review the main non-dyssynchrony determinants of response to cardiac resynchronization therapy are presented and discussed.
Ventricular dyssynchrony
Refractory (planetary science)
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Abstract : The Armored Family of Vehicles (AFV) is a new major acquisition program to build the next generation of armored vehicles. The goals of the program are to build the vehicles with the greatest commonality of parts feasible, for cost reasons, and to take advantage of technology advances as needed to meet the mid-1990s threat. This report presents the methods used, the analyses performed, and the resulting conclusions that formulate a hands-on training concept for the AFV in the institution and in the unit. The training media considered were alternative forms of embedded training and stand-alone training devices. Keywords: Embedded training,
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