English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools annual

Global: Zendy Free Plan

Global: Zendy Tools monthly

Global: Zendy Plus monthly

Up to 30-40% of patients undergoing cardiac resynchronization therapy (CRT) are described as nonresponders since the initial studies. This paradigm has inspired several modifi cations of the devices, electrodes and surgical technique in the implant. The defi nition of CRT response should be rethought, standardized, and ratings based on structural and/or clinical response should be proposed. The authors discuss a series of cases in which sustained clinical improvement was achieved despite structural worsening. Objective: To assess the profi le of clinical responders to CRT who have worsened structurally. Method: It is a retrospective cohort of patients in outpatient follow-up from January 2012 to March 2017. We included 13 patients (2.7%) out of a total of 476 submitted to CRT. Inclusion criteria were to present an improvement in functional class according to the New York Heart Association criteria (FC-NYHA) ≥ 1 sustained for at least one year and absence of improvement or worsening of the structural parameters evaluated by transthoracic echocardiogram [ejection fraction (EF), diastolic diameter (LVDD) and systolic diameter (LVSD)]. The variables analyzed were age, gender, FC-NYHA, cardiopathy, echocardiographic and electrocardiographic parameters, medications in use, location of implanted electrodes, device programming, cardiary defi brillator therapies, and mortality. Statistical analysis was performed using non-parametric Wilcoxon and McNemar tests. Results: There were 13 patients, 92% male, mean age 60.9 ± 9.2 years and mean follow-up of 3.3 ± 1.1 years, 76% of CRT associated with implantable cardioverter defi brillator (CRT-D). In pre-implantation, 84.6% were in FC-NYHA III and then 61.5% were in FC-NYHA I (p = 0.001). The mean pre-implantation EF was 31.3 ± 7.6% and 26.6 ± 7.3 (p = 0.002) in the last evaluation. The predominant heart disease was non-ischemic in 92.5%, most of which were chagasic cardiomyopathy (CCM) (66%). In the TRC-D group, no shock therapy was recorded in the period; there was one death in a patient with ischemic cardiomyopathy (IC) for the septic shock of pulmonary focus after 2.2 years of follow-up. The mean QRS was 189.9 ± 23.1 ms to 157.9 ± 35.2 after CRT (p = 0.032). There was no signifi cant change in pre-and postimplant medications during follow-up. Conclusion: The absence of structural improvement should not be considered therapeutic failure, since CRT seeks to modify the electrical activation, and may be related to better performance and decrease of symptoms, even in evolutionary heart diseases.

Cardiac Resynchronization Therapy: the Structural Response Is not Always Necessary