AIMS Cardiac resynchronization therapy (CRT) response is proportional to QRS duration (QRSd). We ... more AIMS Cardiac resynchronization therapy (CRT) response is proportional to QRS duration (QRSd). We hypothesize that this is, in part, due to slower conduction velocity and hence wider range of programmed device settings that produce adequate electrical wavefront fusion and resynchronization in wider QRSd patients. METHODS CRT patients (n = 122) with left ventricular (LV) conduction delay, sinus rhythm and intact atrioventricular node conduction were studied. Patients were categorized by QRSd: narrow (<120 ms; n = 20); moderate (120-150 ms, n = 37); and prolonged (≥150 ms; n = 65). Electrocardiographic data was acquired during native rhythm and LV-only pacing at varying atrioventricular delays (AVDs). Electrical synchrony was quantified as cardiac resynchronization index (CRI) using multi‑lead electrocardiographic systems and a proprietary algorithm that quantified wavefront fusion. A Gaussian distribution equation was fitted to CRI response. RESULTS Peak CRI was high (87.6 ± 6.3%) and similar (p = 0.716) across QRSd groups. The standard deviation of the Gaussian distribution significantly correlated with QRSd (R = 0.614, p < 0.001), and progressively and significantly (p < 0.001) increased as QRSd increased from narrow (34.8 ± 10.0 ms), to moderate (50.6 ± 8.4 ms), to prolonged (67.6 ± 18.3 ms). At AVDs 20 and 40 ms from optimal, CRI differed significantly (p < 0.001) between groups, with progressively higher CRI values as native QRSd increased. CONCLUSION Electrical resynchronization with optimally programmed LV-only pacing was similar between patients with varying QRSd, including patients with narrow QRSd. The resynchronization window that corresponded with optimal electrical resynchronization decreased as native QRSd decreased. This finding provides one potential explanation for the lack of significant benefit of CRT in narrow QRSd patients in previous studies.
BACKGROUND Left ventricular (LV) endocardial pacing is a promising method to deliver cardiac resy... more BACKGROUND Left ventricular (LV) endocardial pacing is a promising method to deliver cardiac resynchronization therapy (CRT). WiSE-CRT is a wireless LV endocardial pacing system, and delivers ultrasonic energy to an LV electrode. OBJECTIVE The purpose of this study was to present short-term outcomes with the WiSE-CRT system in centers with no prior implanting experience. METHODS Data were prospectively collected from 19 centers where WiSE-CRT systems were implanted during the roll-in phase of the SOLVE-CRT trial. Patients were followed at 1, 3, and 6 months, including transthoracic echo (TTE) at 6 months. RESULTS The WiSE-CRT was successfully implanted in all 31 attempted cases, and 30 patients completed the 6-month follow-up. One patient underwent heart transplantation 1 month after implantation, and was excluded. Fourteen (46.7%) patients demonstrated ≥1 NYHA class improvement. TTE data were available in 29 patients. LV ejection fraction, LV end-systolic volume, and LV end-diastolic volume improved from 28.3% ± 6.7% to 33.5% ± 6.9% (P < .001), 134.9 ± 51.3 mL to 111.1 ± 40.3 mL (P = .0004), and 185.4 ± 58.8 mL to 164.9 ± 50.6 mL (P = .0017), respectively. There were 3 (9.7%) device-related type 1 complications: 1 insufficient LV pacing, 1 embolization of an unanchored LV electrode, and 1 skin infection. CONCLUSIONS We demonstrated a high success rate of LV endocardial electrode placement in centers with no prior implanting experience. Favorable clinical responses in heart failure symptoms and significant LV reverse remodeling were noted.
Journal of the Minneapolis Heart Institute Foundation, 2019
Reducing readmission following heart failure is emerging as a target of quality initiatives in th... more Reducing readmission following heart failure is emerging as a target of quality initiatives in the Centers for Medicare & Medicaid Services Hospital Readmission Reduction Program. In response to higher readmission rates than desired following heart failure (HF) hospitalization, Allina Health hospital's cardiovascular subspecialty care developed an HF nurse care coordinator program to reduce readmissions. The nurse HF care coordinator serves as the bridge to help manage care following hospital discharge and ensure adherence to protocols developed by the HF management program. This effort was initially developed and implemented at Mercy and Unity Hospital and was associated with a 4.3% reduction in HF readmissions. Subsequent expansion of the HF nurse care coordinator program to United and Abbott Northwestern Hospitals was associated similar reductions in HF readmissions. Concurrently, all-cause mortality at 6 months post-discharge was also significantly lower following implementa...
The authors hypothesized that carvedilol controlled‐release plus lisinopril combination therapy (... more The authors hypothesized that carvedilol controlled‐release plus lisinopril combination therapy (C+L) would increase endothelial function and decrease oxidative stress to a greater extent than hydrochlorothiazide plus lisinopril combination therapy (H+L) in obese patients with hypertension. Twenty‐five abdominally obese patients (aged 54.4±7.3 years; 14 women) with hypertension/prehypertension were enrolled in a 7‐month (two 3‐month treatment periods separated by a 1‐month washout), randomized, double‐blind, controlled, crossover clinical trial comparing C+L vs H+L. Endothelial function, measured by digital reactive hyperemic index (RHI), circulating oxidized low‐density lipoprotein (oxLDL), 8‐isoprostane, and asymmetric dimethylarginine (ADMA) were obtained at baseline, post‐period 1, post‐washout, and post‐period 2. Analyses were adjusted for baseline measurements by analysis of covariance, with robust variance estimation for confidence intervals and P values. C+L treatment compar...
Introduction: Patients with right bundle branch block (RBBB) are controversial candidates for car... more Introduction: Patients with right bundle branch block (RBBB) are controversial candidates for cardiac resynchronization therapy (CRT). Systolic stretch index (SSI) is a novel marker developed by co...
Introduction: Primary predictors of cardiac resynchronization therapy (CRT) are based on conducti... more Introduction: Primary predictors of cardiac resynchronization therapy (CRT) are based on conduction system characteristics, such as QRS duration and morphology. The ability of MRI to predict CRT response is less understood. Methods: We studied 83 patients who received cardiac MRI with gadolinium delayed enhancement (DE) prior to CRT. Patients had preCRT EF ≤ 40%, preCRT QRS ≥ 120ms, and paired ~1 year postCRT echocardiograms. MRIs were read without knowledge of patient characteristics or CRT outcomes and echocardiograms were read in a core-lab blinded to MRI results. Results: Patients were classified as having no DE (n=27), only septal midwall DE (n=20), or scar / DE (transmural, subendocardial, or subepicardial) (n=36). Prior to CRT, those with septal midwall DE (25 ± 7) had lower EFs than those with scar / DE (31 ± 6, p=0<0.01), but not statistically different from those without DE (29 ± 6). Those without DE had better (p<0.001) EF (14.2 ± 10 units) and LVESV improvements (-42 ± 21%) following CRT than ...
AIMS Cardiac resynchronization therapy (CRT) response is proportional to QRS duration (QRSd). We ... more AIMS Cardiac resynchronization therapy (CRT) response is proportional to QRS duration (QRSd). We hypothesize that this is, in part, due to slower conduction velocity and hence wider range of programmed device settings that produce adequate electrical wavefront fusion and resynchronization in wider QRSd patients. METHODS CRT patients (n = 122) with left ventricular (LV) conduction delay, sinus rhythm and intact atrioventricular node conduction were studied. Patients were categorized by QRSd: narrow (<120 ms; n = 20); moderate (120-150 ms, n = 37); and prolonged (≥150 ms; n = 65). Electrocardiographic data was acquired during native rhythm and LV-only pacing at varying atrioventricular delays (AVDs). Electrical synchrony was quantified as cardiac resynchronization index (CRI) using multi‑lead electrocardiographic systems and a proprietary algorithm that quantified wavefront fusion. A Gaussian distribution equation was fitted to CRI response. RESULTS Peak CRI was high (87.6 ± 6.3%) and similar (p = 0.716) across QRSd groups. The standard deviation of the Gaussian distribution significantly correlated with QRSd (R = 0.614, p < 0.001), and progressively and significantly (p < 0.001) increased as QRSd increased from narrow (34.8 ± 10.0 ms), to moderate (50.6 ± 8.4 ms), to prolonged (67.6 ± 18.3 ms). At AVDs 20 and 40 ms from optimal, CRI differed significantly (p < 0.001) between groups, with progressively higher CRI values as native QRSd increased. CONCLUSION Electrical resynchronization with optimally programmed LV-only pacing was similar between patients with varying QRSd, including patients with narrow QRSd. The resynchronization window that corresponded with optimal electrical resynchronization decreased as native QRSd decreased. This finding provides one potential explanation for the lack of significant benefit of CRT in narrow QRSd patients in previous studies.
BACKGROUND Left ventricular (LV) endocardial pacing is a promising method to deliver cardiac resy... more BACKGROUND Left ventricular (LV) endocardial pacing is a promising method to deliver cardiac resynchronization therapy (CRT). WiSE-CRT is a wireless LV endocardial pacing system, and delivers ultrasonic energy to an LV electrode. OBJECTIVE The purpose of this study was to present short-term outcomes with the WiSE-CRT system in centers with no prior implanting experience. METHODS Data were prospectively collected from 19 centers where WiSE-CRT systems were implanted during the roll-in phase of the SOLVE-CRT trial. Patients were followed at 1, 3, and 6 months, including transthoracic echo (TTE) at 6 months. RESULTS The WiSE-CRT was successfully implanted in all 31 attempted cases, and 30 patients completed the 6-month follow-up. One patient underwent heart transplantation 1 month after implantation, and was excluded. Fourteen (46.7%) patients demonstrated ≥1 NYHA class improvement. TTE data were available in 29 patients. LV ejection fraction, LV end-systolic volume, and LV end-diastolic volume improved from 28.3% ± 6.7% to 33.5% ± 6.9% (P < .001), 134.9 ± 51.3 mL to 111.1 ± 40.3 mL (P = .0004), and 185.4 ± 58.8 mL to 164.9 ± 50.6 mL (P = .0017), respectively. There were 3 (9.7%) device-related type 1 complications: 1 insufficient LV pacing, 1 embolization of an unanchored LV electrode, and 1 skin infection. CONCLUSIONS We demonstrated a high success rate of LV endocardial electrode placement in centers with no prior implanting experience. Favorable clinical responses in heart failure symptoms and significant LV reverse remodeling were noted.
Journal of the Minneapolis Heart Institute Foundation, 2019
Reducing readmission following heart failure is emerging as a target of quality initiatives in th... more Reducing readmission following heart failure is emerging as a target of quality initiatives in the Centers for Medicare & Medicaid Services Hospital Readmission Reduction Program. In response to higher readmission rates than desired following heart failure (HF) hospitalization, Allina Health hospital's cardiovascular subspecialty care developed an HF nurse care coordinator program to reduce readmissions. The nurse HF care coordinator serves as the bridge to help manage care following hospital discharge and ensure adherence to protocols developed by the HF management program. This effort was initially developed and implemented at Mercy and Unity Hospital and was associated with a 4.3% reduction in HF readmissions. Subsequent expansion of the HF nurse care coordinator program to United and Abbott Northwestern Hospitals was associated similar reductions in HF readmissions. Concurrently, all-cause mortality at 6 months post-discharge was also significantly lower following implementa...
The authors hypothesized that carvedilol controlled‐release plus lisinopril combination therapy (... more The authors hypothesized that carvedilol controlled‐release plus lisinopril combination therapy (C+L) would increase endothelial function and decrease oxidative stress to a greater extent than hydrochlorothiazide plus lisinopril combination therapy (H+L) in obese patients with hypertension. Twenty‐five abdominally obese patients (aged 54.4±7.3 years; 14 women) with hypertension/prehypertension were enrolled in a 7‐month (two 3‐month treatment periods separated by a 1‐month washout), randomized, double‐blind, controlled, crossover clinical trial comparing C+L vs H+L. Endothelial function, measured by digital reactive hyperemic index (RHI), circulating oxidized low‐density lipoprotein (oxLDL), 8‐isoprostane, and asymmetric dimethylarginine (ADMA) were obtained at baseline, post‐period 1, post‐washout, and post‐period 2. Analyses were adjusted for baseline measurements by analysis of covariance, with robust variance estimation for confidence intervals and P values. C+L treatment compar...
Introduction: Patients with right bundle branch block (RBBB) are controversial candidates for car... more Introduction: Patients with right bundle branch block (RBBB) are controversial candidates for cardiac resynchronization therapy (CRT). Systolic stretch index (SSI) is a novel marker developed by co...
Introduction: Primary predictors of cardiac resynchronization therapy (CRT) are based on conducti... more Introduction: Primary predictors of cardiac resynchronization therapy (CRT) are based on conduction system characteristics, such as QRS duration and morphology. The ability of MRI to predict CRT response is less understood. Methods: We studied 83 patients who received cardiac MRI with gadolinium delayed enhancement (DE) prior to CRT. Patients had preCRT EF ≤ 40%, preCRT QRS ≥ 120ms, and paired ~1 year postCRT echocardiograms. MRIs were read without knowledge of patient characteristics or CRT outcomes and echocardiograms were read in a core-lab blinded to MRI results. Results: Patients were classified as having no DE (n=27), only septal midwall DE (n=20), or scar / DE (transmural, subendocardial, or subepicardial) (n=36). Prior to CRT, those with septal midwall DE (25 ± 7) had lower EFs than those with scar / DE (31 ± 6, p=0<0.01), but not statistically different from those without DE (29 ± 6). Those without DE had better (p<0.001) EF (14.2 ± 10 units) and LVESV improvements (-42 ± 21%) following CRT than ...
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