Browsing by Author "Ventura, M"
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- Cardiac resynchronization therapy is effective even in elderly patients with comorbiditiesPublication . António, N; Lourenço, C; Teixeira, R; Saraiva, F; Coelho, L; Ventura, M; Cristovão, J; Elvas, L; Gonçalves, L; Providência, LAPURPOSE: The purpose of this study was to compare the effects of cardiac resynchronization therapy (CRT) in elderly patients (> or =65 years) with younger patients and to assess the impact of comorbidities in CRT remodeling response. METHODS: This is a prospective study of 87 consecutive patients scheduled for CRT who underwent clinical and echocardiographic evaluation before and 6 months after CRT. A reduction in left ventricular end-systolic volume (LVESV) > or =15% after CRT defined remodeling responders, and a reduction of at least one New York Heart Association class defined clinical responders. Multivariate analysis was used to identify independent predictors of non-response to CRT in terms of reverse remodeling. RESULTS: The mean age was 62 +/- 11 years, with 36 elderly patients (41%). The baseline QRS duration was 145 +/- 32 ms. After CRT, there were significant and similar improvements of left ventricular (LV) ejection fraction, LVESV, LV dP/dt, and mitral regurgitation jet area (JA) between elderly (> or =65 years) and younger (<65 years) patients. The number of clinical and remodeling responders was comparable, and we found no significant differences in unplanned cardiac hospitalizations at 6 months between groups. Independent predictors of lack of remodeling response to CRT were QRS duration <120 ms, LV diastolic diameter >74 mm, and JA >10 cm(2) before CRT, but not comorbidities. CONCLUSION: This work suggests that being elderly is not an impediment to CRT success even in the presence of comorbidities.
- Identification of 'super-responders' to cardiac resynchronization therapy: the importance of symptom duration and left ventricular geometryPublication . António, N; Teixeira, R; Coelho, L; Lourenço, C; Monteiro, P; Ventura, M; Cristovão, J; Elvas, L; Gonçalves, L; Providência, LAAIMS: Some patients show such an important clinical improvement and reverse remodelling after cardiac resynchronization therapy (CRT) that anatomy and function approach normal. These patients have been called 'super-responders'. The aim of our study was to identify predictors of becoming a super-responder after CRT. METHODS AND RESULTS: Eighty-seven consecutive patients who underwent CRT were prospectively studied. Before CRT and 6 months after, clinical and echocardiographic evaluation was performed. Patients with a decrease in New York Heart Association functional class >or=1, a two-fold or more increase of left ventricular ejection fraction (LVEF) or a final LVEF >45%, and a decrease in LV end-systolic volume >15% were classified as super-responders. There were 12% super-responders. At baseline, there were no significant differences between super-responders and the other patients, except for the fact that super-responders had significantly smaller mitral regurgitation and LV end-diastolic diameter (LVEDD) and a shorter duration of heart failure symptoms. Mitral regurgitation jet area, LVEDD, and duration of heart failure symptoms were correlated with this super-response. Moreover, an evolution of symptoms for <12 months was an independent predictor of super-response to CRT. CONCLUSION: Patients in earlier phases of the cardiomyopathy, with a less altered ventricular geometry, seem to have a greater probability of becoming super-responders.
- Pacing biventricular: experiência inicialPublication . Pires, R; Monteiro, P; Cristovão, J; Antunes, A; Ventura, M; Costa, M; Ermida, P; Providência, LAINTRODUCTION: Biventricular pacing has been studied for the treatment of chronic heart failure (CHF). This technique seems to be able to improve symptoms and exercise tolerance, in patients with advanced CHF and prolonged QRS duration. OBJECTIVE: To present our experience with biventricular pacing in the management of severe CHF. METHODS: Between June 2000 and March 2001, 8 patients with dilated cardiomyopathy and left bundle branch block (LBBB) were selected for transvenous biventricular pacing system implantation. Mean age: 54.12 +/- 16.8 years; 5 males. The etiology was: idiopathic in 6 cases; operated congenital heart disease in 1, and ischemic in the other. Despite tailored treatment of CHF (with all patients taking diuretics and angiotensin-converting enzyme inhibitors), 7 patients remained in NYHA class III and 1 in IV. The quality of life score (assessed by the "Minnesota living with heart failure questionnaire") was 62.25 +/- 11.29. Seven patients had sinus rhythm and only one chronic atrial fibrillation; mean PQ duration--220 +/- 76.37 ms; mean QRS duration--168.75 +/- 20.31 ms. RESULTS: Implant failure, due to coronary sinus dissection and to excessive fluoroscopy time, with no coronary sinus catheterization, occurred in 2 cases (success rate: 75%). Implant data: mean implant procedure duration: 122.5 +/- 47.82 min; mean fluoroscopy time: 35.66 +/- 22.06 min; QRS duration, after implant: 133.33 +/- 15.05 ms. Left ventricular lead final position: anterolateral in 2 patients and lateral in 4. Pacing thresholds: biventricular--1.36 +/- 0.6 V; right ventricle--0.28 +/- 0.04 V; right atrium--0.32 +/- 0.08 V. Pacing impedance (left ventricle): 1013.33 +/- 147.87 omega. Follow-up (1st and 3rd month): one patient died, suddenly, 15 days after the procedure. In the others, an improvement in the quality of life index and functional class was found. These results were independent of echocardiography data. There were no significant differences in the pacing threshold and impedance during the follow-up. CONCLUSIONS: Patients with advanced CHF and widened QRS benefited from biventricular stimulation, in which improvement on the clinical status was evident.