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cardiac rehabilitation and mid-term follow-up after transcatheter aortic valve implantation

Journal of Geriatric Cardiology 2014年第4期11卷 279-285页

作者： Renzo Zanettini Gemma Gatto Ileana Mori Maria Beatrice Pozzoni Stefano Pelenghi Luigi Martinelli Silvio Klugmann cardiac Rehabilitation centre Istituti Clinici di Perfezionamento Hospital via Bignami 1 20126 Milan Italy De Gasperis Cardiology and cardiac Surgery Department Niguarda Ca' Granda Hospital Piazza Ospedale Maggiore 3 20162 Milan Italy

Background Evaluation of patient outcomes following transcatheter aortic valve implantation （TAVI） has usually been based on survival and clinical improvement. Studies on quality of life are limited, and data from comprehensive assessments after the procedure are lacking. Methods Sixty patients referred for cardiac rehabilitation after TAVI underwent in-hospital and after-discharge multidimensional assessments to evaluate clinical, functional, and nutritional statuses, degree of autonomy, cognitive impairment, depression and quality of life. Results On admission to rehabilitation, approximately half of the patients had severe functional impairment and dependence for basic activities of daily living. During their hospital stay, one-third of the patients suffered significant clinical complications and two had to be transferred to the implantation center. Despite this, the overall outcome was very good. All of the remaining patients were clinically stable at discharge and functional status, autonomy and quality of life were improved in most. During a mean follow-up of 540 days （range： 192-738 days）, five patients died from noncardiac causes, three were hospitalized for cardiac events, and nine for non cardiac reasons. Functional status and autonomy remained satisfactory in the majority of patients and most continued to live independently. Conclusions Patients referred for rehabilitation after TAVI are often very frail, with a high grade of functional impairment, dependence on others and high risk of clinical complications. During a rehabilitation programme, based on a multidimensional assessment and intervention, most patients showed significant improvement in functional status, quality of life, and autonomy, which remained stable in the majority of subjects during mid-term follow-up.

关键词： cardiac rehabilitation Comprehensive assessment Follow-up Transcatheter aortic valve implantation

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Leadless cardiac Pacemaker: Does Anatomical Position at Implant Affect Long-Term Electrical Performance?

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Journal of Biomedical Science and Engineering 2017年第11期10卷 500-508页

作者： John Ip Abdul R. Safadi Randy Ip Matthew Gaskill Rajesh Banker Derek Exner Srinivas Dukkipati Mayer Rashtian Imran Niazi cardiac Electrophysiology Department Michigan State University Lansing USA cardiac Electrophysiology Department Premier Cardiology Inc Newport Beach USA cardiac Electrophysiology Department Foothills Medical Centre Calgary Canada cardiac Electrophysiology Department Mount Sinai Hospital New York USA cardiac Electrophysiology Department Huntington Memorial Hospital Pasadena USA cardiac Electrophysiology Department Aurora Medical Group Milwaukee USA

Background: The Nanostim {trade mark, serif} Leadless cardiac Pacemaker (LCP) has been shown to be safe and effective in human clinical trials. Since there is little information on the effect of implant location on LCP performance, the aim of this study was to determine whether anatomic position affects the long-term pacing performance of the LCP. Methods: Patients who enrolled in the Leadless II IDE Clinical Trial and had finished 6 months follow up (n = 479) were selected for the study. The implanting investigators determined the LCP final position under fluoroscope, which was categorized into three groups: RV apex (RVA, n = 174), RV apical septum (RVAS, n = 101), and RV septum (RVS, n = 204) (Figure 1). Data on capture threshold (at a 0.4 ms pulse width), R-wave amplitude and impedance were analyzed at implant, hospital discharge and 2 weeks, 6 weeks, 3 months and 6 months post-implant. Results: At implant, the mean capture thresholds in the RVA, RVAS and RVS were 0.77 ± 0.45, 0.81 ± 0.61 and 0.78 ± 0.59 volts, respectively. R-wave amplitudes were 8.0 ± 3.0 mV, 7.7 ± 2.9 mV and 7.6 ± 2.9 mV, respectively. Impedance values were 727 ± 311, 765 ± 333, and 677 ± 227 respectively. There were no differences among the 3 implant locations in capture threshold or R-wave amplitudes at 6 months (P > 0.06);however, all 3 performance parameters significantly improved over time (P < 0.001). Conclusions: The LCP implant location does not affect capture thresholds or R-wave amplitudes at 6 months, and there is little effect on impedance. Although implant location does not appear to be a predictor of electrical performance, additional long-term data will help guide optimal implant location.

关键词： Pacing Lead Location Leadless Pacing Lead Impedance Pacing Threshold R-Wave Amplitude

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An unusual cause of cyanosis after intra-extra cardiac Fontan procedure: anastomotic leakage between conduit and inferior vena cava

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World Journal of Pediatric Surgery 2023年第4期6卷 282-284页

作者： Jiajun Xu Weize Xu Jin Yu Shanshan Shi Qiang Shu Zhuo Shi Department of cardiac Intensive Care Unit(CICU) Children’s HospitalZhejiang University School of MedicineNational Clinical Research Center for Child HealthHangzhouZhejiangChina Department of cardiac Surgery Children’s HospitalZhejiang University School of MedicineNational Clinical Research Center for Child HealthHangzhouZhejiangChina Department of Ultrasound Diagnosis Children’s HospitalZhejiang University School of MedicineNational Clinical Research Center for Child HealthHangzhouZhejiangChina

A child aged 7 years was admitted to our hospital nearly 5 years after an intra-extra cardiac Fontan operation due to aggravated *** was diagnosed with pulmonary atresia(PA),atrial septal defect,patent ductus arteriosus(PDA)and thickened tricuspid valve with severe regurgitation 1 month after being born,which was considered PA with intact ventricular septum(IVS)with severely hypoplastic right ventricle and was similar to functional single ventricle.

关键词： admitted cardiac septal

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Device-based neuromodulation for cardiovascular diseases and patient’s age

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Journal of Geriatric Cardiology 2022年第11期19卷 876-893页

作者： Evgeny N Mikhaylov Nigar Z Gasimova Natalia N Belyaeva Heber Ivan Condori Leandro Aleksandr D Vakhrushev Evgeny V Shlyakhto Almazov National Medical research centre Saint-PetersburgRussia

The autonomic nervous system plays an important role in the pathogenesis of cardiovascular *** aging,autonomic activity changes,and this impacts the physiological reactions to internal and external *** sympathetic and parasympathetic responses seem to decline,reflecting functional and structural changes in nervous *** some investigators suggested that both the sympathetic and parasympathetic activities were suppressed,others found that only the parasympathetic activity was suppressed while the sympathetic activity *** addition,cardiac innervation progressively diminishes with ***,one may suggest that neuromodulation interventions may have different effects,and older age groups can express an attenuated *** article aims to discuss the effect of device-based neuromodulation in different cardiovascular diseases,depending on the patient’s ***,we cover renal denervation,pulmonary artery denervation,baroreceptor activation therapy,vagus nerve stimulation,spinal cord stimulation,ganglionated plexi ablation for the management of arterial and pulmonary hypertension,heart failure,angina and *** results of many clinical studies appeared to be *** view of the low rate of positive findings in clinical studies incorporating neuromodulation approaches,we suggest the underestimation of advanced age as a potential contributing factor to poorer *** of outcomes between different age groups in clinical trials may shed more light on the true effects of neuromodulation when neutral/ambiguous results are obtained.

关键词： stimulation cardiovascular diseases

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Incidence and peri-operative risk factors for development of acute kidney injury in patients after cardiac surgery:A prospective observational study

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World Journal of Clinical Cases 2023年第16期11卷 3791-3801页

作者： Stavros Dimopoulos Georgios Zagkotsis Charalambia Kinti Niki Rouvali Magda Georgopoulou Mariantzela Mavraki Androniki Tasouli Efterpi Lyberopoulou Antonios Roussakis Ioannis Vasileiadis Serafim Nanas Andreas Karabinis Department of cardiac Surgery Intensive Care Unit Onassis Cardiac Surgery CenterAthens 17674Greece Department of Clinical Ergospirometry Exercise and Rehabilitation LaboratoryNational and Kapodistrian University of AthensAthens 10676Greece

BACKGROUND Patients admitted to intensive care unit(ICU) after cardiac surgery develop acute kidney injury(AKI) immediately post-operation. We hypothesized that AKI occurs mainly due to perioperative risk factors and may affect *** To assess peri-operative risk factors for AKI post cardiac surgery and its relationship with clinical *** This was an observational single center, tertiary care setting study, which enrolled 206 consecutive patients, admitted to ICU after cardiac surgery. Patients were followed-up until ICU discharge or death, in order to determine the incidence of AKI, perioperative risk factors for AKI and its association with *** and multivariate logistic regression analysis was performed to assess predictor variables for AKI *** After ICU admission, 55 patients(26.7%) developed AKI within 48 h. From the logistic regression analysis performed, high EuroScore Ⅱ(OR: 1.18;95%CI: 1.06-1.31, P = 0.003), white blood cells(WBC) pre-operatively(OR: 1.0;95%CI: 1.0-1.0, P = 0.002) and history of chronic kidney disease(OR: 2.82;95%CI: 1.195-6.65, P = 0.018) emerged as independent predictors of AKI among univariate predictors. AKI that developed AKI had longer duration of mechanical ventilation [1113(777–2195) vs 714(511–1020) min, P = 0.0001] and ICU length of stay [70(28–129) vs 26(21–51) h, P = 0.0001], higher rate of ICU-acquired weakness(16.4% vs 5.3%, P =0.015), reintubation(10.9% vs 1.3%, P = 0.005), dialysis(7% vs 0%, P = 0.005), delirium(36.4% vs 23.8%, P = 0.001) and mortality(3.6% vs 0.7%, P = 0.046).CONCLUSION Patients present frequently with AKI after cardiac surgery. EuroScore Ⅱ, WBC count and chronic kidney disease are independent predictors of AKI development. The occurrence of AKI is associated with poor outcome.

关键词： Acute kidney injury Renal failure cardiac surgery Predisposing factors Prognosis Outcome

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The Temporal Relation between Cardiomyopathy and LBBB and Response to cardiac Resynchronization Therapy:Case Series and Literature Review

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Cardiovascular Innovations and Applications 2020年第1期4卷 163-172页

作者： Sanshuai Chang Yi He Hui Wang Fei Guo Qiang Lv Junping Kang Rong Bai Xiaohui Liu Xin Du Changsheng Ma Jianzeng Dong Department of Cardiology Beijing AnZhen HospitalCapital Medical UniversityNational Clinical Research Centre for Cardiovascular DiseasesBeijingChina Department of Radiology Beijing AnZhen HospitalCapital Medical UniversityNational Clinical Research Centre for Cardiovascular DiseasesBeijingChina

Background:Left bundle branch block(LBBB)-induced cardiomyopathy has been proposed,but the association between LBBB and cardiac resynchronization therapy(CRT)response remains unclear and practical criteria for selecting CRT candidates are ***:One hundred and seventeen consecutive heart failure patients were reviewed,24 of whom received *** two patients had a clear temporal relation between cardiomyopathy and ***:Compared with the patient with“cardiomyopathy-induced LBBB,”the patient with“LBBB-induced cardiomyopathy”had higher left ventricular(LV)wall thickness,higher LV wall thickening rate,higher peak circumferential strain,and longer peak circumferential strain *** LV deformation patterns in the two patients were obviously distinct on cardiovascular magnetic resonance tissue *** follow-up,the patient with LBBB-induced cardiomyopathy had a good response to CRT(LV ejection fraction 23 before CRT vs.30%at 6 months vs.29 at 12 months vs.32%at 18 months;LV end-diastolic diameter 77 mm before CRT vs.66 mm at 6 months vs.62 mm at 12 months vs.63 mm at 18 months),and the other patient had no response to CRT(LV ejection fraction 29 before CRT vs.29%at 6 months vs.26 at 12 months vs.22%at 24 months;LV end-diastolic diameter 85 mm before CRT vs.88 mm at 6 months vs.85 mm at 12 months vs.84 mm at 24 months).Conclusion:The temporal relation between cardiomyopathy and LBBB could be a determinant for CRT *** magnetic resonance tissue tracking may be a useful tool to identify the chronological order and a principal consideration for selecting candidates for *** prospective clinical trials are needed to study the prevalence of,time course of,and risk factors for LBBB-induced cardiomyopathy.

关键词： left bundle branch block cardiomyopathy heart failure cardiovascular magnetic resonance cardiac resynchronization therapy

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Clinical analysis of 14 infective endocarditis in patients with obstructive hypertrophic cardiomyopathy

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China Medical Abstracts(Internal Medicine) 2021年第1期38卷 29-30页

作者： WANG PENG cardiac arrhythmia Center Fuwai HospPUMC&CAMSBeijing 100037

Objective To analyze the clinical characteristics of infective endocarditis(IE)in patients with hypertrophic cardiomyopathy(HCM).Methods A total of 668 patients with IE,and 7427 patients with HCM were treated in Fuwai... 详细信息

关键词： patients cardiomyopathy infective

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Tissue Engineering to Restore cardiac Function

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Engineering 2022年第6期8卷 13-17页

作者： Richard D.Weisel Toronto General research Institute Toronto General HospitalUniversity Health Network&Department of SurgeryDivision of Cardiac SurgeryUniversity of TorontoTorontoON M5G 2C4Canada

1. Introduction The purpose of cardiac surgery is to restore the injured heart to full function. For many congenital cardiac defects, appropriate repair is able to establish nearly normal cardiac function. One example of such repair is closing abnormal holes between cardiac chambers in young children, which usually restores normal function that persists for the lifetime of the child. However, the advent of surgery for ischemic heart disease has resulted in new challenges for cardiac surgeons.

关键词： function surgery lifetime

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Risk factors for sudden cardiac death to determine high risk patients in specific patient populations that may benefit from a wearable defibrillator

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World Journal of Cardiology 2019年第3期11卷 103-119页

作者： Hilal Mohammed Khan Stephen J Leslie cardiac Unit Raigmore Hospital Department of Diabetes and Cardiovascular Science University of the Highlands and Islands The Centre for Health Science

BACKGROUND There is a high risk for sudden cardiac death(SCD) in certain patient groups that would not meet criteria for implantable cardioverter defibrillator(ICD) *** conditions such as hypertrophic cardiomyopathy(HCM) there are clear risk scores that help define patients who are high risk for SCD and would benefit from ICD therapy. There are however many areas of uncertainty such as certain patients post myocardial infarction(MI). These patients are high risk for SCD but there is no clear tool for risk stratifying such *** To assess risk factors for sudden cardiac death in major cardiac disorders and to help select patients who might benefit from Wearable cardiac defibrillators(WCD).METHODS A literature search was performed looking for risk factors for SCD in patients post-MI, patients with left ventricular systolic dysfunction(LVSD), HCM, long QT syndrome(LQTS). There were 41 studies included and risk factors and the relative risks for SCD were compiled in table *** We extracted data on relative risk for SCD of specific variables such as age,gender, ejection fraction. The greatest risk factors for SCD in post MI patients was the presence of diabetes [Hazard ratio(HR) 1.90-3.80], in patient with LVSD was ventricular tachycardia(Relative risk 3.50), in LQTS was a prolonged QTc(HR36.53) and in patients with HCM was LVH greater than 20 mm(HR 3.10). A proportion of patients currently not suitable for ICD might benefit from a WCDCONCLUSION There is a very high risk of SCD post MI, in patients with LVSD, HCM and LQTS even in those who do not meet criteria for ICD implantation. These patients may be candidates for a WCD. The development of more sensitive risk calculators to predict SCD is necessary in these patients to help guide treatment.

关键词： Sudden cardiac death Wearable cardiac defibrillators Myocardial infarction Hypertrophic cardiomyopathy Left ventricular systolic dysfunction

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Vectorcardiographic QRS area as a predictor of response to cardiac resynchronization therapy

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Journal of Geriatric Cardiology 2022年第1期19卷 9-20页

作者： Mohammed A Ghossein Antonius MW van Stipdonk Frits W Prinzen Kevin Vernooy Department of Physiology Cardiovascular Research Institute Maastricht(CARIM)Maastricht UniversityMaastrichtThe Netherlands Department of Cardiology Cardiovascular Research Institute Maastricht(CARIM)Maastricht University Medical CenterMaastrichtThe Netherlands Department of Cardiology Radboud University Medical CentreNijmegenThe Netherlands

cardiac resynchronization therapy(CRT)is a good treatment for heart failure accompanied by ventricular conduction *** ECG criteria in international guidelines seem to be suboptimal to select heart failure patients for *** criteria QRS duration and left bundle branch block(LBBB)QRS morphology insufficiently detect left ventricular activation delay,which is required for benefit from ***,there are various definitions for LBBB,in which each one has a different association with CRT benefit and is prone to subjective *** studies have shown that the objectively measured vectorcardiographic QRS area identifies left ventricular activation delay with higher accuracy than any of the current ECG ***,various studies have consistently shown that a high QRS area prior to CRT predicts both echocardiographic and clinical improvement after *** beneficial relation of QRS area with CRT-outcome was largely independent from QRS morphology,QRS duration,and patient characteristics known to affect CRT-outcome including ischemic etiology and *** top of QRS area prior to CRT,the reduction in QRS area after CRT further improves *** area is easily obtainable from a standard 12-lead ECG though it currently requires off-line *** applicability will be significantly improved when QRS area is automatically determined by ECG equipment.

关键词： ventricular synchronization conduction

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