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ABSTRACT: This review aims at updating the results of cardiac resynchronization therapy (CRT) in mild heart failure patients, and investigating whether CRT can prevent or reverse heart failure progression in an earlier stage.
Randomized controlled trials of CRT in patients with New York Heart Association (NYHA) Class I or II heart failure were identified. The effects of CRT on worsening heart failure hospitalization, all-cause mortality, and overall adverse events were meta-analyzed, and the effects of CRT on left ventricular (LV) were systematically reviewed and meta-analyzed.
Eight studies were identified with a total of 4,302 patients. CRT was associated with a substantial improvement in LV end-systolic volume (WMD -39, 95%CI -41.56 to -36.45). CRT also had a marked effect in reducing new hospitalizations for worsening heart failure by 31% (RR 0.69, 95%CI 0.60 to 0.79). In addition, CRT significantly decreased all-cause mortality by 21% (RR 0.79, 95%CI 0.67 to 0.93). However, complications in patients with CRT increased by 74% (RR 1.74, 95%CI 1.44 to 2.11).
This meta-analysis suggests that CRT could improve the prognosis in patients with mild heart failure and ventricular dyssynchrony, but these improvements are accompanied by more adverse events. Since most patients in the included trials had received ICD therapy, our analysis suggests that CRT could offer an additional benefit.
Cardiovascular Drugs and Therapy 08/2011; 25(4):331-40. · 3.13 Impact Factor
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Zhiyu Zeng,
Chen Tan,
Siyong Teng,
Jianhong Chen,
Shaoyong Su,
Xiaoyang Zhou,
Fangzheng Wang,
Shu Zhang,
Dongfeng Gu,
Jonathan C Makielski,
Jielin Pu
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ABSTRACT: Recent studies suggest that genetic mutation of the slow delayed rectifier potassium channel (I(Ks)) may underlie atrial fibrillation (AF). We investigated the association between AF and the single nucleotide polymorphisms (SNPs) of genes KCNQ1, KCNE1 and KCNE4 associated with this channel. Common non-synonymous SNPs in KCNQ1 and KCNE1 known to be frequent in Asian people were selected and direct sequencing of KCNE4 was performed to identify possible SNPs. The AF group consisted of 142 hospitalized patients with AF, the community control group consisted of 120 subjects, and a ward control group consisted of 118 hospitalized patients without AF. Restriction fragment length polymorphism analysis was performed to determine the genotypes. The minor allele frequencies of P448R, R519H, G643S for KCNQ1 and G38S and D85N for KCNE1 in the AF group, the community control group and the ward control group were 9.9, 7.9, 9.3%; 0, 0, -; 4.3, 4.2, 1.7%; 28.4, 31.7, 29.7%; 0.7, 0.4%, -, respectively. There was no significant association between these SNPs and AF phenotype. There were eight SNPs in the whole length of KCNE4 plus 1,000 bases upstream of this gene including the non-synonymous SNP E145D. Logistical regression analysis revealed a difference in the distribution of KCNE4 E145D in the AF and the community control group (minor allele frequency was 34.0 versus 27.1% respectively, OR = 1.66, p = 0.044). We provided the frequencies of non-synonymous SNPs of KCNQ1 and KCNE1 in Chinese population; none of these SNPs was associated with AF. But KCNE4 E145D may be associated with the AF phenotype.
Cardiology 02/2007; 108(2):97-103. · 1.71 Impact Factor
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ABSTRACT: The effects of percutaneous transluminal septal myocardial ablation (PTSMA) with septal myectomy in patients with hypertrophic obstructive cardiomyopathy (HOCM) are not thoroughly compared.
Three articles comparing the effects of PTSMA and septal myectomy treatment for HOCM were identified from a search in Pubmed, and a meta analysis was conducted.
177 patients (86 underwent PTSMA and 91 underwent septal myectomy) were included. Interventricular septum thickness was decreased from 22.1 to 15.1 mm (p<0.05) in PTSMA group and from 22.0 to 13.9 mm (p<0.05) in septal myectomy group; left ventricular end-diastolic dimension was increased from 41.8 to 45.2 mm (p<0.05) in PTSMA group and from 41.8 to 43.9 mm (p<0.05) in septal myectomy group; NYHA class was improved from 3.17 to 1.47 (p<0.05) in PTSMA group and from 2.97 to 1.36 (p<0.05) in septal myectomy group; there were no differences in the two groups. However, left ventricular outflow tract gradient was decreased from 76.0 to 15.7 mm Hg (p<0.05) in PTSMA group and from 74.7 to 9.4 mm Hg (p<0.05) in septal myectomy group and the effect of septal myectomy was better than PTSMA (p<0.05).
The effects of septal myectomy treatment for HOCM are better with regard to relief of LVOT gradient, and lower risk of pacemaker requirement, compared to PTSMA. Large randomized clinical trials further comparing the two treatments are suggested.
International Journal of Cardiology 10/2006; 112(1):80-4. · 7.08 Impact Factor
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ABSTRACT: To explore the effect and the mechanism of felodipine on pulmonary hypertension.
Adult male Wistar rats were given a single dose of subcutaneous monocrotaline (MCT, 60 mg/kg) to induce the mold of pulmonary hypertension. Felodipine (5 mg/kg) was administered intraperitoneally every day for 4 weeks after MCT injection. The parameters of right ventricular systolic pressure were monitored. The levels of endothelin-like immunoreactivity (ir-ET) and calcitonin gene related peptide (CGRP) in the plasma and the heart and pulmonary tissues were measured by radioimmunoassay and colorimetric analysis. Right ventricular myocardial tissue was studied under electron microscope.
Continuous injection of felodipine significantly inhibited the progression of pulmonary artery pressure [(44.6 +/- 4.4) mm Hg versus (30.3 +/- 2.1) mm Hg, (18.7 +/- 2.2) mm Hg]. Histological examination revealed that felodipine effectively prevented pulmonary arterial medial thickening. Felodipine significantly increased the level of CGRP in plasma [(84 +/- 19) pg/ml versus 149 +/- 21) pg/ml], pulmonary homogenate [(22 +/- 4) pg/ml versus (29 +/- 3) pg/ml] and myocardial homogenate [(20.9 +/- 1.6) pg/ml versus 27.5 +/- 2.9) pg/ml]. There was no change in the level of ir-ET in the heart and pulmonary tissues. Myocardial damage in the right ventricle was less severe in the felodipine treated group.
Long-term use of felodipine was effective in preventing pulmonary hypertension induced by MCT. The underlying mechanism may be partly related to the increase of CGRP as well as the inhibition of Ca(2+) inflow. The results indicate that felodipine may be considered for clinical trials in the treatment of primary pulmonary hypertension.
Zhonghua jie he he hu xi za zhi = Zhonghua jiehe he huxi zazhi = Chinese journal of tuberculosis and respiratory diseases 09/2002; 25(8):461-4.
