Osama Tayeh

Temporal Changes of Left Ventricular Synchronization Parameters and Outcomes of Cardiac Resynchronization Therapy

Background: Left ventricular dyssynchrony plays an important role in predicting response to cardiac resynchronization therapy (CRT). Methods: Thirty patients underwent CRT implantation. Assessment of left ventricular (LV) dyssynchrony was done through Gated SPECT LV phase analysis. Results: Thirty patients received CRT (mean age 58.7 ± 9.0, 24 males). CRT implantation had a favorable prognosis on cardiac functions (LVEF preimplantation: 26.8 ± 4.7% versus 29.1 ± 6.4% post‐implantation; P = 0.002). Reverse LV remodeling (≥15%) was documented in 19 patients. Temporal changes in LV dyssynchrony parameters were correlated to LV reverse remodeling. Applying ROC curve for LV phase analysis showed that a cutoff value of 152° for histogram bandwidth had a sensitivity of 72.7% and specificity of 63.2% for predicting CRT non‐response status. Also, a cutoff value of 54° for histogram standard deviation had a sensitivity of 81.8% and specificity of 63.2%. Conclusion: Responders of CRT showed improved LV dyssynchrony profiles. Utilizing Gated SPECT LV analysis could provide predictors for CRT non‐response. Reverse LV remodeling is associated with temporal improvements in LV dyssynchrony parameters.

Urinary albumin/creatinine ratio as an early predictor of outcome in critically-ill septic patients

&NA; Several cumbersome scoring systems were developed for prognosis and outcome prediction in sepsis. We intended in this study to evaluate the urinary albumin/creatinine ratio (ACR) as a prognostic predictor in sepsis. We included 40 adult septic patients in a prospective observational study. We excluded patients with preexisting chronic kidney disease or diabetes mellitus. After clinical evaluation, urine spot samples were collected on admission and 24 h later for ACR1 and ACR2. Admission APACHE IV score and the highest recorded SOFA score of their daily estimation were considered. We also evaluated the need for mechanical ventilation, inotropic and/or vasoactive support, renal replacement therapy (RRT), and in‐hospital mortality. In a population with 63 (55–71) year old with 29 (72.5%) males, we found that the ACR2 is correlated with the SOFA score (r = 0.4, P = 0.03). SOFA was higher in patients with increasing ACR [14(4.8–16.8) vs 5(3–8), P = 0.01]. None of the ACR measures was correlated with APACHE IV score. ACR2 was higher in patients who needed mechanical ventilation and inotropic and/or vasoactive support [140(125–207) and 151(127–218) mg/g respectively] compared to [65(47–174) and 74(54–162) mg/g], P = 0.01 and 0.009. None of the measured parameters was related to the need of RRT. ACR1, ACR2, APACHE IV and increasing ACR were predictors of mortality. The AUC for mortality prediction was largest for APACHE IV (0.90) then ACR2 (0.88). ACR2 of 110.5 mg/g was 100% sensitive and 86% specific to predict mortality. We concluded that the urinary ACR may be used as a simple test for prognosis and mortality prediction in sepsis.

Left ventricular scar impact on left ventricular synchronization parameters and outcomes of cardiac resynchronization therapy

BACKGROUND Left ventricular scar, including global scar and lateral wall, plays an important role in predicting response to cardiac resynchronization therapy (CRT). MATERIALS AND METHODS Thirty patients underwent CRT implantation. Assessment of left ventricular (LV) dyssynchrony was done through Gated SPECT LV phase analysis. Pre-implantation cardiac magnetic resonance (CMR) with late gadolinium enhancement technique to examine LV scar burden. Echocardiographic examination of LV end-systolic volume (LVES) prior to CRT and 6 months later. RESULTS Thirty patients received CRT (mean age 58.7±9.0, 24 males). Reverse LV remodeling (decline ≥15% from baseline VES) was documented in 19 patients. Temporal changes in LV dyssynchrony parameters were correlated to LV reverse remodeling. Applying ROC for predicting CRT non-response showed a cutoff 36.5% of global LV scar burden had a sensitivity of 81.8% and specificity of 68.4%. A cutoff for lateral wall scar burden 40.5% of whole lateral wall had a sensitivity of 72.7% and specificity of 68.4%. CONCLUSION Reverse LV remodeling is associated with temporal improvements in LV dyssynchrony parameters. LV scar had an unfavorable impact on CRT response. Both global and lateral wall scar burden could predict CRT nonresponse status.