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Cardiac Resynchronization Therapy with or Without Defibrillation Capabilities | Bentham Science
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server.geod.in/que-se-puede-hacer-hoy-en-madrid.php These patients did not show clinical improvement after CRT implantation. The use of imaging methods to identify desynchronization has been validated; 16 however, its routine use as a support tool for the selection of patients for CRT remains a topic to be studied, such as the study of Henneman et al.
In the study by Henneman et al. Medical therapy decision-making should always focus on treatments that lead to changes in clinical outcomes, rather than just changes in imaging or laboratory tests. Thus, more than ventricular function improvement, the aim of this study was to select an ideal patient, who shows a reduction in morbidity and mortality after CRT.
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Recent studies have demonstrated that the phase analysis parameters are markers of adverse prognosis, as observed by Al Jaroudi et al. The subgroup of patients with end-stage renal disease was also extensively studied by Aggarwal et al. A relatively recent study by Zafrir et al. Our study did not have data on adverse clinical outcomes in the long term, but ventricular function improvement has been used in several situations, as a valuable surrogate outcome.
Studying clinical outcomes specifically in patients with HF, Al Jaroudi et al. More recently, Zafrir et al. Perhaps the study of these combined parameters can increase the sensitivity and specificity of the technique for CRT indication. In summary, the findings of the present study, together with the growing literature in the area, support that phase analysis by GSPECT is considered a clinically useful tool, to be used both in the assessment of patients in specific subgroups of high cardiovascular risk end-stage chronic renal failure, hypertensive patients, patients with ICDs and in the selection of patients with CRT indication.
The main study limitation was the small number of patients, which limited the statistical analysis. Despite the small sample size, statistical significance was observed in parameters that corroborate previous studies in the dyssynchrony area. Another study limitation was the absence of a control group with ventricular dysfunction without CRT.
From the ethical point of view, it is not possible to maintain patients with CRT indication as controls, considering the impact of this treatment on mortality and its broad indication recommended in several guidelines. The study of phase analysis by GSPECT was able to differentiate patients with isolated electrical dyssynchrony from those with associated mechanical dyssynchrony, through the intraventricular dyssynchrony parameters.
Technologic and Clinical Aspects
The cardiac resynchronization therapy is associated with the improvement of both the mechanical desynchronization improvement of desynchronization parameters through the phase analysis and electrical dyssynchrony QRS interval reduction at the electrocardiogram. Thus, because of the pre-implantation GSPECT assessment, it was possible to verify that patients with associated electrical and mechanical dyssynchrony showed better response to cardiac resynchronization therapy than those with isolated electrical dyssynchrony.
This article is part of the thesis of master submitted by Christiane Cigagna Wiefels, from Universidade Federal Fluminense. All the procedures in this study were in accordance with the Helsinki Declaration, updated in Informed consent was obtained from all participants included in the study.
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Cardiac resynchronization therapy: a meta-analysis of randomized controlled trials. The current role of cardiac resynchronization therapy in reducing mortality and hospitalization in heart failure patients: a meta-analysis from clinical trials. Heart Vessels. Eur Heart J. Congestive heart failure in Latin America: the next epidemic.