Scientific letter
Cardiac resynchronization therapy: 6 year experience of a comprehensive follow-up protocol
Terapia de resincronización cardíaca: experiencia de seis años con un protocolo de seguimiento integral
A.O. Luque-Lezcano
, J.M. Porres-Aracama, F. García-Urra, V. Urbistondo-Ayestaran, R. García-Martín, P. Marco-Garde
Corresponding author
Servicio de Medicina Intensiva, Hospital Donostia, Unidad de Arritmias, Hospital Donostia, Donostia, Spain
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Blancas, B. López-Matamala, Ó. Martínez-González, D. Ballesteros-Ortega" "autores" => array:4 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Blancas" ] 1 => array:2 [ "nombre" => "B." "apellidos" => "López-Matamala" ] 2 => array:2 [ "nombre" => "Ó." "apellidos" => "Martínez-González" ] 3 => array:2 [ "nombre" => "D." 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The CNS receives information from the periphery via three pathways: humoral, neural and cellular. (1) The recruitment of monocytes or macrophages in the lung increases the levels of inflammatory mediators (IL-6, TNFα, IL-1β), which are able to directly reach the CNS via the humoral pathway through the circumventricular organs (CVOs), without having to cross the blood–brain barrier (BBB). Other active transport mechanisms also intervene, leading to the release of PGE<span class="elsevierStyleInf">2</span> and nitric oxide (NO) at brain level. (2) The vagus nerve afferents reach the brain through the nucleus of the solitary tract (NST). (3) The cellular pathway is directly regulated by the release of TNFα in the lung, which in turn stimulates the release of MCP-1 in the brain. This can enhance the recruitment of activated monocytes both in the CNS and at peripheral level.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. López-Aguilar, M.S. Fernández-Gonzalo, M. Turon, M.E. Quílez, V. Gómez-Simón, M.M. Jódar, L. Blanch" "autores" => array:8 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "López-Aguilar" ] 1 => array:2 [ "nombre" => "M.S." "apellidos" => "Fernández-Gonzalo" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Turon" ] 3 => array:2 [ "nombre" => "M.E." "apellidos" => "Quílez" ] 4 => array:2 [ "nombre" => "V." "apellidos" => "Gómez-Simón" ] 5 => array:2 [ "nombre" => "M.M." "apellidos" => "Jódar" ] 6 => array:2 [ "nombre" => "L." "apellidos" => "Blanch" ] 7 => array:1 [ "colaborador" => "GT-IRA de la SEMICYUC" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210569112003142" "doi" => "10.1016/j.medin.2012.10.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569112003142?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572713000854?idApp=WMIE" "url" => "/21735727/0000003700000007/v1_201311290205/S2173572713000854/v1_201311290205/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Cardiac resynchronization therapy: 6 year experience of a comprehensive follow-up protocol" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "497" "paginaFinal" => "498" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A.O. Luque-Lezcano, J.M. Porres-Aracama, F. García-Urra, V. Urbistondo-Ayestaran, R. García-Martín, P. Marco-Garde" "autores" => array:6 [ 0 => array:4 [ "nombre" => "A.O." "apellidos" => "Luque-Lezcano" "email" => array:1 [ 0 => "oskar.luke@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "J.M." "apellidos" => "Porres-Aracama" ] 2 => array:2 [ "nombre" => "F." "apellidos" => "García-Urra" ] 3 => array:2 [ "nombre" => "V." "apellidos" => "Urbistondo-Ayestaran" ] 4 => array:2 [ "nombre" => "R." "apellidos" => "García-Martín" ] 5 => array:2 [ "nombre" => "P." "apellidos" => "Marco-Garde" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Medicina Intensiva, Hospital Donostia, Unidad de Arritmias, Hospital Donostia, Donostia, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Terapia de resincronización cardíaca: experiencia de seis años con un protocolo de seguimiento integral" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 997 "Ancho" => 1453 "Tamanyo" => 119930 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The proportion of patients who improved along the first year after device implantation. EF better: more than 5% increase measured; QRS width, LVPEI, SPWMD better: more than 10<span class="elsevierStyleHsp" style=""></span>ms decrease measured; LVEDD better: more than 5<span class="elsevierStyleHsp" style=""></span>mm decrease measured. All measures expressed in percentage of patients.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Cardiac resynchronization therapy is a worldwide accepted technique to improve quality of life and reduce mortality in selected patients with congestive heart failure and reduced EF. Guidelines carefully define the patients for whom this technique is most likely to succeed.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> After many trials published we can say that a patient in NYHA class III, in sinus rhythm, left bundle branch block (LBBB), EF<span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>35%, QRS width<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>120<span class="elsevierStyleHsp" style=""></span>ms, with optimal medical therapy and non-ischemic cardiomyopathy will be an ideal case for CRT. However, some other groups of patients are also beneficiaries of the technique: ischemic cardiomyopathy, atrial fibrillation patients (AV node ablation required) (according to 2012 European Society of Cardiology Guidelines is indication IIb), NYHA class II and wide QRS with right bundle branch block.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> From the launching of CRT the technique has shown a significant proportion of non responders as high as 30%. To overcome this burden many echocardiography techniques have been proposed as predictors of CRT response. None of them were able to discriminate adequately responders from non-responders.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Nevertheless echocardiography is paradoxically the cornerstone on which most studies rely to assess the improvement in heart failure symptoms. We provide a comprehensive follow-up protocol in order to supply a faster and convenient office review of CRT device carrier patients.</p><p id="par0015" class="elsevierStylePara elsevierViewall">From March 1, 2006 until March 23, 2012 a total of 154 patients were implanted with a CRT device in our unit and entered into the follow-up protocol. Patient variables are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. Once the referral paper of a patient with a brief medical history was received in our unit the patient was scheduled for the first medical visit in the arrhythmia-CRT office.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">In the first office visit the patient was carefully assessed to establish NYHA class, etiology of the cardiomyopathy and co-morbidities as age, renal failure and peripheral arterial disease. Medical treatment was also registered. Electrocardiogram and echocardiography were performed. Although echocardiographic techniques are not included in CRT Guidelines, exception made for LVEF, atrioventricular (AV), interventricular and intraventricular dyssynchrony were fully determined (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> These data are of major importance in order to adjust AV and VV pacing intervals in the follow-up visits.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">After assessment patients were informed about the necessity or not of implanting a CRT device. In most of the cases the patients met Guidelines criteria for CRT. They were instructed about the technique in order to gain confidence and facilitate comprehension of what they would go through. This reassured patients and made them decide more accurately. Information about non-responders and the characteristics of the ideal candidate were also given. After informed consent was signed the patient was scheduled for intervention.</p><p id="par0030" class="elsevierStylePara elsevierViewall">After device implantation on Fridays the patients stay for the week-end. On Saturday a chest X ray exploration and laboratory analysis are performed. The patients are permitted to get out of bed and walk in the hospital ward. On Monday, after routine device exam the patient is discharged home. They take the medical report and the date for the next medical visit within 3 months. On the first year after CRT, patients are assessed 3 times. In every one of these visits a 12-lead EKG, device exam and echocardiography are performed. We also register a clinical evaluation based on NYHA class. The echocardiographic measures and clinical evaluation give us important information to adjust the device parameters like VV and AV intervals. All the information is available for the clinical cardiologist in order to adjust medical treatment to his best knowledge. A schematic view of the protocol is displayed in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>.</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The proportion of patients who improved along the first year after device implantation are presented in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>. Six variables are displayed, EF, NYHA, QRS width, LVPEI, SPWMD and LVEDD. Although the proportion of patients who improved varies from 40%(LVEDD) to 80% (SPWMD) approximately, one sample <span class="elsevierStyleItalic">t</span>-test was used to compare basal and final results of the variables measured. The improvement measured in each one of the variables showed statistical significance (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.0001). These results are consistent with global literature on the outcome of CRT patients.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">The satisfaction level of the patients was not assessed by any questionnaire. We cannot offer objective data in that particular issue. What we know is that patients stay 30–45<span class="elsevierStyleHsp" style=""></span>min with the doctor in every CRT follow-up visit and that is much more of what they have ever spent in any other medical visit. That makes them feel well cared during the first year after resynchronization. Furthermore they do not need to arrange more than one medical visit for the follow-up of their device.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The implementation of this protocol was not intended to improve the proportion of responders to CRT therapy nor to enhance their clinical outcome. The aim of the protocol was showing how one physician in one office can examine the device, analyze the ECG and display echocardiographic techniques for comprehensive assessing of a CRT patient. The results are consistent with other series published.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The obvious limitation for this work is the lack of a control group with standard follow-up. Also, the satisfaction of patients was not assessed by a normalized questionnaire. Anyway, we wanted to point out the necessity of implementing innovative protocols in order to streamline the limited resources currently available in Europe. A vast proportion of our efforts must go in the direction of making medicine practice more efficient for Health Services while maintaining average level clinical results.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2012-08-23" "fechaAceptado" => "2012-10-18" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Luque-Lezcano AO, et al. Cardiac resynchronization therapy: 6 year experience of a comprehensive follow-up protocol. Med Intensiva. 2012. <span class="elsevierStyleInterRef" id="intr0005" href="doi:10.1016/j.medin.2012.10.004">http://dx.doi.org/10.1016/j.medin.2012.10.004</span></p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 997 "Ancho" => 1453 "Tamanyo" => 119930 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The proportion of patients who improved along the first year after device implantation. EF better: more than 5% increase measured; QRS width, LVPEI, SPWMD better: more than 10<span class="elsevierStyleHsp" style=""></span>ms decrease measured; LVEDD better: more than 5<span class="elsevierStyleHsp" style=""></span>mm decrease measured. All measures expressed in percentage of patients.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">NYHA: New York Heart Association functional class; LVEF: left ventricle ejection fraction; LVTDD: left ventricle end diastolic diameter; SPWMD: septal-to-posterior wall motion delay; LVPEI: left ventricle pre-ejection interval. QRS, LVEDD, SPWMD, LVPEI expressed as mean values.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Patients</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">154 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Age (mean)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">68 years \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">NYHA (mean: 2.95)</span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">87 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">LVEF (mean: 27.15)</span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>≤20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>≤25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>≤30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>≤35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>>35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">QRS width</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">156.95<span class="elsevierStyleHsp" style=""></span>ms \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">LVEDD</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65.84<span class="elsevierStyleHsp" style=""></span>mm \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">SPWMD</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">151.95<span class="elsevierStyleHsp" style=""></span>ms \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">LVPEI</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">171.35<span class="elsevierStyleHsp" style=""></span>ms \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Isquemic cardiomiopathy</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70 (45.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Primary prevention</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">127 (82.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab431144.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Clinical and echocardiographic variables of patients.</p>" ] ] 2 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">PWPSD: posterior wall post-systolic displacement as the difference of intervals from QRS onset to maximal systolic displacement of the LV posterior wall and from QRS onset to the beginning of E wave velocity; IVMD: interventricular mechanical delay as the difference of LVPEI and RVPEI (left and right ventricular pre-ejection interval); PSS: TDI post systolic shortening of left ventricle segments. LVDF: relation between mitral inflow pattern and heart cycle length.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LVEF \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LVEDD (>55<span class="elsevierStyleHsp" style=""></span>mm) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SPWMD (>130<span class="elsevierStyleHsp" style=""></span>ms) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PWPSD \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LVPEI (>140<span class="elsevierStyleHsp" style=""></span>ms) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IVMD (LVPEI-RVPEI) (>40<span class="elsevierStyleHsp" style=""></span>ms) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TDI Septal-to-lateral delay (>50<span class="elsevierStyleHsp" style=""></span>ms) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PSS (>50<span class="elsevierStyleHsp" style=""></span>ms) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LVDF (<40%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab431145.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Echocardiographic measures.</p>" ] ] 3 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">First visit \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">2–3 month follow up \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">6–8 month follow up \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">11–13 month follow up \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Clinical assessment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Echocardiography assessment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ECG \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ICD interrogation and re-programming if necessary \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Informed consent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab431143.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A schematic view of the protocol.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Developed with the special contribution of the Heart Failure Association and the European Heart Rhythm Association" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "2010 Focused update of ESC guidelines on device therapy in heart failure. An update of the 2008 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure and the 2007 ESC guidelines for cardiac and resynchronization therapy" "etal" => true "autores" => array:6 [ 0 => "K. Dickstein" 1 => "P.E. Vardas" 2 => "A. Auricchio" 3 => "J.C. Daubert" 4 => "C. Linde" 5 => "J. McMurray" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurjhf/hfq192" "Revista" => array:6 [ "tituloSerie" => "Eur J Heart Fail" "fecha" => "2010" "volumen" => "12" "paginaInicial" => "1143" "paginaFinal" => "1153" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20965877" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reduction in the risk of heart failure events" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.J. Moss" 1 => "D.S. Cannom" 2 => "M.W. Brown" 3 => "H. Klein" 4 => "M.W. Brown" 5 => "J.P. Daubert" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa0906431" "Revista" => array:6 [ "tituloSerie" => "NEJM" "fecha" => "2009" "volumen" => "361" "paginaInicial" => "1329" "paginaFinal" => "1338" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19723701" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Significance of QRS morphology in determining the prevalence of mechanical dyssynchrony in heart failure patients eligible for cardiac resynchronization: particular focus on patients with right bundle branch block with and without coexistent left-sided conduction defects" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Haghjoo" 1 => "A. Bagherzadeh" 2 => "M. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 10 | 16 |
| 2024 October | 31 | 35 | 66 |
| 2024 September | 33 | 27 | 60 |
| 2024 August | 42 | 38 | 80 |
| 2024 July | 28 | 25 | 53 |
| 2024 June | 29 | 41 | 70 |
| 2024 May | 36 | 33 | 69 |
| 2024 April | 33 | 42 | 75 |
| 2024 March | 37 | 18 | 55 |
| 2024 February | 31 | 31 | 62 |
| 2024 January | 32 | 27 | 59 |
| 2023 December | 23 | 40 | 63 |
| 2023 November | 35 | 39 | 74 |
| 2023 October | 33 | 35 | 68 |
| 2023 September | 29 | 40 | 69 |
| 2023 August | 22 | 17 | 39 |
| 2023 July | 31 | 19 | 50 |
| 2023 June | 21 | 20 | 41 |
| 2023 May | 28 | 28 | 56 |
| 2023 April | 28 | 18 | 46 |
| 2023 March | 36 | 33 | 69 |
| 2023 February | 31 | 31 | 62 |
| 2023 January | 22 | 27 | 49 |
| 2022 December | 37 | 28 | 65 |
| 2022 November | 45 | 33 | 78 |
| 2022 October | 38 | 41 | 79 |
| 2022 September | 29 | 38 | 67 |
| 2022 August | 34 | 42 | 76 |
| 2022 July | 33 | 34 | 67 |
| 2022 June | 29 | 38 | 67 |
| 2022 May | 37 | 47 | 84 |
| 2022 April | 37 | 47 | 84 |
| 2022 March | 38 | 48 | 86 |
| 2022 February | 26 | 25 | 51 |
| 2022 January | 29 | 26 | 55 |
| 2021 December | 35 | 48 | 83 |
| 2021 November | 37 | 44 | 81 |
| 2021 October | 46 | 54 | 100 |
| 2021 September | 33 | 44 | 77 |
| 2021 August | 22 | 40 | 62 |
| 2021 July | 35 | 57 | 92 |
| 2021 June | 33 | 24 | 57 |
| 2021 May | 36 | 44 | 80 |
| 2021 April | 49 | 60 | 109 |
| 2021 March | 36 | 14 | 50 |
| 2021 February | 49 | 29 | 78 |
| 2021 January | 36 | 28 | 64 |
| 2020 December | 22 | 13 | 35 |
| 2020 November | 33 | 30 | 63 |
| 2020 October | 24 | 27 | 51 |
| 2020 September | 28 | 23 | 51 |
| 2020 August | 27 | 18 | 45 |
| 2020 July | 25 | 24 | 49 |
| 2020 June | 36 | 16 | 52 |
| 2020 May | 18 | 6 | 24 |
| 2020 April | 18 | 13 | 31 |
| 2020 March | 16 | 10 | 26 |
| 2020 February | 29 | 20 | 49 |
| 2020 January | 15 | 22 | 37 |
| 2019 December | 17 | 22 | 39 |
| 2019 November | 16 | 14 | 30 |
| 2019 October | 13 | 14 | 27 |
| 2019 September | 24 | 20 | 44 |
| 2019 August | 12 | 10 | 22 |
| 2019 July | 24 | 15 | 39 |
| 2019 June | 17 | 13 | 30 |
| 2019 May | 22 | 18 | 40 |
| 2019 April | 14 | 12 | 26 |
| 2019 March | 12 | 14 | 26 |
| 2019 February | 14 | 24 | 38 |
| 2019 January | 18 | 22 | 40 |
| 2018 December | 14 | 19 | 33 |
| 2018 November | 49 | 96 | 145 |
| 2018 October | 45 | 23 | 68 |
| 2018 September | 17 | 5 | 22 |
| 2018 August | 14 | 4 | 18 |
| 2018 July | 22 | 6 | 28 |
| 2018 June | 23 | 12 | 35 |
| 2018 May | 13 | 2 | 15 |
| 2018 April | 16 | 5 | 21 |
| 2018 March | 33 | 3 | 36 |
| 2018 February | 52 | 4 | 56 |
| 2018 January | 37 | 7 | 44 |
| 2017 December | 50 | 5 | 55 |
| 2017 November | 22 | 8 | 30 |
| 2017 October | 18 | 8 | 26 |
| 2017 September | 23 | 7 | 30 |
| 2017 August | 12 | 7 | 19 |
| 2017 July | 20 | 11 | 31 |
| 2017 June | 28 | 11 | 39 |
| 2017 May | 12 | 7 | 19 |
| 2017 April | 19 | 26 | 45 |
| 2017 March | 11 | 6 | 17 |
| 2017 February | 8 | 4 | 12 |
| 2017 January | 9 | 8 | 17 |
| 2016 December | 26 | 3 | 29 |
| 2016 November | 15 | 7 | 22 |
| 2016 October | 21 | 10 | 31 |
| 2016 September | 27 | 13 | 40 |
| 2016 August | 21 | 7 | 28 |
| 2016 July | 9 | 8 | 17 |
| 2015 December | 2 | 0 | 2 |
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