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
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Servicio de Medicina Intensiva, Hospital Donostia, Unidad de Arritmias, Hospital Donostia, Donostia, Spain
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"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:1 [ "entidad" => "Servicio de Medicina Intensiva, Hospital Donostia, Unidad de Arritmias, Hospital Donostia, Donostia, Spain" ] ] "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" => 80837 ] ] "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 "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" => 80837 ] ] "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 => "xTab411874.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 => "xTab411872.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 => "xTab411873.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. Moshkani Farahani" 3 => "Z.O. Haghighi" 4 => "M.A. Sadr-Ameli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/europace/eun081" "Revista" => array:6 [ "tituloSerie" => "Europace" "fecha" => "2008" "volumen" => "10" "paginaInicial" => "566" "paginaFinal" => "571" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18390536" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Results of the predictors of response to CRT (PROSPECT) trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E.S. Chung" 1 => "A.R. Leon" 2 => "L. Tavazzi" 3 => "J.P. Sun" 4 => "P. Nihoyannopoulos" 5 => "J. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 3 | 8 | 11 |
| 2024 Octubre | 45 | 46 | 91 |
| 2024 Septiembre | 44 | 24 | 68 |
| 2024 Agosto | 56 | 34 | 90 |
| 2024 Julio | 32 | 24 | 56 |
| 2024 Junio | 48 | 34 | 82 |
| 2024 Mayo | 39 | 22 | 61 |
| 2024 Abril | 48 | 36 | 84 |
| 2024 Marzo | 36 | 24 | 60 |
| 2024 Febrero | 51 | 37 | 88 |
| 2024 Enero | 36 | 24 | 60 |
| 2023 Diciembre | 33 | 36 | 69 |
| 2023 Noviembre | 46 | 35 | 81 |
| 2023 Octubre | 39 | 30 | 69 |
| 2023 Septiembre | 33 | 38 | 71 |
| 2023 Agosto | 26 | 19 | 45 |
| 2023 Julio | 32 | 22 | 54 |
| 2023 Junio | 26 | 17 | 43 |
| 2023 Mayo | 47 | 33 | 80 |
| 2023 Abril | 25 | 20 | 45 |
| 2023 Marzo | 42 | 23 | 65 |
| 2023 Febrero | 36 | 33 | 69 |
| 2023 Enero | 30 | 23 | 53 |
| 2022 Diciembre | 40 | 33 | 73 |
| 2022 Noviembre | 46 | 37 | 83 |
| 2022 Octubre | 26 | 28 | 54 |
| 2022 Septiembre | 30 | 49 | 79 |
| 2022 Agosto | 32 | 45 | 77 |
| 2022 Julio | 27 | 30 | 57 |
| 2022 Junio | 34 | 35 | 69 |
| 2022 Mayo | 33 | 37 | 70 |
| 2022 Abril | 40 | 42 | 82 |
| 2022 Marzo | 38 | 56 | 94 |
| 2022 Febrero | 35 | 32 | 67 |
| 2022 Enero | 40 | 36 | 76 |
| 2021 Diciembre | 48 | 44 | 92 |
| 2021 Noviembre | 44 | 55 | 99 |
| 2021 Octubre | 85 | 59 | 144 |
| 2021 Septiembre | 27 | 41 | 68 |
| 2021 Agosto | 24 | 36 | 60 |
| 2021 Julio | 31 | 30 | 61 |
| 2021 Junio | 31 | 31 | 62 |
| 2021 Mayo | 35 | 45 | 80 |
| 2021 Abril | 61 | 81 | 142 |
| 2021 Marzo | 51 | 19 | 70 |
| 2021 Febrero | 57 | 27 | 84 |
| 2021 Enero | 37 | 21 | 58 |
| 2020 Diciembre | 34 | 17 | 51 |
| 2020 Noviembre | 27 | 18 | 45 |
| 2020 Octubre | 31 | 30 | 61 |
| 2020 Septiembre | 18 | 21 | 39 |
| 2020 Agosto | 32 | 16 | 48 |
| 2020 Julio | 25 | 18 | 43 |
| 2020 Junio | 48 | 10 | 58 |
| 2020 Mayo | 20 | 11 | 31 |
| 2020 Abril | 27 | 20 | 47 |
| 2020 Marzo | 20 | 22 | 42 |
| 2020 Febrero | 25 | 52 | 77 |
| 2020 Enero | 29 | 21 | 50 |
| 2019 Diciembre | 28 | 17 | 45 |
| 2019 Noviembre | 26 | 22 | 48 |
| 2019 Octubre | 20 | 16 | 36 |
| 2019 Septiembre | 23 | 24 | 47 |
| 2019 Agosto | 26 | 19 | 45 |
| 2019 Julio | 26 | 16 | 42 |
| 2019 Junio | 51 | 17 | 68 |
| 2019 Mayo | 60 | 20 | 80 |
| 2019 Abril | 22 | 31 | 53 |
| 2019 Marzo | 16 | 30 | 46 |
| 2019 Febrero | 35 | 21 | 56 |
| 2019 Enero | 20 | 27 | 47 |
| 2018 Diciembre | 39 | 35 | 74 |
| 2018 Noviembre | 90 | 50 | 140 |
| 2018 Octubre | 47 | 22 | 69 |
| 2018 Septiembre | 21 | 15 | 36 |
| 2018 Agosto | 16 | 8 | 24 |
| 2018 Julio | 20 | 12 | 32 |
| 2018 Junio | 28 | 9 | 37 |
| 2018 Mayo | 16 | 6 | 22 |
| 2018 Abril | 19 | 10 | 29 |
| 2018 Marzo | 13 | 9 | 22 |
| 2018 Febrero | 13 | 6 | 19 |
| 2018 Enero | 42 | 21 | 63 |
| 2017 Diciembre | 20 | 8 | 28 |
| 2017 Noviembre | 23 | 7 | 30 |
| 2017 Octubre | 20 | 4 | 24 |
| 2017 Septiembre | 19 | 20 | 39 |
| 2017 Agosto | 17 | 13 | 30 |
| 2017 Julio | 14 | 8 | 22 |
| 2017 Junio | 18 | 5 | 23 |
| 2017 Mayo | 15 | 7 | 22 |
| 2017 Abril | 38 | 18 | 56 |
| 2017 Marzo | 17 | 15 | 32 |
| 2017 Febrero | 9 | 2 | 11 |
| 2017 Enero | 7 | 4 | 11 |
| 2016 Diciembre | 12 | 4 | 16 |
| 2016 Noviembre | 22 | 4 | 26 |
| 2016 Octubre | 31 | 9 | 40 |
| 2016 Septiembre | 29 | 12 | 41 |
| 2016 Agosto | 10 | 4 | 14 |
| 2016 Julio | 7 | 6 | 13 |
| 2015 Diciembre | 2 | 0 | 2 |
| 2014 Julio | 1 | 0 | 1 |
| 2014 Marzo | 11 | 11 | 22 |
| 2014 Febrero | 12 | 5 | 17 |
| 2014 Enero | 9 | 5 | 14 |
| 2013 Diciembre | 9 | 4 | 13 |
| 2013 Noviembre | 6 | 4 | 10 |
| 2013 Octubre | 10 | 6 | 16 |
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