angiopoietin br Material and methods br Results br Discussio

Material and methods
Results
Discussion Previously, various small studies reported that CRT is an effective therapy in patients with NAHF [7,10–15]. These studies demonstrated favorable outcomes in patients treated with CRT, including the ability to wean patients from intravenous inotropes to oral drugs. Milliez et al. demonstrated an acute hemodynamic and biological improvement in 20 dobutamine-dependent patients with NAHF following CRT implantation [14]. A marked blood pressure elevation with a mean systolic blood pressure increase of 15mmHg was observed in all patients. This led to a rapid improvement of urine output, biological markers of renal function, and BNP levels. Theodorakis et al. reported on long-term prognosis in 18 patients with NAHF who received CRT [15]. Sustained improvements in NYHA classification and 6-min walk distance were documented 855 days after implantation. The cumulative proportion of deaths and angiopoietin transplantations at 18 months was 18%. Echocardiographic data at 12 months post-implantation documented a significant reduction in LVESV (248 vs. 269mL, p=0.03). Herweg et al. studied 10 patients with inotrope-dependent NAHF and reported improved outcomes [10]. These patients underwent CRT-D implantation with inotropic support, and all were alive 1088±284 days post-implantation including three patients who underwent cardiac transplantation. Our study results are essentially consistent with those of prior reports with regard to safety and long-term outcomes. To the best of our knowledge, this is the first study to analyze factors predicting response in this severely afflicted population of patients with heart failure undergoing CRT. Our study shows that similar to other reports on conventional CRT indications, LV dyssynchrony is significantly related to response [8,9]. The STAR study was the first to associate radial strain LV dyssynchrony (>130ms) with long-term survival after CRT. Although the STAR study included NYHA IV patients, it did not describe whether they were ambulatory. No trials have reported on the usefulness of LV dyssynchrony prior to CRT implantation in patients with NAHF. One case report described a 73-year-old man with a pacemaker who was admitted for refractory heart failure [16]. A speckle tracking strain identified severe LV dysfunction and LV dyssynchrony following RV pacing. As the patient׳s clinical condition worsened despite optimal medical treatment, a CRT device was implanted as rescue therapy. After implantation, the patient׳s symptoms rapidly improved and an echocardiographic assessment showed dramatic improvement in his LV systolic function. This case report suggested that an echocardiographic assessment of dyssynchrony is useful for deciding on a CRT indication in patients with refractory heart failure due to RV pacing. Established predictors of CRT response such as the presence of LBBB and QRS width are not associated with reverse remodeling. These outcomes may be the result of a selection bias, because the indication for CRT implantation was at the discretion of each physician and involved consideration of various factors including both the electrographic and echocardiographic status. In 2004, Auricchio et al. stated, “CRT may be contraindicated in patients in whom weaning from parenteral inotropic therapy has not been possible” [17]. Our study showed the reverse in a broader population of severely ill patients, if they had significant LV dyssynchrony.
Conclusion
Conflict of interest
Introduction Stroke prevention is of prime importance in the management of patients with atrial fibrillation (AF). Although the risk of thromboembolic stroke is predicted by a variety of factors, including those indicated by the CHADS2 score, electrical cardioversion (ECV) is a special situation where this risk increases temporarily. Warfarin administration is recommended for at least 3 weeks and 4 weeks before and after elective ECV, respectively, unless the possibility of left atrial (LA) thrombus is excluded by transesophageal echocardiography (TEE) [1–4]. However, the validity of this approach for the use of novel oral anticoagulants (NOACs) is unknown.