Predictors of super-response to cardiac resynchronization therapy： the significance of heart failure medication, pre-implant left ventricular geometry and high percentage of biventricular pacing

Background Super-responders （SRs） are defined as patients who show crucial cardiac function improvement after cardiac resynchro- nization therapy （CRT）. The purpose of this study is to identify and validate predictors of SRs after CRT. Methods This study enrolled 201 patients who underwent CRT during the period from 2010 to 2014. Clinical and echocardiographic evaluations were conducted before CRT and 6 months after. Patients with a decrease in New York Heart Association （NYHA） fimctional class 〉 1, a decrease in left ventricular end-systolic volume （LVESV） ≥ 15%, and a final left ventricular ejection fraction （LVEF） ≥ 45% were classified as SRs. Results 29% of the 201 patients who underwent CRT were identified as SRs. At baseline, SRs had significantly smaller left atrial diameter （LAD）, LVESV, left ventricular end-diastolic volume （LVEDV） and higher LVEF than the non-super-responders （non-SRs）. The percentage of patients using angiotensin-converting enzyme inhibitors or angiotensin receptor blockers （ACEI/ARB） was higher in SRs than non-SRs. Most SRs had Biventricular （BiV） pacing percentage greater than 98% six months after CRT. In the multivariate logistic regression analysis, the independ- ent predictors of SRs were lower LVEDV [odd ratios （OR）： 0.93; confidence intervals （CI）： 0.90-0.97], use of ACEI/ARB （OR： 0.33; CI： 0.13~3.82） and BiV pacing percentage greater than 98% （OR： 0.29; CI： 0.16~.87）. Conclusion Patients with a better compliance of ACEI/ARB and a less ectatic ventricular geometry before CRT tends to have a greater probability of becoming SRs. Higher percentage of BiV pacing is essential for becoming SRs.

Cardiac resynchronization therapy improved the clinical outcomes in pacemaker patients upgraded to biventricular device

The right ventricular pacing （RVP） is the standard treat- ment for patients with severe bradyarrhythmias; however, it may cause and exacerbate heart failure symptoms in a long run under some circumstances.{1] In fact, significant left ventricular （LV） systolic dysfimction and symptomatic heart failure （HF） is commonly found in patient population with pacemaker implantations.

The Efficacy and Safety of Wenxin Keli in Patients with Frequent Premature Ventricular Contractions： A Randomized, Double-blind, Placebo-controlled, Parallel-group, Multicenter Trial

Background：Premature ventricular contractions （PVCs） are common in the general population,and frequent PVCs may result in the poor quality of life or even the damage of cardiac function.We examined the efficacy and safety of a traditional Chinese medicine Wenxin Keli for the treatment of frequent PVCs among a relatively large Chinese cohort.Methods：We performed a randomized,double-blind,placebo-controlled,parallel-group,multicenter trial.A total of 1200 eligible participants were randomly assigned in a ratio of 1：1 to receive Wenxin Keli or the placebo for 4 weeks.The primary and secondary endpoint was the change of PVC numbers and PVC-related symptoms after a 4-week treatment compared with baseline,respectively.In addition,vital signs,laboratory values,and electrocardiographic parameters were assessed in a safety analysis.Results：At the initial evaluation,no significant differences in the baseline characteristics were observed between the Wenxin Keli group and the placebo group.A smaller number of PVCs was observed after the 4-week treatment than at baseline,in both the Wenxin Keli group （5686 ± 5940 vs.15,138 ± 7597 beats/d,P ＜ 0.001） and the placebo group （10,592 ± 8009 vs.14,529 ± 5929 beats/d,P ＜ 0.001）;moreover,the Wenxin Keli group demonstrated a significantly greater reduction in the frequency of PVCs than the placebo group （P ＜ 0.001）.In a full analysis set,patients in the Wenxin Keli group exhibited significantly higher total effective responses in the reduction of PVCs compared to those in the placebo group （83.8％ vs.43.5％,P ＜ 0.001）.The per-protocol analysis yielded similar results （83.0％ vs.39.3％,P ＜ 0.001）.Treatment with Wenxin Keli also demonstrated superior performance compared to the placebo with respect to PVC-related symptoms.No severe adverse effects attributable to Wenxin Keli were reported.Conclusions：Wenxin Keli treatment effectively reduced the overall number of PVCs and alleviated PVC-related symptoms in patients without structural heart diseases and had no severe side effects.

Will the symbiotic pacemaker, a self-powered cardiac implanted electronic device, be the next evolution in pacemaker technology?

The first permanent implanted pacemaker was successfully used in clinical practice in 1958. In the past 60 years, the development of pacemakers has been witnessed in clinical application [1]. Early pacemakers were large and cumbersome, and had a short battery life, providing only a single-chamber asynchronous pacing (VOO) pacing mode. In 1967, on-demand pacemakers with synchronous pacing (WI) mode just came out. The emergence of the first dual chamber pacemaker in 1977 symbolized the entry into the physiologic pacing era. In 1982, pacemakers began to provide rate adaptive functions. In this age of accelerating development in scientific technologies and clinical researches, pacemakers have evolved into implantable cardioverter-defibrillators for the treatment of sudden cardiac death and cardiac resynchronization therapy for chronic heart failure, instead of simply being an electronic device that treats bradycardia by pulsing the heart (Fig. 1)[2,3].

Serum Procalcitonin Levels on Admission Predict Death in Severe and Critical COVID-19 Patients in Wuhan, China

Background:We evaluated whether the serum procalcitonin(PCT)level could predict death in severe and critical coronavirus disease 2019(COVID-19)patients.Methods:This study included 129 COVID-19 patients.PCT levels on admission,treatment,and death were collected.The outcomes were compared.Results:The optimum cutoff value of the PCT level determined by receiver operator characteristic curve analysis to predict all-cause death was 0.085 ng/mL,with sensitivity of 95.7%and specifi city of 72.6%.Overall,78 patients had a PCT level below 0.085 ng/mL and 51 patients had a PCT level of 0.085 ng/mL or greater.High-PCT-level patients had lower levels of lymphocytes(P=0.001)and albumin(P=0.002)and higher levels of creatinine(P=0.024),D-dimer(P=0.002),and white blood cells,neutrocytes(P<0.001),high-sensitivity C-reactive protein(P<0.001),interleukin-6(P<0.001),interleukin-8(P=0.001),interleukin-10(P=0.001),tumor necrosis factor(P<0.001),erythrocyte sedimentation rate(P=0.001),and ferritin(P=0.001).During the 30-day observation period,23 patients died.Mortality was significantly higher in high-PCT-level patients than in patients with low PCT levels(43.1%vs.1.3%;P<0.001).The risks of death(P<0.0001)and ventilator use(P<0.0001)were increased in patients with PCT levels of 0.085 ng/mL or greater.Conclusions:A PCT level of 0.085 ng/mL or greater on admission could effectively predict death and ventilator use in severe and critical COVID-19 patients.

Piezoelectric wearable atrial fibrillation prediction wristband enabled by machine learning and hydrogel affinity

Atrial fibrillation(AF)is a common and serious disease.Its diagnosis usually requires 12-lead electrocardiogram,which is heavy and inconvenient.At the same time,the venue for diagnosis is also limited to the hospital.With the development of the concept of intelligent medical,a wearable,portable,and reliable diagnostic method is needed to improve the patient’s comfort and alleviate the patient’s pain.Here,we reported a wearable atrial fibrillation prediction wristband(AFPW)which can provide longterm monitoring and AF diagnosis.AFPW uses polyvinylidene fluoride piezoelectric film as sensing material and hydrogel as skin bonding material,of which the structure and design have been optimized and improved.The hydrogel skin bonding layer has good stability and skin affinity,which can greatly improve the user experience.AFPW has enhanced signal,strong signal-tonoise ratio,and wireless transmission function.After a sample library of 385 normal people/patients is analyzed and tested by linear discriminant analysis,the diagnostic success rate of atrial fibrillation is 91%.All these excellent performances demonstrate the great application potential of AFPW in wearable device diagnosis and intelligent medical treatment.