PURPOSE: This study aimed to elucidate which echocardiographic criteria at three time points, for cardiac resynchronization therapy (CRT) response, are accurate in discriminating the hierarchical clinical composite end point (HCCEP). MATERIALS AND METHODS: We included 120 patients (age, 66.1±12.6 years; men, 54.2%) who underwent CRT implantation for heart failure (HF). Echocardiography was performed before and at 3, 6, and 12 months after CRT implantation. The 1-year HCCEP included all-cause mortality, hospitalization for HF, and New York Heart Association functional class for 12 months. CRT response criteria were decrease in left ventricular (LV) end-systolic volume (LVESV) >15%, decrease in LV end-diastolic volume >15%, absolute increase in LV ejection fraction (LVEF) ≥5%, relative increase in LVEF ≥15%, and decrease in mitral regurgitation ≥1 grade. Temporal changes in CRT response rates, accuracy of CRT response criteria at each time and cutoff value for the discrimination of improvement in HCCEP, and agreements with improvement in HCCEP were analyzed. RESULTS: HCCEP improvement rates were 65.8% in total group. In nonischemic group, CRT response rates according to all echocardiographic criteria significantly increased with time. In ischemic group, CRT response rate did not significantly change with time. In total group, ΔLVESV at 6 months (ΔLVESV6) had the most significant accuracy for the discrimination of HCCEP (area under the curve=0.781). The optimal cutoff value of ΔLVESV6 was 13.5% (sensitivity=0.719, specificity=0.719). ΔLVESV6 had fair agreement with HCCEP (κ=0.391, p < 0.001). CONCLUSION: ΔLVESV6 is the most useful echocardiographic CRT response criterion for the prediction of 1-year HCCEP.
Cardiac Resynchronization Therapy* ; Discrimination (Psychology) ; Echocardiography ; Heart ; Heart Failure ; Hospitalization ; Humans ; Male ; Mitral Valve Insufficiency ; Mortality ; Stroke Volume*

PURPOSE: The purpose of this review was to identify the current status of nursing studies on heart failure (HF) patients in South Korea and to suggest future study direction. METHODS: A literature review of databases such as KoreaMed, KERIS and nursing and allied health journal were searched with key terms ‘heart failure’ and ‘nursing’ for the period from January 2000 to February 2017. A total of 35 studies including 28 articles and 7 theses met the inclusion criteria. RESULTS: Twenty-seven out of 35 studies were observational studies on outpatients and most of the studies did not mention the ejection fraction and New York Heart Association functional classification class (NYHA class) in the inclusion criteria. Self-care and health-related quality of life as psychological factors, and physical activity as a biological factor, were used as main variables. However, we found it difficult to understand how much score indicates better quality of life because of an inconsistent and wide score. In quality assessment, 8 intervention studies had no serious flaws. CONCLUSION: Further studies should consider more biological and social factors influencing HF. The quality assessment with respect to nursing intervention studies in HF showed that randomized and double-blind trials are needed.
Biological Factors ; Classification ; Heart Failure* ; Heart* ; Humans ; Korea* ; Motor Activity ; Nursing* ; Outpatients ; Psychology ; Quality of Life ; Self Care

Cardiac rhythm management devices (pacemakers) are being increasingly implanted worldwide for the management of not only bradycardia but also arrhythmia and heart failure. This increase in the frequency of device therapy is paralleled with an increase in the requirement for systemic extraction. Safe lead extraction is central to the management of several complications related to pacemakers. The most common indication for lead extraction is systemic infection. Adhesions in chronically implanted leads can become major obstacles to safe lead extraction, leading to life-threatening bleeding and cardiac perforations. Currently, several extraction tools enable safe and successful transvenous lead extraction (TLE) of pacemaker and implantable cardioverter–defibrillator leads. This article provides a comprehensive review of the indications, tools, techniques, and outcomes for TLE. Operator experience is vital in determining success, as familiarity with a wide array of techniques will increase the likelihood of uncomplicated extraction. Lead extraction should, therefore, ideally be performed in high-volume centers with experienced staff and on-site support from a cardiothoracic surgical team that is able to deal with bleeding complications from cardiovascular perforation.
Arrhythmias, Cardiac ; Bradycardia ; Heart Failure ; Hemorrhage ; Recognition (Psychology)

BACKGROUND/AIMS: This study is a head-to-head comparison of predictive values for long-term cardiovascular outcomes between exercise electrocardiography (ex-ECG) and computed tomography coronary angiography (CTCA) in patients with chest pain. METHODS: Four hundred and forty-two patients (mean age, 56.1 years; men, 61.3%) who underwent both ex-ECG and CTCA for evaluation of chest pain were included. For ex-ECG parameters, the patients were classified according to negative or positive results, and Duke treadmill score (DTS). Coronary artery calcium score (CACS), presence of plaque, and coronary artery stenosis were evaluated as CTCA parameters. Cardiovascular events for prognostic evaluation were defined as unstable angina, acute myocardial infarction, revascularization, heart failure, and cardiac death. RESULTS: The mean follow-up duration was 2.8 ± 1.1 years. Fifteen patients experienced cardiovascular events. Based on pretest probability, the low- and intermediate-risks of coronary artery disease were 94.6%. Odds ratio of CACS > 40, presence of plaque, coronary stenosis ≥ 50% and DTS ≤ 4 were significant (3.79, p = 0.012; 9.54, p = 0.030; 6.99, p < 0.001; and 4.58, p = 0.008, respectively). In the Cox regression model, coronary stenosis ≥ 50% (hazard ratio, 7.426; 95% confidence interval, 2.685 to 20.525) was only significant. After adding DTS ≤ 4 to coronary stenosis ≥ 50%, the integrated discrimination improvement and net reclassification improvement analyses did not show significant. CONCLUSIONS: CTCA was better than ex-ECG in terms of predicting long-term outcomes in low- to intermediate-risk populations. The predictive value of the combination of CTCA and ex-ECG was not superior to that of CTCA alone.
Angina, Unstable ; Calcium ; Chest Pain ; Coronary Angiography* ; Coronary Artery Disease ; Coronary Stenosis ; Coronary Vessels ; Death ; Discrimination (Psychology) ; Electrocardiography* ; Follow-Up Studies ; Heart Failure ; Humans ; Male ; Myocardial Infarction ; Odds Ratio ; Prognosis

PURPOSE: The focus of this study was on symptom management to predict quality of life among individuals with heart failure. The theoretical model was constructed based on situation-specific theory of heart failure self-care and literature review. METHODS: For participants, 241 outpatients at a university hospital were invited to the study from May 19 to July 30, 2014. Data were collected with structured questionnaires and analyzed using SPSSWIN and AMOS 20.0. RESULTS: The goodness of fit index for the hypothetical model was .93, incremental fit index, .90, and comparative fit index, .90. As the outcomes satisfied the recommended level, the hypothetical model appeared to fit the data. Seven of the eight hypotheses selected for the hypothetical model were statistically significant. The predictors of symptom management, symptom management confidence and social support together explained 32% of the variance in quality of life. The 28% of variance in symptom management was explained by symptom recognition, heart failure knowledge and symptom management confidence. The 4% of variance in symptom management confidence was explained by social support. CONCLUSION: The hypothetical model of this study was confirmed to be adequate in explaining and predicting quality of life among patients with heart failure through symptom management. Effective strategies to improve quality of life among patients with heart failure should focus on symptom management. Symptom management can be enhanced by providing educational programs, encouraging social support and confidence, consequently improving quality of life among this population.
Aged ; Female ; Health Knowledge, Attitudes, Practice ; Heart Failure/*psychology ; Humans ; Male ; Models, Theoretical ; *Quality of Life ; Self Care ; Self Concept ; Social Support ; Surveys and Questionnaires

PURPOSE: The purpose of this study was to assess the psychometric properties of the Dutch Objective Burden Inventory (DOBI) for the Turkish society. METHODS: This is a descriptive, methodological study. The sample was composed of 230 heart failure patients' caregivers. RESULTS: The DOBI was translated using translation and back-translation. The translated Turkish version was submitted to eight experts who analyzed it for its content validity. Scores from the experts were evaluated using the Kendall W analysis, and no statistically significant difference was found among the scores (Kendall W = .13, p = .338). In the confirmatory factor analysis, factor loading was found to be between 0.75 and 1.00 for all subscales. Thus, the DOBI demonstrated acceptable internal consistency (the components displayed alpha scores from .96 to .99), good test-retest reliability (no statistically significant differences were found, p > .050). CONCLUSIONS: The Turkish version of the DOBI scale is a valid and reliable tool for the Turkish population. It can be used in nursing practices and research.
Adult ; Aged ; Aged, 80 and over ; Caregivers/*psychology ; Female ; Heart Failure/*nursing/psychology ; Humans ; Male ; Middle Aged ; Psychometrics/*standards ; Reproducibility of Results ; *Stress, Psychological ; Turkey

Peripartum cardiomyopathy is a cardiac condition characterized by development of heart failure during the last month of pregnancy or during the first five months of post partum period without any other identifiable cause of heart failure. The hypercoagulable state in the pregnancy along with left ventricular (LV) systolic dysfunction predisposes the patient to thromboembolic complications like intraventricular thrombi. We report a case of a 30-year-old female with peripartum cardiomyopathy along with a highly mobile mass in the LV cavity on two dimensional echocardiography. Three dimensional transthoracic echocardiography clearly showed the pedicle of the mass attached to the interventricular septum along with internal echolucent areas within the mass. Due to denial of the patient to undergo surgery, she was started on oral anticoagulation, with complete dissolution of the mass within one month.
Adult ; Cardiomyopathies* ; Denial (Psychology) ; Echocardiography ; Echocardiography, Three-Dimensional* ; Female ; Heart Failure ; Humans ; Peripartum Period* ; Pregnancy ; Thrombosis*

A 61-year-old female patient was diagnosed with dilated cardiomyopathy with severe left ventricle dysfunction. Two days after admission, continuous renal replacement therapy was performed due to oliguria and lactic acidosis. On the fifth day, an intra-aortic balloon pump was inserted due to low cardiac output syndrome. Beginning 4 days after admission, she was supported for 15 days thereafter with an extracorporeal left ventricular assist device (LVAD) because of heart failure with multi-organ failure. A heart transplant was performed while the patient was stabilized with the LVAD. She developed several complications after the surgery, such as cytomegalovirus pneumonia, pulmonary tuberculosis, wound dehiscence, and H1N1 infection. On postoperative day 19, she was discharged from the hospital with close follow-up and treatment for infection. She received follow-up care for 10 months without any immune rejection reaction.
Acidosis, Lactic ; Cardiac Output, Low ; Cardiomyopathy, Dilated ; Cytomegalovirus ; Extracorporeal Membrane Oxygenation ; Female ; Follow-Up Studies ; Heart ; Heart Failure ; Heart Transplantation ; Heart Ventricles ; Heart-Assist Devices ; Humans ; Middle Aged ; Oliguria ; Pneumonia ; Rejection (Psychology) ; Renal Replacement Therapy ; Transplants ; Tuberculosis, Pulmonary

OBJECTIVETo explore the dose-effect relationship of Astragalus granule (AG) on improving the quality of life (QOL) of the patients with chronic heart failure (CHF).

METHODSNinety CHF patients of Fei ()-qi-deficiency and/or Xin ()-Shen () yang-deficiency syndromes were equally randomized divided with a random number table into three groups; they received the high (7.5 g), moderate (4.5 g), and low dosage (2.25 g) of AG orally taken twice a day, respectively, and 4 mg of perindopril tablet once a day for 30 successive days. The heart function grade, patients' left ventricular ejection fraction (LVEF) and walking distance in 6 min (6mWD) were measured before and after treatment, and the patients' QOL was scored by the Minnesota Questionnaire for QOL evaluation in the patients with CHF at the same time.

RESULTSThe heart function grades of all the three groups after treatment were improved compared with those before treatment, but the improvements in high-dose group and moderate dose group were better than that in the low dose group (P<0.05). LVEFs were increased significantly in all the three groups, but the improvements in the high-dose group (59.42%±7.50%) and moderate dose group (61.98%±6.82%) were better than that in the low dose group (51.45%±6.80%, P<0.01); the 6mWDs in the all groups were also significantly increased (P<0.01), up to 419.80±36.23 m, 387.15±34.13 m, and 317.69±39.97 m, respectively; and Minnesota scores in them were lowered to 29.59±4.69 scores, 35.74±5.89 scores, and 42.78±6.06 scores, respectively; comparisons in aspects on 6mWD and Minnesota score showed that the effectiveness with high dose is the most effective, moderate dose as the second, and low dose as the lowest (P<0.01).

CONCLUSIONSAG was sufficient to display an optimal effect on improving heart contraction at the moderate dose. In aspects of improving the QOL of CHF patients, the effectiveness of AG showed a dose-dependent trend. It should be applied discriminatively depending on the actual condition of patients and the aim of treatment in clinic.

Aged ; Astragalus Plant ; chemistry ; Chemistry, Pharmaceutical ; Chronic Disease ; Dose-Response Relationship, Drug ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Heart ; drug effects ; physiology ; Heart Failure ; drug therapy ; psychology ; Heart Function Tests ; Humans ; Male ; Middle Aged ; Plant Preparations ; administration & dosage ; Quality of Life ; Treatment Outcome ; Ventricular Function, Left ; drug effects ; physiology

Heart Failure ; psychology ; Humans ; Liver Failure ; psychology ; Neoplasms ; psychology ; Neurodegenerative Diseases ; psychology ; Organ Transplantation ; Quality of Life ; psychology ; Renal Insufficiency ; psychology