(57) Abstract: Based on a survey of patients, HRV and VO2 Pace action therapy optimized protocol ... more (57) Abstract: Based on a survey of patients, HRV and VO2 Pace action therapy optimized protocol for the treatment of patients with CHF have been devised. During the first pacing mode of action, HRV index is obtained, then the mode is changed, and these steps are repeated for all modes. Then, pacemaker mode with the highest HRV index is programmed. Different from that modify this method, it can be can be applied to drug therapy instead of pace action therapy, or in combination with pace action therapy applications.
Journal of the American College of Cardiology, 2001
We sought to investigate the impact of six months of cardiac resynchronization therapy (CRT) on e... more We sought to investigate the impact of six months of cardiac resynchronization therapy (CRT) on echocardiographic variables of left ventricular (LV) function. BACKGROUND Cardiac resynchronization therapy has recently been introduced as a new therapeutic modality in patients with advanced heart failure (HF) and conduction abnormalities. However, most studies have only investigated the early hemodynamic effects of CRT. METHODS Twenty-five patients (12 women and 13 men; 59.8 Ï® 5.1 years old) with advanced HF caused by ischemic (n Ï 7) or idiopathic dilated cardiomyopathy (n Ï 18) and a prolonged QRS complex were analyzed. All patients underwent early hemodynamic testing with a randomized testing protocol; echocardiographic measurements were compared before implantation and after six months of CRT. RESULTS Left ventricular end-diastolic and end-systolic diameters (LVEDD and LVESD, respectively) were significantly reduced after six months (LVEDD from 71 Ï® 10 to 68 Ï® 11 mm, p Ï 0.027; LVESD from 63 Ï® 11 to 58 Ï® 11 mm, p Ï 0.007), as were LV end-diastolic and end-systolic volumes (LVEDV from 253 Ï® 83 to 227 Ï® 112 ml, p Ï 0.017; LVESV from 202 Ï® 79 to 174 Ï® 101 ml, p Ï 0.009). Ejection fraction was significantly increased (from 22 Ï® 7% to 26 Ï® 9%, p Ï 0.03). "Nonresponders," with regard to LV volume reduction, had significantly higher baseline LVEDV, compared with "responders" (351 Ï® 52 vs. 234 Ï® 74 ml, p Ï 0.018). Overall, there was only mild mitral regurgitation at baseline, with a minor reduction by semiquantitative analysis. The results of early hemodynamic testing did not predict the volume response. CONCLUSIONS Cardiac resynchronization therapy may lead to a reduction in LV volumes in patients with advanced HF and conduction disturbances. Volume nonresponders have significantly higher baseline LVEDV.
The effects of VDD pacing on hemodynarnics can be best studied at a short atrioventricnlar (SAVD)... more The effects of VDD pacing on hemodynarnics can be best studied at a short atrioventricnlar (SAVD) since it avoids fusion with the intrinsic wave generated at the atrium. Although studies have been done to test right ventricular apex (RVA) pacing with short AV delay, little is known about pacing at different sites in the left ventricle (LV) with a normal conduction system. Our aim was to compare the hemodynarnic effects of different activation sequences with SAVD pacing in a normal conduction system. Methods: We studied the acute effects of pacing the ventricles at four sites, individually and in combination, at SAVDs (<10% of PR interval) in five anesthetized greyhound dogs. Pacing sites chosen were the RVA, endocardially, and LV mid-anteroseptal (LV1), LV posterobasal (LV2) and LV apical (LV3), epicardially, via the coronary veins. Hemodynamic data was obtained with micromannmeter-tipped catheters in the RV and LV. Peak LV +dp/dt (DPDT) and aortic pulse pressures (PP) were obtained from hemodynamic data for the shortest AV delays and pacing site combinations. Results are provided as mean-+ one STD. Results: In all dogs, pacing worsened the henmdynamics. Compared to other sites or site combinations, RVA pacing produced the worst outcome (-17-+ 3% in DPDT-14-+ 4% in PP). In all dogs, a combination of pacing sites could be identified which resulted in improved hemodynamics when compared to RVA pacing alone, with a 46-+ 8% improvement in DPDT and 76-+ 35% improvement in PP. In four dogs, the highest DPDT was obtained by pacing LV1 +LV3 together, and in the fifth dog, the combinations LVI+LV3 and LVI+LV2 produced equally high DPDT. Conclusions: Ventricular pacing at RVA with SAVD pacing has adverse hemodynamic consequences in the anesthetized dog. The deterioration in LV functional parameters can be ameliorated by multisite LV pacing via the coronary veins. These effects are measurable in animals with normal hearts, and are likely to be even more significant in patients with impaired LV function and intraventricular conduction defects.
The InSync clinical study is an ongoing prospective multicenter evaluation of Cardiac Resynchroni... more The InSync clinical study is an ongoing prospective multicenter evaluation of Cardiac Resynchronization in heart failure (HF) patients. Inclusion criteria include advanced HF (NYHA class III and IV), dilated cardiomyopathy (EF<35%, LVEDD>60 mm) and ventricular conduction abnormalities (QRS->I50 ms). METHODS: 103 patients (77% male, average age 67_+years) entered in this trial. NYHA class, 6 minute Hail Walk Distance in meters (HWD) and Quality Of Life (QOL) questionnaire (Minnesota Living with HF score) were collected at baseline, 1, 3 and 6 months after implantation.
Due to concerns regarding increased likelihood of rejection, with subsequent transplant vasculopa... more Due to concerns regarding increased likelihood of rejection, with subsequent transplant vasculopathy (TV) and decreased survival in different racial groups, we retrospectively reviewed the outcomes of 366 cardiac transplant (CT) recipients based racial similarity between donor (D) and recipient (R). We retrospectively reviewed 366 CT patients. There were 322 (88%) Caucasians (CA) and 44 (12%) African American (AA). Patients were divided into four groups based on race of the donor (D) and recipient (R):
(57) Abstract: Based on a survey of patients, HRV and VO2 Pace action therapy optimized protocol ... more (57) Abstract: Based on a survey of patients, HRV and VO2 Pace action therapy optimized protocol for the treatment of patients with CHF have been devised. During the first pacing mode of action, HRV index is obtained, then the mode is changed, and these steps are repeated for all modes. Then, pacemaker mode with the highest HRV index is programmed. Different from that modify this method, it can be can be applied to drug therapy instead of pace action therapy, or in combination with pace action therapy applications.
Journal of the American College of Cardiology, 2001
We sought to investigate the impact of six months of cardiac resynchronization therapy (CRT) on e... more We sought to investigate the impact of six months of cardiac resynchronization therapy (CRT) on echocardiographic variables of left ventricular (LV) function. BACKGROUND Cardiac resynchronization therapy has recently been introduced as a new therapeutic modality in patients with advanced heart failure (HF) and conduction abnormalities. However, most studies have only investigated the early hemodynamic effects of CRT. METHODS Twenty-five patients (12 women and 13 men; 59.8 Ï® 5.1 years old) with advanced HF caused by ischemic (n Ï 7) or idiopathic dilated cardiomyopathy (n Ï 18) and a prolonged QRS complex were analyzed. All patients underwent early hemodynamic testing with a randomized testing protocol; echocardiographic measurements were compared before implantation and after six months of CRT. RESULTS Left ventricular end-diastolic and end-systolic diameters (LVEDD and LVESD, respectively) were significantly reduced after six months (LVEDD from 71 Ï® 10 to 68 Ï® 11 mm, p Ï 0.027; LVESD from 63 Ï® 11 to 58 Ï® 11 mm, p Ï 0.007), as were LV end-diastolic and end-systolic volumes (LVEDV from 253 Ï® 83 to 227 Ï® 112 ml, p Ï 0.017; LVESV from 202 Ï® 79 to 174 Ï® 101 ml, p Ï 0.009). Ejection fraction was significantly increased (from 22 Ï® 7% to 26 Ï® 9%, p Ï 0.03). "Nonresponders," with regard to LV volume reduction, had significantly higher baseline LVEDV, compared with "responders" (351 Ï® 52 vs. 234 Ï® 74 ml, p Ï 0.018). Overall, there was only mild mitral regurgitation at baseline, with a minor reduction by semiquantitative analysis. The results of early hemodynamic testing did not predict the volume response. CONCLUSIONS Cardiac resynchronization therapy may lead to a reduction in LV volumes in patients with advanced HF and conduction disturbances. Volume nonresponders have significantly higher baseline LVEDV.
The effects of VDD pacing on hemodynarnics can be best studied at a short atrioventricnlar (SAVD)... more The effects of VDD pacing on hemodynarnics can be best studied at a short atrioventricnlar (SAVD) since it avoids fusion with the intrinsic wave generated at the atrium. Although studies have been done to test right ventricular apex (RVA) pacing with short AV delay, little is known about pacing at different sites in the left ventricle (LV) with a normal conduction system. Our aim was to compare the hemodynarnic effects of different activation sequences with SAVD pacing in a normal conduction system. Methods: We studied the acute effects of pacing the ventricles at four sites, individually and in combination, at SAVDs (<10% of PR interval) in five anesthetized greyhound dogs. Pacing sites chosen were the RVA, endocardially, and LV mid-anteroseptal (LV1), LV posterobasal (LV2) and LV apical (LV3), epicardially, via the coronary veins. Hemodynamic data was obtained with micromannmeter-tipped catheters in the RV and LV. Peak LV +dp/dt (DPDT) and aortic pulse pressures (PP) were obtained from hemodynamic data for the shortest AV delays and pacing site combinations. Results are provided as mean-+ one STD. Results: In all dogs, pacing worsened the henmdynamics. Compared to other sites or site combinations, RVA pacing produced the worst outcome (-17-+ 3% in DPDT-14-+ 4% in PP). In all dogs, a combination of pacing sites could be identified which resulted in improved hemodynamics when compared to RVA pacing alone, with a 46-+ 8% improvement in DPDT and 76-+ 35% improvement in PP. In four dogs, the highest DPDT was obtained by pacing LV1 +LV3 together, and in the fifth dog, the combinations LVI+LV3 and LVI+LV2 produced equally high DPDT. Conclusions: Ventricular pacing at RVA with SAVD pacing has adverse hemodynamic consequences in the anesthetized dog. The deterioration in LV functional parameters can be ameliorated by multisite LV pacing via the coronary veins. These effects are measurable in animals with normal hearts, and are likely to be even more significant in patients with impaired LV function and intraventricular conduction defects.
The InSync clinical study is an ongoing prospective multicenter evaluation of Cardiac Resynchroni... more The InSync clinical study is an ongoing prospective multicenter evaluation of Cardiac Resynchronization in heart failure (HF) patients. Inclusion criteria include advanced HF (NYHA class III and IV), dilated cardiomyopathy (EF<35%, LVEDD>60 mm) and ventricular conduction abnormalities (QRS->I50 ms). METHODS: 103 patients (77% male, average age 67_+years) entered in this trial. NYHA class, 6 minute Hail Walk Distance in meters (HWD) and Quality Of Life (QOL) questionnaire (Minnesota Living with HF score) were collected at baseline, 1, 3 and 6 months after implantation.
Due to concerns regarding increased likelihood of rejection, with subsequent transplant vasculopa... more Due to concerns regarding increased likelihood of rejection, with subsequent transplant vasculopathy (TV) and decreased survival in different racial groups, we retrospectively reviewed the outcomes of 366 cardiac transplant (CT) recipients based racial similarity between donor (D) and recipient (R). We retrospectively reviewed 366 CT patients. There were 322 (88%) Caucasians (CA) and 44 (12%) African American (AA). Patients were divided into four groups based on race of the donor (D) and recipient (R):
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Papers by Julio Spinelli