RESUMEN
BACKGROUND: In spite of cardiac resynchronization therapy (CRT) benefits, 25-30% of patients are still non responders. One of the possible reasons could be the non optimal atrioventricular (AV) and interventricular (VV) intervals settings. Our aim was to exploit a numerical model of cardiovascular system for AV and VV intervals optimization in CRT. METHODS: A numerical model of the cardiovascular system CRT-dedicated was previously developed. Echocardiographic parameters, Systemic aortic pressure and ECG were collected in 20 consecutive patients before and after CRT. Patient data were simulated by the model that was used to optimize and set into the device the intervals at the baseline and at the follow up. The optimal AV and VV intervals were chosen to optimize the simulated selected variable/s on the base of both echocardiographic and electrocardiographic parameters. RESULTS: Intervals were different for each patient and in most cases, they changed at follow up. The model can well reproduce clinical data as verified with Bland Altman analysis and T-test (p > 0.05). Left ventricular remodeling was 38.7% and left ventricular ejection fraction increasing was 11% against the 15% and 6% reported in literature, respectively. CONCLUSIONS: The developed numerical model could reproduce patients conditions at the baseline and at the follow up including the CRT effects. The model could be used to optimize AV and VV intervals at the baseline and at the follow up realizing a personalized and dynamic CRT. A patient tailored CRT could improve patients outcome in comparison to literature data.
Asunto(s)
Terapia de Resincronización Cardíaca , Procesamiento de Imagen Asistido por Computador , Modelos Cardiovasculares , Terapia de Resincronización Cardíaca/normas , Humanos , Modelos Estadísticos , Proyectos PilotoRESUMEN
OBJECTIVE: The aim of this study was to verify the effects of Italian Mediterranean Diet (IMD), consisting of organic versus conventional foods, on body composition, and biochemical parameters in a healthy individuals and in Chronic Kidney Disease (CKD) patients, in order to decrease cardiovascular diseases (CVD) risk factor and the progression of renal diseases. DESIGN: After providing a written fully informed consent to the study, 150 Caucasian Italian men were recruited: 100 healthy male individuals (mean age 44,66+/-13,98 years; range 30-65 years) and 50 male CKD patients (mean age 46,25+/-5,97 years; range 42-54 years). These patients were affected by stage 2 and 3 of Chronic Renal Failure according to the K-DOQI 2003. Usual dietary intake and physical activity, during the previous 12 months were estimated by a semiquantitative food-frequency questionnaire. The following were measured at baseline and after consumption of conventional/organic 14 days IMD: Body mass index (BMI), Body composition, by Dual-X absorptiometry (DXA) scanner, total plasma homocysteine (tHcy), serum phosphorus, glycemia concentrations, lipid profile, and microalbuminuria. RESULTS: A significant reduction of total homocysteine (tHcy) and phosphorus blood values were observed in the studied subjects. Body composition analysis by DXA highlighted high significant differences between conventional (T(0)) and organic diet (T(1)) for fat mass parameter, expressed as kilograms and as percentage (p<0.001). Improvement of lean body mass was observed in CDK patients (p=0.004). CONCLUSIONS: Our study clearly demonstrates that the Italian Mediterranean Organic Diet (IMOD), according to the "Nicotera diet", was able to reduce tHcy, phosphorus, microalbuminuria levels and CVD risk in healthy individuals and in CDK patients.