Behçet’s disease is a vasculitic condition of unknown etiology that is characterized by oral and genital ulcers as well as various skin and ocular lesions. Cardiovascular manifestations of Behçet’s disease are rare, with very few cases having been reported previously in literature. We report a case of severe tricuspid stenosis and pulmonary artery aneurysm in a 29-year-old man with Behçet’s disease, who demonstrated characteristic vascular findings on computed tomography angiography and diagnostic valvular findings on transthoracic echocardiogram and cardiac magnetic resonance imaging. The patient’s Behçet’s disease was treated initially with cyclophosphamide, azathioprine, and prednisone, which subsequently led to complete resolution of the pulmonary artery aneurysm. As for the tricuspid stenosis, though symptoms were managed with diuretic therapy, the severity of valvular dysfunction required consideration and an attempt at tricuspid valve replacement surgery, which unfortunately was met with complications and led to an unfavorable outcome of refractory cardiogenic shock and death. Given the rarity of cardiovascular involvement in patients with Behçet’s disease, along with the lack of clear treatment guidelines, management of findings of tricuspid stenosis and pulmonary artery aneurysm in these patients can be challenging.
Cardiac resynchronisation therapy (CRT) has emerged as a transformative treatment in heart failure management, particularly for patients with significant left ventricular systolic dysfunction in the context of electrical dyssynchrony. Over time, CRT has evolved to address broader patient populations and more complex clinical scenarios. Despite its well-documented benefits in improving survival, reducing hospitalisation and enhancing quality of life, approximately 30% of patients fail to respond, making ongoing research critical for optimising outcomes. This review provides a comprehensive update on the evolving landscape of CRT therapy. Focus is placed on expanding indications, novel assessment techniques for dyssynchrony, application in special populations and innovations in device programming.
Pacemaker programming recommendations in patients post-heart transplant include a higher lower rate limit, activating rate response mode, maximising battery longevity and minimising ventricular pacing in patients without atrioventricular block. This study sought to investigate how variability in pacemaker programming following orthotopic heart transplant affects morbidity. We conducted a retrospective analysis of heart transplant recipients at a single transplant centre between 1991 and 2023. Patients requiring pacemaker implantation following transplantation were matched with non-pacemaker recipients by age, sex and height. Patient and device characteristics were reviewed. Clinical outcomes, programming and physiological parameters were compared within the pacemaker group and between subject and comparator groups. Forty-five heart transplant recipients were included: 15 with pacemakers and 30 without. Within the pacemaker group, 20% were programmed with LRL > 60 bpm, rate-response mode in 47% and algorithms minimising ventricular pacing in 27%. Fifty-three percent were NYHA class I, and 46% NYHA class II; resting heart rate was similar between the groups (85 (SD14.9) and 79 (SD8) bpm: p = 0.33). NYHA class I group achieved a higher workload (METS 9 (SD2.7) vs. 6.9 (SD1) mL/kg/min: p = 0.21), and peak heart rate (135 (18.8) vs. 123 (14.8) bpm: p = 0.29) during exercise stress echocardiogram (ESE). The pacemaker group was more symptomatic than the comparator group (NYHA class II 46% vs. 10%: p = 0.016) and exhibited higher rates of cardiac allograft vasculopathy (53% vs. 10%: p = 0.005). There is substantial variability in pacemaker programming in heart transplant recipients. Patients who require a pacemaker have a greater symptom and comorbidity burden than those without. No identifiable physiological or programming differences stratified the greater morbidity within the pacemaker cohort.
