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Clearance of hepatitis B surface antigen (HBsAg) is an ideal therapeutic goal for patients with chronic hepatitis B virus (HBV) infection. Haematopoietic stem cell transplantation (HSCT) is the most effective therapy for a variety of haematological diseases. For patients with chronic HBV infection who received allo-HSCT, recipient hepatitis B serological status might change after allo-HSCT; however, data on the loss of HBsAg following allo-HSCT are relatively rare. We first reviewed patients with chronic HBV infection who received allo-HSCT in our centre from 2010 to 2020, and 125 patients were included in our study. A total of 62 patients (49.6%) with chronic HBV infection achieved HBsAg loss after allo-HSCT. Positivity for HBeAb and HBsAb in donors as well as no cytomegalovirus (CMV) infection were identified as independent risk factors for HBsAg loss after allo-HSCT. A predictive model including positivity for HBeAb and HBsAb in donors and no CMV infection was subsequently developed and performed well with effective discrimination and calibration. In addition, patients could benefit when this model is used in the clinic, as revealed via decision-curve analysis (DCA). However, multicentre prospective studies are required for validation.

In patients with t(8;21) acute myeloid leukemia (AML) with recurrent minimal residual disease (MRD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT), pre-emptive interferon-α therapy and donor lymphocyte infusion are noneffective in 30–50% of patients. Avapritinib is a novel tyrosine kinase inhibitor targeting KIT mutations. We report about 20 patients with t(8;21) AML and KIT mutations treated with avapritinib after allo-HSCT with MRD and most failing to respond to immunotherapy. Reduction of RUNX1-RUNX1T1 transcripts after 1 month of treatment was ≥ 1 log in 12 patients (60%), which became negative in 4 patients (20%). In 13 patients who received avapritinib for ≥ 3 months, the reduction was ≥ 1 log in all patients, which became negative in 7 patients (53.8%). The median follow-up time was 5.5 (2.0–10.0) months from avapritinib initiation to the last follow-up. Three patients underwent hematologic relapse and survived. Among all 20 patients, RUNX1-RUNX1T1 transcripts turned negative in 9 patients (45%). The efficacy did not differ significantly between D816 and non-D816 KIT mutation groups. The main adverse effect was hematological toxicity, which could generally be tolerated. In summary, avapritinib was effective for MRD treatment in patients with t(8;21) AML with KIT mutations failing to respond to immunotherapy after allo-HSCT.

Objective：To evaluate whether the effect of radiofrequency ablation can be improved by using Sacubitril/Valsartan (S/V) to control blood pressure in hypertensive patients with persistent atrial fibrillation. Methods: A total of 63 and 67 hypertension patients with persistent atrial fibrillation were enrolled in an S/V group and ACEI/ARB group, respectively. All patients underwent radiofrequency ablation (RFCA). The blood pressure of the two groups was controlled within the range of 100–140 mmHg (high pressure) and 60–90 mmHg (low pressure). The clinical indexes of the two groups were observed after 12 months of follow-up. Results: No significant differences in blood pressure were observed between the S/V and ACEI/ARB group. In addition, the recurrence rate of atrial fibrillation between the two groups was not different. The left atrial diameter was an independent predictor of recurrence (HR = 1.063, P = 0.008). However, in the heart failure subgroup, the recurrence rate of S/V was significantly lower than that of the ACEI/ARB group (P = 0.005), and cox regression analysis showed that the recurrence risk of atrial fibrillation of the S/V group was 0.302 lower than that of the ACEI/ARB group. NT ProBNP, LVEF, and LAD were significantly improved in hypertension patients with heart failure when comparing cases before and at the end of follow-up. Conclusions: S/V is better than ACEI/ARB in reducing the recurrence of persistent atrial fibrillation in patients with hypertension and heart failure after RFCA.

MiR-17 is found upregulated in diabetic mice; however, its effect(s) on renal fibrosis of diabetic nephropathy remain(s) unknown. This study aimed to explore the mechanism underlying the downregulation of miR-17 in renal fibrosis of diabetic nephropathy (DN). Patients with diabetes mellitus (DM) and DN and normal healthy individual controls, mice (db/db, db/m), and human mesangial cells (HMCs) and human proximal tubule epithelial cells (HK-2) were used as research subjects in the study. Quantitative real-time polymerase chain reaction (qRT-PCR) was performed to measure the expression of miR-17 in the serum samples, renal tissues and cells. Acid-Schiff (PAS) and Masson staining experiments were performed to detect glomerular mesangial matrix and collagen deposition. Levels of fibrosis-related proteins (E-Cadherin (E-cad), vimentin, fibronectin and collagen I) were measured by Western blot (WB). The target gene of miR-17 was predicted by TargetScan 7.2 and confirmed by dual-luciferase reporter analysis. The study found that miR-17 expression was elevated in the serums of DN patients as well as in the serums and kidney tissues of db/db mice. db/db mice showed a severe renal fibrosis condition. The levels of E-cad in db/db mice, HMC and HK-2 cells were increased by downregulating miR-17 expression, while expressions of vimentin, fibronectin and collagen I were reduced. Smad7 was predicted to be the target gene of miR-17, and its expression was promoted by downregulation of miR-17. Moreover, the reduced Smad7 expression could inhibit the expressions of fibrosis-related proteins, which, however, can be ameliorated by the downregulation of miR-17. In addition, downregulation of miR-17 could suppress renal fibrosis mediated by TGF-β1 through targeting Smad7, which might be a clinical therapeutic target for patients with DN.

In this paper, Gd2O3@mSiO2@CaTiO3:Pr nanoparticles with a novel core/shell structure featured by mesoporous, magnetic and long persistent luminescent properties have been synthesized via a facile template method. The as-prepared nanoparticles show ordered mesoporous characteristics, monodisperse spherical morphology and narrow size distribution, so they are expected to be suitable as a drug carrier. These nanoparticles exhibit bright red phosphorescence at 614 nm after UV irradiation and the persistent luminescence can persist for more than one hour. Moreover, they possess a prominent longitudinal relaxivity (r1) value of 6.43 mM−1 s−1, which suggests that these nanoparticles can be used as MR imaging agents. The combination of long persistent luminescent and magnetic properties reveals the high imaging sensitivity, which suggests that these nanoparticles can be used for imaging in vivo with a high signal to noise ratio. Drug release results indicate that the nanoparticles hold excellent drug sustained properties. The cumulative released amount of drugs can also be easily monitored by the change of luminescence intensity. After modification with polyethylene glycol, the resulting nanoparticles demonstrate good biocompatibility and low toxicity. Furthermore, we can realize in vivo imaging for over 20 min using these nanoparticles. These results indicate the promising use of these nanoparticles as multifunctional traceable drug carriers in vivo.

INTRODUCTION The outcomes of repeated cardiovascular implantable electronic device (CIED) lead extraction have not been well studied. We sought to determine the indications, outcomes, and safety of repeated lead extraction procedures. METHODS This retrospective study was conducted using data from two medical centers, including 38 patients who had undergone two or more lead extraction procedures compared to 439 patients who had a single procedure. The electronic medical records and procedural databases were reviewed to determine the indications, procedural characteristics, and outcomes. The outcomes of the first procedure were compared to the outcomes of subsequent procedures. RESULTS The 5-year cumulative probability of a repeated extraction procedure was 11% (95% confidence interval, 7%-15%). In 439 patients who underwent single lead extractions, 72% had device and lead related infections as the procedure indication compared to 39% for 38 patients who underwent repeated extraction (P

OBJECTIVE Early atrial fibrillation (AF) recurrences are common and have been shown to predict AF recurrences late after AF ablation during follow-up. Neiguan point acupuncture has been recognized to be therapeutic in treating AF in clinical practice. METHODS AND RESULTS Eighty-five patients were enrolled in succession due to persistent AF. All patients were randomized divided into control group and acupuncture group. In the control group (n = 45), amiodarone was orally taken from the first day after pulmonary vein isolation (PVI). In the acupuncture group (n = 40), patients were treated with Neiguan point acupuncture for 7 days and amiodarone was prescribed as same as the control group after PVI. The levels of inflammatory factors were analyzed before operation, 1 week after the operation and 3 months later. After 3 months, the acupuncture group had a lower rate of early recurrences than the control group (5/40 [12.5%] vs 15/45 [33.3%], P = 0.039). The inflammatory factors level in the two groups were significantly increased after ablation. However, compared with the control group, the levels of TNF-α, IL-6, CRP, TGF-β1, MMP2 in the acupuncture group significantly lower (P

Objective It is important to evaluate the effect of age on muscular athletic capability in knee joints over healthy woman aged 45 to 64. The research could provide female ageing effect on muscular athletic capability for elderly persons, aiming to promote the relative research on exercise improvement and Women's health. Methods A total of 126 volunteers were selected. The knee muscle strength indexes were tested on side-to-side using self-developed digital isometric muscle function test system. Main indexes include muscle strength, muscle explosive force and muscle endurance on side-to-side. The age groups are classified with 5 years intervals recommended by WHO. The statistics of trend, correlation network, ANOVA and PCA were employed to distinguish the aging effects. All test were implemented in R platform (version 3.3.3). Results (1) muscle strength showed obvious differences between left and right; the relative higher explosive force occurred with extensor muscles on the left showing the significant changing point at 100 ms after 50; the muscle endurance and fatigue index showed side differences after 60. (2) muscle strength trend showed “down then up” characteristics with the slightly ahead of 55 on the right side as well as muscle endurance indexes. (3) indexes between explosive force variables showed strong significant difference (p

Objective Maximal oxygen uptake (VO2 max) is a key indicator to assess health as well as sports performance. In heterogeneous, athletic populations, VO2 max is one of the most frequently measured variables in exercise physiology laboratories. The purpose of this study was to investigate the relationship between Maximal oxygen uptake with other metabolism parameters during one high-intensity activity, and provide simple solution for VO2 max prediction. Methods A total of 27 young athletes were selected. The incremental test was performed on a cycle ergometer (Monark 874 E, Sweden). Participants warmed up for 5 min at 50 watts (W); thereafter, the power output was increased 125 W every 3 min until exhaustion, which was defined as the incapacity to maintain a pedal cadence above 60 revolution per minute (rpm). Oxygen uptake (V̇O2), carbon dioxide production (V̇CO2) and other metabolism indexes were obtained breath-by-breath throughout the test using a metabolic cart (Quark b2, COSMED, Italy). Heart rate (HR) was measured throughout the test using a HR monitor (Polar Vantage NV, Finland). The main method in the VO2 prediction is the use of a mixed effects regression model. The potential explanatory variables include VO2kg (functional data with information on oxygen consumption per kg weight during the test), HR (functional data with heart rate information during the test), MHR (maximum heart rate of the athlete), VO2kgmean (average oxygen consumption during the test), VO2kgmax (maximum oxygen consumption value during the test), VCO2 (carbon dioxide emissions per minute during the test), HRmean (heart rate average), HRmax (maximum heart rate value during the test), age, height, weight. The model statistical analyses were implemented in R platform (version 3.3.3). Results (1) regression model results revealed MHR did not have stronger effects on VO2 max prediction. (2) Parameters of VO2kg, HR, HRmean, height, weight showed relative higher r2 values and lower RMSE values indicating the possible indexes for VO2 max prediction. (3) the interaction effects occurred between indicators which increase the complexity of the model. Conclusions In this study, a simple methodology for the prediction of maximum oxygen consumption has been presented. It combines a relatively simple level of base metabolism parameters. Despite the easy test and low level of exercise required the test provides an rational prediction of VO2 max, which could provide necessary information when it applied as a simple way.

New-onset atrial fibrillation (AF) is frequently observed following acute stroke. The aim of this study was to investigate the effects of the brain-stellate ganglion-atrium network on AF vulnerability in a canine model with acute middle cerebral artery occlusion (MCAO).Twenty-six dogs were randomly divided into the sham-operated group (n = 6), acute stroke (AS) group (n = 7), stellate ganglion ablation (SGA) group (n = 6) and clodronate liposome (CL) group (n = 7). In the sham-operated group, dogs received craniotomy without MCAO. Cerebral ischemic model was established in AS dogs by right MCAO. Right MCAO along with SGA and CL injection into the atrium was performed in SGA and CL dogs, respectively. After 3 days, atrial electrophysiology, neural activity, and the phenotype and function of macrophages in the atrium were studied in all the dogs.Higher AF inducibility (24.4 ± 4.4% versus 4.4 ± 2.2%, P 0.05) and AF duration (15.7 ± 3.8 s versus 2.6 ± 1.1 s, P 0.05) were observed in the AS group compared with the sham-operated group, and were associated with increased left stellate ganglion activity, higher macrophage infiltration and higher levels of inflammatory cytokines in the atrium. SGA or CL injection sharply suppressed AF inducibility (5.5 ± 2.7% versus 24.4 ± 4.4%; 5.3 ± 3.2% versus 24.4 ± 4.4%, both P 0.05) and AF duration (2.9 ± 1.2 s versus 15.7 ± 3.8 s; 3.6 ± 1.0 s versus 15.7 ± 3.8 s, both P 0.05) in canines with acute stroke.A brain-stellate ganglion-atrium network may increase AF vulnerability through macrophage activation after acute stroke.

Background Left ventricular (LV) pacing in cardiac resynchronization therapy (CRT) can be achieved via a transvenous or epicardial route. A surgically implanted epicardial LV (eLV) lead is used after a standard transvenous LV (tLV) lead implantation has failed. However, studies of clinical outcomes in patients with eLV leads and comparisons of outcome between tLV and eLV-CRT are sparse. Therefore, the purpose of this study is to compare clinical response between tLV-CRT and eLV-CRT, as well as to understand the differences within the eLV-CRT population. Methods Forty-four patients received eLV-CRT following unsuccessful attempts of tLV-CRT implantation between 2002 and 2013 at the University of California, San Diego (UCSD) and Mayo Clinics. These patients were matched for age, gender, and etiology of cardiomyopathy in a 1:2 ratio with a cohort of patients who received tLV-CRT during the same time period. Results During a mean follow-up of 57 months, similar clinical outcomes and survival rate were noted between tLV and eLV-CRT patients (all P > 0.05). Within the eLV-CRT group, dilated cardiomyopathy patients had significant improvement in New York Heart Association class and ejection fraction (both P 0.05). eLV-CRT patients with nonanterior lead location had significantly improved survival (P < 0.001). There was also a trend for improved survival in those with nonapical lead location (P = 0.09). Conclusion In this case-matched two-centered study, comparable improvements were noted in patients with tLV-CRT and eLV-CRT. Operators should target nonanterior and nonapical locations during eLV-CRT implantation. Use of eLV-CRT should be considered a viable alternative for CRT candidates.

In order to realize super-long time (more than 3 days) in vivo imaging, SrAl 2 O 4 :Eu 2+ ,Dy 3+ (SAO) nanoparticles were employed as probes with in situ repeatable excitation capability. In our experiments, strontium aluminate nanoparticles were prepared. After surface modified with pyrophosphoric acid (PPA), grafted by PEG-5000-OCH 3 and irradiated with 365 nm UV light for 10 min, the afterglow signal can be observed in real time for more than 30 min in live mouse after intravenous injection. In order to monitor for a super-long time, the mouse was re-illuminated for 10 min by a white-light LED lamp and then the imaging signals were recovered and also persisted for 30 min again. The super-long time in vivo imaging was achieved by employing these repeatedly excited luminescent nanoprobes.

Background: Permanent His bundle pacing (HBP) is a promising therapy in cardiac pacing field with high challenge of the heart structure. Cardiac mapping system provides us a comprehensive model of heart structure. The study aimed to investigate the feasibility and efficacy of HBP guided by three-dimensional (3D) mapping system. Subjects and Methods: Thirty patients undergoing permanent HBP through 3D mapping system were enrolled in this observational study between January 2016 and May 2018. The study was approved by the Ethics Review Committee of Fuwai Central China Cardiovascular Hospital. The average age of the study population was 59.2 years old, with 17 male patients. Factors including the whole operation time, the X-ray exposure time, the lead parameters, and QRS duration before and after the surgery were analyzed. Results: The study population was divided into two groups: 20 patients in selective HBP group (only capture His bundle) and 10 patients in nonselective HBP group (capture both His bundle and Para-Hisian ventricular tissue). The average whole operation time of HBP guided by 3D mapping system was 113 minutes, and there is no significant difference in the X-ray exposure time between selective HBP and nonselective HBP (P > 0.05). Four patients received HBP with zero fluoroscopy. The intraprocedural lead parameters threshold was significantly increased (1.80 ± 0.50 V vs. 1.21 ± 0.41 V) while sensing was significantly decreased (3.30 ± 0.63 mV vs. 7.40 ± 0.99 mV) in the selective HBP group compared with in the nonselective HBP group (P

Long-lasting phosphorescence functionalization of the ordered mesoporous silica nanospheres (MSNs) was realized by depositing a CaTiO 3 :Pr 3+ phosphor layer on its surface via the Pechini sol–gel process, resulting in the formation of the MSNs@CaTiO 3 :Pr 3+ composite material. This material, which combines the mesoporous structure of MSNs and the red long-lasting phosphorescence property of CaTiO 3 :Pr 3+ , can be used as a novel functional drug delivery system. The results indicate that a CaTiO 3 :Pr 3+ layer can be synthesized when the annealing temperature reaches 600 °C and impurity phases start to appear when the annealing temperature reaches 800 °C or higher. The specific surface area of MSNs@CaTiO 3 :Pr 3+ decreases along with the increase of annealing temperature. The MSNs@CaTiO 3 :Pr 3+ sample synthesized at 700 °C has appropriate phosphorescence intensity and enough specific surface area (306 m 2 /g) to load drug molecules. The as-synthesized MSNs@CaTiO 3 :Pr 3+ composite material can be tracked in vivo by optical imaging in 12 min after peritoneal injection. The quercetin-loaded MSNs@CaTiO 3 :Pr 3+ system still shows the red phosphorescence of Pr 3+ (614 nm) after UV irradiation and possesses sustained drug release property. In addition, the phosphorescence intensity of Pr 3+ increases with an increase in the cumulative released amount of quercetin in the system, making the extent of drug release easily identifiable, trackable, and monitorable by the change of phosphorescence. Our research supplies a new way to fabricate in vivo visible drug delivery system.

In this paper, we utilized double layer method to prepare SrAl2O4:Eu (SAOE) film on silicon substrate (400). The Al2O3 layer (about 200 nm) was used as a hetero-buffer layer to eliminate the large difference of crystal lattice and thermal mismatch between the SAOE and silicon substrate. Thin SAOE layer (about 600 nm) was grown on Al2O3 layer as homo-buffer layer to reduce internal stress during film growth process. On double buffer layers, continuous sputtering formed about 1.5 μm SAOE film. The resulting thick SAOE/Al2O3/Si film possessed both excellent photoluminescence (PL) and mechanoluminescence (ML) properties. The similarity of PL and ML spectra suggested that PL and ML both originated from same emitting center of Eu2 +. The strong ML intensity showed that the as-prepared SAOE film can be regarded as an indicator to detect stress distribution of an object. The thermoluminescent (ThL) results indicated that a large amount of trapped electrons existing in the resulting film answered for the strong ML intensity.

This study offers a new method to facilely synthesize morphology-controllable Zn2SiO4:Mn nanophosphors. Mesoporous silica nanoparticles (MSNs) were employed both as nanoreactors and templates in this process. First, Zn2+ and Mn2+ ions were impregnated into the mesopores of MSNs. Second, Zn2+ and Mn2+ ions reacted with the MSNs at high temperature and α phase Zn2SiO4:Mn phosphors were synthesized at a temperature higher than 800 °C. Zn2SiO4:Mn phosphors with various sizes and morphologies were successfully synthesized by using the corresponding MSNs as templates. The influences of the annealing temperature, Zn/Si molar ratio, annealing time, and particle size on the photoluminescence intensities of the as-prepared nanophosphors were investigated and the results indicate that the annealing temperature and Zn/Si molar ratio are the main factors. The resulting samples exhibit tunable morphologies, non-agglomeration, narrow size distribution and intense emission at 525 nm. The advantages of this method include simplified procedure, low annealing temperature, timesaving, controllable sizes and morphologies, large-scale production and wide practicality for other phosphor materials.

The principle of color conversion process was used to generate red long-lasting phosphorescence (LLP) using SrAl2O4:Eu, Dy (SAO) as primary light source and rhodamine B encapsulated mesoporous silica nanoparticles (MCM-R) as effective color conversion agent. The phosphorescence spectra of MCM-R/SAO hybrid samples show green peaks from 425 nm to 550 nm and red peaks from 550 nm to 700 nm, which can be attributed to the phosphorescence of SAO and the fluorescence of MCM-R, respectively. The phosphorescence color can be adjusted from green to red by changing the mass ratio of MCM-R/SAO. When the mass ratio of MCM-R/SAO increases from 0.05 to 1.5, a blue shift for the green peak and a red shift for the red peak of the phosphorescence spectra can be observed and the intensity of the red emission peak increase relatively towards the green one. The phosphorescence decay curves show that MCM-R and SAO have similar decay dynamics and the MCM-R can inherit the LLP properties of SAO. The phosphorescence decay spectra indicate that the MCM-R/SAO hybrid can retain constant and steady visual phosphorescence color. The red phosphorescence can be seen in the dark with naked eyes for more than 5 h. So, the red LLP can be successfully achieved based on the principle of color conversion process.

AIM To identify whether neuronavigation-assisted aspiration (NA) combined with electro-acupuncture (EA) provides better motor recovery in events of hypertensive putaminal hematoma (HPH) sized 30 to 50 ml. This study aims to examine whether neuronavigation-assisted aspiration and electro-acupuncture have additional value to cerebral hemorrhage motor rehabilitation. MATERIAL AND METHODS 240 patients with HPH sized 30 to 50 ml and admitted within 6 to 10 hours after stroke ictus were included in this study. Group 1 contained 60 patients who underwent neuronavigation-assisted aspiration and electro-acupuncture (NAEA), group 2 contained 60 patients who underwent neuronavigation-assisted aspiration (NA), group 3 contained 60 patients who underwent electro-acupuncture (EA), and group 4 contained 60 patients who received conservative therapy consisting solely of medications. All the patients received the same therapeutic plan on admission and functional exercises three days after stroke onset. Electro-acupuncture was performed on the third day of admission; motor recovery was examined on weeks zero and eight by blinded assessors. Outcome measures included Fugl-Meyer assessment, modified Ashworth Scale and Functional Independence Measure. RESULTS Group one showed significantly improved motor outcomes compared to group four (p < 0.01). Group one also showed significant motor improvement when pre-and post- therapy functioning was examined (p < 0.01). Cerebral edema and ischemia were significantly decreased in group one compared to group 3 and 4 (p < 0.05). While not as effective as group one treatment, group two and group three patients had significant motor recovery after intervention when compared to group four (p < 0.05). Muscular tension secondary to stroke was considerably improved between group one and group four, group two and group four, group three and group four respectively (p < 0.05). Activities of daily living (ADL) improved a lot with EA together with NA. CONCLUSION Neuronavigation-assisted aspiration and electro-acupuncture of HPH at the early stage can provide improved motor recovery with fewer complications. Significant motor recovery can be achieved by neuronavigation-assisted aspiration with acupuncture. Based on our findings, we recommend early intervention with NA and EA in order to promote early rehabilitation of hemiplegia secondary to HPH.

New-onset atrial fibrillation (AF) is not uncommon after ablation of typical atrial flutter (AFL); however, limited data are available for a risk prediction model for the future occurrence of AF in patients with typical AFL undergoing successful catheter ablation.This study aimed to determine whether the HATCH score (which is based on hypertension, age ≥75 years, transient ischemic attack or stroke, chronic obstructive pulmonary disease, and heart failure) is useful for risk prediction of subsequent AF after ablation of typical AFL.A total of 216 consecutive patients presenting with typical AFL and no history of AF who underwent successful catheter ablation were enrolled in the study. The clinical endpoint was occurrence of new-onset AF during follow-up after ablation.During a follow-up period of 29.1 ± 18.3 months, 85 patients (39%) experienced at least 1 episode of AF. Multivariate Cox regression analysis demonstrated that the HATCH score (hazard ratio 1.784; 95% confidence interval 1.352-2.324; P.001) and left atrial diameter (hazard ratio 1.270; 95% confidence interval 1.115-1.426; P.001) were independently associated with new-onset AF after typical AFL ablation. The area under the receiver operator characteristic curve based on the HATCH score for prediction of new-onset AF was 0.743. The HATCH score could be used to stratify the patients into 2 groups with different incidences of new-onset AF (69% vs 27%, P.001) at a cutoff value of 2.The HATCH score is a useful predictor of new-onset AF after typical AFL ablation.

Left ventricular (LV) pacing in cardiac resynchronization therapy (CRT) can be achieved via a transvenous or epicardial route. A surgically implanted epicardial LV (eLV) lead is used after a standard transvenous LV (tLV) lead implantation has failed. However, studies of clinical outcomes in patients with eLV leads and comparisons of outcome between tLV and eLV-CRT are sparse. Therefore, the purpose of this study is to compare clinical response between tLV-CRT and eLV-CRT, as well as to understand the differences within the eLV-CRT population.Forty-four patients received eLV-CRT following unsuccessful attempts of tLV-CRT implantation between 2002 and 2013 at the University of California, San Diego (UCSD) and Mayo Clinics. These patients were matched for age, gender, and etiology of cardiomyopathy in a 1:2 ratio with a cohort of patients who received tLV-CRT during the same time period.During a mean follow-up of 57 months, similar clinical outcomes and survival rate were noted between tLV and eLV-CRT patients (all P0.05). Within the eLV-CRT group, dilated cardiomyopathy patients had significant improvement in New York Heart Association class and ejection fraction (both P0.05), while ischemic cardiomyopathy patients did not (both P0.05). eLV-CRT patients with nonanterior lead location had significantly improved survival (P0.001). There was also a trend for improved survival in those with nonapical lead location (P = 0.09).In this case-matched two-centered study, comparable improvements were noted in patients with tLV-CRT and eLV-CRT. Operators should target nonanterior and nonapical locations during eLV-CRT implantation. Use of eLV-CRT should be considered a viable alternative for CRT candidates.