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Dawood M, Elsharkawy E, Nawar M, Sanhoury M. Right Ventricular Response to Cardiac Resynchronization Therapy: A Three-Dimensional and Speckle Tracking Echocardiographic Study. Am J Cardiol 2023; 205:150-161. [PMID: 37598600 DOI: 10.1016/j.amjcard.2023.07.105] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/23/2023] [Indexed: 08/22/2023]
Abstract
Cardiac resynchronization therapy (CRT) induces left ventricle reverse remodeling; however, its effects on right ventricular (RV) volumes and function were not well described. This study aimed to assess the effects of CRT on RV. Of 112 patients, 63 enrolled with a mean age of 62.77 ± 7.23 years, including 40 males (63.5%). All patients met criteria for CRT implantation and were followed at 3-month and 6-month intervals. Standard 2-dimensional/3-dimensional (3D) echocardiography and speckle-tracking analyses were conducted for assessment of LV and left atrium (LA). RV maximum diameters, tricuspid lateral annular systolic velocity, tricuspid annular plane systolic excursion, fractional area change, RV global (RV 4-chamber strain (RV4CSL), and RV free wall strain (RVFWSL), in addition to 3D echocardiographic assessment of RV, were done before CRT implantation and at follow-up visits. Mean follow-up period was 6.76 ± 1.25 months. A total of 48 patients (76.2%) were LV responders (LVR) whereas the rest were nonresponders (LVNR). Both groups had similar baseline characteristics, risk factors, device implantation, and programming values. Only LVR had significant reduction in RV basal diameter, together with significant improvement of RV systolic performance: systolic velocity, fractional area change, RV4CSL, RVFWSL, and 3D-derived RV volumes and ejection fraction, compared with baseline values. In addition, pulmonary arterial systolic pressure decreased in LVR with reduction of tricuspid regurgitation severity. LV response, percentage change of RV4CSL, LA end-systolic volume index, and LA emptying fraction at 3-month follow-up were the most independent predictors of RV response by multivariate analysis. Reduced left ventricular end-systolic volume >13.5% had 92.3% sensitivity and 81.8% specificity. In conclusion, CRT-induced RV reverse remodeling and improved RV-arterial coupling. These effects were associated with left side response to CRT.
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Affiliation(s)
- Moustafa Dawood
- Department of Cardiology and Angiology, Faculty of Medicine, Alexandria University, Egypt.
| | - Eman Elsharkawy
- Department of Cardiology and Angiology, Faculty of Medicine, Alexandria University, Egypt
| | - Moustafa Nawar
- Department of Cardiology and Angiology, Faculty of Medicine, Alexandria University, Egypt
| | - Mohamed Sanhoury
- Department of Cardiology and Angiology, Faculty of Medicine, Alexandria University, Egypt
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2
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Wouters P, Schoots T, Niemeijer V, Spee RF, Kemps H. Does recovery from submaximal exercise predict response to cardiac resynchronisation therapy? Open Heart 2022; 9:openhrt-2022-002047. [PMID: 36376007 PMCID: PMC9664270 DOI: 10.1136/openhrt-2022-002047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 10/19/2022] [Indexed: 11/16/2022] Open
Abstract
Background Exercise parameters are not routinely incorporated in decision making for cardiac resynchronisation therapy (CRT). Submaximal exercise parameters better reflect daily functional capacity of heart failure patients than parameters measured at maximal exertion, and may therefore better predict response to CRT. We compared various exercise parameters, and sought to establish which best predict CRT response. Methods In 31 patients with chronic heart failure (61% male; age 68±7 years), submaximal and maximal cycling testing was performed before and 3 months after CRT. Submaximal oxygen onset (τVO2 onset) and recovery kinetics (τVO2 recovery), peak oxygen uptake (VO2 peak) and oxygen uptake efficiency slope (OUES) where measured. Response was defined as ≥15% relative reduction in end-systolic volume. Results After controlling for age, New York Heart Association and VO2 peak, fast submaximal VO2 kinetics were significantly associated with response to CRT, measured either during onset or recovery of submaximal exercise (area under the curve, AUC=0.719 for both; p<0.05). By contrast, VO2 peak (AUC=0.632; p=0.199) and OUES (AUC=0.577; p=0.469) were not associated with response. Among patients with fast onset and recovery kinetics, below 60 s, a significantly higher percentage of responders was observed (91% and 92% vs 43% and 40%, respectively). Conclusions Impaired VO2 kinetics may serve as an objective marker of submaximal exercise capacity that is age-independently associated with non-response following CRT, whereas maximal exercise parameters are not. Assessment of VO2 kinetics is feasible and easy to perform, but larger studies should confirm their clinical utility.
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Affiliation(s)
- Philippe Wouters
- Department of Cardiology, Máxima Medisch Centrum, Eindhoven, The Netherlands .,Department of Cardiology, University Medical Centre, Utrecht, The Netherlands
| | - Thijs Schoots
- Department of Cardiology, Máxima Medisch Centrum, Eindhoven, The Netherlands.,Technical University of Eindhoven, Eindhoven, The Netherlands
| | - Victor Niemeijer
- Department of Sports Medicine, Elkerliek Hospital, Helmond, The Netherlands
| | - Ruud F Spee
- Department of Cardiology, Máxima Medisch Centrum, Eindhoven, The Netherlands
| | - Hareld Kemps
- Department of Cardiology, Máxima Medisch Centrum, Eindhoven, The Netherlands.,Technical University of Eindhoven, Eindhoven, The Netherlands
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3
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Yadav CP, Baharia R, Ranjha R, Hussain SSA, Singh K, Faizi N, Sharma A. An investigation of the efficacy of different statistical models in malaria forecasting in the semi-arid regions of Gujarat, India. J Vector Borne Dis 2022; 59:337-347. [PMID: 36751765 DOI: 10.4103/0972-9062.355959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND & OBJECTIVES Robust forecasting of malaria cases is desirable as we are approaching towards malaria elimination in India. Methods enabling robust forecasting and timely case detection in unstable transmission areas are the need of the hour. METHODS Forecasting efficacy of the eight most prominent statistical models that are based on three statistical methods: Generalized linear model (Model A and Model B), Smoothing method (Model C), and SARIMA (Model D to model H) were compared using last twelve years (2008-19) monthly malaria data of two districts (Kheda and Anand) of Gujarat state of India. RESULTS The SARIMA Model F was found the most appropriate when forecasted for 2017 and 2018 using model-building data sets 1 and 2, respectively, for both the districts: Kheda and Anand. Model H followed by model C were the two models found appropriate in terms of point estimates for 2019. Still, we regretted these two because confidence intervals from these models are wider that they do not have any forecasting utility. Model F is the third one in terms of point prediction but gives a relatively better confidence interval. Therefore, model F was considered the most appropriate for the year 2019 for both districts. INTERPRETATION & CONCLUSION Model F was found relatively more appropriate than others and can be used to forecast malaria cases in both districts.
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Affiliation(s)
- Chander Prakash Yadav
- ICMR-National Institute of Malaria Research, New Delhi; Academy of Scientific and Innovative Research; ICMR-National Institute of Cancer Prevention & Research, Noida, NCR, India
| | | | - Ritesh Ranjha
- ICMR-National Institute of Malaria Research, New Delhi, India
| | | | - Kuldeep Singh
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Nafis Faizi
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Amit Sharma
- ICMR-National Institute of Malaria Research; Academy of Scientific and Innovative Research; Molecular Medicine Division, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
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4
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Shabtaie SA, Sehrawat O, Lee JZ, Cha Y, Mulpuru SK, Kowlgi NG, Siontis KC, Rosenbaum AN, Bois JP, AbouEzzeddine OF, Noseworthy PA, Asirvatham SJ, DeSimone CV, Deshmukh AJ. Cardiac Resynchronization Therapy Response in Cardiac Sarcoidosis. J Cardiovasc Electrophysiol 2022; 33:2072-2080. [DOI: 10.1111/jce.15631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/25/2022] [Accepted: 05/11/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Samuel A. Shabtaie
- Department of Cardiovascular MedicineMayo Clinic200 First Street SWRochesterMN55905USA
| | - Ojasav Sehrawat
- Department of Cardiovascular MedicineMayo Clinic200 First Street SWRochesterMN55905USA
| | - Justin Z. Lee
- Department of Cardiovascular MedicineMayo Clinic200 First Street SWRochesterMN55905USA
| | - Yong‐Mei Cha
- Department of Cardiovascular MedicineMayo Clinic200 First Street SWRochesterMN55905USA
| | - Siva K. Mulpuru
- Department of Cardiovascular MedicineMayo Clinic200 First Street SWRochesterMN55905USA
| | - Narayan G. Kowlgi
- Department of Cardiovascular MedicineMayo Clinic200 First Street SWRochesterMN55905USA
| | | | - Andrew N. Rosenbaum
- Department of Cardiovascular MedicineMayo Clinic200 First Street SWRochesterMN55905USA
| | - John P. Bois
- Department of Cardiovascular MedicineMayo Clinic200 First Street SWRochesterMN55905USA
| | - Omar F. AbouEzzeddine
- Department of Cardiovascular MedicineMayo Clinic200 First Street SWRochesterMN55905USA
| | - Peter A. Noseworthy
- Department of Cardiovascular MedicineMayo Clinic200 First Street SWRochesterMN55905USA
| | - Samuel J. Asirvatham
- Department of Cardiovascular MedicineMayo Clinic200 First Street SWRochesterMN55905USA
| | | | - Abhishek J. Deshmukh
- Department of Cardiovascular MedicineMayo Clinic200 First Street SWRochesterMN55905USA
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de Amorim Fernandes F, Peix A, Giubbini R, Karthikeyan G, Massardo T, Patel C, Pabon LM, Jimenez-Heffernan A, Alexanderson E, Butt S, Kumar A, Marin V, Morozova O, Paez D, Mesquita CT, Garcia EV. Reproducibility of global LV function and dyssynchrony parameters derived from phase analysis of gated myocardial perfusion SPECT: A multicenter comparison with core laboratory setting. J Nucl Cardiol 2022; 29:952-961. [PMID: 33083983 DOI: 10.1007/s12350-020-02397-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/14/2020] [Accepted: 09/04/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Gated myocardial perfusion scintigraphy (GMPS) phase analysis is an important tool to investigate the physiology of left ventricular (LV) dyssynchrony. We aimed to test the performance of GMPS LV function and phase analysis in different clinical settings and on a diverse population. METHODS This is a post hoc analysis of a prospective, non-randomized, multinational, multicenter cohort study. Clinical evaluation and GMPS prior to cardiac resynchronization therapy (CRT)(baseline) and 6-month post CRT (follow-up) were done. LV end-systolic volume (LVESV), LV end-diastolic volume (LVEDV), LV ejection fraction (LVEF), LV phase standard deviation (LVPSD), and percentage of left ventricle non-viable (PLVNV) were obtained by 10 centers and compared to the core lab. RESULTS 276 GMPS studies had all data available from individual sites and from core lab. There were no statistically significant differences between all variables except for LVPSD. When subjects with no mechanical dyssynchrony were excluded, LVPSD difference became non-significant. LVESV, LVEF, LVPSD and PLVNV had strong correlation in site against core lab comparison. Bland-Altman plots demonstrated good agreement. CONCLUSIONS The presented correlation and agreement of LV function and dyssynchrony analysis over different sites with a diverse sample corroborate the strength of GMPS in the management of heart failure in clinical practice.
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Affiliation(s)
- Fernando de Amorim Fernandes
- Nuclear Medicine Department, Hospital Universitario Antonio Pedro-EBSERH-UFF, 303 Marquês de Parana street, Niterói, Rio de Janeiro, 24033-900, Brazil.
| | - Amalia Peix
- Nuclear Medicine Department, Institute of Cardiology, La Habana, Cuba
| | | | | | | | - Chetan Patel
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | - Sadaf Butt
- Oncology and Radiotherapy Institute (NORI), Islamabad, Pakistan
| | - Alka Kumar
- Dr. B L Kapur Memorial Hospital, New Delhi, India
| | | | - Olga Morozova
- Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency, Vienna, Austria
| | - Diana Paez
- Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency, Vienna, Austria
| | - Claudio T Mesquita
- Nuclear Medicine Department, Hospital Universitario Antonio Pedro-EBSERH-UFF, 303 Marquês de Parana street, Niterói, Rio de Janeiro, 24033-900, Brazil
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Clinical significance of the albumin–bilirubin score in patients with heart failure undergoing cardiac resynchronization therapy. Heart Vessels 2022; 37:1136-1145. [DOI: 10.1007/s00380-021-02008-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 12/03/2021] [Indexed: 02/08/2023]
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Rosalia L, Ozturk C, Shoar S, Fan Y, Malone G, Cheema FH, Conway C, Byrne RA, Duffy GP, Malone A, Roche ET, Hameed A. Device-Based Solutions to Improve Cardiac Physiology and Hemodynamics in Heart Failure With Preserved Ejection Fraction. JACC Basic Transl Sci 2021; 6:772-795. [PMID: 34754993 PMCID: PMC8559325 DOI: 10.1016/j.jacbts.2021.06.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/03/2021] [Indexed: 12/28/2022]
Abstract
Characterized by a rapidly increasing prevalence, elevated mortality and rehospitalization rates, and inadequacy of pharmaceutical therapies, heart failure with preserved ejection fraction (HFpEF) has motivated the widespread development of device-based solutions. HFpEF is a multifactorial disease of various etiologies and phenotypes, distinguished by diminished ventricular compliance, diastolic dysfunction, and symptoms of heart failure despite a normal ejection performance; these symptoms include pulmonary hypertension, limited cardiac reserve, autonomic imbalance, and exercise intolerance. Several types of atrial shunts, left ventricular expanders, stimulation-based therapies, and mechanical circulatory support devices are currently under development aiming to target one or more of these symptoms by addressing the associated mechanical or hemodynamic hallmarks. Although the majority of these solutions have shown promising results in clinical or preclinical studies, no device-based therapy has yet been approved for the treatment of patients with HFpEF. The purpose of this review is to discuss the rationale behind each of these devices and the findings from the initial testing phases, as well as the limitations and challenges associated with their clinical translation.
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Key Words
- BAT, baroreceptor activation therapy
- CCM, cardiac contractility modulation
- CRT, cardiac resynchronization therapy
- HF, heart failure
- HFmEF, heart failure with mid-range ejection fraction
- HFpEF
- HFpEF, heart failure with preserved ejection fraction
- HFrEF, heart failure with reduced ejection fraction
- IASD, Interatrial Shunt Device
- LAAD, left atrial assist device
- LAP, left atrial pressure
- LV, left ventricular
- LVEF, left ventricular ejection fraction
- MCS, mechanical circulatory support
- NYHA, New York Heart Association
- PCWP, pulmonary capillary wedge pressure
- QoL, quality of life
- TAA, transapical approach
- atrial shunt devices
- electrostimulation
- heart failure devices
- heart failure with preserved ejection fraction
- left ventricular expanders
- mechanical circulatory support
- neuromodulation
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Affiliation(s)
- Luca Rosalia
- Health Sciences and Technology Program, Harvard–Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Caglar Ozturk
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | | | - Yiling Fan
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Grainne Malone
- Tissue Engineering Research Group (TERG), Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Faisal H. Cheema
- HCA Healthcare, Houston, Texas, USA
- University of Houston, College of Medicine, Houston, Texas, USA
| | - Claire Conway
- Tissue Engineering Research Group (TERG), Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Robert A. Byrne
- Department of Cardiology, Mater Private Hospital, Dublin, Ireland
- Cardiovascular Research, School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Garry P. Duffy
- Tissue Engineering Research Group (TERG), Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Anatomy & Regenerative Medicine Institute, School of Medicine, College of Medicine, Nursing, and Health Sciences, National University of Ireland Galway, Galway, Ireland
- Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
- Advanced Materials for Biomedical Engineering and Regenerative Medicine, Trinity College Dublin, and National University of Ireland Galway, Galway, Ireland
- Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland
| | - Andrew Malone
- Tissue Engineering Research Group (TERG), Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ellen T. Roche
- Health Sciences and Technology Program, Harvard–Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Aamir Hameed
- Tissue Engineering Research Group (TERG), Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland
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8
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Lee R, Shah RV, Murthy VL. Assessment of dyssynchrony by gated myocardial perfusion imaging does not improve patient management. J Nucl Cardiol 2018; 25:526-531. [PMID: 28791621 PMCID: PMC6312556 DOI: 10.1007/s12350-017-1022-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 05/10/2017] [Indexed: 01/14/2023]
Abstract
Clinical trials have demonstrated improved outcomes with cardiac resynchronization therapy in patients with heart failure and electrical evidence of dyssynchrony. There has been intense effort at developing imaging markers of dyssynchrony with the aim of improved risk stratification. However, these efforts have not been fruitful to date. This article discusses mechanisms of cardiac dyssynchrony, reviews clinical data supporting resynchronization therapy, and addresses the lack of convincing evidence to support the use of noninvasive imaging measures of dyssynchrony in improving patient management.
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Affiliation(s)
- Ran Lee
- Frankel Cardiovascular Center, Michigan Medicine, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109-5873, USA.
| | - Ravi V Shah
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Venkatesh L Murthy
- Frankel Cardiovascular Center, Michigan Medicine, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109-5873, USA
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9
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Santini L, Forleo GB, Minni V, Mafhouz K, Della Rocca DG, Fresiello L, Romeo F, Ferrari G, Di Molfetta A. Towards a Personalized and Dynamic CRT-D. Methods Inf Med 2018; 51:495-506. [DOI: 10.3414/me12-01-0011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 07/20/2012] [Indexed: 11/09/2022]
Abstract
SummaryBackground: 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.
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10
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Kubala M, Guédon-Moreau L, Anselme F, Klug D, Bertaina G, Traullé S, Buiciuc O, Savouré A, Diouf M, Hermida JS. Utility of Frailty Assessment for Elderly Patients Undergoing Cardiac Resynchronization Therapy. JACC Clin Electrophysiol 2017; 3:1523-1533. [DOI: 10.1016/j.jacep.2017.06.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/14/2017] [Accepted: 06/30/2017] [Indexed: 01/24/2023]
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Sharma A, Lavie CJ, Vallakati A, Garg A, Goel S, Lazar J, Fonarow GC. Changes in parameters of right ventricular function with cardiac resynchronization therapy. Clin Cardiol 2017; 40:1033-1043. [PMID: 28898433 DOI: 10.1002/clc.22762] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 06/09/2017] [Accepted: 06/22/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Studies have shown that cardiac resynchronization therapy (CRT) significantly improves right ventricle (RV) size and function in patients with heart failure (HF). HYPOTHESIS CRT does not lead to improvement in RV function independent of baseline clinical variables. METHODS A systematic search of studies published between 1966 to August 31, 2015 was conducted using Pub Med, CINAHL, Cochrane CENTRAL and the Web of Science databases. Studies reporting tricuspid annular plane systolic excursion (TAPSE) or RV basal strain or RV long axis diameter or RV short axis diameter or RV fractional area change (FAC), before and after CRT, were identified. A meta-analysis was performed using random effects with inverse variance method to determine the pooled mean difference in various parameters of RV function after CRT. Meta-regression analysis was performed to test the relationship between change in various parameters of RV functions after CRT and covariates- age, QRS duration, and left ventricular ejection fraction (LVEF). RESULTS Thirteen studies (N=1541) were selected for final analysis. CRT therapy led to statistically significant increases in TAPSE [1.21 (95% CI 0.55-1.86; p<0.001)], RV FAC [2.26 (95% CI 0.50-4.01; p<0.001)] and basal strain [2.82 (95% CI 0.59-5.05; p<0.001)] and statistically significant decreases in mean RV long axis diameter [-2.94 (95% CI -5.07- -0.82; p=0.005)] and short axis diameter [-1.39 (95% CI -2.10- -0.67; p=0.876)] after a mean follow up period of 9 months. However, after meta-regression analysis for age, QRS duration, and baseline LVEF as covariates, there was no significant improvement in any of the parameters of RV function after CRT. CONCLUSION There was a statistically significant improvement in TAPSE, RV basal strain, RV fractional area, RV long axis and short axis with CRT. However, improvement in these echocardiographic parameters of RV function after CRT was not independent of baseline clinical variables but statistically dependent on age, QRS duration and baseline LVEF.
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Affiliation(s)
- Abhishek Sharma
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center, Brooklyn, New York.,Institute of Cardiovascular Research and Technology, Brooklyn, New York
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, Louisiana
| | - Ajay Vallakati
- Division of Cardiovascular Diseases, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Akash Garg
- Department of Medicine, Saint Peter's University Hospital, New Brunswick, New Jersey
| | - Sunny Goel
- Department of Cardiovascular Medicine, Maimonides Medical Center, Brooklyn, New York
| | - Jason Lazar
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center, Brooklyn, New York
| | - Gregg C Fonarow
- Division of Cardiology, University of California, Los Angeles, California
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12
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Spitzer E, Ren B, Zijlstra F, Mieghem NMV, Geleijnse ML. The Role of Automated 3D Echocardiography for Left Ventricular Ejection Fraction Assessment. Card Fail Rev 2017; 3:97-101. [PMID: 29387460 DOI: 10.15420/cfr.2017:14.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Ejection fraction is one of the most powerful determinants of prognosis and is a crucial parameter for the determination of cardiovascular therapies in conditions such as heart failure, valvular conditions and ischaemic heart disease. Among echocardiographic methods, 3D echocardiography has been attributed as the preferred one for its assessment, given an increased accuracy and reproducibility. Full-volume multi-beat acquisitions are prone to stitching artefacts due to arrhythmias and require prolonged breath holds. Single-beat acquisitions exhibit a lower temporal resolution, but address the limitations of multi-beat acquisitions. If not fully automated, 3D echocardiography remains time-consuming and resource-intensive, with suboptimal observer variability, preventing its implementation in routine practice. Further developments in hardware and software, including fully automated knowledge-based algorithms for left ventricular quantification, may bring 3D echocardiography to a definite turning point.
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Affiliation(s)
- Ernest Spitzer
- Cardiology, Thoraxcenter, Erasmus University Medical Center,Rotterdam, the Netherlands.,Cardialysis, Clinical Trial Management & Core Laboratories,Rotterdam, the Netherlands
| | - Ben Ren
- Cardiology, Thoraxcenter, Erasmus University Medical Center,Rotterdam, the Netherlands.,Cardialysis, Clinical Trial Management & Core Laboratories,Rotterdam, the Netherlands
| | - Felix Zijlstra
- Cardiology, Thoraxcenter, Erasmus University Medical Center,Rotterdam, the Netherlands
| | - Nicolas M Van Mieghem
- Cardiology, Thoraxcenter, Erasmus University Medical Center,Rotterdam, the Netherlands
| | - Marcel L Geleijnse
- Cardiology, Thoraxcenter, Erasmus University Medical Center,Rotterdam, the Netherlands
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13
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Badhwar N, James J, Hoffmayer KS, O'Connell JW, Green D, De Marco T, Botvinick EH. Utility of Equilibrium Radionuclide Angiogram–Derived Measures of Dyssynchrony to Predict Outcomes in Heart Failure Patients Undergoing Cardiac Resynchronization Therapy. J Nucl Med 2016; 57:1880-1886. [DOI: 10.2967/jnumed.116.174789] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 04/19/2016] [Indexed: 01/22/2023] Open
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Ghani A, Delnoy PPHM, Ottervanger JP, Ramdat Misier AR, Smit JJJ, Adiyaman A, Elvan A. Association of apical rocking with long-term major adverse cardiac events in patients undergoing cardiac resynchronization therapy. Eur Heart J Cardiovasc Imaging 2016; 17:146-53. [PMID: 26453544 PMCID: PMC4882884 DOI: 10.1093/ehjci/jev236] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 08/31/2015] [Indexed: 01/14/2023] Open
Abstract
AIMS Correctly identifying patients who will benefit from cardiac resynchronization therapy (CRT) is still challenging. 'Apical rocking' is observed in asynchronously contracting ventricles and is associated with echocardiographic response to CRT. The association of apical rocking and long-term clinical outcome is however unknown at present. We assessed the predictive value of left ventricular (LV) apical rocking on a long-term clinical outcome in patients treated with CRT. METHODS AND RESULTS Consecutive heart failure patients treated with primary indication for CRT-D between 2005 and 2009 were included in a prospective registry. Echocardiography was performed prior to CRT to assess apical rocking, defined as motion of the LV apical myocardium perpendicular to the LV long axis. Major adverse cardiac event (MACE) was defined as combined end point of cardiac death and/or heart failure hospitalization and/or appropriate therapy (ATP and/or ICD shocks). All echocardiograms were assessed by independent cardiologists, blinded for clinical data. Multivariable analyses were performed to adjust for potential confounders. Two hundred and ninety-five patients with echocardiography prior to implantation were included in the final analyses. Apical rocking was present in 45% of the study patients. Apical rocking was significantly more common in younger patients, females, patients with sinus rhythm, non-ischaemic cardiomyopathy, and in patients with LBBB and wider QRS duration. During a mean clinical follow-up of 5.2 ± 1.6 years, 92 (31%) patients reached the end point of the study (MACE). Patients with MACE had shorter QRS duration, had more ischaemic cardiomyopathy, and were more often on Amiodarone. In univariate analyses, MACE was associated with shorter QRS duration, ischaemic aetiology, and the absence of apical rocking. After multivariable analyses, apical rocking was associated with less MACE (hazards ratio, HR 0.44, 95% confidence interval, CI 0.25-0.77). CONCLUSION Apical rocking is an independent predictor of a favourable long-term outcome in CRT-D patients.
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Affiliation(s)
- Abdul Ghani
- Department of Cardiology, Isala Hospital, Dr. Van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | - Peter Paul H M Delnoy
- Department of Cardiology, Isala Hospital, Dr. Van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | - Jan Paul Ottervanger
- Department of Cardiology, Isala Hospital, Dr. Van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | - Anand R Ramdat Misier
- Department of Cardiology, Isala Hospital, Dr. Van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | - Jaap Jan J Smit
- Department of Cardiology, Isala Hospital, Dr. Van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | - Ahmet Adiyaman
- Department of Cardiology, Isala Hospital, Dr. Van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | - Arif Elvan
- Department of Cardiology, Isala Hospital, Dr. Van Heesweg 2, 8025 AB Zwolle, The Netherlands
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Lam WC, Pennell DJ. Imaging of the heart: historical perspective and recent advances. Postgrad Med J 2015; 92:99-104. [DOI: 10.1136/postgradmedj-2015-133831] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 11/09/2015] [Indexed: 02/01/2023]
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Mostafa SA, Mansour HA, Aboelazm TH, Elrabat KE, Sabry S. Impact of elective PCI on left intraventricular mechanical dyssynchrony in patients with chronic stable angina (tissue Doppler study). Egypt Heart J 2015. [DOI: 10.1016/j.ehj.2014.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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Ghani A, Delnoy PPHM, Adiyaman A, Ottervanger JP, Ramdat Misier AR, Smit JJJ, Elvan A. Response to cardiac resynchronization therapy as assessed by time-based speckle tracking imaging. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:455-64. [PMID: 25684239 DOI: 10.1111/pace.12589] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 12/09/2014] [Accepted: 01/04/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Response to cardiac resynchronization therapy (CRT) is still difficult to predict with previously investigated dyssynchrony indices. The predictive value of speckle tracking strain analysis has not been fully delineated yet. The objective of this study was to assess the predictive value of longitudinal strain (LS) and radial strain (RS) speckle tracking measurements on echocardiographic and clinical response to CRT. METHODS A total of 138 consecutive patients with functional class II-IV heart failure who underwent CRT were studied. Echocardiography was performed at baseline and during follow-up. Six different time-based left ventricular (LV)-dyssynchrony indices were measured with LS and RS. Echocardiographic response to CRT was defined as a reduction in LV end-systolic volume ≥15% and clinical response as survival without heart failure hospitalization. Multivariable analyses were performed to adjust for potential confounding factors. RESULTS Echocardiographic and clinical follow-up was 22 ± 8 and 42 ± 8 months, respectively. Ninety-six patients (70%) were classified as echocardiographic responders and 114 patients (83%) survived without heart failure hospitalization. QRS duration and nonischemic etiology predicted echocardiographic response to CRT. None of the speckle tracking indices was different between echocardiographic responders and nonresponders to CRT. Regarding clinical response, only maximal delay between six segments in four-chamber view measured with LS was different between responders and nonresponders, with 154-ms delay as the optimal cut-off value. Neither stratified analyses in patients with sinus rhythm nor multivariable analyses did change these findings. CONCLUSION Of all time-based measured speckle tracking indices, only maximal delay between six segments in four-chamber view as assessed with LS was associated with clinical response to CRT.
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Affiliation(s)
- Abdul Ghani
- Department of Cardiology, Isala Hospital, Zwolle, the Netherlands
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Ghani A, Delnoy PPHM, Ottervanger JP, Misier ARR, Smit JJJ, Adiyaman A, Elvan A. Apical rocking is predictive of response to cardiac resynchronization therapy. Int J Cardiovasc Imaging 2015; 31:717-25. [DOI: 10.1007/s10554-015-0607-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 01/28/2015] [Indexed: 01/14/2023]
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Practical and conceptual limitations of tissue Doppler imaging to predict reverse remodelling in cardiac resynchronisation therapy. Eur J Heart Fail 2014; 10:281-90. [DOI: 10.1016/j.ejheart.2008.02.003] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2007] [Revised: 01/02/2008] [Accepted: 02/04/2008] [Indexed: 11/23/2022] Open
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Abstract
Biventricular pacing has been an exciting recent advance in the management of drug-refractory heart failure. This new therapy has evolved as much from necessity as scientific observation, since benefits derived from pharmacotherapy currently appear to have reached their peak. Clinical trials of biventricular pacing are establishing morbidity and mortality benefits in heart failure. New challenges in the use of these pacemakers are now arising. These include the accurate diagnosis of ventricular dyssynchrony and, hence, potential responders to the refinement of implantation of the left ventricular lead to the appropriate dyssynchronous ventricular area and optimization of pacemaker programming. This review gives a general overview of the principles and the current evidence for the use of biventricular pacemakers in the treatment of heart failure. In addition, a discussion of current research and future projects is included.
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Affiliation(s)
- Paul A Gould
- Wynn Department of Metabolic Cardiology, Baker Heart Research Institute, PO Box 6492, Melbourne, Victoria 8008, Australia.
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Boogers MM, Chen J, Bax JJ. Role of nuclear imaging in cardiac resynchronization therapy. Expert Rev Cardiovasc Ther 2014; 7:65-72. [DOI: 10.1586/14779072.7.1.65] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Stabile G, Bertaglia E, Botto G, Isola F, Mascioli G, Pepi P, Caico SI, De Simone A, D’Onofrio A, Pecora D, Palmisano P, Maglia G, Arena G, Malacrida M, Padeletti L. Cardiac Resynchronization Therapy MOdular REgistry. J Cardiovasc Med (Hagerstown) 2013; 14:886-93. [DOI: 10.2459/jcm.0b013e3283644bb2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Santini L, Capria A, Di Molfetta A, Mahfouz K, Panattoni G, Minni V, Sergi D, Forleo GB, Romeo F. Endothelial dysfunction is a marker of systemic response to the cardiac resynchronization therapy in heart failure. J Card Fail 2013; 19:419-25. [PMID: 23743492 DOI: 10.1016/j.cardfail.2013.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 03/11/2013] [Accepted: 05/01/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) induces a significant improvement in patients with heart failure (HF), who are often characterized by the presence of endothelial dysfunction (ED) with impaired flow-mediated vasodilation (FMD). We aimed to study the ED in patients with HF candidates to CRT with defibrillator (CRT-D). METHODS AND RESULTS We studied 57 consecutive patients affected by HF and undergoing CRT-D. At the baseline we recorded a high prevalence of ED (64.9%) with impaired FMD (4.1 ± 3.8%). After 12 months of CRT, we reported a marked increase of the mean FMD (8.8 ± 4.8% vs 4.1 ± 3.8%; P < .05) along with significant improvement of left ventricular ejection fraction (LVEF), left ventricular end-systolic volume (LVESV), New York Heart Association (NYHA) functional class, and 6-minute walk test (6MWT); 42 patients (73.7%) were classified as responders according to standard criteria. FMD was related to LVEF (r = 0.169; P < .05), LVESV (r = -0.169; P < .05), NYHA functional class (r = -0.27; P < .051), and 6MWT (r = 0.360; P < .01). CONCLUSIONS ED is not an independent predictor of CRT response, but it is able to intercept the systemic effects of CRT and is an affordable marker of response to CRT, especially in patients unable to perform the 6MWT.
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Affiliation(s)
- Luca Santini
- Department of Cardiology, University Hospital of Tor Vergata, Rome, Italy.
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Barretto RBDM, Piegas LS, Assef JE, Melo JF, Resende TU, Moreira DA, LeBihan DC, França FF, Meneghelo RS, Sousa AGMR. Mechanical dyssynchrony is similar in different patterns of left bundle-branch block. Arq Bras Cardiol 2013; 101:449-56. [PMID: 24061684 PMCID: PMC4081169 DOI: 10.5935/abc.20130190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 06/26/2013] [Indexed: 11/23/2022] Open
Abstract
Background Left bundle-branch block (LBBB) and the presence of systolic dysfunction are the
major indications for cardiac resynchronization therapy (CRT). Mechanical
ventricular dyssynchrony on echocardiography can help identify patients responsive
to CRT. Left bundle-branch block can have different morphologic patterns. Objective To compare the prevalence of mechanical dyssynchrony in different patterns of LBBB
in patients with left systolic dysfunction. Methods This study assessed 48 patients with ejection fraction (EF) < 40% and LBBB
consecutively referred for dyssynchrony analysis. Conventional echocardiography
and mechanical dyssynchrony analysis were performed, interventricular and
intraventricular, with ten known methods, using M mode, Doppler and tissue Doppler
imaging, isolated or combined. The LBBB morphology was categorized according to
left electrical axis deviation in the frontal plane and QRS duration > 150 ms.
Results The patients' mean age was 60 ± 11 years, 24 were males, and mean EF was 29% ± 7%.
Thirty-two had QRS > 150 ms, and 22, an electrical axis between −30° and +90°.
Interventricular dyssynchrony was identified in 73% of the patients, while
intraventricular dyssynchrony, in 37%-98%. Patients with QRS > 150 ms had
larger left atrium and ventricle, and lower EF (p < 0.05). Left electrical axis
deviation associated with worse diastolic function and greater atrial diameter.
Interventricular and intraventricular mechanical dyssynchrony (ten methods) was
similar in the different LBBB patterns (p = ns). Conclusion In the two different electrocardiographic patterns of LBBB analyzed, no difference
regarding the presence of mechanical dyssynchrony was observed.
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Affiliation(s)
- Rodrigo Bellio de Mattos Barretto
- Mailing Address: Rodrigo Bellio de Mattos Barretto, Rua Alagoas, 134,
apt.º 91, Higienópolis. Postal Code 01242-000, São Paulo, SP - Brazil. E-mail:
,
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Kostić T, Perišić Z, Koraćević G, Stanojević D, Milić D, Mitov V, Pavlović M, Šalinger Martinović S, Todorović L, Ćirić Zdravković S, Golubović M. RESYNCHRONIZATION THERAPY IN PATIENTS WITH HEART FAILURE. ACTA MEDICA MEDIANAE 2013. [DOI: 10.5633/amm.2013.0202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Di Molfetta A, Forleo GB, Santini L, Fresiello L, Papavasileiou LP, Magliano G, Sergi D, Capria A, Romeo F, Ferrari G. A novel methodology for AV and VV delay optimization in CRT: results from a randomized pilot clinical trial. J Artif Organs 2013; 16:273-83. [PMID: 23504186 DOI: 10.1007/s10047-013-0701-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 02/24/2013] [Indexed: 11/30/2022]
Abstract
The aim of this work was to determine whether the use of a newly developed methodology (Alg1) for AV and VV optimization improves cardiac resynchronization therapy (CRT) clinical and echocardiographic (ECHO) outcomes. In this single-center pilot clinical trial, 80 consecutive patients (79 % male; 70.1 ± 11.2 years) receiving CRT were randomly assigned to AV and VV optimization using Alg1 (group A) or standard commercial procedures (group B). Clinical status and ECHOs were analyzed at baseline (_0) , 3 (fu1), and 6 months (fu2) of follow-up evaluating left ventricular end systolic (LVESV) and end diastolic (LVEDV) volumes, ejection fraction (EF), Minnesota test, and 6-min walk test (6MWT). Alg1 is based on a cardiovascular model fed with patient data. Baseline characteristics did not differ significantly between groups. Group A had a better clinical outcome and reverse remodeling. Remodeling was calculated as the difference (Δ) between fu1 and _0 and between fu2 and fu1, respectively: [LVESV (ml): ΔA_fu1 = -55.3, ΔB_fu1 = -13.5, p_fu1 = 0.002; ΔA_fu2 = -22.8, ΔB_fu2 = 3.0, p_fu2 = 0.04], [LVEDV (ml): ΔA_fu1 = -61.9, ΔB_fu1 = -16.1, p_fu1 = 0.01; ΔA_fu2 = -30.4, ΔB_fu2 = 11.3, p_fu2 = 0.02]; Minnesota test: total (p_fu1 = 0.01; p_fu2 = 0.04), physical (p_fu1 = 0.01; p_fu2 = 0.03) and emotional scores (p_fu1 = 0.04; p_fu2 = 0.03) and in 6MWT (m) (p_fu2 = 0.008). No statistically significant difference was observed in QRS width. Compared with current standard of care, CRT optimization using Alg1 is associated with better outcomes, showing the power of a tailored CRT.
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Affiliation(s)
- Arianna Di Molfetta
- Cardiovascular Engineering Group, Institute of Clinical Physiology, Italian National Research Council, via San Martino della Battaglia, 44, 00185, Rome, Italy,
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Sullivan RM, Murillo J, Gerritse B, Chung E, Orlov MV, Stegemann B, Fedewa M, Peterson BJ, Sun JP, Olshansky B. Do baseline diastolic echocardiographic parameters predict outcome after resynchronization therapy? Results from the PROSPECT trial. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 36:214-20. [PMID: 23121136 DOI: 10.1111/pace.12042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 08/14/2012] [Accepted: 08/27/2012] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Cardiac resynchronization therapy (CRT) can improve clinical and cardiac structural status in heart failure patients. The role of baseline diastolic echocardiographic parameters to characterize the likelihood of positive outcomes is not well known. We explored relationships between diastolic parameters and outcomes 6 months after CRT implant in the Predictors of Response to CRT (PROSPECT) Trial. HYPOTHESIS We hypothesized that diastolic echocardiographic parameters were associated with clinical and structural outcomes in CRT patients. METHODS For 426 patients in PROSPECT, a prospective observational trial of CRT, baseline E/A ratio, left atrial (LA) area, isovolumic relaxation time, left ventricular inflow deceleration time, E' velocity, and E/E' ratio were evaluated and related to 6-month clinical composite score (CCS) and left ventricular end-systolic volume (LVESV) reduction using Spearman rank-order correlations. Parameters associated with outcomes were analyzed further by discrete categorization. RESULTS As continuous variables, only E/A ratio and LA area correlated with CCSs (P = 0.017, P = 0.045, respectively) and relative change in LVESV at 6 months (P < 0.0001, P = 0.001, respectively). As discrete variables, E/A ratio and LA area also correlated with CCSs and LVESV. CONCLUSION Diastolic echo parameters E/A ratio and LA area were associated with clinical and structural outcomes in CRT patients at 6 months.
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Affiliation(s)
- Renee M Sullivan
- University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA
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Mele D, Ascione L, Caso P, Manuppelli V, Martiniello AR, Nipote C. Ruolo attuale dell’ecocardiografia nella terapia di resincronizzazione cardiaca. J Cardiovasc Echogr 2011. [DOI: 10.1016/j.jcecho.2011.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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Orjuela A. Angioplastia del seno coronario en el implante de electrodo del ventrículo izquierdo. REVISTA COLOMBIANA DE CARDIOLOGÍA 2011. [DOI: 10.1016/s0120-5633(11)70188-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Zhang Q, Yu CM. Is mechanical dyssynchrony still a major determinant for responses after cardiac resynchronization therapy? J Cardiol 2011; 57:239-48. [DOI: 10.1016/j.jjcc.2011.02.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 02/10/2011] [Indexed: 11/29/2022]
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Ishikawa T. Limitations and Problems of Assessment of Mechanical Dyssynchrony in Determining Cardiac Resynchronization Therapy Indication - Is Assessment of Mechanical Dyssynchrony Necessary in Determining CRT Indication? (Con) -. Circ J 2011; 75:465-71. [DOI: 10.1253/circj.cj-10-1252] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Kuppahally SS, Fowler MB, Vagelos R, Wang P, Al-Ahmad A, Hsia H, Liang D. Dyssynchrony Assessment with Tissue Doppler Imaging and Regional Volumetric Analysis by 3D Echocardiography Do Not Predict Long-Term Response to Cardiac Resynchronization Therapy. Cardiol Res Pract 2010; 2011:568918. [PMID: 21234100 PMCID: PMC3014673 DOI: 10.4061/2011/568918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Revised: 11/09/2010] [Accepted: 11/28/2010] [Indexed: 11/20/2022] Open
Abstract
Background. Currently there are no reliable predictors of response to cardiac resynchronization therapy (CRT) before implantation. We compared pre-CRT left ventricular (LV) dyssynchrony by tissue Doppler imaging (TDI) and regional volumetric analysis by 3-dimensional transthoracic echocardiography (3DTTE) in predicting response to CRT. Methods. Thirty-eight patients (79% nonischemic cardiomyopathy) with symptomatic heart failure who underwent CRT were enrolled. Clinical and echocardiographic responses were defined as improvement in one NYHA class and reduction in LV end-systolic volume by ≥15% respectively. Functional status was assessed by Minnesota Living with Heart Failure questionnaire and 6-minute walk distance. Results. In 33 patients, after CRT for 7.86 ± 2.27 months, there were 24 (73%) clinical and 19 (58%) echocardiographic responders. Functional parameters, LV dimensions, volumes and synchrony by TDI and 3DTTE improved significantly in responders. There was no difference in the number of responders and nonresponders when cut-off values for dyssynchrony by different measurements validated in other trials were applied. Area under receiver-operating-characteristic curve ranged from 0.4 to 0.6. Conclusion. CRT improves clinical and echocardiographic parameters in patients with systolic heart failure. The dyssynchrony measurements by TDI and 3DTTE are not comparable and are unable to predict response to CRT.
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Affiliation(s)
- Suman S Kuppahally
- Department of Cardiovascular Medicine, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA
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Jaussaud J, Blanc P, Bordachar P, Roudaut R, Douard H. Response to cardiac resynchronization therapy: the muscular metabolic pathway. Cardiol Res Pract 2010; 2011:830279. [PMID: 21197405 PMCID: PMC3010693 DOI: 10.4061/2011/830279] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Accepted: 11/23/2010] [Indexed: 12/21/2022] Open
Abstract
Background. Changes in peripheral muscle in heart failure lead to a shift from aerobic to early anaerobic metabolism during exercise leading to ergoreflex overactivation and exaggerated hyperventilation evaluated by the VE/VCO2 slope. Methods. 50 patients (38 males, 59 ± 12 years) performed cardio-pulmonary exercise test with gaz exchange measurement and echocardiographic evaluation before and 6 months after CRT. Results. The peak respiratory exchange (VCO2/ VO2) ratio was significantly reduced from 1.16 ± 0.14 to 1.11 ± 0.07 (P < .05) and the time to the anaerobic threshold was increased from 153 ± 82 to 245 ± 140 seconds (P = .01). Peak VO2, VE/VCO2, peak circulatory power and NYHA were improved after CRT (13 ± 4 to16 ± 5 ml/kg/min (P < .05), 45 ± 16 to 39 ± 13 (P < .01), 1805 ± 844 to 2225 ± 1171 mmHg.ml/kg/min (P < .01) and 3 ± 0.35 to 1.88 ± 0.4 (P = .01)). In addition, left ventricular ejection fraction and end-systolic volumes were improved from 24 ± 8 to 29 ± 7% (P < .01) and from 157 ± 69 to 122 ± 55 ml (P < .01). Conclusion. We suggest that CRT leads to an increase in oxidative muscular metabolism and postponed anaerobic threshold reducing exaggerated hyperventilation during exercise.
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Affiliation(s)
- Jérémie Jaussaud
- Division de Cardiologie Clinique, Hôpital Cardiologique, du Haut Lévêque, CHU de Bordeaux, Avenue Magellan, 33600 Pessac, France
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Cui W, Gambetta K, Zimmerman F, Freter A, Sugeng L, Lang R, Roberson DA. Real-Time Three-Dimensional Echocardiographic Assessment of Left Ventricular Systolic Dyssynchrony in Healthy Children. J Am Soc Echocardiogr 2010; 23:1153-9. [DOI: 10.1016/j.echo.2010.08.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Indexed: 11/26/2022]
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Silva E, Sitges M, Doltra A, Mont L, Vidal B, Castel MA, Tolosana JM, Berruezo A, Juanatey JRG, Brugada J. Analysis of temporal delay in myocardial deformation throughout the cardiac cycle: Utility for selecting candidates for cardiac resynchronization therapy. Heart Rhythm 2010; 7:1580-6. [DOI: 10.1016/j.hrthm.2010.06.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Accepted: 06/28/2010] [Indexed: 11/26/2022]
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Hoth KF, Poppas A, Ellison KE, Paul RH, Sokobin A, Cho Y, Cohen RA. Link between change in cognition and left ventricular function following cardiac resynchronization therapy. J Cardiopulm Rehabil Prev 2010; 30:401-8. [PMID: 20562712 PMCID: PMC2978265 DOI: 10.1097/hcr.0b013e3181e1739a] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE In patients with heart failure, reduced cardiac ejection fraction has been associated with impaired cognition. Improving cardiac function may have beneficial effects on cognition; however, no controlled intervention studies have examined this possibility. Cardiac resynchronization therapy (CRT) is one intervention that has been shown to increase cardiac function. The goals of the current study were to (1) evaluate neuropsychological performance before and 3 months after crt and (2) examine follow-up neuropsychological performance of patients classified on the basis of extent of improved left ventricular ejection fraction (LVEF). METHODS Twenty-seven patients with moderate to severe heart failure completed a neuropsychological assessment, 6-minute walk test, and transthoracic echocardiography before and 3 months after CRT. Patients were classified on the basis of improvement in LVEF. Results of a multivariate analysis of variance revealed a significant effect of improvement in LVEF on change in cognition (Wilks Λ, P = .031). RESULTS Patients with improved LVEF demonstrated significant increases on measures of executive functioning (F = 8.57, P = .007) and visuospatial function (F = 7.52, P = .011) and less decline on global cognition (F = 5.73, P = .024) than those without LVEF improvement. CONCLUSIONS Findings provide preliminary evidence that improved LVEF in response to CRT is associated with enhanced cognitive outcomes within 3 months of CRT. Patients with improved LVEF showed better outcomes on measures of executive functioning, global cognition, and visuospatial functioning. Future, controlled, large-scale trials will be necessary to determine whether there is an underlying causal relationship linking increase in LVEF and cognition.
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Affiliation(s)
- Karin F Hoth
- Department of Medicine, National Jewish Health, University of Colorado Denver, CO 80206, USA.
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Gorcsan J, Oyenuga O, Habib PJ, Tanaka H, Adelstein EC, Hara H, McNamara DM, Saba S. Relationship of echocardiographic dyssynchrony to long-term survival after cardiac resynchronization therapy. Circulation 2010; 122:1910-8. [PMID: 20975000 DOI: 10.1161/circulationaha.110.954768] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND The ability of echocardiographic dyssynchrony to predict response to cardiac resynchronization therapy (CRT) has been unclear. METHODS AND RESULTS A prospective, longitudinal study was designed with predefined dyssynchrony indexes and outcome variables to test the hypothesis that baseline dyssynchrony is associated with long-term survival after CRT. We studied 229 consecutive class III to IV heart failure patients with ejection fraction ≤35 and QRS duration ≥120 milliseconds for CRT. Dyssynchrony before CRT was defined as tissue Doppler velocity opposing-wall delay ≥65 milliseconds, 12-site SD (Yu Index) ≥32 milliseconds, speckle tracking radial strain anteroseptal-to-posterior wall delay ≥130 milliseconds, or pulsed Doppler interventricular mechanical delay ≥40 milliseconds. Outcome was defined as freedom from death, heart transplantation, or left ventricular assist device implantation. Of 210 patients (89) with dyssynchrony data available, there were 62 events: 47 deaths, 9 transplantations, and 6 left ventricular assist device implantations over 4 years. Event-free survival was associated with Yu Index (P=0.003), speckle tracking radial strain (P=0.003), and interventricular mechanical delay (P=0.019). When adjusted for confounding baseline variables of ischemic origin and QRS duration, Yu Index and radial strain dyssynchrony remained independently associated with outcome (P<0.05). Lack of radial dyssynchrony was particularly associated with unfavorable outcome in those with QRS duration of 120 to 150 milliseconds (P=0.002). CONCLUSIONS The absence of echocardiographic dyssynchrony was associated with significantly less favorable event-free survival after CRT. Patients with narrower QRS duration who lacked dyssynchrony had the least favorable long-term outcome. These observations support the relationship of dyssynchrony and CRT response.
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Affiliation(s)
- John Gorcsan
- University of Pittsburgh, Scaife 564, 200 Lothrop St, Pittsburgh, PA 15213-2582, USA.
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Lalonde M, Birnie D, Ruddy TD, deKemp RA, Wassenaar RW. SPECT blood pool phase analysis can accurately and reproducibly quantify mechanical dyssynchrony. J Nucl Cardiol 2010; 17:803-10. [PMID: 20428986 DOI: 10.1007/s12350-010-9231-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Accepted: 04/06/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Phase analysis of SPECT blood pool imaging has the potential to assess mechanical dyssynchrony (MD). However, wall motion of the left ventricle (LV) from SPECT images can be based on either time-activity or time-distance curves. In this paper, these two techniques were compared using receiver-operator characteristics (ROC) analysis at detecting MD patients from a population of normal subjects. METHODS SPECT phase analysis was performed on 48 normal subjects (LVEF > 55%, normal wall motion, QRS < 120 ms), and 55 MD patients (LVEF < 35%, QRS > 120 ms). ROC analysis was individually performed on each of three phase parameters (phase standard deviation, synchrony, and entropy) for each LV wall motion technique. ROC area differences were assessed using the Student t-test. Intra- and inter-observer reproducibilities were investigated using regression analysis. RESULTS Time-activity-based phase analysis produced excellent ROC areas of .93 or better for all three phase parameters. The time-distance techniques produced significantly (P < .05) lower ROC areas in the range of .53-.76. Time-activity-based phase analysis had excellent intra- and inter-observer reproducibility with correlation coefficients >.96, compared to values of ~.85 for the time-distance methods. CONCLUSION SPECT time-activity-based phase analysis had excellent sensitivity and specificity at detecting MD patients with very high intra- and inter-observer reproducibility.
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Affiliation(s)
- Michel Lalonde
- Department of Physics, Carleton University, Ottawa, ON, Canada
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Stoylen A. Possible benefit of cardiac resynchronization therapy with ejection fraction >35%. Eur J Heart Fail 2010; 12:1140-1; author reply 1141. [PMID: 20810474 DOI: 10.1093/eurjhf/hfq148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Chan PS, Khumri T, Chung ES, Ghio S, Reid KJ, Gerritse B, Nallamothu BK, Spertus JA. Echocardiographic dyssynchrony and health status outcomes from cardiac resynchronization therapy: insights from the PROSPECT trial. JACC Cardiovasc Imaging 2010; 3:451-60. [PMID: 20466340 DOI: 10.1016/j.jcmg.2009.08.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Revised: 08/03/2009] [Accepted: 08/10/2009] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study sought to assess the prognostic utility of echocardiographic dyssynchrony for health status improvement after cardiac resynchronization therapy (CRT). BACKGROUND Echocardiographic measures of dyssynchrony have been proposed for patient selection for CRT, but prospective validation studies are lacking. METHODS A prospective cohort of 324 patients from 53 centers with moderate to severe heart failure, left ventricular dysfunction, QRS > or =130 ms, and available echocardiographic and health status information were identified from the PROSPECT (Predictors of Response to Cardiac Re-Synchronization Therapy) trial, which evaluated the prognostic utility of dyssynchrony measures in CRT recipients. The association of 12 echocardiographic dyssynchrony parameters with 6-month improvement in health status, as measured by the Kansas City Cardiomyopathy Questionnaire (KCCQ), was assessed both as a continuous variable and by responder status (DeltaKCCQ > or =+10 points reflecting moderate to large improvement). RESULTS Of 12 pre-defined dyssynchrony parameters, only 3 were consistently reported: interventricular mechanical delay (IVMD), left ventricular filling time relative to the cardiac cycle (LVFT), and left ventricular pre-ejection interval. After multivariable adjustment, IVMD (+5.18, 95% confidence interval [CI]: +0.76 to +9.60; p = 0.02) and LVFT (+5.19, 95% CI: +0.45 to +0.94; p = 0.03) were independently associated with 6-month improvements in KCCQ. Patients with 6-month improvements in KCCQ had lower subsequent mortality (adjusted hazard ratio [HR] for each 5-point improvement: 0.83; 95% CI: 0.72 to 0.93; p = 0.03). Additionally, IVMD was associated with CRT responder status (for DeltaKCCQ > or =+10 points: odds ratio [OR]: 1.85; 95% CI: 1.12 to 3.05; p = 0.03), whereas LVFT was not (OR: 1.63; 95% CI: 0.85 to 3.11; p = 0.14). Patients classified as health status responders had a 76% lower subsequent risk of all-cause mortality (adjusted HR: 0.24; 95% CI: 0.07 to 0.84; p = 0.03). CONCLUSIONS The presence of pre-implantation IVMD and LVFT was associated with 6-month health status improvement, and IVMD was associated with a significant CRT response. These echocardiographic factors may help clinicians counsel patients regarding their likelihood of symptomatic improvement with CRT. ( PROSPECT Predictors of Response to Cardiac Re-Synchronization Therapy; NCT00253357).
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Affiliation(s)
- Paul S Chan
- Mid America Heart Institute, Kansas City, Missouri 64111, USA.
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Use of a comprehensive numerical model to improve biventricular pacemaker temporization in patients affected by heart failure undergoing to CRT-D therapy. Med Biol Eng Comput 2010; 48:755-64. [DOI: 10.1007/s11517-010-0623-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Accepted: 04/10/2010] [Indexed: 10/19/2022]
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Ventilatory response and peak circulatory power: New functional markers of response after cardiac resynchronization therapy. Arch Cardiovasc Dis 2010; 103:184-91. [DOI: 10.1016/j.acvd.2010.01.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Revised: 01/15/2010] [Accepted: 01/15/2010] [Indexed: 11/23/2022]
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Chung ES, Katra RP, Ghio S, Bax J, Gerritse B, Hilpisch K, Peterson BJ, Feldman DS, Abraham WT. Cardiac resynchronization therapy may benefit patients with left ventricular ejection fraction >35%: a PROSPECT trial substudy. Eur J Heart Fail 2010; 12:581-7. [PMID: 20150328 DOI: 10.1093/eurjhf/hfq009] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
AIMS Cardiac resynchronization therapy (CRT) is currently limited to those with left ventricular ejection fraction (LVEF) < or =35%. To evaluate whether patients with LVEF >35% might benefit from CRT, we performed a retrospective analysis of the predictors of response to CRT (PROSPECT) database. METHODS AND RESULTS PROSPECT was a prospective, multicentre study that enrolled CRT patients based on enrolling centre-evaluated LVEF <35%, but all echocardiograms were subsequently analysed by a core laboratory. Patients with core laboratory-measured LVEF >35% (OVER35) were compared with those whose LVEF was <35% (UNDER35). Clinical composite score (CCS) and change in LV end systolic volume (LVESV) were analysed from baseline to 6-month follow-up. Of 361 patients, 86 (24%) had LVEF >35%. At entry, OVER35 had smaller LV volumes, shorter QRS duration, shorter 6-min walk distance, and were more likely to have ischaemic aetiology than UNDER35. Outcomes were comparable between the groups, with 62.8% of OVER35 improved in CCS (70.2% in UNDER35) and 50.8% of OVER35 improved in LVESV (57.8% in UNDER35). CONCLUSION Patients with LVEF >35%, New York heart association functional Class III-IV status, and QRS >130 ms appear to derive clinical and structural benefit from CRT. As CRT may offer a valuable option for these patients, this hypothesis should be formally tested in a prospective, randomized multicentre trial.
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Affiliation(s)
- Eugene S Chung
- The Christ Hospital and The Ohio Heart and Vascular Center, 2123 Auburn Avenue, Ste 100, Cincinnati, OH, USA.
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Kaplan Ş, Kırış A, Erem C, Kaplan T, Kırış G, Gedikli Ö, Koçak M, Baykan M, Çelik Ş. Assessment of Left Ventricular Systolic Asynchrony in Patients with Clinical Hypothyroidism. Echocardiography 2010; 27:117-22. [DOI: 10.1111/j.1540-8175.2009.00982.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Usefulness of Echocardiographic Dyssynchrony in Patients With Borderline QRS Duration to Assist With Selection for Cardiac Resynchronization Therapy. JACC Cardiovasc Imaging 2010; 3:132-40. [DOI: 10.1016/j.jcmg.2009.09.020] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Revised: 09/03/2009] [Accepted: 09/16/2009] [Indexed: 11/17/2022]
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van Geldorp IE, Vernooy K, Delhaas T, Prins MH, Crijns HJ, Prinzen FW, Dijkman B. Beneficial effects of biventricular pacing in chronically right ventricular paced patients with mild cardiomyopathy. Europace 2009; 12:223-9. [DOI: 10.1093/europace/eup378] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Schaber D. Clarification and correction about the design and implementation of the PROSPECT Trial. J Am Coll Cardiol 2009; 54:2203-4; author reply 2204. [PMID: 19942097 DOI: 10.1016/j.jacc.2009.06.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Accepted: 06/16/2009] [Indexed: 11/29/2022]
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Reply. J Am Coll Cardiol 2009. [DOI: 10.1016/j.jacc.2009.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Izumo M, Lancellotti P, Suzuki K, Kou S, Shimozato T, Hayashi A, Akashi YJ, Osada N, Omiya K, Nobuoka S, Ohtaki E, Miyake F. Three-dimensional echocardiographic assessments of exercise-induced changes in left ventricular shape and dyssynchrony in patients with dynamic functional mitral regurgitation. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2009; 10:961-7. [DOI: 10.1093/ejechocard/jep114] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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van Bommel RJ, Bax JJ, Abraham WT, Chung ES, Pires LA, Tavazzi L, Zimetbaum PJ, Gerritse B, Kristiansen N, Ghio S. Characteristics of heart failure patients associated with good and poor response to cardiac resynchronization therapy: a PROSPECT (Predictors of Response to CRT) sub-analysis. Eur Heart J 2009; 30:2470-7. [PMID: 19717847 DOI: 10.1093/eurheartj/ehp368] [Citation(s) in RCA: 157] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Predictors of Response to Cardiac Resynchronization Therapy (CRT) (PROSPECT) was the first large-scale, multicentre clinical trial that evaluated the ability of several echocardiographic measures of mechanical dyssynchrony to predict response to CRT. Since response to CRT may be defined as a spectrum and likely influenced by many factors, this sub-analysis aimed to investigate the relationship between baseline characteristics and measures of response to CRT. METHODS AND RESULTS A total of 286 patients were grouped according to relative reduction in left ventricular end-systolic volume (LVESV) after 6 months of CRT: super-responders (reduction in LVESV > or =30%), responders (reduction in LVESV 15-29%), non-responders (reduction in LVESV 0-14%), and negative responders (increase in LVESV). In addition, three subgroups were formed according to clinical and/or echocardiographic response: +/+ responders (clinical improvement and a reduction in LVESV > or =15%), +/- responders (clinical improvement or a reduction in LVESV > or =15%), and -/- responders (no clinical improvement and no reduction in LVESV > or =15%). Differences in clinical and echocardiographic baseline characteristics between these subgroups were analysed. Super-responders were more frequently females, had non-ischaemic heart failure (HF), and had a wider QRS complex and more extensive mechanical dyssynchrony at baseline. Conversely, negative responders were more frequently in New York Heart Association class IV and had a history of ventricular tachycardia (VT). Combined positive responders after CRT (+/+ responders) had more non-ischaemic aetiology, more extensive mechanical dyssynchrony at baseline, and no history of VT. CONCLUSION Sub-analysis of data from PROSPECT showed that gender, aetiology of HF, QRS duration, severity of HF, a history of VT, and the presence of baseline mechanical dyssynchrony influence clinical and/or LV reverse remodelling after CRT. Although integration of information about these characteristics would improve patient selection and counselling for CRT, further randomized controlled trials are necessary prior to changing the current guidelines regarding patient selection for CRT.
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Affiliation(s)
- Rutger J van Bommel
- Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
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