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Sadeghian H, Kousari A, Majidi S, Rezvanfard M, Kazemisaeid A, Moezzi SA, Vasheghani Farahani A, Abdar Esfahani M, Sahebjam M, Zoroufian A, Sadeghian A. Association between Latest Activated Sites in the Left Ventricle and Akinetic Segments in Patients with Ischemic Cardiomyopathy. J Tehran Heart Cent 2016; 11:115-122. [PMID: 27956911 PMCID: PMC5148814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: It is not clear whether the latest activation sites in the left ventricle (LV) are matched with infracted regions in patients with ischemic cardiomyopathy (ICM). We aimed to investigate whether the latest activation sites in the LV are in agreement with the region of akinesia in patients with ICM. Methods: Data were analyzed in 106 patients (age = 60.5 ± 12.1 y, male = 88.7%) with ICM (ejection fraction ≤ 35%) who were refractory to pharmacological therapy and were referred to the echocardiography department for an evaluation of the feasibility of cardiac resynchronization therapy. Wall motion abnormalities, time to peak systolic myocardial velocity (Ts) of 6 basal and 6 mid-portion segments of the LV, and 4 frequently used dyssynchrony indices were measured using 2-dimensional echocardiography and tissue Doppler imaging (TDI). To evaluate the influence of the electrocardiographic pattern, we categorized the patients into 2 groups: patients with QRS ≤ 120 ms and those with QRS >120 ms. Results: A total of 1 272 segments were studied. The latest activation sites (with longest Ts) were most frequently located in the mid-anterior (n = 32, 30.2%) and basal-anterior segments (n = 29, 27.4%), while the most common sites of akinesia were the mid-anteroseptal (n = 65, 61.3%) and mid-septal (n = 51, 48.1%) segments. Generally, no significant concordance was found between the latest activated segments and akinesia either in all the patients or in the QRS groups. Detailed analysis within the segments indicated a good agreement between akinesia and delayed activation in the basal-lateral segment solely in the patients with QRS duration ≤ 120 ms (Φ = 0.707; p value ≤ 0.001). Conclusion: The akinetic segment on 2-dimensional echocardiogram was not matched with the latest activation sites in the LV determined by TDI in patients with ICM.
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Affiliation(s)
- Hakimeh Sadeghian
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.,Corresponding Author: Hakimeh Sadeghian, Associate Professor of Cardiology, Tehran Heart Center, North Kargar Street, Tehran, Iran. 1411713138. Tel: +98 21 88029257. Fax: +98 21 88029256.
| | - Aliasghar Kousari
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Shahla Majidi
- Emam Khomeini Hospital, Ahvaz University of Medical Sciences, Ahvaz, Iran.
| | - Mehrnaz Rezvanfard
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Ali Kazemisaeid
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Seyed Ali Moezzi
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
| | | | | | - Mohammad Sahebjam
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Arezoo Zoroufian
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
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Gyalai Z, Jeremiás Z, Baricz E, Rudzik R, Dobreanu D. Echocardiographic evaluation of mechanical dyssynchrony in heart failure patients with reduced ejection fraction. Technol Health Care 2016; 24 Suppl 2:S587-92. [DOI: 10.3233/thc-161185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Zsolt Gyalai
- Department of Cardiology, University of Medicine and Pharmacy Târgu Mureş, Mureş County Clinical Hospital, Târgu Mureş, Romania
| | - Zsuzsanna Jeremiás
- Department of Cardiology, University of Medicine and Pharmacy Târgu Mureş, Mureş County Clinical Hospital, Târgu Mureş, Romania
| | - Emoke Baricz
- Department of Cardiology, University of Medicine and Pharmacy Târgu Mureş, Mureş County Clinical Hospital, Târgu Mureş, Romania
| | - Roxana Rudzik
- Department of Cardiology, University of Medicine and Pharmacy Târgu Mureş, Institute of Cardiovascular Diseases and Transplant, Târgu Mureş, Romania
| | - Dan Dobreanu
- Department of Cardiology, University of Medicine and Pharmacy Târgu Mureş, Institute of Cardiovascular Diseases and Transplant, Târgu Mureş, Romania
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Satija U, Ramkumar B, Manikandan MS. Robust cardiac event change detection method for long-term healthcare monitoring applications. Healthc Technol Lett 2016; 3:116-23. [PMID: 27382480 DOI: 10.1049/htl.2015.0062] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 03/14/2016] [Accepted: 04/05/2016] [Indexed: 11/19/2022] Open
Abstract
A long-term continuous cardiac health monitoring system highly demands more battery power for real-time transmission of electrocardiogram (ECG) signals and increases bandwidth, treatment costs and traffic load of the diagnostic server. In this Letter, the authors present an automated low-complexity robust cardiac event change detection (CECD) method that can continuously detect specific changes in PQRST morphological patterns and heart rhythms and then enable transmission/storing of the recorded ECG signals. The proposed CECD method consists of four stages: ECG signal quality assessment, R-peak detection and beat waveform extraction, temporal and RR interval feature extraction and cardiac event change decision. The proposed method is tested and validated using both normal and abnormal ECG signals including different types of arrhythmia beats, heart rates and signal quality. Results show that the method achieves an average sensitivity of 99.76%, positive predictivity of 94.58% and overall accuracy of 94.32% in determining the changes in heartbeat waveforms of the ECG signals.
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Affiliation(s)
- Udit Satija
- School of Electrical Sciences , Indian Institute of Technology Bhubaneswar , Bhubaneswar, Odisha-751013 , India
| | - Barathram Ramkumar
- School of Electrical Sciences , Indian Institute of Technology Bhubaneswar , Bhubaneswar, Odisha-751013 , India
| | - M Sabarimalai Manikandan
- School of Electrical Sciences , Indian Institute of Technology Bhubaneswar , Bhubaneswar, Odisha-751013 , India
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Vancheri F, Vancheri S, Henein MY. Effect of Age on Left Ventricular Global Dyssynchrony in Asymptomatic Individuals: A Population Study. Echocardiography 2016; 33:977-83. [DOI: 10.1111/echo.13218] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
| | | | - Michael Y. Henein
- Department of Public Health and Clinical Medicine; Umeå University; Umeå Sweden
- Department of Cardiology; Heart Centre; Umeå Sweden
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55
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Saporito S, van Assen HC, Houthuizen P, Aben JPMM, Strik M, van Middendorp LB, Prinzen FW, Mischi M. Assessment of left ventricular mechanical dyssynchrony in left bundle branch block canine model: Comparison between cine and tagged MRI. J Magn Reson Imaging 2016; 44:956-63. [PMID: 26973138 DOI: 10.1002/jmri.25225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 02/23/2016] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To compare cine and tagged magnetic resonance imaging (MRI) for left ventricular dyssynchrony assessment in left bundle branch block (LBBB), using the time-to-peak contraction timing, and a novel approach based on cross-correlation. MATERIALS AND METHODS We evaluated a canine model dataset (n = 10) before (pre-LBBB) and after induction of isolated LBBB (post-LBBB). Multislice short-axis tagged and cine MRI images were acquired using a 1.5 T scanner. We computed contraction time maps by cross-correlation, based on the timing of radial wall motion and of circumferential strain. Finally, we estimated dyssynchrony as the standard deviation of the contraction time over the different regions of the myocardium. RESULTS Induction of LBBB resulted in a significant increase in dyssynchrony (cine: 13.0 ± 3.9 msec for pre-LBBB, and 26.4 ± 5.0 msec for post-LBBB, P = 0.005; tagged: 17.1 ± 5.0 msec at for pre-LBBB, and 27.9 ± 9.8 msec for post-LBBB, P = 0.007). Dyssynchrony assessed by cine and tagged MRI were in agreement (r = 0.73, P = 0.0003); differences were in the order of time difference between successive frames of 20 msec (bias: -2.9 msec; limit of agreement: 10.1 msec). Contraction time maps were derived; agreement was found in the contraction patterns derived from cine and tagged MRI (mean difference in contraction time per segment: 3.6 ± 13.7 msec). CONCLUSION This study shows that the proposed method is able to quantify dyssynchrony after induced LBBB in an animal model. Cine-assessed dyssynchrony agreed with tagged-derived dyssynchrony, in terms of magnitude and spatial direction. J. MAGN. RESON. IMAGING 2016;44:956-963.
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Affiliation(s)
- Salvatore Saporito
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.
| | - Hans C van Assen
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Patrick Houthuizen
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | | | - Marc Strik
- Department of Physiology, Maastricht University, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Lars B van Middendorp
- Department of Physiology, Maastricht University, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Frits W Prinzen
- Department of Physiology, Maastricht University, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Massimo Mischi
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
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Ebrille E, DeSimone CV, Vaidya VR, Chahal AA, Nkomo VT, Asirvatham SJ. Ventricular pacing - Electromechanical consequences and valvular function. Indian Pacing Electrophysiol J 2016; 16:19-30. [PMID: 27485561 PMCID: PMC4936653 DOI: 10.1016/j.ipej.2016.02.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Although great strides have been made in the areas of ventricular pacing, it is still appreciated that dyssynchrony can be malignant, and that appropriately placed pacing leads may ameliorate mechanical dyssynchrony. However, the unknowns at present include: 1. The mechanisms by which ventricular pacing itself can induce dyssynchrony; 2. Whether or not various pacing locations can decrease the deleterious effects caused by ventricular pacing; 3. The impact of novel methods of pacing, such as atrioventricular septal, lead-less, and far-field surface stimulation; 4. The utility of ECG and echocardiography in predicting response to therapy and/or development of dyssynchrony in the setting of cardiac resynchronization therapy (CRT) lead placement; 5. The impact of ventricular pacing-induced dyssynchrony on valvular function, and how lead position correlates to potential improvement. This review examines the existing literature to put these issues into context, to provide a basis for understanding how electrical, mechanical, and functional aspects of the heart can be distorted with ventricular pacing. We highlight the central role of the mitral valve and its function as it relates to pacing strategies, especially in the setting of CRT. We also provide future directions for improved pacing modalities via alternative pacing sites and speculate over mechanisms on how lead position may affect the critical function of the mitral valve and thus overall efficacy of CRT.
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Affiliation(s)
- Elisa Ebrille
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA; Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | | | - Vaibhav R Vaidya
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Anwar A Chahal
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA; Clinical and Translational Science, Mayo Graduate School, Rochester, MN, USA
| | - Vuyisile T Nkomo
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Samuel J Asirvatham
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA; Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.
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Voskoboinik A, McGavigan AD, Mariani JA. Cardiac resynchronisation therapy in 2015: keeping up with the pace. Intern Med J 2016; 46:255-65. [DOI: 10.1111/imj.12774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 03/24/2015] [Indexed: 11/28/2022]
Affiliation(s)
- A. Voskoboinik
- Department of Cardiology; Western Hospital; Melbourne Victoria Australia
- Department of Cardiology; Alfred Hospital; Melbourne Victoria Australia
| | - A. D. McGavigan
- Department of Cardiovascular Medicine; Adelaide South Australia Australia
| | - J. A. Mariani
- Department of Cardiology; Alfred Hospital; Melbourne Victoria Australia
- Cardiac Investigation Unit; St Vincent' Hospital; Melbourne Victoria Australia
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Fang F, Luo XX, Zhang Q, Azlan H, Razali O, Ma Z, Gan SF, Xie JM, Yu CM. Deterioration of left ventricular systolic function in extended Pacing to Avoid Cardiac Enlargement (PACE) trial: the predictive value of early systolic dyssynchrony. Europace 2016; 17 Suppl 2:ii47-53. [PMID: 26842115 DOI: 10.1093/europace/euv130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
AIMS Biventricular (BiV) pacing was superior to right ventricular apical (RVA) pacing at extended follow-up in the Pacing to Avoid Cardiac Enlargement (PACE) trial. Early pacing-induced systolic dyssynchrony (DYS) might be related to mid-term result. However, it remains unknown whether early pacing-induced DYS can predict long-term reduction of left ventricular (LV) systolic function. METHODS AND RESULTS Patients with standard pacing indications and normal LV ejection fraction (LVEF) were randomized either to BiV (n = 89) or RVA (n = 88) pacing. Seventy-four patients in the RVA group and 72 in the BiV pacing group completed follow-up longer than 2 years. Serial echocardiography was performed with DYS assessed by tissue Doppler imaging, and the early pacing-induced DYS was defined as >33 ms by using standard deviation of the time to peak systolic velocity (Dyssynchrony Index) in a 12-segment model of LV at 1 month. There were 46 (32%) patients having early pacing-induced DYS that was more prevalent in the RVA pacing group than that in the BiV pacing group (50.7 vs. 12.3%, χ(2) = 25.1, P < 0.001) despite the similar DYS between the two groups at baseline (30 ± 13 vs. 26 ± 11 ms, P = 0.051). At a median follow-up of 4.8 years, patients developing early DYS had lower LVEF (53.2 ± 9.4 vs. 60.9 ± 8.0%, P < 0.001) and larger LV end-systolic volume (40.3 ± 23.7 vs. 29.3 ± 13.4 mL, P < 0.001) than those without DYS. Significant EF reduction (defined as ≥5%) occurred in 71.7% (33 in 46) of patients with DYS, but only in 30% (30 in 100) in those without DYS (χ(2) = 22.4, P < 0.001). Further analysis showed that both DYS at 1 month [odds ratio (OR): 3.113, P = 0.013] and RVA pacing (OR: 7.873, P < 0.001) independently predicted the deterioration of LV systolic function with pacing period of 4.8 years. CONCLUSION Early pacing-induced DYS is a significant predictor of reduction of LV systolic function for long-term pacing, which could be prevented by BiV pacing at relatively long-period follow-up. CLINICAL TRIAL REGISTRATION Centre for Clinical Trials number, CUHK_CCT00037 (URL: http://www.cct.cuhk.edu.hk/Registry/publictrialrecord.aspx?trialid=CUHK_CCT00037).
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Affiliation(s)
- Fang Fang
- Division of Cardiology, Department of Medicine and Therapeutics, Institute of Vascular Medicine, Institute of Innovative Medicine, Heart Education And Research Training (HEART) Center, and Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR
| | - Xiu-Xia Luo
- Division of Cardiology, Department of Medicine and Therapeutics, Institute of Vascular Medicine, Institute of Innovative Medicine, Heart Education And Research Training (HEART) Center, and Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR
| | - Qing Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hussin Azlan
- Department of Cardiology, National Heart Institute, Kuala Lumpur, Malaysia
| | - Omar Razali
- Department of Cardiology, National Heart Institute, Kuala Lumpur, Malaysia
| | - Zhan Ma
- Department of Cardiology, Beijing Jishuitan Hospital, Peking University, Beijing, China
| | - Shu-Fen Gan
- Department of Ultrasound, Xiamen Zhongshan Hospital, Xiamen, China
| | - Jun-Min Xie
- Division of Cardiology, Department of Medicine and Therapeutics, Institute of Vascular Medicine, Institute of Innovative Medicine, Heart Education And Research Training (HEART) Center, and Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR
| | - Cheuk-Man Yu
- Division of Cardiology, Department of Medicine and Therapeutics, Institute of Vascular Medicine, Institute of Innovative Medicine, Heart Education And Research Training (HEART) Center, and Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR
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Krishnan S, Verma S, Cheng M, Krishnan R, Pai RG. Left Ventricular Septolateral Mechanical Delay Is Associated with Reduced Long-Term Survival in Systolic Heart Failure with Narrow QRS Duration: Nine-Year Outcome in 109 Patients. Echocardiography 2015; 32:1515-9. [DOI: 10.1111/echo.12904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Srikanth Krishnan
- Divisions of Cardiology; Riverside County Regional Medical Center; Moreno Valley California
- Loma Linda University School of Medicine; Loma Linda California
| | - Sanjay Verma
- Divisions of Cardiology; Riverside County Regional Medical Center; Moreno Valley California
- Loma Linda University School of Medicine; Loma Linda California
| | - Michael Cheng
- Divisions of Cardiology; Riverside County Regional Medical Center; Moreno Valley California
- Loma Linda University School of Medicine; Loma Linda California
| | - Rajagopal Krishnan
- Divisions of Cardiology; Riverside County Regional Medical Center; Moreno Valley California
- Loma Linda University School of Medicine; Loma Linda California
| | - Ramdas G. Pai
- Divisions of Cardiology; Riverside County Regional Medical Center; Moreno Valley California
- Loma Linda University School of Medicine; Loma Linda California
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Ketha S, Kusumoto FM. Cardiac Resynchronization Therapy in 2015: Lessons Learned. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2015. [DOI: 10.15212/cvia.2015.0011] [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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Hedman K, Tamás É, Bjarnegård N, Brudin L, Nylander E. Cardiac systolic regional function and synchrony in endurance trained and untrained females. BMJ Open Sport Exerc Med 2015; 1:e000015. [PMID: 27900120 PMCID: PMC5117015 DOI: 10.1136/bmjsem-2015-000015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2015] [Indexed: 01/20/2023] Open
Abstract
Background Most studies on cardiac function in athletes describe overall heart function in predominately male participants. We aimed to compare segmental, regional and overall myocardial function and synchrony in female endurance athletes (ATH) and in age-matched sedentary females (CON). Methods In 46 ATH and 48 CON, echocardiography was used to measure peak longitudinal systolic strain and myocardial velocities in 12 left ventricular (LV) and 2 right ventricular (RV) segments. Regional and overall systolic function were calculated together with four indices of dyssynchrony. Results There were no differences in regional or overall LV systolic function between groups, or in any of the four dyssynchrony indices. Peak systolic velocity (s′) was higher in the RV of ATH than in CON (9.7±1.5 vs 8.7±1.5 cm/s, p=0.004), but not after indexing by cardiac length (p=0.331). Strain was similar in ATH and CON in 8 of 12 LV myocardial segments. In septum and anteroseptum, basal and mid-ventricular s′ was 6–7% and 17–19% higher in ATH than in CON (p<0.05), respectively, while s′ was 12% higher in CON in the basal LV lateral wall (p=0.013). After indexing by cardiac length, s′ was only higher in ATH in the mid-ventricular septum (p=0.041). Conclusions We found differences between trained and untrained females in segmental systolic myocardial function, but not in global measures of systolic function, including cardiac synchrony. These findings give new insights into cardiac adaptation to endurance training and could also be of use for sports cardiologists evaluating female athletes.
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Affiliation(s)
- Kristofer Hedman
- Department of Clinical Physiology and Department of Medical and Health Sciences , Linköping University , Linköping , Sweden
| | - Éva Tamás
- Department of Cardiothoracic and Vascular Surgery and Department of Medical and Health Sciences , Linköping University , Linköping , Sweden
| | - Niclas Bjarnegård
- Department of Medical and Health Sciences , Linköping University , Linköping ; Department of Clinical Physiology , County Hospital Ryhov , Jönköping , Sweden
| | - Lars Brudin
- Department of Medical and Health Sciences, Linköping University, Linköping and Department of Clinical Physiology, County Hospital, Kalmar, Sweden
| | - Eva Nylander
- Department of Clinical Physiology and Department of Medical and Health Sciences , Linköping University , Linköping , Sweden
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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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63
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Wang G, Zhao Z, Zhao S, Ding S, Shen S, Wang L. Effect of cardiac resynchronization therapy on patients with heart failure and narrow QRS complexes: a meta-analysis of five randomized controlled trials. J Interv Card Electrophysiol 2015; 44:71-9. [DOI: 10.1007/s10840-015-0018-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 05/10/2015] [Indexed: 10/23/2022]
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Jackson T, Claridge S, Behar J, Sammut E, Webb J, Carr-White G, Razavi R, Rinaldi CA. Narrow QRS systolic heart failure: is there a target for cardiac resynchronization? Expert Rev Cardiovasc Ther 2015; 13:783-97. [PMID: 26048215 DOI: 10.1586/14779072.2015.1049945] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Cardiac resynchronization therapy has revolutionized the management of systolic heart failure in patients with prolonged QRS during the past 20 years. Initially, the use of this treatment in patients with shorter QRS durations showed promising results, which have since been opposed by larger randomized controlled trials. Despite this, some questions remain, such as, whether correction of mechanical dyssynchrony is the therapeutic target by which biventricular pacing may confer benefit in this group, or are there other mechanisms that need consideration? In addition, novel techniques of cardiac resynchronization therapy delivery such as endocardial and multisite pacing may reduce potential detrimental effects of biventricular pacing, thereby improving the benefit/harm balance of this therapy in some patients.
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Affiliation(s)
- Tom Jackson
- Department of Cardiovascular Imaging, 4th Floor Lambeth Wing, St Thomas' Hospital, London, SE1 7EH, UK
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Sunbul M, Tigen K. Pathophysiological links, echocardiographic characteristics, and clinical implications of QRS morphology in patients with dilated cardiomyopathy. Ther Adv Cardiovasc Dis 2015; 9:325-9. [DOI: 10.1177/1753944715586321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Heart failure is an important clinical problem worldwide. There is great interest in evaluating the relationship between electrocardiographic variations and dilated cardiomyopathy (DCM) since it has been used as a predictor of increased morbidity and mortality. The presence of fragmentation in the QRS complexes on 12-lead electrocardiogram (ECG) was reported as a marker of depolarization abnormality in patients with DCM. Previous studies have investigated the relation between QRS morphology and DCM. QRS morphology and duration are associated with clinical deterioration and increased mortality in patients with DCM. Although surface ECG provides valuable information on prognosis of these patients, echocardiographic methods have been used for further investigation of patients with DCM. The aim of the present review is to provide an overview of the pathophysiological links, echocardiographic characteristics and clinical implications of QRS morphology in patients with DCM.
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Affiliation(s)
- Murat Sunbul
- Department of Cardiology, Marmara University Faculty of Medicine, Fevzi Cakmak Mahallesi, Muhsin Yazicioglu Caddesi, No: 10, Ustkaynarca, Pendik, Istanbul, Turkey
| | - Kursat Tigen
- Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
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Abstract
Transthoracic echocardiography is the most widely used imaging test in cardiology. Although completely noninvasive, transthoracic echocardiography has a well-established role in the diagnosis of numerous cardiovascular diseases, and also provides critical qualitative and quantitative information on their prognosis and pathophysiological processes. The aim of this Review is to outline the broad principles of transthoracic echocardiography, including the traditional techniques of two-dimensional, colour, and spectral Doppler echocardiography, and newly developed advances including tissue Doppler, myocardial deformation imaging, torsion, stress echocardiography, contrast and three-dimensional echocardiography. The advantages and disadvantages, clinical application, prognostic value, and salient research findings of each modality are described. Advances in complex imaging techniques are expected to continue unabated, and this Review highlights technical improvements that will influence the diagnosis and improve our understanding of cardiovascular function and disease.
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Affiliation(s)
- Anita C Boyd
- South Western Sydney Clinical School, University of New South Wales, Liverpool Hospital, Corner Elizabeth/Goulburn Street, NSW 2170, Australia
| | - Nelson B Schiller
- University of California, 505 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Liza Thomas
- South Western Sydney Clinical School, University of New South Wales, Liverpool Hospital, Corner Elizabeth/Goulburn Street, NSW 2170, Australia
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Gasparini M, Klersy C, Leclercq C, Lunati M, Landolina M, Auricchio A, Santini M, Boriani G, Proclemer A, Leyva F. Validation of a simple risk stratification tool for patients implanted with Cardiac Resynchronization Therapy: the VALID-CRT risk score. Eur J Heart Fail 2015; 17:717-24. [PMID: 25903349 DOI: 10.1002/ejhf.269] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 03/06/2015] [Accepted: 03/10/2015] [Indexed: 11/08/2022] Open
Abstract
AIMS Mortality after cardiac resynchronization therapy (CRT) is difficult to predict. We sought to design and validate a simple prognostic score for patients implanted with CRT, based on readily available clinical variables, including age, gender, left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) class, presence/absence of atrial fibrillation, presence/absence of atrioventricular junction ablation, coronary heart disease, diabetes, and implantation of a CRT device with defibrillation. METHODS For predictive modelling, 5153 consecutive patients enrolled in 72 European centres (79% male; LVEF 25.9 ± 6.85%; NYHA class III-IV 77.5%; QRS 158.4 ± 32.3 ms) were randomly split into derivation (70%) and validation (30%) samples. The primary endpoint was total mortality and the secondary endpoint was cardiovascular mortality. The final predictive model fit was assessed by plotting observed vs. predicted survival. RESULTS In the entire cohort, 1004 deaths occurred over a follow-up of 14 409 person years. Total mortality ranged from 3.1% to 28.2% at 2 years in the first and fifth quintile of the risk score, respectively. At 5 years, total mortality was 10.3%, 18.6%, 27.6%, 36.1%, and 58.8%, from the first to the fifth quintile. Compared with the lowest quintile (Q), total mortality was significantly higher in the other four quintiles [Q2 hazard ratio (HR) = 1.71; Q3 HR = 2.20; Q4 HR = 4.03; Q5 HR = 8.03; all P < 0.001). The final model, which was based on the entire cohort using the above variables, showed a good discrimination (Harrell's c = 0.70) and high explained variation (0.26). The mean predicted survival fitted well with the observed survival for up to 6 years of follow-up. CONCLUSIONS The VALID-CRT risk score, which is based on routine, readily available clinical variables, reliably predicted the long-term total and cardiovascular mortality in patients undergoing CRT. While this score cannot be used to predict the benefit of CRT, it may be useful for predicting survival after CRT. This may have useful implications for follow-up.
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Affiliation(s)
- Maurizio Gasparini
- Electrophysiology and Pacing Unit, Humanitas Research Hospital IRCCS, Via Manzoni 56 Rozzano (Milano), 20089, Italy
| | - Catherine Klersy
- Biometry and Clinical Epidemiology, Research Department, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | | | - Maurizio Lunati
- Cardiology Department, Niguarda Ca' Granda Hospital, Milano, Italy
| | - Maurizio Landolina
- Cardiology Department, Fondazione Policlinico S. Matteo IRCCS, Pavia, Italy
| | | | - Massimo Santini
- Department of Cardiology, San Filippo Neri Hospital, Rome, Italy
| | - Giuseppe Boriani
- Institute of Cardiology, University of Bologna and Azienda Ospedaliera S.Orsola-Malpighi, Bologna, Italy
| | | | - Francisco Leyva
- Aston University Medical School and Queen Elizabeth Hospital, Birmingham, UK
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Kırış A, Kırış G, Turan OE, Öztürk M, Şahin M, İlter A, Bektaş O, Kutlu M, Kaplan Ş, Gedikli Ö. Relationship between epicardial fat tissue and left ventricular synchronicity: An observational study. Anatol J Cardiol 2015; 15:990-4. [PMID: 25880051 PMCID: PMC5368471 DOI: 10.5152/akd.2014.5877] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Objective: Left ventricular (LV) systolic synchrony is defined as simultaneous activation of corresponding cardiac segments. Impaired synchrony has some adverse cardiovascular effects, such as LV dysfunction and impaired prognosis. Epicardial fat tissue (EFT) is visceral fat around the heart. Increased EFT thickness is associated with some disorders, such as LV dysfunction and hypertrophy, which play a role in the impairment of LV synchrony. However, the relationship between EFT and LV systolic synchrony has never been assessed. Thus, we aimed to evaluate the possible relationship between EFT and LV synchrony in this study. Methods: The study population consisted of 55 consecutive patients (mean age 46.4±13.4 years, 32 female) without bundle branch block (BBB). EFT and LV systolic synchrony were evaluated by transthoracic echocardiography using 2D and tissue Doppler imaging. Maximal difference (Ts-6) and standard deviation (Ts-SD-6) of time to peak systolic (Ts) myocardial tissue velocity obtained from 6 LV basal segments were used to assess LV synchrony. Multiple regression analysis was used to detect the independently related factors to LV synchrony. Results: The mean values of EFT thickness, Ts-6, and Ts-SD-6 were found to be 2.7±1.6 mm (ranging from 1-7 mm), 20.1±14.2 msec, and 7.7±5.6, respectively. EFT thickness also was independently associated with Ts-6 (β =0.332, p=0.01) and Ts-SD-6 (β =0.286, p=0.04). Conclusion: EFT thickness is associated with LV systolic synchrony in patients without BBB.
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Affiliation(s)
- Abdulkadir Kırış
- Department of Cardiology, Faculty of Medicine, Karadeniz Technical University; Trabzon-Turkey.
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Effect of positive end-expiratory pressure on porcine right ventricle function assessed by speckle tracking echocardiography. BMC Anesthesiol 2015; 15:49. [PMID: 25873786 PMCID: PMC4396172 DOI: 10.1186/s12871-015-0028-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 03/24/2015] [Indexed: 02/07/2023] Open
Abstract
Background Right ventricle (RV) dysfunction and hypotension can be induced by high levels of positive end-expiratory pressure (PEEP). We sought to determine in an animal model if a novel ultrasound analysis technique: speckle tracking echocardiography (STE), could determine deterioration in RV function induced by PEEP and to compare this to a conventional method of RV analysis: fractional area change (FAC). STE is a sensitive, angle-independent method for describing cardiac deformation (‘strain’) and is particularly useful in analyzing RV function as has been shown in pulmonary hypertension cohorts. Methods Ten pigs, 40-90 kg, anaesthetized, fully mechanically ventilated at 6 ml/kg were subject to step-wise escalating levels of PEEP at two-minute intervals (0, 5, 10, 15, 20, 25 and 30cmH20). Intracardiac echocardiography was used to image the RV as transthoracic and transesophageal echocardiography did not give sufficient image quality or flexibility. Off-line STE analysis was performed using Syngo Velocity Vector Imaging (Seimens Medical Solutions Inc., USA). STE systolic parameters are RV free wall strain (RVfwS) and strain rate (RVfwSR) and the diastolic parameter RV free wall strain rate early relaxation (RVfwSRe) Results With escalating levels of PEEP there was a clear trend of reduction in STE parameters (RVfwS, RVfwSR, RVfwSRe) and FAC. Significant hypotension (fall in mean arterial blood pressure of 20 mmHg) occurred at approximately PEEP 15 cmH2O. Comparing RVfwS, RVfwSR and RVfwSRe values at different PEEP levels showed a significant difference at PEEP 0 cmH2O vs PEEP 10 cmH2O and above. FAC only showed a significant difference at PEEP 0 cmH2O vs PEEP 20 cmH2O and above. 30% of pigs displayed dyssychronous RV free wall contraction at the highest PEEP level reached. Conclusions STE is a sensitive method for determining RV dysfunction induced by PEEP and deteriorated ahead of a conventional assessment method: FAC. RVfwS decreased to greater extent compared to baseline than FAC, earlier in the PEEP escalation process and showed a significant decrease before there was a clinical relevant decrease in mean arterial blood pressure. Studies in ICU patients using transthoracic echocardiography are warranted to further investigate the most sensitive echocardiography method for detecting RV dysfunction induced by mechanical ventilation.
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70
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Catanzaro JN, Makaryus JN, Makaryus AN, Sison C, Vavasis C, Fan D, Jadonath R. Echocardiographic predictors of ventricular tachycardia. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2015; 8:37-42. [PMID: 25861227 PMCID: PMC4360853 DOI: 10.4137/cmc.s18499] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 11/03/2014] [Accepted: 11/09/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND Patients with structural heart disease are prone to ventricular tachycardia (VT) and ventricular fibrillation (VF), which account for the majority of sudden cardiac deaths (SCDs). We sought to examine echocardiographic parameters that can predict VT as documented by implantable cardioverter-defibrillator (ICD) appropriate discharge. We examine echocardiographic parameters other than ejection fraction that may predict VT as recorded via rates of ICD discharge. METHODS Analysis of 586 patients (469 males; mean age = 68 ± 3 years; mean follow-up time of 11 ± 14 months) was undertaken. Echo parameters assessed included left ventricular (LV) internal end diastolic/systolic dimension (LVIDd, LVIDs), relative wall thickness (RWT), and left atrial (LA) size. RESULTS The incidence of VT was 0.22 (114 VT episodes per 528 person-years of follow-up time). Median time-to-first VT was 3.8 years. VT was documented in 79 patients (59 first VT incidence, 20 multiple). The echocardiographic parameter associated with first VT was LVIDs >4 cm (P = 0.02). CONCLUSION The main echocardiographic predictor associated with the first occurrence of VT was LVIDs >4 cm. Patients with an LVIDs >4 cm were 2.5 times more likely to have an episode of VT. Changes in these echocardiographic parameters may warrant aggressive pharmacologic therapy and implantation of an ICD.
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Affiliation(s)
- John N Catanzaro
- Columbia St. Mary's Community Physicians Cardiac Rhythm Specialists, Oshkosh, WI, USA
| | - John N Makaryus
- North Shore-LIJ Health System, Hofstra NSLIJ School of Medicine, Manhasset, NY, USA
| | - Amgad N Makaryus
- North Shore-LIJ Health System, Hofstra NSLIJ School of Medicine, Manhasset, NY, USA ; NuHealth, Nassau University Medical Center, East Meadow, NY, USA
| | - Cristina Sison
- Biostatistics Unit, Feinstein Institute for Medical Research at the North Shore-LIJ Health System, Hofstra NSLIJ School of Medicine, Manhasset, NY, USA
| | - Christos Vavasis
- North Shore-LIJ Health System, Hofstra NSLIJ School of Medicine, Manhasset, NY, USA
| | - Dali Fan
- North Shore-LIJ Health System, Hofstra NSLIJ School of Medicine, Manhasset, NY, USA
| | - Ram Jadonath
- North Shore-LIJ Health System, Hofstra NSLIJ School of Medicine, Manhasset, NY, USA
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Kadappu KK, Thomas L. Tissue Doppler Imaging in Echocardiography: Value and Limitations. Heart Lung Circ 2015; 24:224-33. [DOI: 10.1016/j.hlc.2014.10.003] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 10/15/2014] [Indexed: 10/24/2022]
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Kang SH, Oh IY, Kang DY, Cha MJ, Cho Y, Choi EK, Hahn S, Oh S. Cardiac resynchronization therapy and QRS duration: systematic review, meta-analysis, and meta-regression. J Korean Med Sci 2015; 30:24-33. [PMID: 25552880 PMCID: PMC4278024 DOI: 10.3346/jkms.2015.30.1.24] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 09/04/2014] [Indexed: 01/18/2023] Open
Abstract
Cardiac resynchronization therapy (CRT) has been shown to reduce the risk of death and hospitalization in patients with advanced heart failure with left ventricular dysfunction. However, controversy remains regarding who would most benefit from CRT. We performed a meta-analysis, and meta-regression in an attempt to identify factors that determine the outcome after CRT. A total of 23 trials comprising 10,103 patients were selected for this meta-analysis. Our analysis revealed that CRT significantly reduced the risk of all-cause mortality and hospitalization for heart failure compared to control treatment. The odds ratio (OR) of all-cause death had a linear relationship with mean QRS duration (P=0.009). The benefit in survival was confined to patients with a QRS duration ≥145 ms (OR, 0.86; 95% CI, 0.74-0.99), while no benefit was shown among patients with a QRS duration of 130 ms (OR, 1.00; 95% CI, 0.80-1.25) or less. Hospitalization for heart failure was shown to be significantly reduced in patients with a QRS duration ≥127 ms (OR, 0.77; 95% CI, 0.60-0.98). This meta-regression analysis implies that patients with a QRS duration ≥150 ms would most benefit from CRT, and in those with a QRS duration <130 ms CRT implantation may be potentially harmful.
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Affiliation(s)
- Si-Hyuck Kang
- Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Korea
| | - Il-Young Oh
- Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Korea
| | - Do-Yoon Kang
- Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Korea
| | - Myung-Jin Cha
- Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Korea
| | - Youngjin Cho
- Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Korea
| | - Seokyung Hahn
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Korea
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Rastgou F, Shojaeifard M, Amin A, Ghaedian T, Firoozabadi H, Malek H, Yaghoobi N, Bitarafan-Rajabi A, Haghjoo M, Amouzadeh H, Barati H. Assessment of left ventricular mechanical dyssynchrony by phase analysis of gated-SPECT myocardial perfusion imaging and tissue Doppler imaging: comparison between QGS and ECTb software packages. J Nucl Cardiol 2014; 21:1062-71. [PMID: 25047867 DOI: 10.1007/s12350-014-9941-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Accepted: 05/25/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recently, the phase analysis of gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) has become feasible via several software packages for the evaluation of left ventricular mechanical dyssynchrony. We compared two quantitative software packages, quantitative gated SPECT (QGS) and Emory cardiac toolbox (ECTb), with tissue Doppler imaging (TDI) as the conventional method for the evaluation of left ventricular mechanical dyssynchrony. METHODS AND RESULTS Thirty-one patients with severe heart failure (ejection fraction ≤35%) and regular heart rhythm, who referred for gated-SPECT MPI, were enrolled. TDI was performed within 3 days after MPI. Dyssynchrony parameters derived from gated-SPECT MPI were analyzed by QGS and ECTb and were compared with the Yu index and septal-lateral wall delay measured by TDI. QGS and ECTb showed a good correlation for assessment of phase histogram bandwidth (PHB) and phase standard deviation (PSD) (r = 0.664 and r = 0.731, P < .001, respectively). However, the mean value of PHB and PSD by ECTb was significantly higher than that of QGS. No significant correlation was found between ECTb and QGS and the Yu index. Nevertheless, PHB, PSD, and entropy derived from QGS revealed a significant (r = 0.424, r = 0.478, r = 0.543, respectively; P < .02) correlation with septal-lateral wall delay. CONCLUSION Despite a good correlation between QGS and ECTb software packages, different normal cut-off values of PSD and PHB should be defined for each software package. There was only a modest correlation between phase analysis of gated-SPECT MPI and TDI data, especially in the population of heart failure patients with both narrow and wide QRS complex.
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Affiliation(s)
- Fereydoon Rastgou
- Department of Nuclear Medicine and Molecular Imaging, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Vali-e-Asr Ave., Niayesh Blvd., Tehran, Iran
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Cohen M. Cardiac resynchronization therapy in adults with congenital heart disease. PROGRESS IN PEDIATRIC CARDIOLOGY 2014. [DOI: 10.1016/j.ppedcard.2014.12.003] [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: 10/24/2022]
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Papachristidis A, Monaghan MJ. Echocardiographic Assessment of Cardiac Dyssynchrony. Where do We Stand? CURRENT CARDIOVASCULAR IMAGING REPORTS 2014. [DOI: 10.1007/s12410-014-9300-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Menet A, Greffe L, Ennezat PV, Delelis F, Guyomar Y, Castel AL, Guiot A, Graux P, Tribouilloy C, Marechaux S. Is mechanical dyssynchrony a therapeutic target in heart failure with preserved ejection fraction? Am Heart J 2014; 168:909-16.e1. [PMID: 25458655 DOI: 10.1016/j.ahj.2014.08.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 08/02/2014] [Indexed: 01/22/2023]
Abstract
BACKGROUND Previous studies have found a high frequency of mechanical dyssynchrony in patients with heart failure (HF) with preserved ejection fraction (HFpEF), hence suggesting that cardiac resynchronization therapy (CRT) may be considered in HFpEF. The present study was designed to compare the amount of mechanical dyssynchrony between HFpEF patients and (1) HF with reduced EF (HFrEF) patients with an indication for CRT (HFrEF-CRT(+)) group, (2) HFrEF patients with QRS duration < 120 ms (HFrEF-QRS < 120 ms) group, and (3) hypertensive controls (HTN). METHODS Electrical (ECG) and mechanical dyssynchrony (atrio-ventricular dyssynchrony, interventricular dyssynchrony, intraventricular dyssynchrony) were assessed using conventional, tissue Doppler, and Speckle Tracking strain echocardiography in 40 HFpEF patients, 40 age- and sex-matched HTN controls, 40 HFrEF-QRS < 120 ms patients, and 40 HFrEF-CRT(+) patients. RESULTS The frequency of left bundle branch block was low in HFpEF patients (5%) and similar to HTN controls (5%, P = 0.85). Indices of dyssynchrony were similar between HFpEF and HTN patients or HFrEF-QRS < 120 ms patients. In contrast, most indices of dyssynchrony differed between HFpEF and HFrEF-CRT(+) patients. The principal components analysis on the entire cohort of 160 patients yielded 2 homogeneous groups of patients in terms of dyssynchrony, the first comprising HFrEF-CRT(+) patients and the second comprising HTN, HFrEF-QRS < 120 ms and HFpEF patients. CONCLUSIONS Mechanical dyssynchrony in HFpEF does not differ from that of patients with HTN or patients with HFrEF and a narrow QRS. This data raises concerns regarding the role of dyssynchrony in the pathophysiology of HFpEF and thereby the potential usage of CRT in HFpEF.
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Silva E, Bijnens B, Berruezo A, Mont L, Doltra A, Andreu D, Brugada J, Sitges M. Integración de la imagen mecánica, estructural y eléctrica para entender la respuesta a la terapia de resincronización cardiaca. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2013.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Silva E, Bijnens B, Berruezo A, Mont L, Doltra A, Andreu D, Brugada J, Sitges M. Integration of mechanical, structural and electrical imaging to understand response to cardiac resynchronization therapy. ACTA ACUST UNITED AC 2014; 67:813-21. [PMID: 25262127 DOI: 10.1016/j.rec.2013.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 12/04/2013] [Indexed: 10/25/2022]
Abstract
INTRODUCTION AND OBJECTIVES There is extensive controversy exists on whether cardiac resynchronization therapy corrects electrical or mechanical asynchrony. The aim of this study was to determine if there is a correlation between electrical and mechanical sequences and if myocardial scar has any relevant impact. METHODS Six patients with normal left ventricular function and 12 patients with left ventricular dysfunction and left bundle branch block, treated with cardiac resynchronization therapy, were studied. Real-time three-dimensional echocardiography and electroanatomical mapping were performed in all patients and, where applicable, before and after therapy. Magnetic resonance was performed for evaluation of myocardial scar. Images were postprocessed and mechanical and electrical activation sequences were defined and time differences between the first and last ventricular segment to be activated were determined. Response to therapy was defined as a reduction in left ventricular end-systolic volume ≥ 15% after 12 months of follow-up. RESULTS Good correlation between electrical and mechanical timings was found in patients with normal left ventricular function (r(2) = 0.88; P = .005) but not in those with left ventricular dysfunction (r(2) = 0.02; P = not significant). After therapy, both timings and sequences were modified and improved, except in those with myocardial scar. CONCLUSIONS Despite a close electromechanical relationship in normal left ventricular function, there is no significant correlation in patients with dysfunction. Although resynchronization therapy improves this correlation, the changes in electrical activation may not yield similar changes in left ventricular mechanics particularly depending on the underlying myocardial substrate.
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Affiliation(s)
- Etelvino Silva
- Servicio de Cardiología, Institut del Tórax, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Bart Bijnens
- Servicio de Cardiología, Institut del Tórax, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Antonio Berruezo
- Servicio de Cardiología, Institut del Tórax, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Lluis Mont
- Servicio de Cardiología, Institut del Tórax, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Adelina Doltra
- Servicio de Cardiología, Institut del Tórax, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - David Andreu
- Servicio de Cardiología, Institut del Tórax, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Josep Brugada
- Servicio de Cardiología, Institut del Tórax, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Marta Sitges
- Servicio de Cardiología, Institut del Tórax, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.
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Leyva F, Nisam S, Auricchio A. 20 Years of Cardiac Resynchronization Therapy. J Am Coll Cardiol 2014; 64:1047-58. [DOI: 10.1016/j.jacc.2014.06.1178] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 06/15/2014] [Accepted: 06/17/2014] [Indexed: 01/14/2023]
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Taylor RJ, Umar F, Moody WE, Meyyappan C, Stegemann B, Townend JN, Hor KN, Miszalski-Jamka T, Mazur W, Steeds RP, Leyva F. Feature-tracking cardiovascular magnetic resonance as a novel technique for the assessment of mechanical dyssynchrony. Int J Cardiol 2014; 175:120-5. [PMID: 24852836 DOI: 10.1016/j.ijcard.2014.04.268] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 04/27/2014] [Accepted: 04/30/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Myocardial tagging using cardiovascular magnetic resonance (CMR) is the gold-standard for the assessment of myocardial mechanics. Feature-tracking cardiovascular magnetic resonance (FT-CMR) has been validated against myocardial tagging. We explore the potential of FT-CMR in the assessment of mechanical dyssynchrony, with reference to patients with cardiomyopathy and healthy controls. METHODS Healthy controls (n=55, age: 42.9 ± 13 yrs, LVEF: 70 ± 5%, QRS: 88 ± 9 ms) and patients with cardiomyopathy (n=108, age: 64.7 ± 12 yrs, LVEF: 29 ± 6%, QRS: 147 ± 29 ms) underwent FT-CMR for the assessment of the circumferential (CURE) and radial (RURE) uniformity ratio estimate based on myocardial strain (both CURE and RURE: 0 to 1; 1=perfect synchrony) RESULTS CURE (0.79 ± 0.14 vs. 0.97 ± 0.02) and RURE (0.71 ± 0.14 vs. 0.91 ± 0.04) were lower in patients with cardiomyopathy than in healthy controls (both p<0.0001). CURE (area under the receiver-operator characteristic curve [AUC]: 0.96), RURE (AUC: 0.96) and an average of these (CURE:RUREAVG, AUC: 0.98) had an excellent ability to discriminate between patients with cardiomyopathy and controls (sensitivity 90%; specificity 98% at a cut-off of 0.89). The time taken for semi-automatically tracking myocardial borders was 5.9 ± 1.4 min. CONCLUSION Dyssynchrony measures derived from FT-CMR, such as CURE and RURE, provide almost absolute discrimination between patients with cardiomyopathy and healthy controls. The rapid acquisition of these measures, which does not require specialized CMR sequences, has potential for the assessment of mechanical dyssynchrony in clinical practice.
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Affiliation(s)
- Robin J Taylor
- Department of Cardiology, The Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, United Kingdom; Centre for Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - Fraz Umar
- Department of Cardiology, The Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, United Kingdom; Centre for Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - William E Moody
- Department of Cardiology, The Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, United Kingdom; Centre for Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - Chitra Meyyappan
- Centre for Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | | | - John N Townend
- Department of Cardiology, The Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, United Kingdom; Centre for Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - Kan N Hor
- Department of Cardiology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Tomasz Miszalski-Jamka
- Department of Clinical Radiology and Imaging Diagnostics, 4th Military Hospital, Wrocław, Center for Diagnosis, Prevention and Telemedicine, John Paul II Hospital, Krakow, Poland
| | - Wojciech Mazur
- The Christ Hospital Heart and Vascular Center, Cincinnati, OH, USA
| | - Richard P Steeds
- Department of Cardiology, The Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, United Kingdom; Centre for Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - Francisco Leyva
- Department of Cardiology, The Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, United Kingdom; Centre for Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom.
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81
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Dewhurst MJ, Linker NJ. Current Evidence and Recommendations for Cardiac Resynchronisation Therapy. Arrhythm Electrophysiol Rev 2014; 3:9-14. [PMID: 26835058 DOI: 10.15420/aer.2011.3.1.9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Accepted: 03/13/2014] [Indexed: 11/04/2022] Open
Abstract
The number of people in Europe living with symptomatic heart failure is increasing. Since its advent in the 1990s, cardiac resynchronisation therapy (CRT) has proven beneficial in terms of morbidity and mortality in selected heart failure (HF) patient populations, when combined with optimal pharmacological therapy. We review the evidence for CRT and the populations of HF patients it is currently shown to benefit, and those in which more research needs to be performed.
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Affiliation(s)
| | - Nicholas J Linker
- Consultant Cardiologist, The James Cook University Hospital, Middlesbrough, UK
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82
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Sénéchal M. What is the best therapeutic strategy in patients with low flow, low-gradient aortic stenosis, and wide QRS? Eur J Heart Fail 2014; 16:598-600. [PMID: 24782294 DOI: 10.1002/ejhf.96] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 03/20/2014] [Indexed: 11/07/2022] Open
Affiliation(s)
- Mario Sénéchal
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Canada
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83
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Yu CM, Fang F. Expanding the indications for cardiac resynchronisation therapy. BRITISH HEART JOURNAL 2014; 100:447-9. [DOI: 10.1136/heartjnl-2013-304271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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84
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Klimusina J, De Boeck BW, Leenders GE, Faletra FF, Prinzen F, Averaimo M, Pasotti E, Klersy C, Moccetti T, Auricchio A. Redistribution of left ventricular strain by cardiac resynchronization therapy in heart failure patients. Eur J Heart Fail 2014; 13:186-94. [DOI: 10.1093/eurjhf/hfq197] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Julija Klimusina
- Division of Cardiology; Fondazione Cardiocentro Ticino; Via Tesserete 48, CH-6900 Lugano Switzerland
| | | | | | - Francesco F. Faletra
- Division of Cardiology; Fondazione Cardiocentro Ticino; Via Tesserete 48, CH-6900 Lugano Switzerland
| | - Frits Prinzen
- Department of Physiology; Cardiovascular Research Institute Maastricht; Maastricht The Netherlands
| | - Manuela Averaimo
- Division of Cardiology; Fondazione Cardiocentro Ticino; Via Tesserete 48, CH-6900 Lugano Switzerland
| | - Elena Pasotti
- Division of Cardiology; Fondazione Cardiocentro Ticino; Via Tesserete 48, CH-6900 Lugano Switzerland
| | - Catherine Klersy
- Service of Biometry and Statistics, Research Department; IRCCS Fondazione Policlinico San Matteo; Pavia Italy
| | - Tiziano Moccetti
- Division of Cardiology; Fondazione Cardiocentro Ticino; Via Tesserete 48, CH-6900 Lugano Switzerland
| | - Angelo Auricchio
- Division of Cardiology; Fondazione Cardiocentro Ticino; Via Tesserete 48, CH-6900 Lugano Switzerland
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85
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Shimamoto S, Ito T, Nogi S, Kizawa S, Ishizaka N. Left Ventricular Mechanical Discoordination in Nonischemic Hearts: Relationship with Left Ventricular Function, Geometry, and Electrical Dyssynchrony. Echocardiography 2014; 31:1077-84. [DOI: 10.1111/echo.12538] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
| | - Takahide Ito
- Department of Cardiology; Osaka Medical College; Osaka Japan
| | - Shimpei Nogi
- Department of Cardiology; Osaka Medical College; Osaka Japan
| | - Shun Kizawa
- Department of Cardiology; Osaka Medical College; Osaka Japan
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86
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Canpolat U, Kabakçi G. The effect of different circadian blood pressure rhythms on left ventricular systolic dyssynchrony in patients with newly diagnosed essential hypertension. Echocardiography 2014; 31:260. [PMID: 24495084 DOI: 10.1111/echo.12435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Uğur Canpolat
- Cardiology Clinic, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkey
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87
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Abstract
Initial studies established patient selection criteria for cardiac resynchronization therapy (CRT) as left ventricular ejection fraction less than or equal to 35%, QRS greater than or equal to 120 ms, and New York Heart Association 3-4. Based on newer data, post hoc analyses, and meta-analyses, these criteria have been refined and guidelines updated, highlighting left bundle branch morphology and QRS greater than 150 ms in selecting patients with a likelihood of favorable outcomes. Guidelines will change as more data become available; the decision to apply CRT should be based on patient clinical profile and the balance of risk tolerance and likelihood of benefit.
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88
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Chattopadhyay S, Alamgir MF, Nikitin NP, Fraser AG, Clark AL, Cleland JG. The effect of pharmacological stress on intraventricular dyssynchrony in left ventricular systolic dysfunction. Eur J Heart Fail 2014; 10:412-20. [DOI: 10.1016/j.ejheart.2008.02.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2007] [Revised: 12/03/2007] [Accepted: 02/04/2008] [Indexed: 10/22/2022] Open
Affiliation(s)
| | | | | | | | - Andrew L. Clark
- Department of Cardiology; University of Hull; Kingston-upon-Hull UK
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89
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El-Menyar AA, Abdou SM. Impact of left bundle branch block and activation pattern on the heart. Expert Rev Cardiovasc Ther 2014; 6:843-57. [DOI: 10.1586/14779072.6.6.843] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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90
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Nayar V, Pugh PJ. Cardiac resynchronization therapy for the treatment of heart failure. Expert Rev Cardiovasc Ther 2014; 8:229-39. [DOI: 10.1586/erc.10.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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91
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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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92
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Egnaczyk GF, Chung ES. The Relationship Between Cardiac Resynchronization Therapy and Diastolic Function. Curr Heart Fail Rep 2013; 11:64-9. [DOI: 10.1007/s11897-013-0181-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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93
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Örem C, Kazaz Z, Yaylı S, Çevik OÇ, Kırış A, Öztürk M, Arslan B, Örem A. Left ventricular systolic asynchrony: an important sign for cardiac involvement in plaque-type psoriasis. Int J Dermatol 2013; 53:369-75. [DOI: 10.1111/ijd.12276] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Cihan Örem
- Department of Cardiology; Faculty of Medicine; Karadeniz Technical University; Trabzon Turkey
| | - Zeynep Kazaz
- Cardiology Department; Of State Hospital; Trabzon Turkey
| | - Savaş Yaylı
- Department of Dermatology; Faculty of Medicine; Karadeniz Technical University; Trabzon Turkey
| | - Osman Çağlar Çevik
- Department of Dermatology; Kanuni Education and Training Hospital; Trabzon Turkey
| | - Abdulkadir Kırış
- Department of Cardiology; Faculty of Medicine; Karadeniz Technical University; Trabzon Turkey
| | - Mustafa Öztürk
- Department of Cardiology; Faculty of Medicine; Karadeniz Technical University; Trabzon Turkey
| | - Bilgihan Arslan
- Department of Cardiology; Faculty of Medicine; Karadeniz Technical University; Trabzon Turkey
| | - Asım Örem
- Department of Biochemistry; Faculty of Medicine; Karadeniz Technical University; Trabzon Turkey
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94
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Calibration of the Normal Cutoff Values of Systolic Dyssynchrony of the Left Ventricular Synchronicity in Normal Subjects Using Real-Time 3-Dimensional Echocardiography and the Effects of Age and Heart Rate. Cell Biochem Biophys 2013; 69:115-21. [DOI: 10.1007/s12013-013-9777-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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95
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Obaid FA, Maskon O, Abdolwahid F. Systolic Function and Intraventricular Mechanical Dyssynchrony Assessed by Advanced Speckle Tracking Imaging with N-terminal Prohormone of Brain Natriuretic Peptide for Outcome Prediction in Chronic Heart Failure Patients. Sultan Qaboos Univ Med J 2013; 13:551-9. [PMID: 24273666 DOI: 10.12816/0003315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Revised: 05/01/2013] [Accepted: 06/02/2013] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess longitudinal systolic function and mechanical synchrony parameters derived from advanced speckle tracking echocardiography (STE) and to determine their correlation with N-terminal prohormone of brain natriuretic peptide (NT-proBNP). Their influence on heart failure (HF) outcomes at a one-year follow-up, not clarified in previous studies, was also examined. METHODS Advanced STE was performed from August 2009 to January 2012 in 103 chronic HF patients at the University Kebangsaan Malaysia Medical Center to assess their longitudinal systolic function and synchrony parameters; NT-proBNP blood measurement was taken at the same time. RESULTS Longitudinal cardiac velocity; strain; strain rate; displacement; intraventricular mechanical dyssynchrony based on the standard deviation (SD) of time to peak systolic strain rate (Tsr-SD); displacement, and antero-septal to posterior (AS-P) delay were associated with cardiac events. In multivariate analysis, NT-proBNP and AS-P delay were identified as independent predictors for cardiac events. Significant correlations were found between NT-proBNP and longitudinal velocity; displacement; strain; strain rate, and ejection fraction. Log NT-proBNP levels correlated moderately with the SD of time to peak displacement and to peak strain, and there was a small correlation with maximal differences and SD of time to peak velocity. A multiple linear analysis revealed that NT-proBNP levels significantly correlated to age, ejection fraction and velocity. CONCLUSION Advanced STE is a promising technique which accelerates the clinical application of the quantification of myocardial function and synchrony. STE parameters and NT-proBNP have the ability to identify patients at higher risk of death and hospitalisation.
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Affiliation(s)
- Faida A Obaid
- Medical Center, Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia
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96
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El Ghannudi S, Germain P, Jeung MY, Breton E, Croisille P, Durand E, Roy C, Gangi A. Quantification of left ventricular dyssynchrony in patients with systolic dysfunction: A comparison of circumferential strain MR-tagging metrics. J Magn Reson Imaging 2013; 40:1238-46. [DOI: 10.1002/jmri.24447] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 09/10/2013] [Indexed: 11/05/2022] Open
Affiliation(s)
- Soraya El Ghannudi
- Department of Radiology; University Hospital; Strasbourg France
- Department of Nuclear Medicine; University Hospital; Strasbourg France
| | - Philippe Germain
- Department of Radiology; University Hospital; Strasbourg France
- Department of Cardiology; University Hospital; Strasbourg France
| | - Mi-Young Jeung
- Department of Radiology; University Hospital; Strasbourg France
| | - Elodie Breton
- ICube; Université de Strasbourg, CNRS; Strasbourg France
| | - Pierre Croisille
- Department of Radiology; University Jean Monnet Saint-Etienne; CREATIS, UMR CNRS 5220-INSERM U1044 Lyon France
| | - Emmanuel Durand
- Department of Nuclear Medicine; University Hospital; Strasbourg France
| | - Catherine Roy
- Department of Radiology; University Hospital; Strasbourg France
| | - Afshin Gangi
- Department of Radiology; University Hospital; Strasbourg France
- ICube; Université de Strasbourg, CNRS; Strasbourg France
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97
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Chan YH, Wang CL, Kuo CT, Yeh YH, Wu CT, Wu LS. Clinical Assessment and Implication of Left Ventricular Mechanical Dyssynchrony in Patients with Heart Failure. ACTA CARDIOLOGICA SINICA 2013; 29:505-514. [PMID: 27122751 PMCID: PMC4805029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 10/04/2013] [Indexed: 06/05/2023]
Abstract
UNLABELLED There have been numerous studies focusing on the assessment of left ventricular mechanical dyssynchrony. These studies are diverse in their purposes, which include more effectively predicting the response to cardiac resynchronization therapy, improving the guidance of the left ventricular lead position, and better prediction of outcome in patients with heart failure. This article reviews the current assessment methods, clinical applications and limitations of left ventricular dyssynchrony indices derived from echocardiography, magnetic resonance imaging and radionuclide imaging in patients with heart failure. KEY WORDS Cardiac resynchronization therapy; Dyssynchrony; Echocardiography; Heart failure.
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Affiliation(s)
- Yi-Hsin Chan
- Cardiovascular Department, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Li Wang
- Cardiovascular Department, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Tai Kuo
- Cardiovascular Department, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yung-Hsin Yeh
- Cardiovascular Department, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Tung Wu
- Cardiovascular Department, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Lung-Sheng Wu
- Cardiovascular Department, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
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98
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Santos ABS, Kraigher-Krainer E, Bello N, Claggett B, Zile MR, Pieske B, Voors AA, McMurray JJV, Packer M, Bransford T, Lefkowitz M, Shah AM, Solomon SD. Left ventricular dyssynchrony in patients with heart failure and preserved ejection fraction. Eur Heart J 2013; 35:42-7. [PMID: 24164863 DOI: 10.1093/eurheartj/eht427] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AIMS Mechanical dyssynchrony has been postulated to play a pathophysiologic role in heart failure with preserved ejection fraction (HFpEF). METHODS AND RESULTS We quantified left ventricular (LV) systolic dyssynchrony in 130 HFpEF patients with NYHA class II-IV symptoms, ejection fraction (EF) ≥45%, and NT-proBNP levels >400 pg/mL enrolled in the PARAMOUNT trial, and compared them to 40 healthy controls of similar age and gender. Dyssynchrony was assessed by 2D speckle tracking as standard deviation (SD) of time to peak longitudinal systolic strain in 12 ventricular segments and related to measures of systolic and diastolic function. Heart failure with preserved ejection fraction patients (62% women, mean age of 71 ± 9 years, body mass index of 30.2 ± 5.9 kg/m(2), systolic blood pressure 139 ± 15 mmHg) demonstrated significantly greater dyssynchrony than controls (SD of time to peak longitudinal strain; 90.6 ± 50.9 vs. 56.4 ± 33.5 ms, P < 0.001), even in the subset of patients (n = 63) with LVEF ≥55% and narrow QRS (≤100 ms). Among HFpEF patients, dyssynchrony was related to wider QRS interval, higher LV mass, and lower early diastolic tissue Doppler myocardial velocity (E'). Greater dyssynchrony remained significantly associated with worse diastolic function even after restricting the analysis to patients with EF≥55% and adjusting for age, gender, systolic blood pressure, LV mass index, and LVEF. CONCLUSION Heart failure with preserved EF is associated with greater mechanical dyssynchrony compared with healthy controls of similar age and gender. Within an HFpEF population, the severity of dyssynchrony is related to the width of QRS complex, LV hypertrophy, and diastolic dysfunction.
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Affiliation(s)
- Angela B S Santos
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02445, USA
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99
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Ruschitzka F, Abraham WT, Singh JP, Bax JJ, Borer JS, Brugada J, Dickstein K, Ford I, Gorcsan J, Gras D, Krum H, Sogaard P, Holzmeister J. Cardiac-resynchronization therapy in heart failure with a narrow QRS complex. N Engl J Med 2013; 369:1395-405. [PMID: 23998714 DOI: 10.1056/nejmoa1306687] [Citation(s) in RCA: 587] [Impact Index Per Article: 53.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Cardiac-resynchronization therapy (CRT) reduces morbidity and mortality in chronic systolic heart failure with a wide QRS complex. Mechanical dyssynchrony also occurs in patients with a narrow QRS complex, which suggests the potential usefulness of CRT in such patients. METHODS We conducted a randomized trial involving 115 centers to evaluate the effect of CRT in patients with New York Heart Association class III or IV heart failure, a left ventricular ejection fraction of 35% or less, a QRS duration of less than 130 msec, and echocardiographic evidence of left ventricular dyssynchrony. All patients underwent device implantation and were randomly assigned to have CRT capability turned on or off. The primary efficacy outcome was the composite of death from any cause or first hospitalization for worsening heart failure. RESULTS On March 13, 2013, the study was stopped for futility on the recommendation of the data and safety monitoring board. At study closure, the 809 patients who had undergone randomization had been followed for a mean of 19.4 months. The primary outcome occurred in 116 of 404 patients in the CRT group, as compared with 102 of 405 in the control group (28.7% vs. 25.2%; hazard ratio, 1.20; 95% confidence interval [CI], 0.92 to 1.57; P=0.15). There were 45 deaths in the CRT group and 26 in the control group (11.1% vs. 6.4%; hazard ratio, 1.81; 95% CI, 1.11 to 2.93; P=0.02). CONCLUSIONS In patients with systolic heart failure and a QRS duration of less than 130 msec, CRT does not reduce the rate of death or hospitalization for heart failure and may increase mortality. (Funded by Biotronik and GE Healthcare; EchoCRT ClinicalTrials.gov number, NCT00683696.).
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Affiliation(s)
- Frank Ruschitzka
- Clinic for Cardiology, University Hospital Zurich, Zurich, Switzerland
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100
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Lee APW, Zhang Q, Looi JL, Sun JP, Fang F, Liu YT, Liang YJ, Xie JM, Li RJ, Yu CM. Left ventricular systolic dyssynchrony in acute decompensated heart failure. Int J Cardiol 2013; 168:4285-6. [PMID: 23701936 DOI: 10.1016/j.ijcard.2013.04.200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 04/20/2013] [Indexed: 01/19/2023]
Affiliation(s)
- Alex Pui-Wai Lee
- Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
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