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Nguyên UC, Mafi-Rad M, Aben JP, Smulders MW, Engels EB, van Stipdonk AMW, Luermans JGLM, Bekkers SCAM, Prinzen FW, Vernooy K. A novel approach for left ventricular lead placement in cardiac resynchronization therapy: Intraprocedural integration of coronary venous electroanatomic mapping with delayed enhancement cardiac magnetic resonance imaging. Heart Rhythm 2016; 14:110-119. [PMID: 27663606 DOI: 10.1016/j.hrthm.2016.09.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Placing the left ventricular (LV) lead at a site of late electrical activation remote from scar is desired to improve cardiac resynchronization therapy (CRT) response. OBJECTIVE The purpose of this study was to integrate coronary venous electroanatomic mapping (EAM) with delayed enhancement cardiac magnetic resonance (DE-CMR) enabling LV lead guidance to the latest activated vein remote from scar. METHODS Eighteen CRT candidates with focal scar on DE-CMR were prospectively included. DE-CMR images were semi-automatically analyzed. Coronary venous EAM was performed intraprocedurally and integrated with DE-CMR to guide LV lead placement in real time. Image integration accuracy and electrogram parameters were evaluated offline. RESULTS Integration of EAM and DE-CMR was achieved using 8.9 ± 2.8 anatomic landmarks and with accuracy of 4.7 ± 1.1 mm (mean ± SD). Maximal electrical delay ranged between 72 and 197ms (57%-113% of QRS duration) and was heterogeneously located among individuals. In 12 patients, the latest activated vein was located outside scar, and placing the LV lead in the latest activated vein remote from scar was accomplished in 10 patients and prohibited in 2 patients. In the other 6 patients, the latest activated vein was located in scar, and targeting alternative veins was considered. Unipolar voltages were on average lower in scar compared to nonscar (6.71 ± 3.45 mV vs 8.18 ± 4.02 mV [median ± interquartile range), P <.001) but correlated weakly with DE-CMR scar extent (R -0.161, P <.001) and varied widely among individual patients. CONCLUSION Integration of coronary venous EAM with DE-CMR can be used during CRT implantation to guide LV lead placement to the latest activated vein remote from scar, possibly improving CRT.
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Affiliation(s)
- Uyên Châu Nguyên
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands.
| | - Masih Mafi-Rad
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Martijn W Smulders
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Elien B Engels
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | | | - Justin G L M Luermans
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
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Carità P, Corrado E, Pontone G, Curnis A, Bontempi L, Novo G, Guglielmo M, Ciaramitaro G, Assennato P, Novo S, Coppola G. Non-responders to cardiac resynchronization therapy: Insights from multimodality imaging and electrocardiography. A brief review. Int J Cardiol 2016; 225:402-407. [PMID: 27776243 DOI: 10.1016/j.ijcard.2016.09.037] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 09/07/2016] [Accepted: 09/15/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) is a successful strategy for heart failure (HF) patients. The pre-requisite for the response is the evidence of electrical dyssynchrony on the surface electrocardiogram usually as left bundle branch block (LBBB). Non-response to CRT is a significant problem in clinical practice. Patient selection, inadequate delivery and sub-optimal left ventricle lead position may be important causes. OBJECTIVES In an effort to improve CRT response multimodality imaging (especially echocardiography, computed tomography and cardiac magnetic resonance) could play a decisive role and extensive literature has been published on the matter. However, we are so far from routinary use in clinical practice. Electrocardiography (with respect to left ventricle capture and QRS narrowing) may represent a simple and low cost approach for early prediction of potential non-responder, with immediate practical implications. CONCLUSION This brief review covers the current recommendations for CRT in HF patients with particular attention to the potential benefits of multimodality imaging and electrocardiography in improving response rate.
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Affiliation(s)
- Patrizia Carità
- Department of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy.
| | - Egle Corrado
- Department of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy
| | | | - Antonio Curnis
- Chair and Unit of Cardiology University of Brescia, Spedali Civili Hospital, Italy
| | - Luca Bontempi
- Chair and Unit of Cardiology University of Brescia, Spedali Civili Hospital, Italy
| | - Giuseppina Novo
- Department of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy
| | | | | | - Pasquale Assennato
- Department of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy
| | - Salvatore Novo
- Department of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy
| | - Giuseppe Coppola
- Department of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy
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103
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The Role of Cardiovascular Magnetic Resonance in Cardiac Resynchronization Therapy. Card Electrophysiol Clin 2016; 7:619-33. [PMID: 26596807 DOI: 10.1016/j.ccep.2015.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Randomized, controlled trials have shown that cardiac resynchronization therapy (CRT) is beneficial in patients with heart failure, impaired left ventricular (LV) systolic function, and a wide QRS complex. Other studies have shown that targeting the LV pacing site can also improve patient outcomes. Cardiovascular magnetic resonance (CMR) is a radiation-free imaging modality that provides unparalleled spatial resolution. In addition, emerging data suggest that targeted LV lead deployment over viable myocardium improves the outcome of patients undergoing CRT. This review explores the role of CMR in the preoperative workup of patients undergoing CRT.
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104
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Rademakers LM, van Hunnik A, Kuiper M, Vernooy K, van Gelder B, Bracke FA, Prinzen FW. A Possible Role for Pacing the Left Ventricular Septum in Cardiac Resynchronization Therapy. JACC Clin Electrophysiol 2016; 2:413-422. [DOI: 10.1016/j.jacep.2016.01.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 01/11/2016] [Accepted: 01/21/2016] [Indexed: 11/30/2022]
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Ahmed W, Samy W, Tayeh O, Behairy N, Abd El Fattah A. Left ventricular scar impact on left ventricular synchronization parameters and outcomes of cardiac resynchronization therapy. Int J Cardiol 2016; 222:665-670. [PMID: 27517660 DOI: 10.1016/j.ijcard.2016.07.158] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 07/26/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Left ventricular scar, including global scar and lateral wall, plays an important role in predicting response to cardiac resynchronization therapy (CRT). MATERIALS AND METHODS Thirty patients underwent CRT implantation. Assessment of left ventricular (LV) dyssynchrony was done through Gated SPECT LV phase analysis. Pre-implantation cardiac magnetic resonance (CMR) with late gadolinium enhancement technique to examine LV scar burden. Echocardiographic examination of LV end-systolic volume (LVES) prior to CRT and 6 months later. RESULTS Thirty patients received CRT (mean age 58.7±9.0, 24 males). Reverse LV remodeling (decline ≥15% from baseline VES) was documented in 19 patients. Temporal changes in LV dyssynchrony parameters were correlated to LV reverse remodeling. Applying ROC for predicting CRT non-response showed a cutoff 36.5% of global LV scar burden had a sensitivity of 81.8% and specificity of 68.4%. A cutoff for lateral wall scar burden 40.5% of whole lateral wall had a sensitivity of 72.7% and specificity of 68.4%. CONCLUSION Reverse LV remodeling is associated with temporal improvements in LV dyssynchrony parameters. LV scar had an unfavorable impact on CRT response. Both global and lateral wall scar burden could predict CRT nonresponse status.
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Affiliation(s)
- Walid Ahmed
- Critical Care Medicine Department, Cairo University, Egypt.
| | - Wael Samy
- Critical Care Medicine Department, Cairo University, Egypt.
| | - Osama Tayeh
- Critical Care Medicine Department, Cairo University, Egypt.
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106
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Marek J, Gandalovičová J, Kejřová E, Pšenička M, Linhart A, Paleček T. Echocardiography and cardiac resynchronization therapy. COR ET VASA 2016. [DOI: 10.1016/j.crvasa.2015.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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107
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108
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Wieslander B, Loring Z, Zareba W, McNitt S, Wagner GS, Daubert JP, Strauss DG. Scar burden assessed by Selvester QRS score predicts prognosis, not CRT clinical benefit in preventing heart failure event and death: A MADIT-CRT sub-study. J Electrocardiol 2016; 49:603-9. [PMID: 27212144 DOI: 10.1016/j.jelectrocard.2016.04.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Indexed: 11/18/2022]
Affiliation(s)
- Björn Wieslander
- Department of Clinical Physiology, Karolinska Institutet, Stockholm, Sweden
| | - Zak Loring
- Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD.
| | - Wojciech Zareba
- Cardiology Unit of the Department of Medicine, University of Rochester Medical Center, Rochester, NY
| | - Scott McNitt
- The Heart Research Follow-Up Program, University of Rochester Medical Center, Rochester, NY
| | | | - James P Daubert
- Electrophysiology Section/Cardiology Division, and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - David G Strauss
- Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD
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MEMON SARFARAZ, GANGA HARSHAV, KLUGER JEFFREY. Late Gadolinium Enhancement in Patients with Nonischemic Dilated Cardiomyopathy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:731-47. [DOI: 10.1111/pace.12873] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 03/22/2016] [Accepted: 04/06/2016] [Indexed: 01/23/2023]
Affiliation(s)
- SARFARAZ MEMON
- Division of Cardiology; Hartford Hospital; Hartford Connecticut
| | - HARSHA V. GANGA
- Division of Cardiology; Brown University; Providence Rhode Island
| | - JEFFREY KLUGER
- Division of Cardiology; Hartford Hospital; Hartford Connecticut
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Melero-Ferrer JL, López-Vilella R, Morillas-Climent H, Sanz-Sánchez J, Sánchez-Lázaro IJ, Almenar-Bonet L, Martínez-Dolz L. Novel Imaging Techniques for Heart Failure. Card Fail Rev 2016; 2:27-34. [PMID: 28875038 DOI: 10.15420/cfr.2015:29:2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Imaging techniques play a main role in heart failure (HF) diagnosis, assessment of aetiology and treatment guidance. Echocardiography is the method of choice for its availability, cost and it provides most of the information required for the management and follow up of HF patients. Other non-invasive cardiac imaging modalities, such as cardiovascular magnetic resonance (CMR), nuclear imaging-positron emission tomography (PET) and single-photon emission computed tomography (SPECT) and computed tomography (CT) could provide additional aetiological, prognostic and therapeutic information, especially in selected populations. This article reviews current indications and possible future applications of imaging modalities to improve the management of HF patients.
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Affiliation(s)
- Josep L Melero-Ferrer
- Advanced Heart Failure and Heart Transplantation Unit, Cardiology Department, Hospital Universitari i Politècnic La Fe,Valencia, Spain
| | - Raquel López-Vilella
- Advanced Heart Failure and Heart Transplantation Unit, Cardiology Department, Hospital Universitari i Politècnic La Fe,Valencia, Spain
| | - Herminio Morillas-Climent
- Advanced Heart Failure and Heart Transplantation Unit, Cardiology Department, Hospital Universitari i Politècnic La Fe,Valencia, Spain
| | - Jorge Sanz-Sánchez
- Advanced Heart Failure and Heart Transplantation Unit, Cardiology Department, Hospital Universitari i Politècnic La Fe,Valencia, Spain
| | - Ignacio J Sánchez-Lázaro
- Advanced Heart Failure and Heart Transplantation Unit, Cardiology Department, Hospital Universitari i Politècnic La Fe,Valencia, Spain
| | - Luis Almenar-Bonet
- Advanced Heart Failure and Heart Transplantation Unit, Cardiology Department, Hospital Universitari i Politècnic La Fe,Valencia, Spain
| | - Luis Martínez-Dolz
- Advanced Heart Failure and Heart Transplantation Unit, Cardiology Department, Hospital Universitari i Politècnic La Fe,Valencia, Spain
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111
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Sanchis L, Prat S, Sitges M. Cardiovascular Imaging in the Electrophysiology Laboratory. ACTA ACUST UNITED AC 2016; 69:595-605. [PMID: 27107802 DOI: 10.1016/j.rec.2016.01.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 01/09/2016] [Indexed: 10/21/2022]
Abstract
In recent years, rapid technological advances have allowed the development of new electrophysiological procedures that would not have been possible without the parallel development of imaging techniques used to plan and guide these procedures and monitor their outcomes. Ablation of atrial fibrillation is among the interventions with the greatest need for imaging support. Echocardiography allows the appropriate selection of patients and the detection of thrombi that would contraindicate the intervention; cardiac magnetic resonance imaging and computed tomography are also essential in planning this procedure, by allowing a detailed anatomical study of the pulmonary veins. In addition, in cardiac resynchronization therapy, echocardiography plays a central role in both patient selection and, later, in device adjustment and in assessing the effectiveness of the technique. More recently, ablation of ventricular tachycardias has been established as a treatment option; this would not be possible without planning using an imaging study such as cardiac magnetic resonance imaging of myocardial scarring.
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Affiliation(s)
- Laura Sanchis
- Instituto Cardiovascular, Hospital Clínic, IDIBAPS, Universidad de Barcelona, IDIBAPS-Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Susanna Prat
- Instituto Cardiovascular, Hospital Clínic, IDIBAPS, Universidad de Barcelona, IDIBAPS-Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Marta Sitges
- Instituto Cardiovascular, Hospital Clínic, IDIBAPS, Universidad de Barcelona, IDIBAPS-Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.
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112
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Delgado V. Correct the left ventricular dyssynchrony, correct the rocking. Eur Heart J Cardiovasc Imaging 2016; 17:270-1. [DOI: 10.1093/ehjci/jev324] [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: 11/13/2022] Open
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113
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Shanks M, Delgado V, Bax JJ. Cardiac Resynchronization Therapy in Non-Ischemic Cardiomyopathy. J Atr Fibrillation 2016; 8:1362. [PMID: 27909478 DOI: 10.4022/jafib.1362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 02/04/2016] [Accepted: 02/05/2016] [Indexed: 12/12/2022]
Abstract
Cardiac resynchronization therapy (CRT) is an established therapy for heart failure patients who remain symptomatic despite optimal medical therapy, have reduced left ventricular ejection fraction (<35%) and wide QRS duration (>120 ms), preferably with left bundle branch block morphology. The response to CRT depends on the cardiac substrate: presence of correctable left ventricular mechanical dyssynchrony, presence of myocardial fibrosis (scar) and position of the left ventricular pacing lead. Patients with non-ischemic cardiomyopathy have shown higher response rates to CRT compared with patients with ischemic cardiomyopathy. Differences in myocardial substrate may partly explain this disparity. Multimodality imaging plays an important role to assess the cardiac substrate and the pathophysiological determinants of response to CRT.
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Affiliation(s)
- Miriam Shanks
- University of Alberta, Mazankowski Alberta Heart Institute, Edmonton (Canada) and Heart Lung Center, Leiden University Medical Center, Leiden (The Netherlands)
| | - Victoria Delgado
- University of Alberta, Mazankowski Alberta Heart Institute, Edmonton (Canada) and Heart Lung Center, Leiden University Medical Center, Leiden (The Netherlands)
| | - Jeroen J Bax
- University of Alberta, Mazankowski Alberta Heart Institute, Edmonton (Canada) and Heart Lung Center, Leiden University Medical Center, Leiden (The Netherlands)
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Leyva F, Umar F, Taylor RJ, Steeds RP, Frenneaux MP. The clinical outcome of cardiac resynchronization therapy in post-surgical valvular cardiomyopathy. Europace 2016; 18:732-8. [DOI: 10.1093/europace/euv287] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 07/30/2015] [Indexed: 11/12/2022] Open
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Ziacchi M, Saporito D, Zardini M, Luzi M, Quartieri F, Morgagni G, De Maria E, Bertini M, Carinci V, Boriani G, Biffi M. Left Ventricular Reverse Remodeling Elicited by a Quadripolar Lead: Results from the Multicenter Per4mer Study. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:250-60. [PMID: 26643691 DOI: 10.1111/pace.12792] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 11/07/2015] [Accepted: 12/01/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND To understand the impact of a quadripolar left ventricular (LV) lead on reverse remodeling and phrenic nerve stimulation (PNS) in congestive heart failure patients treated by cardiac resynchronization therapy at 8-month follow-up (FU). METHODS One hundred and fifty-eight patients received an LV Medtronic Performa lead (Medtronic Inc., Minneapolis, MN, USA) and were reevaluated at FU by echocardiography and measurement of electrical parameters. RESULTS A targeted LV lead placement was achieved in 140 (89%) patients. Super responders and responders were 76 (50%) and 26 (18%), respectively, at FU; seven (4%) died and 13 (8%) were hospitalized for any cause. Nonischemic etiology was the only independent predictor of reverse remodeling. The configurations available only with the Performa leads reduced PNS occurrence at 8 V@0.4 ms from 43 (27%) to 14 (9%) of patients at implantation, and from 44 (28%) to 19 (12%) at last FU, compared to configurations available with bipolar leads. Patients with detectable PNS had >10/16 pacing configurations with a PNS safety margin >2 V both at implantation and at FU. During FU 16 (10%) patients had an adverse event possibly related to the lead or to modification of the underlying heart disease but 99% of these events were fixed by reprogramming of the pacing vector. CONCLUSIONS Performa Lead enables an increased capability to achieve a targeted lead positioning in the broad clinical scenario of large- and small-volume implanting centers, with a relevant impact on the occurrence of reverse remodeling compared to literature data. The enhanced management of PNS resulted in a dislodgement rate of only 1%.
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Affiliation(s)
- Matteo Ziacchi
- Institute of Cardiology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | | | - Marco Zardini
- Division of Cardiology, University Hospital, Parma, Italy
| | - Mario Luzi
- Cardiovascular Department, Ospedali Riuniti, Ancona, Italy
| | - Fabio Quartieri
- Division of Cardiology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | | | - Elia De Maria
- Division of Cardiology, Ramazzini Hospital, Carpi, Italy
| | | | | | - Giuseppe Boriani
- Institute of Cardiology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Mauro Biffi
- Institute of Cardiology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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116
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Umar F, Taylor RJ, Stegemann B, Marshall H, Flannigan S, Lencioni M, De Bono J, Griffith M, Leyva F. Haemodynamic effects of cardiac resynchronization therapy using single-vein, three-pole, multipoint left ventricular pacing in patients with ischaemic cardiomyopathy and a left ventricular free wall scar: the MAESTRO study. Europace 2015; 18:1227-34. [PMID: 26718535 DOI: 10.1093/europace/euv396] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 10/31/2015] [Indexed: 11/14/2022] Open
Abstract
AIMS The clinical response to cardiac resynchronization therapy (CRT) is variable. Multipoint left ventricular (LV) pacing could achieve more effective haemodynamic response than single-point LV pacing. Deployment of an LV lead over myocardial scar is associated with a poor haemodynamic response to and clinical outcome of CRT. We sought to determine whether the acute haemodynamic response to CRT using three-pole LV multipoint pacing (CRT3P-MPP) is superior to that to conventional CRT using single-site LV pacing (CRTSP) in patients with ischaemic cardiomyopathy and an LV free wall scar. METHODS AND RESULTS Sixteen patients with ischaemic cardiomyopathy [aged 72.6 ± 7.7 years (mean ± SD), 81.3% male, QRS: 146.0 ± 14.2 ms, LBBB in 14 (87.5%)] in whom the LV lead was intentionally deployed straddling an LV free wall scar (assessed using cardiac magnetic resonance), underwent assessment of LV + dP/dtmax during CRT3P-MPP and CRTSP. Interindividually, the ΔLV + dP/dtmax in relation to AAI pacing with CRT3P-MPP (6.2 ± 13.3%) was higher than with basal and mid CRTSP (both P < 0.001), but similar to apical CRTSP. Intraindividually, significant differences in the ΔLV + dP/dtmax to optimal and worst pacing configurations were observed in 10 (62.5%) patients. Of the 8 patients who responded to at least one configuration, CRT3P-MPP was optimal in 5 (62.5%) and apical CRTSP was optimal in 3 (37.5%) (P = 0.0047). CONCLUSIONS In terms of acute haemodynamic response, CRT3P-MPP was comparable an apical CRTSP and superior to basal and distal CRTSP. In the absence of within-device haemodynamic optimization, CRT3P-MPP may offer a haemodynamic advantage over a fixed CRTSP configuration.
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Affiliation(s)
- Fraz Umar
- Department of Cardiology, University Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK Centre for Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Robin J Taylor
- Department of Cardiology, University Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK Centre for Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | | | - Howard Marshall
- Department of Cardiology, University Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
| | - Sharon Flannigan
- Department of Cardiology, University Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
| | - Mauro Lencioni
- Department of Cardiology, University Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
| | - Joseph De Bono
- Department of Cardiology, University Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
| | - Michael Griffith
- Department of Cardiology, University Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
| | - Francisco Leyva
- Department of Cardiology, University Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham B4 7ET, UK
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Abstract
Robot-assisted left ventricular lead implantation for cardiac resynchronization therapy is a feasible and safe technique with superior visualization, dexterity, and precision to target the optimal pacing site. The technique has been associated with clinical response and beneficial reverse remodeling comparable with the conventional approach via the coronary sinus. The lack of clinical superiority and a residual high nonresponder rate suggest that the appropriate clinical role for the technique remains as rescue therapy.
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Affiliation(s)
- Advay G Bhatt
- Arrhythmia Institute, The Valley Health System, 223 North Van Dien Avenue, Ridgewood, NJ 07450, USA
| | - Jonathan S Steinberg
- Arrhythmia Institute, The Valley Health System, 223 North Van Dien Avenue, Ridgewood, NJ 07450, USA; University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
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118
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Left ventricular lead position, mechanical activation, and myocardial scar in relation to left ventricular reverse remodeling and clinical outcomes after cardiac resynchronization therapy: A feature-tracking and contrast-enhanced cardiovascular magnetic resonance study. Heart Rhythm 2015; 13:481-9. [PMID: 26498258 DOI: 10.1016/j.hrthm.2015.10.024] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND Late mechanical activation (LMA) and viability in the left ventricular (LV) myocardium have been proposed as targets for LV pacing during cardiac resynchronization therapy (CRT). OBJECTIVE The purpose of this study was to determine whether an LV lead position over segments with LMA and no scar improves LV reverse remodeling (LVRR) and clinical outcomes after CRT. METHODS Feature-tracking and late gadolinium enhancement images were analyzed retrospectively in patients with heart failure (HF) (n = 89; mean age 66.8 ± 10.8 years; LV ejection fraction = 23.1% ± 9.9%) who underwent cardiovascular magnetic resonance (CMR) scanning before CRT implantation. Lead positions were classified as concordant (no scar and LMA [time to peak systolic circumferential strain]) or nonconcordant (scar and/or no LMA). RESULTS LVRR occurred in 68% and 24% of patients with concordant and nonconcordant LV lead positions, respectively (P < .001). Over a median of 4.4 years (range 0.1-8.7 years), LV lead concordance predicted cardiac mortality (adjusted odds ratio [aOR] 0.27; 95% confidence interval [CI] 0.12-0.62) and cardiac mortality or HF hospitalizations (aOR 0.26, 95% CI 0.12-0.58). "No scar" in the paced segment predicted cardiac mortality (aOR 0.24; 95% CI 0.11-0.52) and cardiac mortality or HF hospitalizations (adjusted aOR 0.24; 95% CI 0.12-0.49). CONCLUSION LV lead deployment over nonscarred LMA segments was associated with better LVRR and clinical outcomes after CRT. LVRR was primarily related to LMA, whereas events were primarily related to scar. These findings support the use of late gadolinium enhancement CMR and feature-tracking CMR in guiding LV lead deployment.
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119
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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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Daoulah A, Alsheikh-Ali AA, Al-Faifi SM, Ocheltree SR, Haq E, Asrar FM, Fathey A, Haneef AA, Al Mousily F, O ES, Lotfi A. Cardiac resynchronization therapy in patients with postero-lateral scar by cardiac magnetic resonance: A systematic review and meta-analysis. J Electrocardiol 2015; 48:783-90. [DOI: 10.1016/j.jelectrocard.2015.06.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Indexed: 10/23/2022]
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Atwater BD, Babatunde A, Swan C, Wieslander B, Andresen A, Rabineau D, Tomfohr J, Wagner G, Jackson KP, Daubert JP. ECG myocardial scar quantification predicts reverse left ventricular remodeling and survival after cardiac resynchronization therapy implantation: A retrospective pilot study. J Electrocardiol 2015; 48:565-70. [DOI: 10.1016/j.jelectrocard.2015.05.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Indexed: 11/17/2022]
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Martens P, Verbrugge FH, Mullens W. Optimizing CRT - Do We Need More Leads and Delivery Methods. J Atr Fibrillation 2015; 7:1202. [PMID: 27957161 DOI: 10.4022/jafib.1202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 04/23/2015] [Accepted: 04/24/2015] [Indexed: 11/10/2022]
Abstract
Cardiac resynchronization therapy (CRT) is an established therapeutic option in symptomatic heart failure with reduced ejection fraction and evidence of left ventricular (LV) conduction delay (QRS width ≥120 ms), especially when typical left bundle branch block is present. The rationale behind CRT is restoration of aberrant LV electrical activation. As there is considerable heterogeneity of the LV electrical activation pattern among CRT candidates, an individualized approach with targeting of the LV lead in the region of latest electrical activation while avoiding scar tissue may enhance CRT response. Echocardiography, electro anatomic mapping, and cardiac magnetic resonance imaging with late gadolinium enhancement are helpful to guide such targeted LV lead placement. However, an important limitation remains the anatomy of the coronary sinus, which often does not allow concordant LV lead placement in the optimal region. Epicardial LV lead placement through minimal invasive surgery or endocardial LV lead placement through transseptal punction may overcome this limitation, obviously with an increased complication risk. Furthermore, recent pacing algorithms suggest superiority of LV-only versus biventricular pacing in patients with preserved atrio ventricular (AV) conduction and a typical LBBB pattern. Finally, pacing from only one LV site might not overcome the wide electrical dispersion often seen in patients with LV conduction delays. Therefore, multisite pacing has gained significant interest to improve CRT response. The use of multiple LV leads may potentially lead to more favorable reverse remodeling, improved functional capacity and quality of life in CRT candidates, but adverse events and a shorter battery span are more frequent because of the extra lead. The use of one multipolar LV lead increases the number of pacing configurations within the same coronary sinus side branch (within small distances from each other) without the use of an additional lead. Small observational studies suggest that more effective resynchronization can be achieved with this approach. Finally, there are many reasons for non effective CRT delivery in carefully selected patients with an adequately implanted device. Multidisciplinary, post implantation care inside a dedicated CRT clinic ensures optimal CRT delivery, improves response rate and should be considered standard of care.
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Affiliation(s)
- Pieter Martens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Frederik Hendrik Verbrugge
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium; Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium; Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
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Varma N, Ploux S, Ritter P, Wilkoff B, Eschalier R, Bordachar P. Noninvasive mapping of electrical dyssynchrony in heart failure and cardiac resynchronization therapy. Card Electrophysiol Clin 2015; 7:125-134. [PMID: 25784029 DOI: 10.1016/j.ccep.2014.11.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Causes for diverse effects of cardiac resynchronization therapy (CRT) are poorly understood. Because CRT is an electrical therapy, it may be best understood by detailed characterization of electrical substrate and its interaction with pacing. Electrocardiogram (ECG) features affect CRT outcomes. However, the surface ECG reports rudimentary electrical data. In contrast, noninvasive electrocardiographic imaging provides high-resolution single-beat ventricular mapping. Several complex characteristics of electrical substrate, not decipherable from the 12-lead ECG, are linked to CRT effect. CRT response may be improved by candidate selection and left ventricular lead placement directed by more precise electrical evaluation, on an individual patient basis.
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Affiliation(s)
- Niraj Varma
- Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Sylvain Ploux
- CHU Bordeaux, Liryc Institute Bordeaux, Université de Bordeaux, France
| | - Philippe Ritter
- CHU Bordeaux, Liryc Institute Bordeaux, Université de Bordeaux, France
| | - Bruce Wilkoff
- Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Romain Eschalier
- CHU Bordeaux, Liryc Institute Bordeaux, Université de Bordeaux, France
| | - Pierre Bordachar
- CHU Bordeaux, Liryc Institute Bordeaux, Université de Bordeaux, France
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Hinojar R, Botnar R, Kaski JC, Prasad S, Nagel E, Puntmann VO. Individualized cardiovascular risk assessment by cardiovascular magnetic resonance. Future Cardiol 2015; 10:273-89. [PMID: 24762254 DOI: 10.2217/fca.13.102] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) is gaining clinical importance in preventive medicine. Evidence on diagnostic accuracy and prognostic value, in addition to the development of faster imaging, increased availability of equipment and imaging expertise have led to a wide-spread use of CMR in a growing number of clinical indications. The first part of this review summarizes the role of CMR biomarkers for risk assessment focusing on the patients groups that benefit from the use of CMR. In the second part, the future directions for CMR are discussed and their role in prevention of cardiovascular disease.
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Affiliation(s)
- Rocio Hinojar
- Cardiovascular Imaging Department, Division of Imaging Sciences & Biomedical Engineering, King's College London, London, UK
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126
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Yoon YE, Hong YJ, Kim HK, Kim JA, Na JO, Yang DH, Kim YJ, Choi EY. 2014 korean guidelines for appropriate utilization of cardiovascular magnetic resonance imaging: a joint report of the korean society of cardiology and the korean society of radiology. Korean Circ J 2014; 44:359-85. [PMID: 25469139 PMCID: PMC4248609 DOI: 10.4070/kcj.2014.44.6.359] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 10/17/2014] [Accepted: 10/19/2014] [Indexed: 12/19/2022] Open
Abstract
Cardiac magnetic resonance (CMR) imaging is now widely used in several fields of cardiovascular disease assessment due to recent technical developments. CMR can give physicians information that cannot be found with other imaging modalities. However, there is no guideline which is suitable for Korean people for the use of CMR. Therefore, we have prepared a Korean guideline for the appropriate utilization of CMR to guide Korean physicians, imaging specialists, medical associates and patients to improve the overall medical system performances. By addressing CMR usage and creating these guidelines we hope to contribute towards the promotion of public health. This guideline is a joint report of the Korean Society of Cardiology and the Korean Society of Radiology.
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Affiliation(s)
- Yeonyee E Yoon
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yoo Jin Hong
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyung-Kwan Kim
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jeong A Kim
- Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jin Oh Na
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Dong Hyun Yang
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Jin Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eui-Young Choi
- Division of Cardiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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127
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Yoon YE, Hong YJ, Kim HK, Kim JA, Na JO, Yang DH, Kim YJ, Choi EY, The Korean Society of Cardiology and the Korean Society of Radiology. 2014 Korean guidelines for appropriate utilization of cardiovascular magnetic resonance imaging: a joint report of the Korean Society of Cardiology and the Korean Society of Radiology. Korean J Radiol 2014; 15:659-88. [PMID: 25469078 PMCID: PMC4248622 DOI: 10.3348/kjr.2014.15.6.659] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 09/25/2014] [Indexed: 12/18/2022] Open
Abstract
Cardiac magnetic resonance (CMR) imaging is now widely used in several fields of cardiovascular disease assessment due to recent technical developments. CMR can give physicians information that cannot be found with other imaging modalities. However, there is no guideline which is suitable for Korean people for the use of CMR. Therefore, we have prepared a Korean guideline for the appropriate utilization of CMR to guide Korean physicians, imaging specialists, medical associates and patients to improve the overall medical system performances. By addressing CMR usage and creating these guidelines we hope to contribute towards the promotion of public health. This guideline is a joint report of the Korean Society of Cardiology and the Korean Society of Radiology.
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Affiliation(s)
- Yeonyee E Yoon
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam 463-707, Korea
| | - Yoo Jin Hong
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Hyung-Kwan Kim
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 110-744, Korea
| | - Jeong A Kim
- Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang 411-706, Korea
| | - Jin Oh Na
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul 152-703, Korea
| | - Dong Hyun Yang
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Young Jin Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Eui-Young Choi
- Division of Cardiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 135-720, Korea
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Huntjens PR, Walmsley J, Ploux S, Bordachar P, Prinzen FW, Delhaas T, Lumens J. Influence of left ventricular lead position relative to scar location on response to cardiac resynchronization therapy: a model study. Europace 2014; 16 Suppl 4:iv62-iv68. [DOI: 10.1093/europace/euu231] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sado DM, Fontana M, Moon JC. Heart muscle disease and cardiovascular magnetic resonance imaging. Br J Hosp Med (Lond) 2014; 75:384-90. [PMID: 25040517 DOI: 10.12968/hmed.2014.75.7.384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This article introduces the reader to the different types of heart muscle disease which are commonly encountered in clinical practice. It then discusses cardiovascular magnetic resonance and explains how it can help in the work up of these diverse conditions.
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130
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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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131
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van Oorschot JW, Gho JM, van Hout GP, Froeling M, Jansen of Lorkeers SJ, Hoefer IE, Doevendans PA, Luijten PR, Chamuleau SA, Zwanenburg JJ. Endogenous contrast MRI of cardiac fibrosis: Beyond late gadolinium enhancement. J Magn Reson Imaging 2014; 41:1181-9. [DOI: 10.1002/jmri.24715] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 07/14/2014] [Accepted: 07/15/2014] [Indexed: 12/27/2022] Open
Affiliation(s)
| | - Johannes M.I.H. Gho
- Department of Cardiology; University Medical Center Utrecht; Utrecht The Netherlands
| | | | - Martijn Froeling
- Department of Radiology; University Medical Center Utrecht; Utrecht The Netherlands
| | | | - Imo E. Hoefer
- Department of Cardiology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Pieter A. Doevendans
- Department of Cardiology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Peter R. Luijten
- Department of Radiology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Steven A.J. Chamuleau
- Department of Cardiology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Jaco J.M. Zwanenburg
- Department of Radiology; University Medical Center Utrecht; Utrecht The Netherlands
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132
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Kydd AC, Khan FZ, Watson WD, Pugh PJ, Virdee MS, Dutka DP. Prognostic Benefit of Optimum Left Ventricular Lead Position in Cardiac Resynchronization Therapy. JACC-HEART FAILURE 2014; 2:205-12. [DOI: 10.1016/j.jchf.2013.11.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 11/07/2013] [Indexed: 11/30/2022]
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Sade LE, Saba S, Marek JJ, Onishi T, Schwartzman D, Adelstein EC, Soman P, Gorcsan J. The Association of Left Ventricular Lead Position Related to Regional Scar by Speckle-Tracking Echocardiography with Clinical Outcomes in Patients Receiving Cardiac Resynchronization Therapy. J Am Soc Echocardiogr 2014; 27:648-56. [DOI: 10.1016/j.echo.2014.01.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Indexed: 10/25/2022]
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Vernooy K, van Deursen CJM, Strik M, Prinzen FW. Strategies to improve cardiac resynchronization therapy. Nat Rev Cardiol 2014; 11:481-93. [PMID: 24839977 DOI: 10.1038/nrcardio.2014.67] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cardiac resynchronization therapy (CRT) emerged 2 decades ago as a useful form of device therapy for heart failure associated with abnormal ventricular conduction, indicated by a wide QRS complex. In this Review, we present insights into how to achieve the greatest benefits with this pacemaker therapy. Outcomes from CRT can be improved by appropriate patient selection, careful positioning of right and left ventricular pacing electrodes, and optimal timing of electrode stimulation. Left bundle branch block (LBBB), which can be detected on an electrocardiogram, is the predominant substrate for CRT, and patients with this conduction abnormality yield the most benefit. However, other features, such as QRS morphology, mechanical dyssynchrony, myocardial scarring, and the aetiology of heart failure, might also determine the benefit of CRT. No single left ventricular pacing site suits all patients, but a late-activated site, during either the intrinsic LBBB rhythm or right ventricular pacing, should be selected. Positioning the lead inside a scarred region substantially impairs outcomes. Optimization of stimulation intervals improves cardiac pump function in the short term, but CRT procedures must become easier and more reliable, perhaps with the use of electrocardiographic measures, to improve long-term outcomes.
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Affiliation(s)
- Kevin Vernooy
- Department of Cardiology, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, Netherlands
| | | | - Marc Strik
- Department of Cardiology, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, Netherlands
| | - Frits W Prinzen
- Department of Physiology, Maastricht University, PO Box 616, 6200 MD Maastricht, Netherlands
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135
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Boriani G, Ziacchi M, Diemberger I, Valzania C, Biffi M, Martignani C. Cardiac resynchronization therapy. J Cardiovasc Med (Hagerstown) 2014; 15:269-72. [DOI: 10.2459/jcm.0000000000000022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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136
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Gasparini M, Leclercq C, Yu CM, Auricchio A, Steinberg JS, Lamp B, Klersy C, Leyva F. Absolute survival after cardiac resynchronization therapy according to baseline QRS duration: a multinational 10-year experience: data from the Multicenter International CRT Study. Am Heart J 2014; 167:203-209.e1. [PMID: 24439981 DOI: 10.1016/j.ahj.2013.10.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 10/28/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND In the major trials of cardiac resynchronization therapy (CRT), the survival benefit of the therapy, relative to control subjects, increases with QRS duration. In the non-CRT heart failure population, however, a wide QRS duration is associated with a shorter survival. Relative survival benefit from a therapy, however, is not synonymous with a longer absolute survival. We sought to determine whether baseline QRS duration relates to the absolute survival after CRT. METHODS AND RESULTS In this prospective, longitudinal, observational study, 3,319 consecutive patients undergoing CRT (QRS 120-149 ms 26%, QRS 150-199 ms 58%, and QRS ≥200 ms 16%) were assessed in relation to mortality over 10 years. Overall mortality rates (per 100 patient-years) were 9.2%, 9.3%, and 13.3% in the 3 groups, respectively (all P < .001). Cardiac mortality rates were 6.2, 6.0, and 9.9 per 100 patient-years, respectively (all P < .001). Compared with the QRS 120-149 ms group, cardiac mortality was highest in the QRS ≥200 ms group (hazard ratio [HR] 1.72 [95% CI 1.35-2.19], P < .001), independent of age, gender, New York Heart Association class, presence of atrial fibrillation, heart failure etiology, and left ventricular ejection fraction. Median survival after CRT was longest in patients with a width of QRS 120-149 ms and shortest in patients with a QRS ≥200 ms (P < .001). In multivariable analyses, a QRS ≥200 ms emerged as a powerful independent predictor of both overall (HR 1.44 [95% CI 1.07-1.94], P = .017) and cardiac mortality (HR 1.59 [95% CI 1.14-2.24], P = .007). CONCLUSIONS At long-term follow-up, absolute overall and cardiac survival after CRT is similar in patients with a preimplant QRS duration of 120 to 149 ms and 150 to 199 ms but markedly shorter in patients with a QRS ≥200 ms.
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Affiliation(s)
- Maurizio Gasparini
- Electrophysiology and Pacing Unit, Humanitas Research Hospital IRCCS, Rozzano-Milano, Italy.
| | | | - Cheuk-Man Yu
- Department of Medicine and Therapeutics, Division of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin New Territories, Hong Kong
| | | | - Jonathan S Steinberg
- Valley Health System and Columbia University College of Physicians & Surgeons, New York, NY
| | - Barbara Lamp
- Department of Cardiology, Heart and Diabetes Centre NRV, Bad Oeynhausen, Germany
| | - Catherine Klersy
- Biometry and Clinical Epidemiology, Research Department, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Francisco Leyva
- Centre for Cardiovascular Sciences, University of Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom
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137
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Affiliation(s)
- Frits W. Prinzen
- From the Departments of Physiology (F.W.P.) and Cardiology (K.V.), Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands; and the Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland (A.A.)
| | - Kevin Vernooy
- From the Departments of Physiology (F.W.P.) and Cardiology (K.V.), Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands; and the Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland (A.A.)
| | - Angelo Auricchio
- From the Departments of Physiology (F.W.P.) and Cardiology (K.V.), Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands; and the Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland (A.A.)
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138
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Wong TC, Piehler KM, Zareba KM, Lin K, Phrampus A, Patel A, Moon JC, Ugander M, Valeti U, Holtz JE, Fu B, Chang CCH, Mathier M, Kellman P, Butler J, Gheorghiade M, Schelbert EB. Myocardial damage detected by late gadolinium enhancement cardiovascular magnetic resonance is associated with subsequent hospitalization for heart failure. J Am Heart Assoc 2013; 2:e000416. [PMID: 24249712 PMCID: PMC3886781 DOI: 10.1161/jaha.113.000416] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hospitalization for heart failure (HHF) is among the most important problems confronting medicine. Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) robustly identifies intrinsic myocardial damage. LGE may indicate inherent vulnerability to HHF, regardless of etiology, across the spectrum of heart failure stage or left ventricular ejection fraction (LVEF). METHODS AND RESULTS We enrolled 1068 consecutive patients referred for CMR where 448 (42%) exhibited LGE. After a median of 1.4 years (Q1 to Q3: 0.9 to 2.0 years), 57 HHF events occurred, 15 deaths followed HHF, and 43 deaths occurred without antecedent HHF (58 total deaths). Using multivariable Cox regression adjusting for LVEF, heart failure stage, and other covariates, LGE was associated with first HHF after CMR (HR: 2.70, 95% CI: 1.32 to 5.50), death (HR: 2.13, 95% CI: 1.08 to 4.21), or either death or HHF (HR: 2.52, 95% CI: 1.49 to 4.25). Quantifying LGE extent yielded similar results; more LGE equated higher risks. LGE improved model discrimination (IDI: 0.016, 95% CI: 0.005 to 0.028, P=0.002) and reclassification of individuals at risk (continuous NRI: 0.40, 95% CI: 0.05 to 0.70, P=0.024). Adjustment for competing risks of death that shares common risk factors with HHF strengthened the LGE and HHF association (HR: 4.85, 95% CI: 1.40 to 16.9). CONCLUSIONS The presence and extent of LGE is associated with vulnerability for HHF, including higher risks of HHF across the spectrum of heart failure stage and LVEF. Even when LVEF is severely decreased, those without LGE appear to fare reasonably well. LGE may enhance risk stratification for HHF and may enhance both clinical and research efforts to reduce HHF through targeted treatment.
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Affiliation(s)
- Timothy C Wong
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
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139
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Sorgente A, Cappato R. A Critical Reappraisal of the Current Clinical Indications to Cardiac Resynchronisation Therapy. Arrhythm Electrophysiol Rev 2013; 2:91-4. [PMID: 26835046 DOI: 10.15420/aer.2013.2.2.91] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Cardiac resynchronisation therapy (CRT) is a well-established non-pharmacological treatment option for patients with refractory symptomatic heart failure (HF) already under optimal medical therapy. CRT is founded on the principle that interventricular conduction disturbances and more in particular left bundle branch block (LBBB) are deleterious to cardiac performance, and may contribute to the systolic and diastolic incompetency typical of patients with HF. Although CRT is associated with a not negligible percentage of non-response, all the international guidelines on chronic HF have extended their indications to CRT, also to patients with less symptomatic HF who are already showing signs of systolic dysfunction and interventricular dyssynchrony, without giving any substantial advice to reduce the number of failures of this therapy. This review seeks to point out the potential issues linked to CRT, with the aim of making a reappraisal of the clinical evidences supporting the current indications to CRT, and to figure out which type of research should be warranted in the field for the future to reduce the percentage of non-responders to this therapy.
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Affiliation(s)
- Antonio Sorgente
- Arrhythmia and Electrophysiology Department, Policlinico San Donato, Milan, Italy
| | - Riccardo Cappato
- Arrhythmia and Electrophysiology Department, Policlinico San Donato, Milan, Italy
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140
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Kotu LP, Engan K, Skretting K, Måløy F, Orn S, Woie L, Eftestøl T. Probability mapping of scarred myocardium using texture and intensity features in CMR images. Biomed Eng Online 2013; 12:91. [PMID: 24053280 PMCID: PMC3849370 DOI: 10.1186/1475-925x-12-91] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 09/12/2013] [Indexed: 12/03/2022] Open
Abstract
Background The myocardium exhibits heterogeneous nature due to scarring after Myocardial Infarction (MI). In Cardiac Magnetic Resonance (CMR) imaging, Late Gadolinium (LG) contrast agent enhances the intensity of scarred area in the myocardium. Methods In this paper, we propose a probability mapping technique using Texture and Intensity features to describe heterogeneous nature of the scarred myocardium in Cardiac Magnetic Resonance (CMR) images after Myocardial Infarction (MI). Scarred tissue and non-scarred tissue are represented with high and low probabilities, respectively. Intermediate values possibly indicate areas where the scarred and healthy tissues are interwoven. The probability map of scarred myocardium is calculated by using a probability function based on Bayes rule. Any set of features can be used in the probability function. Results In the present study, we demonstrate the use of two different types of features. One is based on the mean intensity of pixel and the other on underlying texture information of the scarred and non-scarred myocardium. Examples of probability maps computed using the mean intensity of pixel and the underlying texture information are presented. We hypothesize that the probability mapping of myocardium offers alternate visualization, possibly showing the details with physiological significance difficult to detect visually in the original CMR image. Conclusion The probability mapping obtained from the two features provides a way to define different cardiac segments which offer a way to identify areas in the myocardium of diagnostic importance (like core and border areas in scarred myocardium).
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Affiliation(s)
- Lasya Priya Kotu
- Department of Electrical Eng, and Computer Science, University of Stavanger, Stavanger 4036, Norway.
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Pennell DJ, Baksi AJ, Carpenter JP, Firmin DN, Kilner PJ, Mohiaddin RH, Prasad SK. Review of Journal of Cardiovascular Magnetic Resonance 2012. J Cardiovasc Magn Reson 2013; 15:76. [PMID: 24006874 PMCID: PMC3847143 DOI: 10.1186/1532-429x-15-76] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 08/22/2013] [Indexed: 02/07/2023] Open
Abstract
There were 90 articles published in the Journal of Cardiovascular Magnetic Resonance (JCMR) in 2012, which is an 8% increase in the number of articles since 2011. The quality of the submissions continues to increase. The editors are delighted to report that the 2011 JCMR Impact Factor (which is published in June 2012) has risen to 4.44, up from 3.72 for 2010 (as published in June 2011), a 20% increase. The 2011 impact factor means that the JCMR papers that were published in 2009 and 2010 were cited on average 4.44 times in 2011. The impact factor undergoes natural variation according to citation rates of papers in the 2 years following publication, and is significantly influenced by highly cited papers such as official reports. However, the progress of the journal's impact over the last 5 years has been impressive. Our acceptance rate is approximately 25%, and has been falling as the number of articles being submitted has been increasing. In accordance with Open-Access publishing, the JCMR articles go on-line as they are accepted with no collating of the articles into sections or special thematic issues. For this reason, the Editors have felt that it is useful once per calendar year to summarize the papers for the readership into broad areas of interest or theme, so that areas of interest can be reviewed in a single article in relation to each other and other recent JCMR articles. The papers are presented in broad themes and set in context with related literature and previously published JCMR papers to guide continuity of thought in the journal. We hope that you find the open-access system increases wider reading and citation of your papers, and that you will continue to send your quality manuscripts to JCMR for publication.
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Affiliation(s)
- Dudley J Pennell
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
- Imperial College, London, UK
| | - A John Baksi
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
- Imperial College, London, UK
| | - John Paul Carpenter
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
- Imperial College, London, UK
| | - David N Firmin
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
- Imperial College, London, UK
| | - Philip J Kilner
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
- Imperial College, London, UK
| | - Raad H Mohiaddin
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
- Imperial College, London, UK
| | - Sanjay K Prasad
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
- Imperial College, London, UK
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142
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Kydd AC, McCormick LM, Dutka DP. Optimizing benefit from CRT: role of speckle tracking echocardiography, the importance of LV lead position and scar. Expert Rev Med Devices 2013; 9:521-36. [PMID: 23116079 DOI: 10.1586/erd.12.39] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cardiac resynchronization therapy is demonstrated to be effective in patients with advanced heart failure. Correcting mechanical dyssynchrony is proposed as the predominant mechanism of response. Achieving optimum left ventricular lead position, at the site of maximal mechanical dyssynchrony but away from transmural scar, is identified as one of the main determinants of both symptomatic and prognostic benefit. Strategies employing multimodality cardiac imaging techniques have been used to identify this optimal pacing site, in addition to any potential anatomical limitations to successful implantation. Speckle tracking echocardiography offers prospective lead targeting, incorporating pathophysiological determinants of cardiac resynchronization therapy response. This review considers the key factors in defining optimum left ventricular lead location, emphasizing the role of myocardial scar. The use of speckle tracking echocardiography and the potential for this technique to be incorporated into routine practice to guide the implant strategy in an individual patient is discussed.
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Affiliation(s)
- Anna C Kydd
- Division of Cardiovascular Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, UK
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143
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The Role of Cardiovascular Magnetic Resonance (CMR) and Computed Tomography (CCT) in Facilitating Heart Failure Management. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2013; 15:373-86. [PMID: 23817725 DOI: 10.1007/s11936-013-0253-6] [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: 10/26/2022]
Abstract
OPINION STATEMENT Cardiovascular magnetic resonance (CMR) and cardiac computed tomography (CCT) offer advantages for detecting left or right ventricular dysfunction in patients with or suspected of heart failure. CMR does not expose patients to ionizing radiation, and thus is well-suited for functional assessments and serial studies. CCT provides high spatial resolution, making it useful for the identification of coronary arteriosclerosis associated with ischemic cardiomyopathy. In this review, the clinical applications of CMR and CCT are individually discussed, with comparisons made between them to examine the strengths of each modality. The major techniques for each modality are outlined, as well as their uses for the evaluation of cardiomyopathy in heart failure patients with reduced left ventricular ejection fraction, preserved left ventricular ejection fraction, and valvular heart disease. Finally, we review the utility of CMR and CCT in determining which patients will benefit from cardiac resynchronization therapy.
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144
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Carpenter JP, Patel AR, Fernandes JL. Highlights of the 16th annual scientific sessions of the Society for Cardiovascular Magnetic Resonance. J Cardiovasc Magn Reson 2013; 15:60. [PMID: 23870663 PMCID: PMC3726510 DOI: 10.1186/1532-429x-15-60] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Accepted: 06/13/2013] [Indexed: 12/25/2022] Open
Abstract
The 16th Annual Scientific Sessions of the Society for Cardiovascular Magnetic Resonance (SCMR) took place in San Francisco, USA at the end of January 2013. With a faculty of experts from across the world, this congress provided a wealth of insight into cutting-edge research and technological development. This review article intends to provide a highlight of what represented the most significant advances in the field of cardiovascular magnetic resonance (CMR) during this year's meeting.
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145
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An exploratory study on coronary sinus lead tip three-dimensional trajectory changes in cardiac resynchronization therapy. Heart Rhythm 2013; 10:1360-7. [PMID: 23851066 DOI: 10.1016/j.hrthm.2013.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Prediction of response to cardiac resynchronization therapy (CRT) is still an unsolved major issue. The interface between left ventricular mechanics, coronary sinus (CS) lead, and pacing delivery has been little investigated. OBJECTIVE To investigate CS lead tip movements at baseline and during biventricular pacing (BiV) in the hypothesis that they could provide some insights into left ventricular mechanical behavior in CRT. METHODS Three-dimensional reconstruction of CS lead tip trajectory throughout the cardiac cycle using a novel fluoroscopy-based method was performed in 22 patients with chronic heart failure (19 men; mean age 70 ± 10 years). Three trajectories were computed: before (T-1) and immediately after (T0) BiV start-up and after 6 months (T1). CRT response was the echocardiographic end-systolic volume reduction ≥15% at T1. Metrics describing trajectory at T0, T-1, and T1 were compared between 9 responders (R) and 13 nonresponders (NR). RESULTS At T-1 trajectories demonstrated heterogeneous shapes and metrics, but at T0 the variations in the ratio between the two main axes (S1/S2) and in the eccentricity were statistically different between R and NR, pointing out a trajectory's change toward a significantly more circular shape at BiV start-up in R. Remarkably, R and NR could be completely separated by means of the percent variation in S1/S2 from T-1 to T0 (R: 47.5% [31.5% to 54.1%] vs. NR: -25.6% [-67% to -6.5%]). This single marker computed at T0 would have predicted CRT response at T1. CONCLUSIONS Preliminary data showed that CS lead tip trajectory changes induced by BiV were related to mechanical resynchronization.
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146
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Mele D, Agricola E, Monte AD, Galderisi M, D'Andrea A, Rigo F, Citro R, Chiodi E, Marchese G, Valentina PD, Calabrese A, Ferrari R. Pacing transmural scar tissue reduces left ventricle reverse remodeling after cardiac resynchronization therapy. Int J Cardiol 2013; 167:94-101. [DOI: 10.1016/j.ijcard.2011.12.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 08/22/2011] [Accepted: 12/02/2011] [Indexed: 10/14/2022]
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147
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Abstract
In patients with advanced systolic heart failure and mechanical dyssynchrony, cardiac resynchronization therapy (CRT) is an effective means of improving symptoms and reducing mortality. There are now several recognized approaches to optimize CRT. Imaging modalities can assist with identifying the myocardium with the latest mechanical activation for targeted left ventricular lead implantation. Device programming can be tailored to maximize biventricular pacing, and thereby is its benefit. Cardiac imaging has shown that atrioventricular and interventricular intervals can be adjusted to further reduce dyssynchrony. We review these various approaches that maximize the benefit derived from CRT.
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148
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Wieslander B, Wu KC, Loring Z, Andersson LG, Frank TF, Gerstenblith G, Tomaselli GF, Weiss RG, Wagner GS, Ugander M, Strauss DG. Localization of myocardial scar in patients with cardiomyopathy and left bundle branch block using electrocardiographic Selvester QRS scoring. J Electrocardiol 2013; 46:249-55. [PMID: 23540937 DOI: 10.1016/j.jelectrocard.2013.02.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Outcome of cardiac resynchronization therapy is severely worsened by myocardial scar at the left ventricular (LV) pacing site. We aimed to describe the diagnostic performance of electrocardiographic (ECG) criteria based on the Selvester QRS scoring system, first in localizing myocardial scar and second in screening for any non-septal scar in patients with strictly defined LBBB. METHODS AND RESULTS In 39 cardiomyopathy patients with LBBB, 17 with scar, 22 without scar, late gadolinium-enhancement cardiac magnetic resonance images (CMR-LGE) and 12-lead ECGs were analyzed for scar presence in 5 LV wall segments. The ECG criteria with the best diagnostic performance in detecting scar in each segment and in the four non-septal segments together were identified. Criteria for detecting non-septal scar had 75% (95% CI: 51%-90%) sensitivity, 95% (78%-99%) specificity, 92% (67%-99%) positive predictive value and 84% (65%-94%) negative predictive value. For each individual wall segment, 40%-60% sensitivities and 77%-100% specificities were found. CONCLUSIONS The 12-lead ECG can convey information about scar presence and location in this population of cardiomyopathy patients with LBBB. ECG screening criteria for scar in potential CRT LV pacing sites were identified. Further exploration is required to determine the clinical utility of the 12-lead ECG in combination with other imaging modalities to screen for scar in potential LV pacing sites in CRT candidates.
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Affiliation(s)
- Björn Wieslander
- Cardiac MR Group, Department of Clinical Physiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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Paterson I, Mielniczuk LM, O'Meara E, So A, White JA. Imaging Heart Failure: Current and Future Applications. Can J Cardiol 2013; 29:317-28. [DOI: 10.1016/j.cjca.2013.01.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 01/16/2013] [Accepted: 01/16/2013] [Indexed: 01/11/2023] Open
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Daubert JC, Saxon L, Adamson PB, Auricchio A, Berger RD, Beshai JF, Breithard O, Brignole M, Cleland J, DeLurgio DB, Dickstein K, Exner DV, Gold M, Grimm RA, Hayes DL, Israel C, Leclercq C, Linde C, Lindenfeld J, Merkely B, Mont L, Murgatroyd F, Prinzen F, Saba SF, Shinbane JS, Singh J, Tang AS, Vardas PE, Wilkoff BL, Zamorano JL, Anand I, Blomström-Lundqvist C, Boehmer JP, Calkins H, Cazeau S, Delgado V, Estes NAM, Haines D, Kusumoto F, Leyva P, Ruschitzka F, Stevenson LW, Torp-Pedersen CT. 2012 EHRA/HRS expert consensus statement on cardiac resynchronization therapy in heart failure: implant and follow-up recommendations and management. Europace 2013; 14:1236-86. [PMID: 22930717 DOI: 10.1093/europace/eus222] [Citation(s) in RCA: 201] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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