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Mohammed IOH, Swed S, Ezzdean W, Almoshantaf MB, Shebli B, Sawaf B, Hamoda AMA. Sympathetic crashing acute pulmonary edema following pacemaker insertion. Clin Case Rep 2023; 11:e7518. [PMID: 37305863 PMCID: PMC10256871 DOI: 10.1002/ccr3.7518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 03/20/2023] [Accepted: 05/28/2023] [Indexed: 06/13/2023] Open
Abstract
Key Clinical Message Sympathetic crashing acute pulmonary edema (SCAPE) complicating pacemaker implantation is a very uncommon and dangerous occurrence. Following pacemaker implantation, patients need stringent monitoring, and compelling evidence about SCAPE treatment is required. Abstract Sympathetic crashing acute pulmonary edema complicating a pacemaker insertion as the case in our patient is extremely rare. We report a case of 75-year-old man with a complete AV block, which requires urgent pacemaker implantation. Half an hour following the insertion of the pacemaker, an abrupt SCAPE emerged and the patient was incubated immediately.
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Affiliation(s)
| | - Sarya Swed
- Faculty of MedicineAleppo UniversityAleppoSyria
| | - Weaam Ezzdean
- Department of UrologyIbn Al‐Nafees HospitalDamascusSyria
| | | | - Baraa Shebli
- Cardiology Resident, Department of CardiologyAleppo University Hospital, University of AleppoAleppoSyria
| | - Bisher Sawaf
- Department of Internal MedicineHamad Medical CorporationDohaQatar
| | - Abutalib Mohamed Ahmed Hamoda
- Internal Medicine and Interventional Cardiologist and Fellowship ElectrophysiologyUniversity of Alemam AlmahadiKostiSudan
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2
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Sabouri M, Hajianfar G, Hosseini Z, Amini M, Mohebi M, Ghaedian T, Madadi S, Rastgou F, Oveisi M, Bitarafan Rajabi A, Shiri I, Zaidi H. Myocardial Perfusion SPECT Imaging Radiomic Features and Machine Learning Algorithms for Cardiac Contractile Pattern Recognition. J Digit Imaging 2023; 36:497-509. [PMID: 36376780 PMCID: PMC10039187 DOI: 10.1007/s10278-022-00705-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/31/2022] [Accepted: 09/15/2022] [Indexed: 11/16/2022] Open
Abstract
A U-shaped contraction pattern was shown to be associated with a better Cardiac resynchronization therapy (CRT) response. The main goal of this study is to automatically recognize left ventricular contractile patterns using machine learning algorithms trained on conventional quantitative features (ConQuaFea) and radiomic features extracted from Gated single-photon emission computed tomography myocardial perfusion imaging (GSPECT MPI). Among 98 patients with standard resting GSPECT MPI included in this study, 29 received CRT therapy and 69 did not (also had CRT inclusion criteria but did not receive treatment yet at the time of data collection, or refused treatment). A total of 69 non-CRT patients were employed for training, and the 29 were employed for testing. The models were built utilizing features from three distinct feature sets (ConQuaFea, radiomics, and ConQuaFea + radiomics (combined)), which were chosen using Recursive feature elimination (RFE) feature selection (FS), and then trained using seven different machine learning (ML) classifiers. In addition, CRT outcome prediction was assessed by different treatment inclusion criteria as the study's final phase. The MLP classifier had the highest performance among ConQuaFea models (AUC, SEN, SPE = 0.80, 0.85, 0.76). RF achieved the best performance in terms of AUC, SEN, and SPE with values of 0.65, 0.62, and 0.68, respectively, among radiomic models. GB and RF approaches achieved the best AUC, SEN, and SPE values of 0.78, 0.92, and 0.63 and 0.74, 0.93, and 0.56, respectively, among the combined models. A promising outcome was obtained when using radiomic and ConQuaFea from GSPECT MPI to detect left ventricular contractile patterns by machine learning.
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Affiliation(s)
- Maziar Sabouri
- Department of Medical Physics, School of Medicine, Iran University of Medical Science, Tehran, Iran
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Science, Tehran, Iran
| | - Ghasem Hajianfar
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Science, Tehran, Iran
| | - Zahra Hosseini
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Science, Tehran, Iran
| | - Mehdi Amini
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, CH-1211, Geneva 4, Switzerland
| | - Mobin Mohebi
- Department of Biomedical Engineering, Tarbiat Modares University, Tehran, Iran
| | - Tahereh Ghaedian
- Nuclear Medicine and Molecular Imaging Research Center, School of Medicine, Namazi Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shabnam Madadi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Science, Tehran, Iran
| | - Fereydoon Rastgou
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Science, Tehran, Iran
| | - Mehrdad Oveisi
- Comprehensive Cancer Centre, School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
- Department of Computer Science, University of British Columbia, Vancouver BC, Canada
| | - Ahmad Bitarafan Rajabi
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
- Cardiovascular Interventional Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Isaac Shiri
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, CH-1211, Geneva 4, Switzerland.
| | - Habib Zaidi
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, CH-1211, Geneva 4, Switzerland.
- Geneva University Neurocenter, Geneva University, Geneva, Switzerland.
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
- Department of Nuclear Medicine, University of Southern Denmark, Odense, Denmark.
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Jones KA, Paterson CA, Ray S, Motherwell DW, Hamilton DJ, Small AD, Martin W, Goodfield NER. Beta-blockers and mechanical dyssynchrony in heart failure assessed by radionuclide ventriculography. J Nucl Cardiol 2023; 30:193-200. [PMID: 36417121 PMCID: PMC9984517 DOI: 10.1007/s12350-022-03142-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/08/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Radionuclide ventriculography (RNVG) can be used to quantify mechanical dyssynchrony and may be a valuable adjunct in the assessment of heart failure with reduced ejection fraction (HFrEF). The study aims to investigate the effect of beta-blockers on mechanical dyssynchrony using novel RNVG phase parameters. METHODS A retrospective study was carried out in a group of 98 patients with HFrEF. LVEF and dyssynchrony were assessed pre and post beta-blockade. Dyssynchrony was assessed using synchrony, entropy, phase standard deviation, approximate entropy, and sample entropy from planar RNVG phase images. Subgroups split by ischemic etiology were also investigated. RESULTS An improvement in dyssynchrony and LVEF was measured six months post beta-blockade for both ischemic and non-ischemic groups. CONCLUSIONS A significant improvement in dyssynchrony and LVEF was measured post beta-blockade using novel measures of dyssynchrony.
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Affiliation(s)
- K A Jones
- Department of Nuclear Cardiology, Glasgow Royal Infirmary, Glasgow, UK.
- School of Physics and Astronomy, University of Glasgow, Glasgow, UK.
| | - C A Paterson
- Department of Nuclear Cardiology, Glasgow Royal Infirmary, Glasgow, UK
- School of Physics and Astronomy, University of Glasgow, Glasgow, UK
| | - S Ray
- School of Mathematics and Statistics, University of Glasgow, Glasgow , UK
| | - D W Motherwell
- Department of Nuclear Cardiology, Glasgow Royal Infirmary, Glasgow, UK
| | - D J Hamilton
- School of Physics and Astronomy, University of Glasgow, Glasgow, UK
| | - A D Small
- Department of Nuclear Cardiology, Glasgow Royal Infirmary, Glasgow, UK
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - W Martin
- Department of Nuclear Cardiology, Glasgow Royal Infirmary, Glasgow, UK
- School of Physics and Astronomy, University of Glasgow, Glasgow, UK
| | - N E R Goodfield
- Department of Nuclear Cardiology, Glasgow Royal Infirmary, Glasgow, UK
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He Z, Zhang X, Zhao C, Ling X, Malhotra S, Qian Z, Wang Y, Hou X, Zou J, Zhou W. A method using deep learning to discover new predictors from left-ventricular mechanical dyssynchrony for CRT response. J Nucl Cardiol 2023; 30:201-213. [PMID: 35915327 PMCID: PMC10961110 DOI: 10.1007/s12350-022-03067-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 06/22/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Studies have shown that the conventional parameters characterizing left ventricular mechanical dyssynchrony (LVMD) measured on gated SPECT myocardial perfusion imaging (MPI) have their own statistical limitations in predicting cardiac resynchronization therapy (CRT) response. The purpose of this study is to discover new predictors from the polarmaps of LVMD by deep learning to help select heart failure patients with a high likelihood of response to CRT. METHODS One hundred and fifty-seven patients who underwent rest gated SPECT MPI were enrolled in this study. CRT response was defined as an increase in left ventricular ejection fraction (LVEF) > 5% at 6 [Formula: see text] 1 month follow up. The autoencoder (AE) technique, an unsupervised deep learning method, was applied to the polarmaps of LVMD to extract new predictors characterizing LVMD. Pearson correlation analysis was used to explain the relationships between new predictors and existing clinical parameters. Patients from the IAEA VISION-CRT trial were used for an external validation. Heatmaps were used to interpret the AE-extracted feature. RESULTS Complete data were obtained in 130 patients, and 68.5% of them were classified as CRT responders. After variable selection by feature importance ranking and correlation analysis, one AE-extracted LVMD predictor was included in the statistical analysis. This new AE-extracted LVMD predictor showed statistical significance in the univariate (OR 2.00, P = .026) and multivariate (OR 1.11, P = .021) analyses, respectively. Moreover, the new AE-extracted LVMD predictor not only had incremental value over PBW and significant clinical variables, including QRS duration and left ventricular end-systolic volume (AUC 0.74 vs 0.72, LH 7.33, P = .007), but also showed encouraging predictive value in the 165 patients from the IAEA VISION-CRT trial (P < .1). The heatmaps for calculation of the AE-extracted predictor showed higher weights on the anterior, lateral, and inferior myocardial walls, which are recommended as LV pacing sites in clinical practice. CONCLUSIONS AE techniques have significant value in the discovery of new clinical predictors. The new AE-extracted LVMD predictor extracted from the baseline gated SPECT MPI has the potential to improve the prediction of CRT response.
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Affiliation(s)
- Zhuo He
- College of Computing, Michigan Technological University, 1400 Townsend Drive, Houghton, MI, USA
| | - Xinwei Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, Jiangsu, China
| | - Chen Zhao
- College of Computing, Michigan Technological University, 1400 Townsend Drive, Houghton, MI, USA
| | - Xing Ling
- Department of Mathematical Sciences, Michigan Technological University, Houghton, MI, USA
| | - Saurabh Malhotra
- Division of Cardiology, Cook County Health and Hospitals System, Chicago, IL, USA
- Division of Cardiology, Rush Medical College, Chicago, IL, USA
| | - Zhiyong Qian
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, Jiangsu, China
| | - Yao Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, Jiangsu, China
| | - Xiaofeng Hou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, Jiangsu, China
| | - Jiangang Zou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, Jiangsu, China.
| | - Weihua Zhou
- College of Computing, Michigan Technological University, 1400 Townsend Drive, Houghton, MI, USA.
- Center for Biocomputing and Digital Health, Institute of Computing and Cybersystems, Health Research Institute, Michigan Technological University, Houghton, MI, 49931, USA.
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Loring Z, Holmqvist F, Sze E, Alenezi F, Campbell K, Koontz JI, Velazquez EJ, Atwater BD, Bahnson TD, Daubert JP. Acute echocardiographic and hemodynamic response to his-bundle pacing in patients with first-degree atrioventricular block. Ann Noninvasive Electrocardiol 2022; 27:e12954. [PMID: 35445488 PMCID: PMC9296787 DOI: 10.1111/anec.12954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/02/2022] [Accepted: 03/14/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Atrial pacing and right ventricular (RV) pacing are both associated with adverse outcomes among patients with first-degree atrioventricular block (1°AVB). His-bundle pacing (HBP) provides physiological activation of the ventricle and may be able to improve both atrioventricular (AV) and inter-ventricular synchrony in 1°AVB patients. This study evaluates the acute echocardiographic and hemodynamic effects of atrial, atrial-His-bundle sequential (AH), and atrial-ventricular (AV) sequential pacing in 1°AVB patients. METHODS Patients with 1°AVB undergoing atrial fibrillation ablation were included. Following left atrial (LA) catheterization, patients underwent atrial, AH- and AV-sequential pacing. LA/left ventricular (LV) pressure and echocardiographic measurements during the pacing protocols were compared. RESULTS Thirteen patients with 1°AVB (mean PR 221 ± 26 ms) were included. The PR interval was prolonged with atrial pacing compared to baseline (275 ± 73 ms, p = .005). LV ejection fraction (LVEF) was highest during atrial pacing (62 ± 11%), intermediate with AH-sequential pacing (59 ± 7%), and lowest with AV-sequential pacing (57 ± 12%) though these differences were not statistically significant. No significant differences were found in LA or LV mean pressures or LV dP/dT. LA and LV volumes, isovolumetric times, electromechanical delays, and global longitudinal strains were similar across pacing protocols. CONCLUSION Despite pronounced PR prolongation, the acute effects of atrial pacing were not significantly different than AH- or AV-sequential pacing. Normalizing atrioventricular and/or inter-ventricular dyssynchrony did not result in acute improvements in cardiac output or loading conditions.
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Affiliation(s)
- Zak Loring
- Division of CardiologyDepartment of MedicineDuke UniversityDurhamNorth CarolinaUSA
- Duke Clinical Research InstituteDurhamNorth CarolinaUSA
| | - Fredrik Holmqvist
- Division of CardiologyDepartment of MedicineDuke UniversityDurhamNorth CarolinaUSA
- Department of CardiologyLund UniversityLundSweden
| | - Edward Sze
- Division of CardiologyDepartment of MedicineDuke UniversityDurhamNorth CarolinaUSA
- Maine Medical CenterPortlandMaineUSA
| | - Fawaz Alenezi
- Division of CardiologyDepartment of MedicineDuke UniversityDurhamNorth CarolinaUSA
| | - Kristen Campbell
- Maine Medical CenterPortlandMaineUSA
- Department of PharmacyDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Jason I. Koontz
- Division of CardiologyDepartment of MedicineDuke UniversityDurhamNorth CarolinaUSA
| | - Eric J. Velazquez
- Division of CardiologyDepartment of MedicineDuke UniversityDurhamNorth CarolinaUSA
- Section of Cardiovascular MedicineDepartment of Internal MedicineYale UniversityNew HavenConnecticutUSA
| | - Brett D. Atwater
- Division of CardiologyDepartment of MedicineDuke UniversityDurhamNorth CarolinaUSA
- Section of Cardiac ElectrophysiologyInova Heart and Vascular InstituteFairfaxVirginiaUSA
| | - Tristram D. Bahnson
- Division of CardiologyDepartment of MedicineDuke UniversityDurhamNorth CarolinaUSA
| | - James P. Daubert
- Division of CardiologyDepartment of MedicineDuke UniversityDurhamNorth CarolinaUSA
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Shaik SA, Oruganti SS. Relationship of echocardiographic left ventricular dyssynchrony with QRS width on surface electrocardiogram in patients with systolic heart failure: An observational study. Indian Heart J 2021; 73:664-666. [PMID: 34627591 PMCID: PMC8551543 DOI: 10.1016/j.ihj.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 07/22/2021] [Accepted: 08/04/2021] [Indexed: 11/30/2022] Open
Abstract
This study aimed to evaluate left ventricular dyssynchrony with QRS width on ECG in patients with systolic heart failure. 100 study patients were classified into two groups. Narrow QRS group-N- QRS (80-119 msec) and Wide QRS group-W- QRS (120-160 msec). Out of each 50 patients in W- QRS group, 38(76%) had LV dyssynchrony and 18 (36%) in N- QRS group had ventricular dyssynchrony. Dyssynchrony in narrow QRS patients with heart failure also needs attention as a therapeutic target in future studies.
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Affiliation(s)
- Shabbir Ali Shaik
- Department of Cardiology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, 500082, Telangana, India
| | - Sai Satish Oruganti
- Department of Cardiology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, 500082, Telangana, India.
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Bazzy J, Gadiyaram V, Nguyen BJ, Birgersdotter-Green U, Hoh CK, Obrzut S. Gated single-photon emission computed tomography myocardial perfusion imaging phase analysis as an imaging biomarker for mortality prediction in heart failure patients undergoing cardiac resynchronization therapy. Nucl Med Commun 2021; 42:990-997. [PMID: 34001831 DOI: 10.1097/mnm.0000000000001426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in heart failure patients. The purpose of this study was to assess the value of gated myocardial perfusion single-photon emission computed tomography (GMPS) phase analysis for predicting survival in heart failure patients undergoing CRT. METHODS This retrospective cohort study evaluated heart failure patients who underwent GMPS prior to CRT. Phase histogram bandwidth (PHB) and phase SD (PSD) were calculated using GMPS data. Cox proportional hazards model was used to identify independent predictors of overall survival (OS). RESULTS A total of 35 patients (age 65.1 ± 13.3, 27 men and 8 women), who were followed for mean of 4.1 ± 2.9 years, were enrolled in the study. PSD of greater than 45° was found to be an independent predictor of poor OS (hazard ratio = 12.63, P = 0.011) when compared with age (hazard ratio = 1.00, P = 0.922), gender (hazard ratio = 0.31, P = 0.155), NYHA class (hazard ratio = 0.45, P = 0.087), QRS duration greater than 150 ms (hazard ratio = 2.38, P = 0.401), pre-CRT left ventricular ejection fraction (LVEF) (hazard ratio = 0.95, P = 0.175) and etiology of heart failure (hazard ratio = 1.42, P = 0.641). Furthermore, PHB greater than 140° was also found to be an independent predictor of poor OS (hazard ratio = 5.63, P = 0.040) when compared with age, gender, NYHA class, QRS duration greater than 150 ms, pre-CRT LVEF and etiology of heart failure. CONCLUSIONS PSD and PHB, measured by GMPS, may serve as biomarkers for the prediction of survival in patients undergoing CRT.
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Affiliation(s)
| | | | | | | | - Carl K Hoh
- Division of Nuclear Medicine, University of California San Diego, San Diego, California, USA
| | - Sebastian Obrzut
- Division of Nuclear Medicine, University of California San Diego, San Diego, California, USA
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Mullens W, Auricchio A, Martens P, Witte K, Cowie MR, Delgado V, Dickstein K, Linde C, Vernooy K, Leyva F, Bauersachs J, Israel CW, Lund LH, Donal E, Boriani G, Jaarsma T, Berruezo A, Traykov V, Yousef Z, Kalarus Z, Nielsen JC, Steffel J, Vardas P, Coats A, Seferovic P, Edvardsen T, Heidbuchel H, Ruschitzka F, Leclercq C. Optimized implementation of cardiac resynchronization therapy: a call for action for referral and optimization of care. Europace 2021; 23:1324-1342. [PMID: 34037728 DOI: 10.1093/europace/euaa411] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 12/28/2022] Open
Abstract
Cardiac resynchronization therapy (CRT) is one of the most effective therapies for heart failure with reduced ejection fraction and leads to improved quality of life, reductions in heart failure hospitalization rates and all-cause mortality. Nevertheless, up to two-thirds of eligible patients are not referred for CRT. Furthermore, post-implantation follow-up is often fragmented and suboptimal, hampering the potential maximal treatment effect. This joint position statement from three European Society of Cardiology Associations, Heart Failure Association (HFA), European Heart Rhythm Association (EHRA) and European Association of Cardiovascular Imaging (EACVI), focuses on optimized implementation of CRT. We offer theoretical and practical strategies to achieve more comprehensive CRT referral and post-procedural care by focusing on four actionable domains: (i) overcoming CRT under-utilization, (ii) better understanding of pre-implant characteristics, (iii) abandoning the term 'non-response' and replacing this by the concept of disease modification, and (iv) implementing a dedicated post-implant CRT care pathway.
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Affiliation(s)
- Wilfried Mullens
- Ziekenhuis Oost Limburg, Genk, Belgium
- University Hasselt, Hasselt, Belgium
| | - Angelo Auricchio
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Pieter Martens
- Ziekenhuis Oost Limburg, Genk, Belgium
- University Hasselt, Hasselt, Belgium
| | - Klaus Witte
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Martin R Cowie
- Imperial College London (Royal Brompton Hospital), London, UK
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Cecilia Linde
- Heart and Vascular Theme, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Cardiology, Radboud University Medical Center (Radboudumc), Nijmegen, The Netherlands
| | | | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Carsten W Israel
- Department of Medicine - Cardiology, Diabetology and Nephrology, Bethel-Clinic, Bielefeld, Germany
| | - Lars H Lund
- Department of Medicine Karolinska Institutet, and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Erwan Donal
- Cardiologie, CHU Rennes - LTSI Inserm UMR 1099, Université Rennes-1, Rennes, France
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Tiny Jaarsma
- Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Health, Medicine and Caring Science, Linköping University, Linköping, Sweden
| | | | - Vassil Traykov
- Department of Cardiology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Zaheer Yousef
- Department of Cardiology, University Hospital of Wales & Cardiff University, Cardiff, UK
| | - Zbigniew Kalarus
- Department of Cardiology, Medical University of Silesia, Katowice, Poland
| | | | - Jan Steffel
- UniversitätsSpital Zürich, Zürich, Switzerland
| | - Panos Vardas
- Heart Sector, Hygeia Hospitals Group, Athens, Greece
| | | | - Petar Seferovic
- Faculty of Medicine, Serbian Academy of Science and Arts, Belgrade University, Belgrade, Serbia
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, and University of Oslo, Oslo, Norway
| | - Hein Heidbuchel
- Antwerp University and Antwerp University Hospital, Antwerp, Belgium
| | - Frank Ruschitzka
- Department of Cardiology, University Hospital, University Heart Center, Zurich, Switzerland
| | - Christophe Leclercq
- Cardiologie, CHU Rennes - LTSI Inserm UMR 1099, Université Rennes-1, Rennes, France
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Zavadovskij KV, Saushkin VV, Varlamova YV, Mishkina AI, Shipulin VV, Lebedev DI, Popov SV. Mechanical Dyssynchrony for Prediction of the Cardiac Resynchronization Therapy Response in Patients with Dilated Cardiomyopathy. ACTA ACUST UNITED AC 2021; 61:14-21. [PMID: 34397337 DOI: 10.18087/cardio.2021.7.n1420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 03/12/2021] [Accepted: 04/15/2021] [Indexed: 11/18/2022]
Abstract
Aim To evaluate the predictive value of indexes of left ventricular mechanical dyssynchrony (MD) as determined by data of electrocardiogram (ECG)-gated myocardial perfusion scintigraphy (ECG-MPS) for prediction of the efficacy of resynchronization therapy (RT) in patients with chronic heart failure (CHF).Material and methods This prospective study included 32 patients with nonischemic CHF and standard indications for RT. All patients underwent complete clinical an instrumental examination, including 24-h ECG monitoring and echocardiography (EchoCG). In order to evaluate the left ventricular (LV) myocardial perfusion, contractile function, and MD, myocardial perfusion scintigraphy was performed for all patients at rest prior to RT. In addition to the perfusion defect size at rest and hemodynamic parameters, LV MD was determined. The following indexes were used for analysis of dyssynchronization: phase standard deviation (PSD), phase histogram bandwidth (HBW), and phase histogram asymmetry and steepness. The treatment efficacy was evaluated by the clinical status of patients (clinical condition evaluation scale for CHF patient) and EchoCG at 6 months following RT. The criteria for a positive response to RT were an increase in LV ejection fraction (EF) by 5% and/or a decrease in the LV end-diastolic volume by 15% compared to preoperative values.Results According to ECG-MPS findings, all patients had scintigraphic signs of severe CHF with dilated LV cavity (end-diastolic volume, EDV 246 [217; 269] ml) and also of pronounced mechanical and electrical dyssynchrony. The values of mechanical dyssynchrony were PSD 53 [41; 61], HBW 176 [136; 202], asymmetry 1.62 [1.21; 1.89], and steepness 2.81 [1.21; 3.49]. The QRS duration was 165 [155; 175] msec. Furthermore, the LV perfusion was moderately impaired (perfusion defect size 4 [3; 10] %). Mean follow-up duration after implantation of the resynchronizing device was 6±1.7 mos. According to the selected criteria, 20 (63 %) patients were considered as responders and 12 (37 %) patients as non-responders. Before implantation of the cardiac synchronizing device, responders and non-responders differed only in LV MD (PSD 44 [35; 54] vs. 63 [58; 72]; p=0.0001); HBW 158 [118; 179] vs. 205 [199; 249]; p=0.0001; asymmetry 1.77 [1.62; 2.02] vs. 1.21 [0.93; 1.31]; p=0.0001; steepness 3.03 [2.60; 3.58] vs. 1.21 [0.19; 1.46]; p=0.0001), respectively. A one-factor logistic regression analysis showed that MD values were statistically significant predictors of a positive response to RT. A multi-factor logistic analysis of phase histogram steepness (odds ratio, OR 1.196; 95 % confidence interval, CI 1.04-1.37) and PSD (OR 0.67; 95 % CI 0.47-0.97) were identified as independent predictors for the response to RT. According to results of the ROC analysis, a PSD <55 and a phase histogram steepness >1.54 may predict the effectiveness of RT (AUC= 0.92; р=0.0001).Conclusion LV MD parameters determined with ECG-MPS allow predicting the effectiveness of RT in patients with nonischemic CHF. In this patient group, high values of standard deviation and low values of phase histogram steepness were independent predictors for the absence of response to RT after 6 mos. of follow-up.
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Affiliation(s)
- K V Zavadovskij
- Cardiology Research Institute, Tomsk National Research Medical Center, Tomsk
| | - V V Saushkin
- Cardiology Research Institute, Tomsk National Research Medical Center, Tomsk
| | - Yu V Varlamova
- Cardiology Research Institute, Tomsk National Research Medical Center, Tomsk
| | - A I Mishkina
- Cardiology Research Institute, Tomsk National Research Medical Center, Tomsk
| | - V V Shipulin
- Cardiology Research Institute, Tomsk National Research Medical Center, Tomsk
| | - D I Lebedev
- Cardiology Research Institute, Tomsk National Research Medical Center, Tomsk
| | - S V Popov
- Cardiology Research Institute, Tomsk National Research Medical Center, Tomsk
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10
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Kan K, Phillips LM. Predicting left ventricular dyssynchrony: Can nuclear cardiology bring us closer "In Sync"? J Nucl Cardiol 2021; 28:1151-1152. [PMID: 32548714 DOI: 10.1007/s12350-020-02226-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/02/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Karen Kan
- The Leon H. Charney Division of Cardiology, NYU Langone Health, New York, USA
| | - Lawrence M Phillips
- The Leon H. Charney Division of Cardiology, NYU Langone Health, New York, USA.
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11
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Mullens W, Auricchio A, Martens P, Witte K, Cowie MR, Delgado V, Dickstein K, Linde C, Vernooy K, Leyva F, Bauersachs J, Israel CW, Lund LH, Donal E, Boriani G, Jaarsma T, Berruezo A, Traykov V, Yousef Z, Kalarus Z, Cosedis Nielsen J, Steffel J, Vardas P, Coats A, Seferovic P, Edvardsen T, Heidbuchel H, Ruschitzka F, Leclercq C. Optimized implementation of cardiac resynchronization therapy: a call for action for referral and optimization of care: A joint position statement from the Heart Failure Association (HFA), European Heart Rhythm Association (EHRA), and European Association of Cardiovascular Imaging (EACVI) of the European Society of Cardiology. Eur J Heart Fail 2021; 22:2349-2369. [PMID: 33136300 DOI: 10.1002/ejhf.2046] [Citation(s) in RCA: 100] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 12/28/2022] Open
Abstract
Cardiac resynchronization therapy (CRT) is one of the most effective therapies for heart failure with reduced ejection fraction and leads to improved quality of life, reductions in heart failure hospitalization rates and all-cause mortality. Nevertheless, up to two-thirds of eligible patients are not referred for CRT. Furthermore, post-implantation follow-up is often fragmented and suboptimal, hampering the potential maximal treatment effect. This joint position statement from three European Society of Cardiology Associations, Heart Failure Association (HFA), European Heart Rhythm Association (EHRA) and European Association of Cardiovascular Imaging (EACVI), focuses on optimized implementation of CRT. We offer theoretical and practical strategies to achieve more comprehensive CRT referral and post-procedural care by focusing on four actionable domains: (i) overcoming CRT under-utilization, (ii) better understanding of pre-implant characteristics, (iii) abandoning the term 'non-response' and replacing this by the concept of disease modification, and (iv) implementing a dedicated post-implant CRT care pathway.
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Affiliation(s)
- Wilfried Mullens
- Ziekenhuis Oost Limburg, Genk, Belgium.,University Hasselt, Hasselt, Belgium
| | - Angelo Auricchio
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Pieter Martens
- Ziekenhuis Oost Limburg, Genk, Belgium.,University Hasselt, Hasselt, Belgium
| | - Klaus Witte
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Martin R Cowie
- Imperial College London (Royal Brompton Hospital), London, UK
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Cecilia Linde
- Heart and Vascular Theme, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Cardiology, Radboud University Medical Center (Radboudumc), Nijmegen, The Netherlands
| | | | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Carsten W Israel
- Department of Medicine - Cardiology, Diabetology and Nephrology, Bethel-Clinic, Bielefeld, Germany
| | - Lars H Lund
- Department of Medicine Karolinska Institutet, and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Erwan Donal
- Cardiologie, CHU Rennes - LTSI Inserm UMR 1099, Université Rennes-1, Rennes, France
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Tiny Jaarsma
- Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Health, Medicine and Caring Science, Linköping University, Linköping, Sweden
| | | | - Vassil Traykov
- Department of Cardiology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Zaheer Yousef
- Department of Cardiology, University Hospital of Wales & Cardiff University, Cardiff, UK
| | - Zbigniew Kalarus
- Department of Cardiology, Medical University of Silesia, Katowice, Poland
| | | | - Jan Steffel
- UniversitätsSpital Zürich, Zürich, Switzerland
| | - Panos Vardas
- Heart Sector, Hygeia Hospitals Group, Athens, Greece
| | | | - Petar Seferovic
- Faculty of Medicine, Serbian Academy of Science and Arts, Belgrade University, Belgrade, Serbia
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, and University of Oslo, Oslo, Norway
| | - Hein Heidbuchel
- Antwerp University and Antwerp University Hospital, Antwerp, Belgium
| | - Frank Ruschitzka
- Department of Cardiology, University Hospital, University Heart Center, Zurich, Switzerland
| | - Christophe Leclercq
- Cardiologie, CHU Rennes - LTSI Inserm UMR 1099, Université Rennes-1, Rennes, France
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12
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Yang S, Hu Y, Zhao J, Jing R, Wang J, Gu M, Niu H, Chen L, Hua W. Comprehensive plasma metabolites profiling reveals phosphatidylcholine species as potential predictors for cardiac resynchronization therapy response. ESC Heart Fail 2020; 8:280-290. [PMID: 33211407 PMCID: PMC7835628 DOI: 10.1002/ehf2.13037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/06/2020] [Accepted: 09/15/2020] [Indexed: 11/22/2022] Open
Abstract
Aims This study aimed to identify the plasma metabolite fingerprint in patients with heart failure and to develop a prediction tool based on differential metabolites for predicting the response to cardiac resynchronization therapy (CRT). Methods and results We prospectively recruited 32 healthy individuals and 42 consecutive patients with HF who underwent CRT between January 2018 and January 2019. Peripheral venous blood samples, clinical data, and echocardiographic signatures were collected before CRT implantation. Liquid chromatography‐mass spectrometry was used to perform untargeted metabolites profiling for peripheral plasma under ESI+ and ESI− modes. After 6 month follow‐up, patients were categorized as CRT responders or non‐responders based on the alterations of echocardiographic characteristics. Compared with healthy individuals, patients with HF had distinct metabolomic profiles under both ESI+ and ESI− modes, featuring increased free fatty acids, carnitine, β‐hydroxybutyrate, and dysregulated lipids with heterogeneous alterations such as phosphatidylcholines (PCs) and sphingomyelins. Disparities of baseline metabolomics profile were observed between CRT responders and non‐responders under ESI+ mode but not under ESI− mode. Further metabolites analysis revealed that a group of 20 PCs metabolites under ESI+ mode were major contributors to the distinct profiles between the two groups. We utilized LASSO regression model and identified a panel of four PCs metabolites [including PC (20:0/18:4), PC (20:4/20:0), PC 40:4, and PC (20:4/18:0)] as major predictors for CRT response prediction. Among our whole population (n = 42), receive operating characteristics analysis revealed that the four PCs‐based model could nicely discriminate the CRT responders from non‐responders (area under the curve = 0.906) with a sensitivity of 83.3% and a specificity of 90.0%. Cross‐validation analysis also showed a satisfactory and robust performance of the model with the area under the curve of 0.910 in the training dataset and 0.880 in the testing dataset. Conclusions Patients with HF held significantly altered plasma metabolomics profile compared with the healthy individuals. Within the HF group, the non‐responders had a distinct plasma metabolomics profile in contrast to the responders to CRT, which was characterized by increased PCs species. A novel predictive model incorporating four PCs metabolites performed well in identifying CRT non‐responders. These four PCs might severe as potential biomarkers for predicting CRT response. Further validations are needed in multi‐centre studies with larger external cohorts.
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Affiliation(s)
- Shengwen Yang
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, 100037, China.,Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Yiran Hu
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Junhan Zhao
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Ran Jing
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Jing Wang
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Min Gu
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Hongxia Niu
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Liang Chen
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, 100037, China.,Department of cardiac surgery,State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Wei Hua
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, 100037, China
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13
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Mitropoulou P, Georgiopoulos G, Figliozzi S, Klettas D, Nicoli F, Masci PG. Multi-Modality Imaging in Dilated Cardiomyopathy: With a Focus on the Role of Cardiac Magnetic Resonance. Front Cardiovasc Med 2020; 7:97. [PMID: 32714942 PMCID: PMC7343712 DOI: 10.3389/fcvm.2020.00097] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 05/07/2020] [Indexed: 12/20/2022] Open
Abstract
Heart failure (HF) is recognized as a leading cause of morbidity and mortality worldwide. Dilated cardiomyopathy (DCM) is a common phenotype in patients presenting with HF. Timely diagnosis, appropriate identification of the underlying cause, individualized risk stratification, and prediction of clinical response to treatment have improved the prognosis of DCM over the last few decades. In this article, we reviewed the current evidence on available imaging techniques used for DCM patients. In this direction, we evaluated appropriate scenarios for the implementation of echocardiography, nuclear imaging, and cardiac computed tomography, and we focused on the primordial role that cardiac magnetic resonance (CMR) holds in the diagnosis, prognosis, and tailoring of therapeutic options in this population of special clinical interest. We explored the predictive value of CMR toward left ventricular reverse remodeling and prediction of sudden cardiac death, thus guiding the decisions for device therapy. Principles underpinning the use of state-of-the-art CMR techniques such as parametric mapping and feature-tracking strain analysis are also provided, along with expectations for the anticipated future advances in this field. We also attempted to correlate the evidence with clinical practice, with the intent to address questions on selecting the optimal imaging method for different indications and clinical needs. Overall, we recommend a comprehensive assessment of DCM patients at baseline and at follow-up intervals depending on the clinical status, with the addition of CMR as a second-line modality to other imaging techniques. We also provide an algorithm to guide the detailed imaging approach of the patient with DCM. We expect that future guidelines will upgrade their clinical recommendations for the utilization of CMR in DCM, which is expected to further improve the quality of care and the outcomes. This review provides an up-to-date perspective on the imaging of dilated cardiomyopathy patients and will be of clinical value to training doctors and physicians involved in the area of heart failure.
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Affiliation(s)
| | - Georgios Georgiopoulos
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas Hospital, London, United Kingdom.,Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Stefano Figliozzi
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas Hospital, London, United Kingdom
| | - Dimitrios Klettas
- First Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Flavia Nicoli
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas Hospital, London, United Kingdom
| | - Pier Giorgio Masci
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas Hospital, London, United Kingdom
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14
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Chen Y, Xue X, Gu Y, Xu H, Zhang X. Equilibrium radionuclide angiography compared with tissue doppler imaging for detection of right ventricular dyssynchrony and prediction of acute response to cardiac resynchronization therapy. Medicine (Baltimore) 2020; 99:e19296. [PMID: 32118744 PMCID: PMC7478515 DOI: 10.1097/md.0000000000019296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The aim of this study was to compare tissue doppler imaging (TDI) and equilibrium radionuclide angiography (ERNA) for detection of right ventricular (RV) dyssynchrony and prediction of the acute response to cardiac resynchronization therapy (CRT). METHODS This study was approved by the local ethics committee of Huai'an First People's Hospital. Patient consent was not provided due to the use of completely anonymous images from which the individual could not be identified in this study. Thirty-three patients with nonischemic dilated cardiomyopathy underwent both TDI and ERNA before and within 48 hour after CRT implantation. RV dyssynchrony was measured with TDI using the difference in time to peak systolic velocity between the RV free wall and ventricular septum (RV-T). With ERNA, the standard of RV mean phase angle and RV phase standard deviation (RVmPA% and RVPSD%) were assessed. RESULTS Moderate positive correlations were observed among baseline RVmPA%, RVPSD% and RV-T (r = 0.689 and 0.716, P < .001). Twenty patients (61%) with a reduction of at least 15% in LV end-systolic volume were categorized as acute responders after CRT. Responders showed significant reduction in RVmPA% and RVPSD% after CRT (53.60 ± 4.15% to 43.95 ± 6.88% and 14.00 ± 2.41% to 10.40 ± 1.67%, P < .05), whereas RV-T remained unchanged (50.10 ± 10.28 ms to 49.25 ± 13.64ms, NS). Receiver operating characteristic curve showed that the cut-off value of RV-T was 48.5ms, yielding 65% sensitivity and 77% specificity to predict acute respond to CRT. The cut-off value of RVmPA% was 49.5%, yielding 85% sensitivity and 85% specificity and the cut-off value of RVPSD% was 11.5%, yielding 85% sensitivity and 92% specificity. CONCLUSION ERNA might be an appropriate alternative to TDI for assessment of RV dyssynchrony. Either RVmPA% or RVPSD% was highly predictive for acute response to CRT.
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Affiliation(s)
| | - Xue Xue
- Huai’an Hospital Affiliated to Xuzhou Medical College and Huai’an Second People's Hospital, Huai’an, Jiangsu, China
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15
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Šipula D, Kozák M, Šipula J, Homza M, Plášek J. Cardiac Strains As a Tool for Optimization of Cardiac Resynchronization Therapy in Non-responders: a Pilot Study. Open Med (Wars) 2020; 14:945-952. [PMID: 31934639 PMCID: PMC6947762 DOI: 10.1515/med-2019-0111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 07/30/2019] [Indexed: 11/16/2022] Open
Abstract
Background Approximately 30% of patients do not respond to implantation of Cardiac Resynchronization Therapy – Defibrillators (CRT-D). The aim of this study was to investigate the potential for cardiac strain speckle tracking to optimize the performance of CRT-D in non-responding patients. Methods 30 patients not responding to Cardiac Resynchronization Therapy-Defibrillators after 3 months were randomly divided into control and intervention groups. Atrioventricular interval was adjusted so that E and A waves did not overlap, the interventricular interval was subsequently optimized to yield maximum improvement of the sum of longitudinal+radial+circumferential strains. The left ventricular ejection fraction (LVEF) and NYHA improvement 3 months after optimization were evaluated and use of other strain combinations assessed. Results A significant correlation between the (combined) strain change and LVEF improvement was detected (p<0.01). 75% of patients with non-ischemic etiology of heart failure who did not respond to the original CRT-D reacted favorably with significant LVEF and NYHA improvement. The area strain was the best predictor of LVEF/NYHA improvement in those patients. No significant improvement was recorded in patients with ischemic etiology. Conclusions AV and VV optimization based on speckle tracking is a very promising method potentially leading to a significant improvement of the outcome of CRT-D, especially in patients with non-ischemic etiology of heart failure.
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Affiliation(s)
- David Šipula
- Department of Cardiovascular Diseases, University Hospital in Ostrava, 17. listopadu 1790, 708 00 Ostrava, Czech Republic.,Faculty of Medicine, Masaryk University Brno, Kamenice 5, 625 00 Brno, Czech Republic
| | - Milan Kozák
- Faculty of Medicine, Masaryk University Brno, Kamenice 5, 625 00 Brno, Czech Republic.,Clinic of Internal Medicine - Cardiology, University Hospital Brno, 625 00, Czech Republic
| | - Jaroslav Šipula
- Department of Cardiovascular Diseases, University Hospital in Ostrava, 17. listopadu 1790, 708 00 Ostrava, Czech Republic
| | - Miroslav Homza
- Department of Cardiovascular Diseases, University Hospital in Ostrava, 17. listopadu 1790, 708 00 Ostrava, Czech Republic
| | - Jiří Plášek
- Department of Cardiovascular Diseases, University Hospital in Ostrava, 17. listopadu 1790, 708 00 Ostrava, Czech Republic
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16
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Index of contractile asymmetry improves patient selection for CRT: a proof-of-concept study. Cardiovasc Ultrasound 2019; 17:19. [PMID: 31601248 PMCID: PMC6788085 DOI: 10.1186/s12947-019-0170-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 09/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nearly one-third of heart failure (HF) patients do not respond to cardiac resynchronization therapy (CRT) despite having left bundle branch block (LBBB). The aim of the study was to investigate a novel method of quantifying left ventricular (LV) contractile asymmetry in HF. METHODS Patients with HF and LBBB undergoing CRT (n = 89, 37.1% females, 68 ± 9 years, ischemic etiology in 61%, LV ejection fraction 27.1 ± 7.1%) were analyzed. LV longitudinal systolic strain rate values were extracted from curved anatomical M-mode plots of standard long-axis 2D-echocardiography images and cubic spline interpolation was used to generate a 3D-phantom. Index of contractile asymmetry (ICA) was calculated based on standard deviation of differences in strain rate of opposing walls. Average ICA was individually assessed pairwise in 12 opposing 30-degree LV sectors. Reduction in LV end-systolic volume (ESV) ≥15% after 6 months was considered as positive response to CRT. RESULTS CRT response was found in 66 (74.2%) patients. Responders with both ischemic and non-ischemic cardiomyopathy had a higher and more extensive contractile asymmetry at baseline and achieved a greater ICA reduction after CRT than non-responders. Higher baseline ICA predicted higher degree and wider extent of ICA improvement. Also, both ICA at baseline and reduction of ICA correlated with the degree of ESV reduction after CRT. CONCLUSIONS Quantification of asymmetrical LV activation in 3D by ICA provides valuable insights into LV contraction in case of LBBB and is a promising tool for improved patient selection for CRT.
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17
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Fujii A, Inden Y, Yanagisawa S, Mamiya K, Okamoto H, Sakamoto Y, Tomomatsu T, Shibata R, Murohara T. Discontinuous contraction in the left ventricle assessed by 2‐D speckle tracking echocardiography benefits from CRT. Pacing Clin Electrophysiol 2019; 42:1204-1212. [DOI: 10.1111/pace.13759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 06/22/2019] [Accepted: 07/07/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Aya Fujii
- Department of CardiologyNagoya University Graduate School of Medicine Nagoya Japan
| | - Yasuya Inden
- Department of CardiologyNagoya University Graduate School of Medicine Nagoya Japan
| | | | - Keita Mamiya
- Department of CardiologyNagoya University Graduate School of Medicine Nagoya Japan
| | - Hiroya Okamoto
- Department of CardiologyNagoya University Graduate School of Medicine Nagoya Japan
| | - Yusuke Sakamoto
- Department of CardiologyNagoya University Graduate School of Medicine Nagoya Japan
| | - Toshiro Tomomatsu
- Department of CardiologyNagoya University Graduate School of Medicine Nagoya Japan
| | - Rei Shibata
- Department of Advanced Cardiovascular Therapeutics Nagoya Japan
| | - Toyoaki Murohara
- Department of CardiologyNagoya University Graduate School of Medicine Nagoya Japan
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18
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Truong V, Mazur W, Magier A, Broderick J, Safdar K, Volz B, Bartone C, Kereiakes DJ, Chung ES. Changes in mechanical dyssynchrony in severe aortic stenosis patients undergoing transcatheter aortic valve replacement. Echocardiography 2019; 36:243-248. [PMID: 30623480 DOI: 10.1111/echo.14237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/27/2018] [Accepted: 11/27/2018] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Aortic stenosis (AS) imposes a significant afterload on the left ventricle, but regional manifestations of the overall load may not be uniform, leading to mechanical dyssynchrony. Accordingly, we evaluated the prevalence of dyssynchrony in patients with severe AS at baseline as well as changes after transfemoral aortic valve replacement (TAVR). METHODS This study is a retrospective analysis of 225 patients in sinus rhythm who underwent TAVR for severe AS, in whom inter-ventricular and intra-ventricular dyssynchrony were measured at baseline, discharge, 1 month, and 1 year. Inter-ventricular dyssynchrony was defined as the difference between left and right ventricular pre-ejection intervals; intra-ventricular dyssynchrony was defined as the difference between time to peak systolic velocity of the basal septal and lateral segments. Patients were further stratified into those with QRS <120 ms or >120 ms. RESULTS At baseline, a quarter of patients met the criterion for significant inter-ventricular dyssynchrony, and a third had evidence of intra-ventricular dyssynchrony. Both decreased after TAVR although only the intra-ventricular dyssynchrony reached statistical significance. The interplay between QRS duration and changes in inter- and intra-ventricular dyssynchrony are also explored. CONCLUSIONS In patients with severe AS, there was evidence of mechanical dyssynchrony that is improved post-TAVR. Whether dyssynchrony is clinically and prognostically significant, and if it represents a potential target for additional therapy remains to be studied.
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Affiliation(s)
- Vien Truong
- The Christ Hospital Heart and Vascular Center, Cincinnati, Ohio.,The Lindner Center for Research and Education, Cincinnati, Ohio.,The Christ Hospital, Cincinnati, Ohio
| | - Wojciech Mazur
- The Christ Hospital Heart and Vascular Center, Cincinnati, Ohio.,The Lindner Center for Research and Education, Cincinnati, Ohio.,The Christ Hospital, Cincinnati, Ohio
| | - Adam Magier
- The Christ Hospital Heart and Vascular Center, Cincinnati, Ohio.,The Lindner Center for Research and Education, Cincinnati, Ohio.,The Christ Hospital, Cincinnati, Ohio
| | - John Broderick
- The Christ Hospital Heart and Vascular Center, Cincinnati, Ohio.,The Lindner Center for Research and Education, Cincinnati, Ohio.,The Christ Hospital, Cincinnati, Ohio
| | - Komal Safdar
- The Christ Hospital Heart and Vascular Center, Cincinnati, Ohio.,The Lindner Center for Research and Education, Cincinnati, Ohio.,The Christ Hospital, Cincinnati, Ohio
| | - Brian Volz
- The Christ Hospital Heart and Vascular Center, Cincinnati, Ohio.,The Lindner Center for Research and Education, Cincinnati, Ohio.,The Christ Hospital, Cincinnati, Ohio
| | - Cheryl Bartone
- The Christ Hospital Heart and Vascular Center, Cincinnati, Ohio.,The Lindner Center for Research and Education, Cincinnati, Ohio.,The Christ Hospital, Cincinnati, Ohio
| | - Dean J Kereiakes
- The Christ Hospital Heart and Vascular Center, Cincinnati, Ohio.,The Lindner Center for Research and Education, Cincinnati, Ohio.,The Christ Hospital, Cincinnati, Ohio
| | - Eugene S Chung
- The Christ Hospital Heart and Vascular Center, Cincinnati, Ohio.,The Lindner Center for Research and Education, Cincinnati, Ohio.,The Christ Hospital, Cincinnati, Ohio
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Uhm JS, Oh J, Cho IJ, Park M, Kim IS, Jin MN, Bae HJ, Yu HT, Kim TH, Pak HN, Lee MH, Joung B, Kang SM. Left Ventricular End-Systolic Volume Can Predict 1-Year Hierarchical Clinical Composite End Point in Patients with Cardiac Resynchronization Therapy. Yonsei Med J 2019; 60:48-55. [PMID: 30554490 PMCID: PMC6298892 DOI: 10.3349/ymj.2019.60.1.48] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 11/09/2018] [Accepted: 11/09/2018] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This study aimed to elucidate which echocardiographic criteria at three time points, for cardiac resynchronization therapy (CRT) response, are accurate in discriminating the hierarchical clinical composite end point (HCCEP). MATERIALS AND METHODS We included 120 patients (age, 66.1±12.6 years; men, 54.2%) who underwent CRT implantation for heart failure (HF). Echocardiography was performed before and at 3, 6, and 12 months after CRT implantation. The 1-year HCCEP included all-cause mortality, hospitalization for HF, and New York Heart Association functional class for 12 months. CRT response criteria were decrease in left ventricular (LV) end-systolic volume (LVESV) >15%, decrease in LV end-diastolic volume >15%, absolute increase in LV ejection fraction (LVEF) ≥5%, relative increase in LVEF ≥15%, and decrease in mitral regurgitation ≥1 grade. Temporal changes in CRT response rates, accuracy of CRT response criteria at each time and cutoff value for the discrimination of improvement in HCCEP, and agreements with improvement in HCCEP were analyzed. RESULTS HCCEP improvement rates were 65.8% in total group. In nonischemic group, CRT response rates according to all echocardiographic criteria significantly increased with time. In ischemic group, CRT response rate did not significantly change with time. In total group, ΔLVESV at 6 months (ΔLVESV6) had the most significant accuracy for the discrimination of HCCEP (area under the curve=0.781). The optimal cutoff value of ΔLVESV6 was 13.5% (sensitivity=0.719, specificity=0.719). ΔLVESV6 had fair agreement with HCCEP (κ=0.391, p<0.001). CONCLUSION ΔLVESV6 is the most useful echocardiographic CRT response criterion for the prediction of 1-year HCCEP.
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Affiliation(s)
- Jae Sun Uhm
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jaewon Oh
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - In Jeong Cho
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Minsu Park
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea
| | - In Soo Kim
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Moo Nyun Jin
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Han Joon Bae
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hui Nam Pak
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Moon Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | - Seok Min Kang
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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20
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Yang DM, Yu F, Chen KY, Su H, Wang Q, Liu ZQ, Hu K, Xu J, Yan J. Correlation between Myocardial Velocity Measured using Tissue Doppler Imaging in the Left Ventricular Lead-Implanted Segment and Response to Cardiac Resynchronization Therapy. Clinics (Sao Paulo) 2019; 74:e1077. [PMID: 31596338 PMCID: PMC6761846 DOI: 10.6061/clinics/2019/e1077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 07/17/2019] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES This study investigated whether tissue Doppler imaging parameters, especially the peak systolic velocity of the left ventricular lead-implanted segment (Ss), affect cardiac resynchronization therapy response. METHODS In this case-control study, 110 enrolled patients were divided into cases (responder group, n=65) and controls (nonresponder group, n=45) based on whether their left ventricular end-systolic volume was reduced by ≥15% at 6 months after surgery. Preoperative clinical and echocardiographic data were collected. Multivariate logistic regression models were used to analyze the factors affecting the response to cardiac resynchronization therapy, and receiver operating characteristic curves were plotted to evaluate their diagnostic values. RESULTS The proportion of patients with left bundle branch block in the case group was higher than that in the control group. The control group showed a higher left atrial volume index, E/A ratio and E/Em ratio but lower Ss than that of the case group. A multivariate regression analysis showed that left bundle branch block, Ss, and an E/Em ratio>14 were independent risk factors affecting the response to cardiac resynchronization therapy. Ss=4.1 cm/s was the best diagnostic threshold according to the receiver operating characteristic curve. CONCLUSIONS Ss is an important factor affecting the response to cardiac resynchronization therapy. Patients with heart failure associated with Ss<4.1 cm/s have a higher risk of nonresponse.
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Affiliation(s)
- Dong-Mei Yang
- Division of Cardiology, First Affiliated Hospital of the University of Science and Technology of China, Hefei, Anhui, China
- *Corresponding author. E-mail:
| | - Fei Yu
- Division of Cardiology, First Affiliated Hospital of the University of Science and Technology of China, Hefei, Anhui, China
- *Corresponding author. E-mail:
| | - Kang-Yu Chen
- Division of Cardiology, First Affiliated Hospital of the University of Science and Technology of China, Hefei, Anhui, China
| | - Hao Su
- Division of Cardiology, First Affiliated Hospital of the University of Science and Technology of China, Hefei, Anhui, China
| | - Qi Wang
- Division of Cardiology, First Affiliated Hospital of the University of Science and Technology of China, Hefei, Anhui, China
| | - Zhi-Quan Liu
- Division of Cardiology, First Affiliated Hospital of the University of Science and Technology of China, Hefei, Anhui, China
| | - Kai Hu
- Division of Cardiology, First Affiliated Hospital of the University of Science and Technology of China, Hefei, Anhui, China
| | - Jian Xu
- Division of Cardiology, First Affiliated Hospital of the University of Science and Technology of China, Hefei, Anhui, China
| | - Ji Yan
- Division of Cardiology, First Affiliated Hospital of the University of Science and Technology of China, Hefei, Anhui, China
- *Corresponding author. E-mail:
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21
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Rodrigues I, Abreu A, Oliveira M, Cunha PS, Clara HS, Osório P, Lousinha A, Valente B, Portugal G, Rio P, Morais LA, Santos V, Carmo MM, Ferreira RC. Impact on long-term cardiovascular outcomes of different cardiac resynchronization therapy response criteria. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2018.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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22
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Rodrigues I, Abreu A, Oliveira M, Cunha PS, Clara HS, Osório P, Lousinha A, Valente B, Portugal G, Rio P, Morais LA, Santos V, Carmo MM, Ferreira RC. Impact on long-term cardiovascular outcomes of different cardiac resynchronization therapy response criteria. Rev Port Cardiol 2018; 37:961-969. [DOI: 10.1016/j.repc.2018.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 02/03/2018] [Accepted: 02/18/2018] [Indexed: 12/31/2022] Open
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23
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Forleo GB, Santini L, Giammaria M, Potenza D, Curnis A, Calabrese V, Ricciardi D, D'agostino C, Notarstefano P, Ribatti V, Morani G, Mantica M, Di Biase L, Bertaglia E, Calò L, Zanon F. Multipoint pacing via a quadripolar left-ventricular lead: preliminary results from the Italian registry on multipoint left-ventricular pacing in cardiac resynchronization therapy (IRON-MPP). Europace 2018; 19:1170-1177. [PMID: 27189954 PMCID: PMC5834139 DOI: 10.1093/europace/euw094] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 03/12/2016] [Indexed: 12/02/2022] Open
Abstract
Aims This registry was created to describe the experience of 76 Italian centres with a large cohort of recipients of multipoint pacing (MPP) capable cardiac resynchronization therapy (CRT) devices. Methods and results A total of 507 patients in whom these devices had been successfully implanted were enrolled between August 2013 and May 2015. We analysed: (i) current clinical practices for the management of such patients, and (ii) the impact of MPP on heart failure clinical composite response and on the absolute change in ejection fraction (EF) at 6 months. Multipoint pacing was programmed to ‘ON’ in 46% of patients before discharge. Methods of optimizing MPP programming were most commonly based on either the greatest narrowing of the QRS complex (38%) or the electrical delays between the electrodes (34%). Clinical and echocardiographic follow-up data were evaluated in 232 patients. These patients were divided into two groups according to whether MPP was programmed to ‘ON’ (n = 94) or ‘OFF’ (n = 138) at the time of discharge. At 6 months, EF was significantly higher in the MPP group than in the biventricular-pacing group (39.1 ± 9.6 vs. 34.7 ± 7.6%; P < 0.001). Even after adjustments, early MPP activation remained an independent predictor of absolute increase in LVEF of ≥5% (odds ratio 2.5; P = 0.001). At 6 months, an improvement in clinical composite score was recorded in a greater proportion of patients with MPP-ON than in controls (56 vs. 38%; P = 0.009). On comparing optimal MPP and conventional vectors, QRS was also seen to have decreased significantly (P < 0.001). Conclusion This study provides information that is essential in order to deal with the expected increase in the number of patients receiving MPP devices in the coming years. The results revealed different practices among centres, and establishing the optimal programming that can maximize the benefit of MPP remains a challenging issue. Compared with conventional CRT, MPP improved clinical status and resulted in an additional increase in EF. Clinical Trial Registration http://www.clinicaltrial.gov/. Unique identifier: NCT02606071.
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Affiliation(s)
- Giovanni B Forleo
- Policlinico Universitario Tor Vergata, Viale Oxford, 81, Rome 00133, Italy
| | - Luca Santini
- Policlinico Universitario Tor Vergata, Viale Oxford, 81, Rome 00133, Italy
| | | | - Domenico Potenza
- Ospedale Casa Sollievo Della Sofferenza, S.Giovanni Rotondo, Italy
| | | | - Vito Calabrese
- Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | | | | | | | - Valentina Ribatti
- Policlinico Universitario Tor Vergata, Viale Oxford, 81, Rome 00133, Italy
| | | | | | - Luigi Di Biase
- Albert Einstein College of Medicine at Montefiore Hospital, New York, NY, USA.,Department of Cardiology, University of Foggia, Foggia, Italy
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24
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Sacchi S, Pieragnoli P, Ricciardi G, Grifoni G, Padeletti L. Impact of haemodynamic SonR sensor on monitoring of left ventricular function in patients undergoing cardiac resynchronization therapy. Europace 2017; 19:1695-1699. [PMID: 28011801 DOI: 10.1093/europace/euw318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 09/19/2016] [Indexed: 11/14/2022] Open
Abstract
Aims The haemodynamic SonR sensor is able to measure myocardial contractility. The isometric effort is useful in quantifying left ventricular (LV) performance. We investigated the amplitude changes in SonR signal over time and during static exercise according to the recovery of the left ventricle. Methods and results Twenty five patients [18 male, 70 ± 8 years, LV ejection fraction (LVEF) 29 ± 5%, in sinus rhythm] underwent biventricular SonR implantable cardioverter defibrillator implant. After procedure and at 6 months, each patient underwent detection of SonR signal and continuous measurement of blood pressure, at rest and during isometric effort. During evaluation at baseline device was programmed in VVI at 40 bpm while in DDD at 60 bpm at follow-up. At 6 months, LV reverse remodelling was investigated. Cardiac resynchronization therapy patients were considered responders when an absolute improvement in LV ejection fraction ≥ 5% occurred. At 6 months, 14 (56%) patients were responders and 11 (44%) non-responders (mean LVEF 40 ± 10% vs. 27 ± 6%, respectively). In responders, SonR value did not significantly change at follow-up compared to baseline (P = 0.894). At follow-up, SonR value was not significantly different between two groups (P = 0.651). SonR signal significantly increased during isometric effort in responders (P = 0.002) while it slightly decreased in non-responders at follow-up (P = 0.572). No differences were observed in response to isometric effort between two groups at baseline (P = 0.182, P = 0.069, respectively). Conclusions The absolute SonR amplitude provides limited information on the status of LV performance. The variation in SonR signal during static exercise is more likely to identify responders at follow-up.
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Affiliation(s)
- Stefania Sacchi
- Department of Internal Medicine and Cardiology, Institute of Internal Medicine and Cardiology, University of Florence, Florence, Italy.,International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College, London, UK
| | - Paolo Pieragnoli
- Department of Internal Medicine and Cardiology, Institute of Internal Medicine and Cardiology, University of Florence, Florence, Italy
| | - Giuseppe Ricciardi
- Department of Internal Medicine and Cardiology, Institute of Internal Medicine and Cardiology, University of Florence, Florence, Italy
| | - Gino Grifoni
- Department of Internal Medicine and Cardiology, Institute of Internal Medicine and Cardiology, University of Florence, Florence, Italy
| | - Luigi Padeletti
- Department of Internal Medicine and Cardiology, Institute of Internal Medicine and Cardiology, University of Florence, Florence, Italy.,Department of Cardiology, IRCCS, Multimedica, Sesto San Giovanni, Milan, Italy
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25
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Sassone B, Bertini M, Beltrami M, Malagù M, Pasanisi G, Kuwornu HA, Avigni N, Fucà G, Pacchioni F, Minarelli M, Bacchi Reggiani ML, Padeletti L. Relation of QRS Duration to Response to Cardiac Resynchronization Therapy in Patients With Left Bundle Branch Block. Am J Cardiol 2017; 119:1803-1808. [PMID: 28391991 DOI: 10.1016/j.amjcard.2017.02.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 02/17/2017] [Accepted: 02/17/2017] [Indexed: 11/16/2022]
Abstract
Left ventricular (LV) dyssynchrony (LVdys) is a necessary condition for successful cardiac resynchronization therapy (CRT). Despite left bundle branch block (LBBB) representing a reliable surrogate of LVdys, not all LBBB patients will respond to CRT. Our aim was to investigate the relation between QRS duration and LVdys in patients with LBBB who underwent CRT. We retrospectively studied 165 patients with LBBB who underwent CRT implantation according to the current guidelines. A 6-month reduction of LV end-systolic volume ≥15% identified responders to CRT. Baseline LVdys was defined as the delay between peak systolic velocities of the interventricular septum and lateral wall assessed by color-coded tissue Doppler imaging. Baseline characteristics of responders (61%) and nonresponders (39%) were comparable except for larger QRS complex (172 ± 24 vs 160 ± 16 ms, p <0.001) and lower degree of LVdys (46 ± 42 vs 72 ± 31 ms, p <0.001) in nonresponders. Receiver-operating characteristic curve analysis demonstrated that an optimal cut-off value of 3 for the ratio of QRS duration and LVdys (QRS/LVdys) yielded a sensitivity of 66% and specificity of 80% to predict nonresponsiveness to CRT; QRS/LVdys >3 remained an independent predictor at multivariate analysis. In patients with nonischemic origin of cardiomyopathy, the linear regression analysis documented a significant inverse relation between QRS duration and LVdys, as dyssynchrony progressively decreased as QRS widening increased (p = 0.006). This was not evident in patients with ischemic origin. In conclusion, in LBBB patients with nonischemic origin and marked QRS widening, the absence of LVdys may account for a lower response to CRT compared with patients with intermediate QRS widening.
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Affiliation(s)
- Biagio Sassone
- Department of Cardiology, SS.ma Annunziata Hospital, Azienda Unità Sanitaria Locale Ferrara, Cento, Ferrara, Italy; Department of Cardiology, Delta Hospital, Azienda Unità Sanitaria Locale Ferrara, Lagosanto, Ferrara, Italy.
| | - Matteo Bertini
- Department of Cardiology, S. Anna Hospital, University of Ferrara, Cona, Ferrara, Italy
| | - Matteo Beltrami
- Careggi Hospital, Institute of Internal Medicine and Cardiology, University of Florence, Florence, Italy
| | - Michele Malagù
- Department of Cardiology, S. Anna Hospital, University of Ferrara, Cona, Ferrara, Italy
| | - Giovanni Pasanisi
- Department of Cardiology, Delta Hospital, Azienda Unità Sanitaria Locale Ferrara, Lagosanto, Ferrara, Italy
| | - Helene Afi Kuwornu
- Department of Cardiology, Delta Hospital, Azienda Unità Sanitaria Locale Ferrara, Lagosanto, Ferrara, Italy
| | - Nicola Avigni
- Department of Cardiology, Delta Hospital, Azienda Unità Sanitaria Locale Ferrara, Lagosanto, Ferrara, Italy
| | - Giuseppe Fucà
- Department of Cardiology, SS.ma Annunziata Hospital, Azienda Unità Sanitaria Locale Ferrara, Cento, Ferrara, Italy
| | - Federico Pacchioni
- Department of Cardiology, SS.ma Annunziata Hospital, Azienda Unità Sanitaria Locale Ferrara, Cento, Ferrara, Italy
| | - Monica Minarelli
- Department of Cardiology, SS.ma Annunziata Hospital, Azienda Unità Sanitaria Locale Ferrara, Cento, Ferrara, Italy
| | | | - Luigi Padeletti
- Careggi Hospital, Institute of Internal Medicine and Cardiology, University of Florence, Florence, Italy; IRCCS Multimedica, Milan, Italy
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26
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Zafrir N, Bental T, Strasberg B, Solodky A, Mats I, Gutstein A, Kornowski R. Yield of left ventricular dyssynchrony by gated SPECT MPI in patients with heart failure prior to implantable cardioverter-defibrillator or cardiac resynchronization therapy with a defibrillator: Characteristics and prediction of cardiac outcome. J Nucl Cardiol 2017; 24:122-129. [PMID: 26563336 DOI: 10.1007/s12350-015-0310-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 10/01/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND Mechanical left ventricular dyssynchrony (MLVD) might contribute in the therapeutic decision-making in patients with heart failure (HF) prior to cardiac resynchronization therapy (CRT). Our aim was to assess MLVD in patients with HF prior to implantable cardioverter-defibrillator (ICD) compared to patients with CRT-D. METHODS In a prospective study, patients with LVEF ≤ 35% who were scheduled for ICD or CRT-D, underwent gated SPECT myocardial perfusion imaging with technetium 99m sestamibi within 3 months prior procedure. MLVD was measured by phase analysis. RESULTS The study cohort consisted of 143 patients, 71 with ICD and 72 with CRT-D. Age 68.3 ± 11 and LVEF 24 ± 6%. Phase standard deviation (SD) was 62.5 ± 18 and 59.7 ± 20 (P = NS), respectively. During follow-up of 23.7 ± 12.1 months, there were 10 vs 14 cardiac death in ICD and CRT-D, respectively (P = NS), hospitalization for HF, in 34 vs 53 (P < .001). In multivariate analysis, Phase SD was the independent predictor for cardiac death [HR 2.66 (95% CI 1.046-6.768), P = .04]. Kaplan-Meier curves of phase SD of 60° significantly identified ICD patients with and without cardiac deaths and hospitalization for HF exacerbation. CONCLUSIONS MLVD by phase SD can identify patients with cardiac events and predict cardiac death in patients treated with ICD.
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Affiliation(s)
- Nili Zafrir
- Cardiology Department, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel.
| | - Tamir Bental
- Cardiology Department, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel
| | - Boris Strasberg
- Cardiology Department, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel
| | - Alejandro Solodky
- Cardiology Department, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel
| | - Israel Mats
- Cardiology Department, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel
| | - Ariel Gutstein
- Cardiology Department, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel
| | - Ran Kornowski
- Cardiology Department, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel
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27
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Petrovic M, Petrovic M, Milasinovic G, Vujisic Tesic B, Trifunovic D, Petrovic O, Nedeljkovic I, Petrovic I, Banovic M, Boricic-Kostic M, Petrovic J, Arena R, Popovic D. Gauging the response to cardiac resynchronization therapy: The important interplay between predictor variables and definition of a favorable outcome. Echocardiography 2017; 34:371-375. [PMID: 28075037 DOI: 10.1111/echo.13453] [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: 11/29/2022] Open
Abstract
AIMS Selection of patients who are viable candidates for cardiac resynchronization therapy (CRT), prediction of the response to CRT as well as an optimal definition of a favorable response, all require further exploration. The purpose of this study was to evaluate the interplay between the prediction of the response to CRT and the definition of a favorable outcome. METHODS Seventy patients who received CRT were included. All patients met current guideline criteria for CRT. Forty-three echocardiographic parameters were evaluated before CRT and at 1, 3, 6, and 12 months. M-mode, 2D echocardiography, and Doppler imaging were used to quantify left ventricular (LV) systolic and diastolic function, mitral regurgitation, right ventricular systolic function, pulmonary artery pressure, and myocardial mechanical dyssynchrony. The following definitions of a favorable CRT response were used: left ventricular ejection fraction (LVEF) improvement more >5% acutely following CRT, LVEF improvement >20% at 12-month follow-up, and a LV end-systolic volume (LVESV) decrease >15% at 12-month follow-up. RESULTS For the LVEF improvement >5%, the best predictor was isovolumetric relaxation time (IVRT; P=.035). For improvement of LVEF >20%, the best predictors were left ventricular stroke index (LVSI; P=.044) and left ventricular fractional shortening (LVFS; P=.031). For the drop in left ventricular systolic volume (LVESV >15%), the best predictor was septal-to-lateral wall delay (ΔT) (P=.043, RR=1.023, 95% CI for RR=1.001-1.045). CONCLUSION The definition of a favorable CRT response influenced the optimal predictor variable(s). Standardization of defining a favorable response to CRT is needed to guide clinical decision making processes.
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Affiliation(s)
- Milan Petrovic
- Clinic of Cardiology, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marija Petrovic
- Clinic of Cardiology, Clinical Center of Serbia, Belgrade, Serbia
| | - Goran Milasinovic
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Pacemaker Center, Clinical Center of Serbia, Belgrade, Serbia
| | - Bosiljka Vujisic Tesic
- Clinic of Cardiology, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Danijela Trifunovic
- Clinic of Cardiology, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Olga Petrovic
- Clinic of Cardiology, Clinical Center of Serbia, Belgrade, Serbia
| | - Ivana Nedeljkovic
- Clinic of Cardiology, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivana Petrovic
- Clinic of Cardiology, Clinical Center of Serbia, Belgrade, Serbia
| | - Marko Banovic
- Clinic of Cardiology, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Jelena Petrovic
- Clinic of Cardiology, Clinical Center of Serbia, Belgrade, Serbia
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Dejana Popovic
- Clinic of Cardiology, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
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28
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Sinha SK, Bhagat K, Asif M, Singh K, Sachan M, Mishra V, Afdaali N, Jha MJ, Kumar A, Singh S, Sinha R, Khanra D, Thakur R, Varma CM, Krishna V, Pandey U. Fragmented QRS as a Marker of Electrical Dyssynchrony to Predict Inter-Ventricular Conduction Defect by Subsequent Echocardiographic Assessment in Symptomatic Patients of Non-Ischemic Dilated Cardiomyopathy. Cardiol Res 2016; 7:140-145. [PMID: 28197282 PMCID: PMC5295578 DOI: 10.14740/cr495w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2016] [Indexed: 11/21/2022] Open
Abstract
Background Left ventricular (LV) dyssynchrony frequently occurs in patients with heart failure (HF). QRS ≥ 120 ms is a surrogate marker of electrical dyssynchrony, which occurs in only 30% of HF patients. In contrary, in those with normal QRS (nQRS) duration, LV dyssynchrony has been reported in 20-50%. This study was carried out to investigate the role of fragmented QRS (fQRS) on the surface electrocardiography (ECG) as a marker of electrical dyssynchrony to predict the presence of significant intraventricular dyssynchrony (IVD) by subsequent echocardiographic assessment. Methods A total of 226 consecutive patients with non-ischemic cardiomyopathy were assessed for fQRS on surface ECG as defined by presence of an additional R wave (R prime), notching in nadir of the S wave, notching of R wave, or the presence of more than one R prime (fragmentation) in two contiguous leads corresponding to a major myocardial segment. Tissue Doppler imaging (TDI) was performed in the apical views (four-chamber, two-chamber and long-axis) to analyze all 12 segments at both basal and middle levels. Time-to-peak myocardial sustained systolic (Ts) velocities were calculated. Significant systolic IVD was defined as Ts-SD > 32.6 ms as known as “Yu index”. Result Of the total patients, 112 had fQRS (49.5%), while 114 had nQRS (50.5%) with male dominance (M/F = 71:29). Majority of patients were in NYHA class II (n = 122, 54%) followed by class III (n = 83; 37%), and class IV (n = 21; 9%). There were no significant differences among both groups for baseline parameters except higher QRS duration (102.42 ± 14.05 vs. 91.10 ± 13.75 ms; P = 0.001), higher Yu index (35.64 ± 12.79 vs. 20.45 ± 11.17; P = 0.01) and number of patients with positive Yu index (78.6% vs. 21.1%; P = 0.04) in group with fQRS compared with group with nQRS. fQRS complexes had 84.61% sensitivity and 80.32% specificity with positive predictive value of 78.6% and negative predictive value of 85.9% to detect IVD. On detailed segmental analysis for fQRS distribution, inferior segment had maximum (37%), followed by anterior (23%), lateral (19%), inferior and lateral (11%), anterior and inferior (8%), and anterior and lateral (2%). Among 104 patients with significant dyssynchrony, 88 patients (84.6%) had fQRS in the dyssynchronic segment. Conclusion Fragmentation of QRS complex is an important predictor of electro-mechanical dyssynchrony. It is also helpful in localizing the dyssynchronous segment. In future, larger studies may be carried out to investigate the role of fQRS as a predictor of response to cardiac resynchronization therapy (CRT) in this subgroup of HF patients with narrow QRS.
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Affiliation(s)
- Santosh Kumar Sinha
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Kush Bhagat
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Mohammad Asif
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Karandeep Singh
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Mohit Sachan
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Vikas Mishra
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Nasar Afdaali
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Mukesh Jitendra Jha
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Ashutosh Kumar
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Shravan Singh
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Rupesh Sinha
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Dibbendhu Khanra
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Ramesh Thakur
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Chandra Mohan Varma
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Vinay Krishna
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Umeshwar Pandey
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
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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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Steelant B, Stankovic I, Roijakkers I, Aarones M, Bogaert J, Desmet W, Aakhus S, Voigt JU. The Impact of Infarct Location and Extent on LV Motion Patterns. JACC Cardiovasc Imaging 2016; 9:655-64. [DOI: 10.1016/j.jcmg.2015.07.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 06/25/2015] [Accepted: 07/15/2015] [Indexed: 12/14/2022]
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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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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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Stolfo D, Tonet E, Merlo M, Barbati G, Gigli M, Pinamonti B, Ramani F, Zecchin M, Sinagra G. Early right ventricular response to cardiac resynchronization therapy: impact on clinical outcomes. Eur J Heart Fail 2015; 18:205-13. [DOI: 10.1002/ejhf.450] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 10/13/2015] [Accepted: 10/28/2015] [Indexed: 11/11/2022] Open
Affiliation(s)
- Davide Stolfo
- Cardiovascular Department; ‘Ospedali Riuniti’ and University of Trieste; Trieste Italy
| | - Elisabetta Tonet
- Cardiovascular Department; ‘Ospedali Riuniti’ and University of Trieste; Trieste Italy
| | - Marco Merlo
- Cardiovascular Department; ‘Ospedali Riuniti’ and University of Trieste; Trieste Italy
| | - Giulia Barbati
- Cardiovascular Department; ‘Ospedali Riuniti’ and University of Trieste; Trieste Italy
| | - Marta Gigli
- Cardiovascular Department; ‘Ospedali Riuniti’ and University of Trieste; Trieste Italy
| | - Bruno Pinamonti
- Cardiovascular Department; ‘Ospedali Riuniti’ and University of Trieste; Trieste Italy
| | - Federica Ramani
- Cardiovascular Department; ‘Ospedali Riuniti’ and University of Trieste; Trieste Italy
| | - Massimo Zecchin
- Cardiovascular Department; ‘Ospedali Riuniti’ and University of Trieste; Trieste Italy
| | - Gianfranco Sinagra
- Cardiovascular Department; ‘Ospedali Riuniti’ and University of Trieste; Trieste Italy
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Kuetting DLR, Sprinkart AM, Dabir D, Schild HH, Thomas DK. Assessment of cardiac dyssynchrony by cardiac MR: A comparison of velocity encoding and feature tracking analysis. J Magn Reson Imaging 2015; 43:940-6. [PMID: 26426814 DOI: 10.1002/jmri.25062] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 09/11/2015] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To investigate whether cardiac magnetic resonance (cardiac MR)-based feature tracking (FT) may be used for robust and rapid quantification of dyssynchrony by measurement of the septal to lateral delay (SLD). MATERIALS AND METHODS Healthy volunteers (n = 18) and patients with mechanical dyssynchrony (n = 17) were investigated. Velocity encoding cardiac MR (VENC) and steady-state free precession (SSFP)-cine sequences were acquired in identical horizontal long axis (HLA) positions using a 1.5T MR scanner. Using FT and VENC cardiac MR software, myocardial velocity curves were calculated for the basal segment of the septal and lateral wall. Based on the quantity of dyssynchrony, the patients were classified into three subgroups (minimal, intermediate, extensive). SLD and patient classification were compared and intra- as well as interobserver variability assessed. RESULTS VENC and FT SLD measurements showed strong correlation (r = 0.94) and good agreement (mean 1.33 msec; limits of agreement [LoA] -2.96 to 5.63). Dyssynchrony subclassification based on FT was identical to VENC in 83% of the cases. While FT correctly classified all healthy subjects, three patients with mechanical dyssynchrony were misclassified. Compared to VENC, FT showed higher intra- and interobserver variability. VENC: intraobserver: mean 2.5 msec, LoA -17.5 to 22.5; interobserver: mean 1.5 msec, LoA -17.2 to 21.9. FT: intraobserver: mean 2.1 msec, LoA 27.6 to 31.8; interobserver: mean 2.4 msec LoA -31.4 to 34.5. CONCLUSION Cardiac MR-based FT analysis may be used for rapid appraisal of left ventricle cardiac dyssynchrony from SSFP images. However, FT results are less accurate and reproducible compared to VENC-based assessment of SLD.
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Affiliation(s)
| | | | - Darius Dabir
- Department of Radiology, University of Bonn, Bonn, Germany
| | - Hans H Schild
- Department of Radiology, University of Bonn, Bonn, Germany
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Varma PK, Namboodiri N, Raman SP, Pappu UK, Gadhinglajkar SV, Ho J, Owais K, Mahmood F. CASE 10—2015: Cardiac Resynchronization Therapy: Role of Intraoperative Real-Time Three-Dimensional Transesophageal Echocardiography. J Cardiothorac Vasc Anesth 2015; 29:1365-75. [PMID: 26159744 DOI: 10.1053/j.jvca.2015.04.006] [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: 06/19/2014] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Suneel Puthuvassery Raman
- Department of Anesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | | | | | - Jonathan Ho
- Department of Anesthesiology, University of California, Los Angeles, Los Angeles, CA
| | - Khurram Owais
- Department of Anaesthesia, Beth Israel Deaconess Medical Center, Boston, MA
| | - Feroze Mahmood
- Department of Anaesthesia, Beth Israel Deaconess Medical Center, Boston, MA
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Ishibashi K, Kubo T, Kitabata H, Takarada S, Shimamura K, Tanimoto T, Orii M, Shiono Y, Yamano T, Ino Y, Yamaguchi T, Hirata K, Tanaka A, Imanishi T, Akasaka T. Improvement of Cardiac Function by Increasing Stimulus Strength During Left Ventricular Pacing in Cardiac Resynchronization Therapy. Int Heart J 2015; 56:62-6. [DOI: 10.1536/ihj.14-128] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Kohei Ishibashi
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University
| | | | - Shigeho Takarada
- Department of Cardiovascular Medicine, Wakayama Medical University
| | | | - Takashi Tanimoto
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Makoto Orii
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takashi Yamano
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Yasushi Ino
- Department of Cardiovascular Medicine, Wakayama Medical University
| | | | - Kumiko Hirata
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Toshio Imanishi
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
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Azizian N, Rastgou F, Ghaedian T, Golabchi A, Bahadorian B, Khanlarzadeh V, Azizian Z, Haghjoo M. LV Dyssynchrony Assessed With Phase Analysis on Gated Myocardial Perfusion SPECT Can Predict Response to CRT in Patients With End-Stage Heart Failure. Res Cardiovasc Med 2014; 3:e20720. [PMID: 25785250 PMCID: PMC4347800 DOI: 10.5812/cardiovascmed.20720] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 08/16/2014] [Accepted: 11/01/2014] [Indexed: 11/16/2022] Open
Abstract
Background: Cardiac resynchronization therapy (CRT) is an established treatment in patients with end-stage heart failure and wide QRS complex. However, about 30% of patients do not benefit from CRT (non-responder). Recent studies with tissue Doppler imaging yielded disappointing results in predicting CRT responders. Phase analysis was developed to allow assessment of LV dyssynchrony by gated single photon emission computed tomography (SPECT) myocardial perfusion imaging (GMPS). Objectives: The aim of present study was to investigate the role of quantitative GMPS-derived LV dyssynchrony data to predict CRT responder. Patients and Methods: Thirty eligible patients for CRT implantation underwent GMPS and echocardiography. Response to CRT was evaluated six months after the device implantation. Clinical response to CRT was defined as 50 meters increase in 6-minute walking test (6-MWT) distance. Echocardiographic response to CRT was defined as ≥ 15% decrease in left ventricular end-systolic volume (LVESV). The lead position was considered concordant if it was positioned at the area of latest mechanical activation, and discordant if located outside the area of latest mechanical activation. Results: Clinical response to CRT was observed in 74% of patients. However, only 57% of patients were responder according to the echo criteria. There were statistically significant differences between CRT responders and non-responders for GMPS-derived variables, including phased histogram bandwidth (PHB), phase SD (PSD), and Entropy. Moreover, a cutoff value of 112° for PHB with a sensitivity of 72% and specificity of 70%, a cutoff value of 21° for PSD with a sensitivity of 90% and specificity of 74%, and a cutoff of 52% for Entropy with a sensitivity of 90% and a specificity of 80% were considered to discriminate responders and non-responders. CRT response was more likely in patients with concordant LV lead position compared to those with discordant LV lead position. Conclusions: GMPS-derived LV dyssynchrony variables can predict response to CRT with good sensitivity and specificity.
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Affiliation(s)
- Nasrin Azizian
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Fereydoon Rastgou
- Department of Nuclear Medicine and Molecular Imaging, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Tahereh Ghaedian
- Department of Nuclear Medicine and Molecular Imaging, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Allahyar Golabchi
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Behdad Bahadorian
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Vida Khanlarzadeh
- Department of Nuclear Medicine and Molecular Imaging, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Zahra Azizian
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Majid Haghjoo
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Majid Haghjoo, Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Vali-Asr St., Niayesh Blvd, Tehran, IR Iran. Tel: +98-2123922163, Fax: +98-2122048174, E-mail:
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38
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BOGDAN STEFAN, KLEMPFNER ROBERT, SABBAG AVI, LURIA DAVID, GUREVITZ OSNAT, BAR-LEV DAVID, LIPCHENCA IGOR, NOF EYAL, KUPERSTEIN RAFAEL, GOLDENBERG ILAN, ELDAR MICHAEL, GLIKSON MICHAEL, BEINART ROY. Functional Response to Cardiac Resynchronization Therapy in Patients with Renal Dysfunction and Subsequent Long-Term Mortality. J Cardiovasc Electrophysiol 2014; 25:1188-95. [DOI: 10.1111/jce.12463] [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] [Received: 03/21/2014] [Revised: 05/22/2014] [Accepted: 05/27/2014] [Indexed: 11/28/2022]
Affiliation(s)
- STEFAN BOGDAN
- Davidai Arrhythmia Center; Leviev Heart Center; Sheba Medical Center; Tel Hashomer Israel
- Cardiology Department, Clinical Emergency Hospital Bucharest; “Carol Davila” University of Medicine and Pharmacy; Bucharest Romania
| | - ROBERT KLEMPFNER
- Cardiac Rehabilitation Institute; Leviev Heart Center; Sheba Medical Center; Tel Hashomer Israel
| | - AVI SABBAG
- Department of Echocardiography; Leviev Heart Center; Sheba Medical Center; Tel Hashomer Israel
| | - DAVID LURIA
- Davidai Arrhythmia Center; Leviev Heart Center; Sheba Medical Center; Tel Hashomer Israel
| | - OSNAT GUREVITZ
- Davidai Arrhythmia Center; Leviev Heart Center; Sheba Medical Center; Tel Hashomer Israel
| | - DAVID BAR-LEV
- Davidai Arrhythmia Center; Leviev Heart Center; Sheba Medical Center; Tel Hashomer Israel
| | - IGOR LIPCHENCA
- Davidai Arrhythmia Center; Leviev Heart Center; Sheba Medical Center; Tel Hashomer Israel
| | - EYAL NOF
- Davidai Arrhythmia Center; Leviev Heart Center; Sheba Medical Center; Tel Hashomer Israel
| | - RAFAEL KUPERSTEIN
- Department of Echocardiography; Leviev Heart Center; Sheba Medical Center; Tel Hashomer Israel
| | - ILAN GOLDENBERG
- Department of Cardiology; Leviev Heart Center; Sheba Medical Center; Tel Hashomer Israel
| | - MICHAEL ELDAR
- Davidai Arrhythmia Center; Leviev Heart Center; Sheba Medical Center; Tel Hashomer Israel
| | - MICHAEL GLIKSON
- Davidai Arrhythmia Center; Leviev Heart Center; Sheba Medical Center; Tel Hashomer Israel
| | - ROY BEINART
- Davidai Arrhythmia Center; Leviev Heart Center; Sheba Medical Center; Tel Hashomer Israel
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Zafrir N, Nevzorov R, Bental T, Strasberg B, Gutstein A, Mats I, Kornowski R, Solodky A. Prognostic value of left ventricular dyssynchrony by myocardial perfusion-gated SPECT in patients with normal and abnormal left ventricular functions. J Nucl Cardiol 2014; 21:532-40. [PMID: 24623397 DOI: 10.1007/s12350-014-9852-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 12/22/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Left ventricular (LV) dyssynchrony by phase analysis has been studied by myocardial perfusion imaging (MPI)-gated SPECT in patients with LV dysfunction in various clinical settings. We aimed to investigate the routine use of phase analysis with gated SPECT for predicting cardiac outcome. METHODS Patients referred to a tertiary medical center in 2010-2011 prospectively underwent a gated SPECT and phase analysis, and follow-up for cardiac events. The values of clinical variables, MPI, LV function, and LV dyssynchrony in predicting cardiac events were tested by univariate and multivariate analyses. RESULTS The study group included 787 patients (66.5 ± 11 years, 81% men) followed for a mean duration of 18.3 ± 6.2 months. There were 45 (6%) cardiac events defined as composite endpoint; cardiac death occurred in 26 patients, and the rest had new-onset or worsening heart failure and life-threatening arrhythmias. In multivariate analysis, it was shown that NYHA class, diabetes mellitus, and LVEF <50% were the independent predictors for composite endpoint. However, the independent predictors for cardiac mortality were NYHA class (for each increment in class) and phase standard deviation (SD) (for each 10° increment). CONCLUSION Gated SPECT with phase analysis for the assessment of LV dyssynchrony can successfully predict cardiac death together with NYHA class, in patients with LV dysfunction.
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Affiliation(s)
- Nili Zafrir
- Nuclear Cardiology Unit, Rabin Medical Center, Beilinson Campus, 49100, Petah Tikva, Israel,
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40
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Sakamaki F, Seo Y, Atsumi A, Yamamoto M, Machino-Ohtsuka T, Kawamura R, Yamasaki H, Igarashi M, Sekiguchi Y, Ishizu T, Aonuma K. Novel dyssynchrony evaluation by M-mode imaging in left bundle branch block and the application to predict responses for cardiac resynchronization therapy. J Cardiol 2014; 64:199-206. [PMID: 24582308 DOI: 10.1016/j.jjcc.2013.12.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 11/24/2013] [Accepted: 12/12/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND To determine an appropriate M-mode method in assessing left ventricular (LV) dyssynchrony in left bundle branch block (LBBB), and to assess feasibility of the method to predict cardiac resynchronization therapy (CRT) responses. METHODS AND RESULTS Fifty-one patients with LBBB were enrolled. Among them 31 patients underwent CRT. In addition to original septal to posterior wall motion delay (SPWMD), first peak-SPWMD was proposed as time of difference between the first septal displacement and the maximum displacement of the posterior. If an early septal point was not present, anatomical M-mode was used to visualize an early septal displacement spreading scan-area until inferoseptal wall. CRT responders were defined as LV end-systolic volume reduction (>15%) at 6 months after CRT. Twenty patients (65%) were identified as CRT responders. First peak-SPWMD in responders was significantly higher than those in nonresponders, although SPWMD did not differ between groups. Strong predicting ability of first peak-SPWMD was revealed (first peak-SPWMD: 80/90/83%; SPWMD: 35/100/58%), and area under the curve in receiver operating characteristic analysis of first peak-SPWMD (0.88) was significantly higher than that of SPWMD (0.61) (p<0.05). CONCLUSION In patients with LBBB, time differences between early septal and delayed displacement of posterolateral wall on M-mode images were the appropriate dyssynchrony parameter, and could improve the predictive ability for CRT responses.
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Affiliation(s)
- Fumiko Sakamaki
- Department of Clinical Laboratory, University of Tsukuba Hospital, Tsukuba, Japan
| | - Yoshihiro Seo
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Akiko Atsumi
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masayoshi Yamamoto
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | | | - Ryo Kawamura
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiro Yamasaki
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Miyako Igarashi
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yukio Sekiguchi
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tomoko Ishizu
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kazutaka Aonuma
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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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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42
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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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Cazeau SJ, Daubert JC, Tavazzi L, Frohlig G, Paul V. Responders to cardiac resynchronization therapy with narrow or intermediate QRS complexes identified by simple echocardiographic indices of dyssynchrony: The DESIRE study. Eur J Heart Fail 2014; 10:273-80. [DOI: 10.1016/j.ejheart.2008.02.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2007] [Revised: 01/28/2008] [Accepted: 02/06/2008] [Indexed: 11/28/2022] Open
Affiliation(s)
- Serge J. Cazeau
- Inparys Clinical Research Group; 12 rue Pasteur, 92210 - St. Cloud France
| | | | | | - Gerd Frohlig
- Universitätskliniken des Saarlandes; Homburg Germany
| | - Vince Paul
- St Peters Hospital; Chertsey United Kingdom
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44
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Umar S, Bax JJ, Klok M, van Bommel RJ, Hessel MH, den Adel B, Bleeker GB, Henneman MM, Atsma DE, van der Wall EE, Schalij MJ, van der Laarse A. Myocardial collagen metabolism in failing hearts before and during cardiac resynchronization therapy. Eur J Heart Fail 2014; 10:878-83. [DOI: 10.1016/j.ejheart.2008.06.019] [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: 11/21/2007] [Revised: 05/21/2008] [Accepted: 06/30/2008] [Indexed: 10/21/2022] Open
Affiliation(s)
- Soban Umar
- Department of Cardiology; Leiden University Medical Center; Leiden The Netherlands
| | - Jeroen J. Bax
- Department of Cardiology; Leiden University Medical Center; Leiden The Netherlands
| | - Margreet Klok
- Department of Cardiology; Leiden University Medical Center; Leiden The Netherlands
| | - Rutger J. van Bommel
- Department of Cardiology; Leiden University Medical Center; Leiden The Netherlands
| | - Marleen H.M. Hessel
- Department of Cardiology; Leiden University Medical Center; Leiden The Netherlands
| | - Brigit den Adel
- Department of Cardiology; Leiden University Medical Center; Leiden The Netherlands
| | - Gabe B. Bleeker
- Department of Cardiology; Leiden University Medical Center; Leiden The Netherlands
| | - Maureen M. Henneman
- Department of Cardiology; Leiden University Medical Center; Leiden The Netherlands
| | - Douwe E. Atsma
- Department of Cardiology; Leiden University Medical Center; Leiden The Netherlands
| | | | - Martin J. Schalij
- Department of Cardiology; Leiden University Medical Center; Leiden The Netherlands
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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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Prognostic significance of left ventricular dyssynchrony by phase analysis of gated SPECT in medically treated patients with dilated cardiomyopathy. Clin Nucl Med 2014; 38:510-5. [PMID: 23698460 DOI: 10.1097/rlu.0b013e318292eedf] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE The study aimed to investigate the value of clinical variables and rest gated single-photon emission computed tomography (SPECT) in predicting cardiac deaths in medically treated dilated cardiomyopathy (DCM) patients. METHODS This is a retrospective study. Fifty-six consecutive hospitalized DCM patients who underwent rest gated SPECT myocardial perfusion imaging were initially recruited. Patients were further excluded for receiving heart transplantation, cardiac resynchronization treatment, and noncardiac death during follow-up. The remaining 48 medically treated DCM patients were selected into the final analysis. Phase analysis of gated SPECT was conducted to identify left ventricular (LV) dyssynchrony. Cardiac death during follow-up was considered as the only endpoint. Univariate and multivariate Cox proportional hazards regression analysis were performed to identify the independent predictors of cardiac death. Kaplan-Meier cumulative survival analysis with stratification was performed, and survival curves were compared by log-rank test. RESULTS The mean age was 47.5 ± 15.8 years (range, 15-76 yrs) and 85.4% were men. The mean LV ejection fraction was 22.2 ± 7.7%. During the follow-up period (22.7 ± 5.1 mos), 12 (25.0%) cardiac deaths occurred. Compared to survivors, patients with cardiac death had lower body mass index (BMI, P = 0.010), higher percent of prolonged QRS duration (QRSD, P = 0.043), and severe LV dyssynchrony (P = 0.002). Multivariate Cox analysis demonstrated that severe LV dyssynchrony [hazard ratio = 9.607, 95% confidential interval (95% CI) 2.064-44.713, P = 0.004] and BMI (hazard ratio = 0.851, 95% CI 0.732-0.989, P = 0.036) were predictive of cardiac death. CONCLUSION Left ventricular dyssynchrony assessed by phase analysis of gated SPECT and BMI are predictive of cardiac death in medically treated DCM patients.
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Zoroufian A, Razmi T, Savandroomi Z, Tokaldany ML, Sadeghian H, Sahebjam M, Jalali A. Correlation between systolic deformation and dyssynchrony indices and the grade of left ventricular hypertrophy in hypertensive patients with a preserved systolic ejection fraction undergoing coronary angiography, based on tissue Doppler imaging. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:119-128. [PMID: 24371106 DOI: 10.7863/ultra.33.1.119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES The purpose of this study was to investigate whether systolic mechanical dyssynchrony occurs in hypertensive patients with a normal coronary artery and a normal ejection fraction and its relationship with different degrees of left ventricular (LV) hypertrophy. METHODS A total of 125 angiographically normal coronary patients (42.4% male; mean age ± SD, 57.16 ± 8.26 years) with an ejection fraction greater than 50% were included, of which 84 were hypertensive and 41 normotensive. The hypertensive patients were categorized into 3 groups: no, mild, and moderate LV hypertrophy. Tissue Doppler and deformation imaging parameters were measured in the 6 LV basal segments at peak systole. RESULTS The frequency of dyssynchrony was 40.5% in the hypertensive patients compared to 19.5% in the control patients (P = .020). Among the hypertensive patients, LV dyssynchrony was found in 5 patients (20%) with no hypertrophy, 20 (42.6%) with mild hypertrophy, and 9 (75%) with moderate hypertrophy. There was a moderate correlation between the grade of hypertrophy and septal-lateral wall delay (r = 0.497), 6-basal segment delay (r = 0.454), overall strain (r = 0.453), overall peak systolic velocity (r = -0.430), and standard deviation of the time to peak systolic velocity in the basal segments (r = 0.429). After adjustment for the LV end-systolic diameter and body surface area, overall strain was the best correlate of the hypertrophy grade (odds ratio, 7.043; 95% confidence interval, 1.839-26.980; P = .0044). CONCLUSIONS Among tissue Doppler and deformation indices, overall peak systolic strain was the strongest correlate of the LV hypertrophy grade. Therefore, in hypertensive patients with normal cardiac systolic function, a reduction in overall strain in the 6 basal LV segments may be a good indicator of progression of the LV hypertrophy grade and systolic dysfunction.
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Affiliation(s)
- Arezoo Zoroufian
- Department of Echocardiography, Tehran Heart Center, North Kargar Street, Tehran 14117 13138, Iran.
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Dai M, Lu J, Qian DAJ, Cai JF, Liu XY, Wu XQ, Yang ZY, Li XR, Wang RX. Assessment of left ventricular dyssynchrony and cardiac function in patients with different pacing modes using real-time three-dimensional echocardiography: Comparison with tissue Doppler imaging. Exp Ther Med 2013; 6:1213-1219. [PMID: 24223646 PMCID: PMC3820759 DOI: 10.3892/etm.2013.1292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 09/05/2013] [Indexed: 11/06/2022] Open
Abstract
The aim of this study was to evaluate the left ventricular mechanical dyssynchrony (LVMD) and left ventricular dysfunction of patients in AAI, DDD and VVI pacing modes using real-time three-dimensional echocardiography (RT3DE) and tissue Doppler imaging (TDI). The results from the RT3DE and TDI were subsequently compared. Twenty patients with sick sinus syndrome (SSS) who had undergone the implantation of a dual-chamber pacemaker were enrolled in this study and the pacemakers were programmed to AAI, DDD and VVI modes, sequentially. The RT3DE and TDI parameters were obtained following pacing for 24 h in each mode. With RT3DE, we measured the systolic dyssynchrony indices, including Tmsv16-SD%, Tmsv12-SD%, Tmsv6-SD%, Tmsv16-Dif%, Tmsv12-Dif% and Tmsv6-Dif%, left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV) and left ventricular ejection fraction (LVEF), respectively. With TDI, we measured the standard deviation and the maximal difference in time from the QRS onset to the peak systolic velocity for 12 left ventricular myocardial segments, i.e. Ts-SD and Ts-Dif, respectively. The results showed that the Tmsv16-SD% and Ts-SD in the AAI mode were significantly lower than those in the DDD and VVI modes (P<0.05); however, there were no significant differences between the DDD and VVI modes (P>0.05). The LVEF in the AAI, DDD and VVI modes was 63.1±8.9, 58.6±11.2 and 57.9±7.6%, respectively (P>0.05). There were negative correlations between the LVEF and Tmsv16-SD% (r, −0.651; P<0.001) and Ts-SD (r, −0.649; P<0.0001). A moderate correlation (r, 0.698; P<0.0001) was observed between Tmsv16-SD% and Ts-SD. The concordance rate between Tmsv16-SD% and Ts-SD for detecting LVMD was 76%. This study showed that DDD and VVI pacing modes induced significant LVMD and a reduction in LVEF, unlike the AAI pacing mode. RT3DE and TDI were capable of objectively evaluating LVMD; however, each method had certain faults. At present, there is a lack of a uniform standard for assessing LVMD; therefore, the use of a variety of techniques and indices is necessary in order to comprehensively evaluate LVMD in patients with different cardiac pacing modes.
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Affiliation(s)
- Min Dai
- Department of Cardiology, Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu 214023
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Indexed maximal left atrial volume predicts response to cardiac resynchronization therapy. Int J Cardiol 2013; 168:3629-33. [DOI: 10.1016/j.ijcard.2013.05.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 01/29/2013] [Accepted: 05/04/2013] [Indexed: 11/20/2022]
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Harel F, Finnerty V, Grégoire J, Salimian S, Thibault B. Effects of dobutamine stress on cardiac contraction synchronism in a canine model. Physiol Meas 2013; 34:1387-97. [PMID: 24065617 DOI: 10.1088/0967-3334/34/10/1387] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In cardiac resynchronization therapy, many devices need to be optimized to take into account the magnitude and characteristics of patients' ventricular mechanical dyssynchrony. The optimization process is mostly performed at rest; however, mechanical resynchronization might be more important under stress, while patients need to improve their cardiac efficiency. The objective of this study was to observe if levels of cardiac stress could modify the ventricular contraction synchronism. Cardiac stress was induced with dobutamine infusion in eight healthy canine subjects. Hemodynamic and ventricular synchronism assessments were performed by left ventricular pressure measurements and radionuclide tomographic-gated blood pools. Cardiac output increased from 2.8 ± 1.0 at rest to 5.7 ± 2.2 L min(-1) at 20 µg kg(-1) min(-1), while the ventricular performance (dP/dtmax) increased from 1588 ± 374 to 8004 ± 710 mmHg s(-1). At baseline, the interventricular delay (in degrees) was -6.3 ± 2.6°, the left ventricle contraction preceding the right. The delay significantly increased to -21.6 ± 3.1° with dobutamine stress (p < 0.0001). On assessment of the left intraventricular synchrony, septal-to-lateral delay was -6.9 ± 5.1° at baseline which revealed a preceded contraction of the left lateral wall from the septum. Cardiac stress produced a significant modulation (p = 0.01), with an inversion of the contraction pattern, the septum contraction preceding the lateral wall contraction by 15.5 ± 5.6° at maximum dobutamine infusion; a significant linear trend (p < 0.001) was found between cardiac stress levels and septal-to-lateral delays. Cardiac activity levels modified the ventricular synchronism supporting the fact that optimizations of cardiac resynchronization devices could be improved by taking cardiac stress into account.
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Affiliation(s)
- Francois Harel
- Department of Nuclear Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
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