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Beela AS, Manetti CA, Lyon A, Prinzen FW, Delhaas T, Herbots L, Lumens J. Impact of Estimated Left Atrial Pressure on Cardiac Resynchronization Therapy Outcome. J Clin Med 2023; 12:4908. [PMID: 37568310 PMCID: PMC10419616 DOI: 10.3390/jcm12154908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/16/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND We investigated the impact of baseline left atrial (LA) strain data and estimated left atrial pressure (LAP) by applying the 2016 American Society of Echocardiography and the European Association of Cardiovascular Imaging (ASE/EACVI) guidelines on cardiac resynchronization therapy (CRT) outcomes. METHODS Datasets of 219 CRT patients were retrospectively analysed. All patients had full echocardiographic diastolic function assessment before CRT and were classified based on the guideline algorithm into normal LAP (nLAP = 40%), elevated LAP (eLAP = 49%) and indeterminate LAP (iLAP = 11%). All relevant baseline characteristics were analysed. CRT-induced left ventricular (LV) reverse remodeling was measured as the relative change of LV end-systolic volume (LVESV) at 12 ± 6 months after CRT compared to baseline. Patients were followed up for all-cause mortality for a mean of 4.8 years [interquartile range (IQR): 2.7-6.0 years]. RESULTS At follow-up, CRT resulted in more pronounced reduction of LVESV in patients with nLAP than in patients with eLAP. In univariate analysis, nLAP was associated with LV reverse remodelling (p < 0.001), as well as long-term survival after CRT (p < 0.01). However, multivariable analysis showed that only the association between nLAP and LV reverse remodelling after CRT is independent (p < 0.01). Adding LA strain analysis to the guideline algorithm improved the feasibility of LAP estimation without affecting the association between estimated LAP and CRT outcome. CONCLUSION Normal LAP before CRT, estimated using the 2016 ASE/EACVI guideline algorithm, is associated with LV reverse remodelling and long-term survival after CRT. Albeit non-independent, it can serve as a non-invasive imaging-based predictor of effective therapy. Furthermore, the inclusion of LA reservoir strain in the guideline algorithm can enhance the feasibility of LAP estimation without affecting the association between LAP and CRT outcome.
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Affiliation(s)
- Ahmed S. Beela
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), 6229 ER Maastricht, The Netherlands; (C.A.M.); (A.L.); (T.D.); (J.L.)
- Department of Cardiovascular Diseases, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
| | - Claudia A. Manetti
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), 6229 ER Maastricht, The Netherlands; (C.A.M.); (A.L.); (T.D.); (J.L.)
| | - Aurore Lyon
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), 6229 ER Maastricht, The Netherlands; (C.A.M.); (A.L.); (T.D.); (J.L.)
| | - Frits W. Prinzen
- Department of Physiology, Maastricht University, 6200 MD Maastricht, The Netherlands;
| | - Tammo Delhaas
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), 6229 ER Maastricht, The Netherlands; (C.A.M.); (A.L.); (T.D.); (J.L.)
| | - Lieven Herbots
- Department of Cardiology, Hartcentrum Hasselt, Jessa Hospital, 3500 Hasselt, Belgium;
- Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, 3500 Hasselt, Belgium
| | - Joost Lumens
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), 6229 ER Maastricht, The Netherlands; (C.A.M.); (A.L.); (T.D.); (J.L.)
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Galli E, Smiseth OA, Aalen JM, Larsen CK, Sade E, Hubert A, Anilkumar S, Penicka M, Linde C, Le Rolle V, Hernandez A, Leclercq C, Duchenne J, Voigt JU, Donal E. Prognostic utility of the assessment of diastolic function in patients undergoing cardiac resynchronization therapy. Int J Cardiol 2021; 331:144-151. [PMID: 33535079 DOI: 10.1016/j.ijcard.2021.01.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 12/06/2020] [Accepted: 01/07/2021] [Indexed: 11/18/2022]
Abstract
Conflicting data exist about the relationship between cardiac resynchronization therapy (CRT) and diastolic function. Aims of the study are to assess diastolic patterns in patients undergoing CRT according to the 2016 recommendations of the American Society of Echocardiography/European Association of Cardiovascular Imaging and to evaluate the prognostic value of diastolic dysfunction (DD) in CRT candidates. METHODS AND RESULTS: One-hundred ninety-three patients (age: 67 ± 11 years, QRS width: 167 ± 21 ms) were included in this multicentre prospective study. Mitral filling pattern, mitral tissue Doppler velocity, tricuspid regurgitation velocity, and indexed left atrial volume were used to classify DD from grade I to III. CRT-response, defined as a reduction of left ventricular (LV) end-systolic volume > 15% at 6-month follow-up (FU), occurred in 132 (68%) patients. The primary endpoint was a composite of heart transplantation, LV assisted device implantation, or all-cause death during FU and occurred in 29 (15%) patients. CRT was associated with a degradation of DD in non-responders. At multivariable analysis corrected for clinical variables, QRS duration, mitral regurgitation, CRT-response and LV dyssynchrony, grade I DD was associated with a better outcome (HR 0.37, 95% CI: 0.14-0.96). Non-responders with grade II-III DD had the worse prognosis (HR 4.36, 95%CI: 2.10-9.06). CONCLUSIONS: The evaluation of DD in CRT candidates allows the prognostic stratification of patients, independently from CRT-response.
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Affiliation(s)
- E Galli
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France
| | - O A Smiseth
- Institute for Surgical Research and Department of Cardiology, Oslo University Hospital and University of Oslo, Norway
| | - J M Aalen
- Institute for Surgical Research and Department of Cardiology, Oslo University Hospital and University of Oslo, Norway
| | - C K Larsen
- Institute for Surgical Research and Department of Cardiology, Oslo University Hospital and University of Oslo, Norway
| | - E Sade
- Department of Cardiology, Baskent University Hospital, Ankara, Turkey
| | - A Hubert
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France
| | - S Anilkumar
- Non-Invasive Cardiac Laboratory, Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - M Penicka
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Cecilia Linde
- Heart and Vascular Theme, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - V Le Rolle
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France
| | - A Hernandez
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France
| | - C Leclercq
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France
| | - J Duchenne
- Department of Cardiovascular Disease and Departement of Cardiovascular Science, KU, Leuven, Belgium
| | - J-U Voigt
- Department of Cardiovascular Disease and Departement of Cardiovascular Science, KU, Leuven, Belgium
| | - E Donal
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France.
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Yamamoto M, Seo Y, Ishizu T, Kawamatsu N, Sato K, Sugano A, Atsumi A, Harimura Y, Machino-Ohtsuka T, Sakamaki F, Aonuma K. Prognostic significance of persistent restrictive filling pattern after cardiac resynchronization therapy. J Echocardiogr 2015; 13:20-6. [PMID: 26184518 DOI: 10.1007/s12574-014-0234-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 11/11/2014] [Accepted: 11/21/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) may improve left ventricular (LV) diastolic dysfunction as well as systolic dysfunction. Diastolic dysfunction is a key for prognosis in patients with heart failure; therefore, we aimed to clarify the impact of CRT on diastolic function and prognosis. METHODS In 67 patients who underwent CRT, LV diastolic function was assessed by pulsed Doppler transmitral flow pattern at baseline and 1 week after CRT, and classified into restrictive filling pattern (RFP) and non-RFP groups. Volume responders were defined by reduction of LV end-systolic volume >15% at 6 months after CRT. The clinical endpoint comprised death from any cause or unplanned hospitalization for a major cardiovascular event (MACE). RESULTS During the follow-up period (479 ± 252 days), 26 patients (38.8%) had reached the endpoint of MACE. In Cox proportional hazard analyses, RFP at 1 week after CRT was associated with the endpoints independently of age and New York Heart Association (NYHA) class IV at baseline. Thirty (44.8%) patients were identified as volume responders, who had better prognosis than non-responders. Patients were classified into 4 groups based on their filling pattern at 1 week after CRT and volume responses. The worst prognosis was observed in the RFP and non-responder group, and the best was observed in the non-RFP and responder group. For the remaining 2 groups with intermediate prognosis, the RFP and responder group showed poorer prognosis compared to the non-RFP and non-responder group. CONCLUSIONS Persistent RFP after CRT may be a strong prognostic predictor, which should be treated with more intensive therapy to improve the prognosis of patients following CRT.
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Affiliation(s)
- Masayoshi Yamamoto
- Cardiovascular Division, Faculty of Clinical Medicine, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
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Kato H, Shimano M, Sumi T, Murakami H, Kada K, Inden Y, Tsuboi N, Murohara T. Acute improvement of left ventricular relaxation as a predictor of volume reduction after cardiac resynchronization therapy: a pilot study assessing the value of left ventricular hemodynamic parameter. Pacing Clin Electrophysiol 2014; 37:1544-52. [PMID: 25113752 DOI: 10.1111/pace.12478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Revised: 05/31/2014] [Accepted: 06/09/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) improves cardiac function, but CRT recipients with advanced heart failure (HF) do not always respond well. Because the best parameters for the prediction of CRT response are not established, we investigated whether improvement of invasive left ventricular (LV) hemodynamic diastolic parameters could identify CRT responders. METHODS A total of 34 consecutive patients (age, 69 ± 9 years; 70% men) who received CRT devices for HF were assessed as to whether acute invasive hemodynamic parameters with and without CRT function could predict LV volume responders. RESULTS These patients demonstrated an improvement in LV dP/dtmax (11.1 ± 11.7%), LV dP/dtmin (4.6 ± 12.1%), and tau (3.7 ± 11.6%) by biventricular pacing. Nineteen patients (55%) were classified as CRT responders, which was defined by a >15% decrease in LV end-systolic volume (ESV) at the 6-month follow-up evaluation. The area under the receiver operator characteristic curve to detect CRT volume response was 0.93 for the shortening of tau, which was superior to any other hemodynamic parameter. The multivariate analysis revealed that this improvement in tau was the strongest predictive factor for identifying CRT volume responders. Of note, the magnitude of tau shortening during biventricular pacing was significantly correlated with the reduction in LVESV at the 6-month follow-up evaluation. CONCLUSIONS The extent of acute improvement in LV isovolumic relaxation time, as assessed by tau, was associated with favorable response to CRT. The assessment of invasive diastolic function could provide valuable information about CRT volume response.
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Affiliation(s)
- Hiroyuki Kato
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Division of Cardiology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
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Systolic heart failure and cardiac resynchronization therapy: a focus on diastole. Int J Cardiovasc Imaging 2014; 30:897-905. [PMID: 24706254 PMCID: PMC4008775 DOI: 10.1007/s10554-014-0412-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 03/25/2014] [Indexed: 11/03/2022]
Abstract
Conflicting data exist about the effects of cardiac resynchronization therapy (CRT) on diastolic function (DF). Aim of the study was to assess if and how CRT affects DF in systolic heart failure patients. We also investigated potential relations between CRT-induced left ventricular changes and the composite clinical endpoint of progressive heart failure and cardiac death over 3 years follow-up. 119 CRT patients underwent clinical evaluation and echocardiography before CRT and 4 months later. DF was quantified by transmitral velocities [E/A waves, deceleration time (DT), E/DT], early diastolic mitral annulus velocity (E'), E/E' ratio and 2-D speckle tracking strain rate during isovolumetric relaxation (IVR, SRivr). End-diastolic pressure-volume relationship (EDPVR) was also assessed noninvasively using a single-beat method. Overall stiffness was quantified by ventricular stiffness (Klv) normalized to end-diastolic volume (EDV). New York Heart Association class improved at 4 months (from 2.7 ± 0.7 to 1.9 ± 0.6, p < 0.001) as did ventricular filling (E/DT from 0.48 ± 0.29 to 0.39 ± 0.31 cm/s(2), p = 0.01). In contrast, relaxation (E', SRivr) and filling pressures (E/E', E/SRivr) did not change. Slope of EDPVR did not change with CRT. Such finding, together with an unmodified Klv/EDV and a 7 ± 18 % reduction in EDV (p = 0.001), suggested reverse remodelling towards a smaller equilibrium volume. Finally, end-systolic LV volume decreased from 147 ± 59 to 125 ± 52 ml and ejection fraction increased from 0.26 ± 0.07 to 0.32 ± 0.09 (both p < 0.001). Using a Cox regression model we found that only changes (Δ) in diastolic, but not systolic indexes, correlated with the composite clinical endpoint, with increments in ΔEDV20 and ΔE/DT, single or combined, greatly increasing risk of heart failure and/or cardiac death (p = 0.003). Ventricular reverse remodelling, together with improvement in ventricular filling, rather than improvements of systolic function, predict clinical prognosis long-term post-CRT.
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Shanks M, Antoni ML, Hoke U, Bertini M, Ng AC, Auger D, Marsan NA, van Erven L, Holman ER, Schalij MJ, Bax JJ, Delgado V. The effect of cardiac resynchronization therapy on left ventricular diastolic function assessed with speckle-tracking echocardiography. Eur J Heart Fail 2014; 13:1133-9. [DOI: 10.1093/eurjhf/hfr115] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Miriam Shanks
- Department of Cardiology; Leiden University Medical Center; Albinusdreef 2 2333 ZA Leiden The Netherlands
- Mazankowski Alberta Heart Institute; Edmonton Canada
| | - M. Louisa Antoni
- Department of Cardiology; Leiden University Medical Center; Albinusdreef 2 2333 ZA Leiden The Netherlands
| | - Ulas Hoke
- Department of Cardiology; Leiden University Medical Center; Albinusdreef 2 2333 ZA Leiden The Netherlands
| | - Matteo Bertini
- Department of Cardiology; Leiden University Medical Center; Albinusdreef 2 2333 ZA Leiden The Netherlands
- University of Ferrara, Ferrara and Fundation S. Maugeri Centro di Lumezzane; Brescia Italy
| | - Arnold C.T. Ng
- Department of Cardiology; Leiden University Medical Center; Albinusdreef 2 2333 ZA Leiden The Netherlands
- Princess Alexandra Hospital; University of Queensland; Brisbane Australia
| | - Dominique Auger
- Department of Cardiology; Leiden University Medical Center; Albinusdreef 2 2333 ZA Leiden The Netherlands
- Centre Hospitalier de l'Université de Montréal; Montréal Québec Canada
| | - Nina Ajmone Marsan
- Department of Cardiology; Leiden University Medical Center; Albinusdreef 2 2333 ZA Leiden The Netherlands
| | - Lieselot van Erven
- Department of Cardiology; Leiden University Medical Center; Albinusdreef 2 2333 ZA Leiden The Netherlands
| | - Eduard R. Holman
- Department of Cardiology; Leiden University Medical Center; Albinusdreef 2 2333 ZA Leiden The Netherlands
| | - Martin J. Schalij
- Department of Cardiology; Leiden University Medical Center; Albinusdreef 2 2333 ZA Leiden The Netherlands
| | - Jeroen J. Bax
- Department of Cardiology; Leiden University Medical Center; Albinusdreef 2 2333 ZA Leiden The Netherlands
| | - Victoria Delgado
- Department of Cardiology; Leiden University Medical Center; Albinusdreef 2 2333 ZA Leiden The Netherlands
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Egnaczyk GF, Chung ES. The Relationship Between Cardiac Resynchronization Therapy and Diastolic Function. Curr Heart Fail Rep 2013; 11:64-9. [DOI: 10.1007/s11897-013-0181-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Doltra A, Bijnens B, Tolosana JM, Gabrielli L, Castel MÁ, Berruezo A, Brugada J, Mont L, Sitges M. Effect of Cardiac Resynchronization Therapy on Left Ventricular Diastolic Function: Implications for Clinical Outcome. J Card Fail 2013; 19:795-801. [DOI: 10.1016/j.cardfail.2013.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 10/25/2013] [Accepted: 11/04/2013] [Indexed: 11/26/2022]
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Shen X, Nair CK, Holmberg MJ, Mooss AN, Koruth J, Wang F, Maciejewski S, Esterbrooks DJ. Impact of left atrial volume in prediction of outcome after cardiac resynchronization therapy. Int J Cardiol 2011; 152:13-7. [PMID: 20621370 DOI: 10.1016/j.ijcard.2010.06.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Revised: 05/20/2010] [Accepted: 06/11/2010] [Indexed: 11/17/2022]
Affiliation(s)
- Xuedong Shen
- The Cardiac Center of Creighton University, Omaha, Nebraska, USA.
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Echocardiographic assessment of interventricular and intraventricular mechanical synchrony in normal dogs. J Vet Cardiol 2011; 13:115-26. [PMID: 21641290 DOI: 10.1016/j.jvc.2011.02.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Revised: 02/08/2011] [Accepted: 02/12/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The aims of this prospective study are to (1) generate normal ranges for interventricular and intraventricular mechanical synchrony in dogs, and (2) generate normal ranges for tissue Doppler imaging (TDI) velocity imaging and speckle tracking strain imaging assessment of segmental intraventricular mechanical synchrony in dogs. ANIMALS 10 prospectively recruited healthy dogs. METHODS Dogs were excluded if they had abnormal historical, physical examination, echocardiographic, ECG or systolic blood pressure findings. Interventricular mechanical synchrony was assessed using time difference between left and right ventricular pre-ejection periods. Intraventricular mechanical synchrony was assessed using both M-mode and color M-mode septal to posterior wall mechanical delay (SPWMD). Intraventricular segmental mechanical synchrony was assessed using both color TDI and speckle tracking strain analysis of segmental myocardial motion during systole and diastole. RESULTS All synchrony measures were found to be independent of age or body weight. Normal range for mechanical interventricular synchrony was found to be -10.2 to 12.6 ms. Assessment of mechanical intraventricular synchrony using either M-mode or color M-mode SPWMD was found to be associated with an extremely wide normal range, limiting clinical applicability. Normal ranges for segmental intraventricular mechanical synchrony assessed using either color TDI or speckle tracking were found to be comparable to those published for human subjects. CONCLUSIONS Interventricular and intraventricular mechanical synchrony in dogs is independent of age and body weight. The normal ranges identified in this study form a basis for assessment of normal versus abnormal mechanical synchrony in canine cardiovascular disease patients.
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Abu Sham'a R, Kuperstein R, Barsheshet A, Bar-Lev D, Luria D, Gurevitz O, Bachar S, Eldar M, Feinberg M, Glikson M. The effects of anodal stimulation on electrocardiogram, left ventricular dyssynchrony, and acute haemodynamics in patients with biventricular pacemakers. Europace 2011; 13:997-1003. [DOI: 10.1093/europace/eur076] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Echocardiography and noninvasive imaging in cardiac resynchronization therapy: results of the PROSPECT (Predictors of Response to Cardiac Resynchronization Therapy) study in perspective. J Am Coll Cardiol 2009; 53:1933-43. [PMID: 19460606 DOI: 10.1016/j.jacc.2008.11.061] [Citation(s) in RCA: 148] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Revised: 10/14/2008] [Accepted: 11/02/2008] [Indexed: 11/23/2022]
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YPENBURG CLAUDIA, WESTENBERG JOSJ, BLEEKER GABEB, VAN de VEIRE NICO, MARSAN NINAA, HENNEMAN MAUREENM, van der WALL ERNSTE, SCHALIJ MARTINJ, ABRAHAM THEODOREP, BAROLD SSERGE, BAX JEROENJ. Noninvasive Imaging in Cardiac Resynchronization Therapy-Part 1: Selection of Patients. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2008; 31:1475-99. [DOI: 10.1111/j.1540-8159.2008.01212.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ng AC, Tran DT, Newman M, Allman C, Vidaic J, Leung DY. Comparison of left ventricular dyssynchrony by two-dimensional speckle tracking versus tissue Doppler imaging in patients with non-ST-elevation myocardial infarction and preserved left ventricular systolic function. Am J Cardiol 2008; 102:1146-50. [PMID: 18940281 DOI: 10.1016/j.amjcard.2008.06.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2008] [Revised: 06/30/2008] [Accepted: 06/30/2008] [Indexed: 10/21/2022]
Abstract
Assessment of left ventricular (LV) dyssynchrony after myocardial infarction has prognostic value. There were no reference ranges for 2-dimensional (2D) speckle tracking synchrony, and it was unclear whether color tissue Doppler imaging and 2D speckle tracking synchrony indexes were comparable. One hundred twenty-two healthy volunteers and 40 patients with non-ST-elevation myocardial infarction (NSTEMI) had LV systolic and diastolic synchrony, defined as the SD of time to peak systolic (2D-SDTs) and early diastolic (2D-SDTe) velocities in the 12 basal and mid segments using 2D speckle tracking, respectively. Mean 2D-SDTs and 2D-SDTe were 29.4 +/- 16.1 and 14.2 +/- 6.1 ms in healthy subjects, respectively. Gender and mean 2D systolic velocity independently predicted 2D-SDTs, and mean 2D early diastolic velocity independently predicted 2D-SDTe. Bland-Altman analysis showed suboptimal agreement between 2D speckle tracking and tissue Doppler imaging dyssynchrony indexes. 2D speckle tracking showed lower coefficients of variation for time to peak systolic and early diastolic velocities than tissue Doppler imaging. There were no significant differences in coefficients of variation for 2D speckle tracking systolic and diastolic synchrony for high versus low frame rates. Patients with NSTEMI had significantly lower ejection fraction, but higher LV mass and wall stress than healthy subjects. Only 2D-SDTs was significantly higher in patients with NSTEMI compared with healthy subjects (37.1 +/- 22.5 vs 29.4 +/- 16.1 ms; p = 0.02). In conclusion, 2D-SDTs was gender specific and influenced by global systolic function, and 2D-SDTe was influenced by global diastolic function. 2D speckle tracking and tissue Doppler imaging dyssynchrony indexes were not comparable. 2D speckle tracking may be a more sensitive discriminator of LV systolic dyssynchrony than tissue Doppler imaging.
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Ascione L, Iengo R, Accadia M, Rumolo S, Celentano E, D'Andrea A, De Michele M, Muto C, Carreras G, Maglione M, Tuccillo B, Roelandt J. A radial global dyssynchrony index as predictor of left ventricular reverse remodeling after cardiac resynchronization therapy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2008; 31:819-27. [PMID: 18684278 DOI: 10.1111/j.1540-8159.2008.01096.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cardiac mechanical efficiency requires that opposing left ventricular regions are coupled both in shortening and lengthening during the same phase of cardiac cycle. Aim of this study was to evaluate whether global measures of mechanical dyssynchrony are able to predict reverse remodeling of the left ventricle in patients receiving cardiac resynchronization therapy (CRT). METHODS Sixty-two patients underwent a clinical examination, including New York Heart Association class evaluation and 6-minute walking distance and both echocardiographic study before and 6 months after CRT. Intraventricular dyssynchrony was evaluated by two-dimensional strain echocardiography, measuring the amount of uncoordinated contraction and relaxation between septum and free wall for both longitudinal and radial function and was presented as the longitudinal global dyssynchrony index (LGDI) and the radial global dyssynchrony index (RGDI). Reverse remodeling was defined by a left ventricular end systolic volume reduction >or= 15%. RESULTS After CRT 39 patients showed reverse remodeling. In this group, RGDI (0.74 +/- 0.26 vs 0.32 +/- 0.30; P = 0.0001) and LGDI (0.52 +/- 0.28 vs 0.30 +/- 0.24; P = 0.002) were significantly higher than in nonresponders. A receiver-operating characteristic curve analysis showed that RGDI >0.47 and LGDI >0.34 had a sensitivity and a specificity to predict reverse remodeling of 87% and 74%, 82%, and 74%, respectively. Stepwise forward multiple logistic regression analysis showed that RGDI (O.R.:13.4; 95%C.I.:4.2-120.5; P < 0.0001) was an independent determinant of a positive response to CRT. CONCLUSION A radial global dyssynchrony index predicts left ventricular reverse remodeling after CRT.
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Affiliation(s)
- Luigi Ascione
- Division of Cardiology, S. Maria di Loreto Hospital, Naples, Italy.
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Ng AC, Tran DT, Newman M, Allman C, Vidaic J, Lo ST, Hopkins AP, Leung DY. Left Ventricular Longitudinal and Radial Synchrony and Their Determinants in Healthy Subjects. J Am Soc Echocardiogr 2008; 21:1042-8. [DOI: 10.1016/j.echo.2008.05.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2007] [Indexed: 11/16/2022]
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