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Catrina BI, Batar F, Manitiu I, Prodan L, Tanasescu C, Filip T. Concepts of Cardiac Dyssynchrony and Dynamic Approach. Diagnostics (Basel) 2024; 14:937. [PMID: 38732350 PMCID: PMC11083078 DOI: 10.3390/diagnostics14090937] [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: 02/21/2024] [Revised: 04/12/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
Cardiac conduction involves electrical activity from one myocyte to another, creating coordinated contractions in each. Disruptions in the conducting system, such as left bundle branch block (LBBB), can result in premature activation of specific regions of the heart, leading to heart failure and increased morbidity and mortality. Structural alterations in T-tubules and the sarcoplasmic reticulum can lead to dyssynchrony, a condition that can be treated by cardiac resynchronization therapy (CRT), which stands as a cornerstone in this pathology. The heterogeneity in patient responses underscored the necessity of improving the diagnostic approach. Vectocardiography, ultra-high-frequency ECG, 3D echocardiography, and electrocardiographic imaging seem to offer advanced precision in identifying optimal candidates for CRT in addition to the classic diagnostic methods. The advent of His bundle pacing and left bundle branch pacing further refined the approach in the treatment of dyssynchrony, offering more physiological pacing modalities that promise enhanced outcomes by maintaining or restoring the natural sequence of ventricular activation. HOT-CRT emerges as a pivotal innovation combining the benefits of CRT with the precision of His bundle or left bundle branch area pacing to optimize cardiac function in a subset of patients where traditional CRT might fall short.
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Affiliation(s)
- Bianca Iulia Catrina
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania; (F.B.); (I.M.); (C.T.); (T.F.)
- Pathophysiology Department, Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania
| | - Florina Batar
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania; (F.B.); (I.M.); (C.T.); (T.F.)
- Physiology Pathophysiology Department, Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania
| | - Ioan Manitiu
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania; (F.B.); (I.M.); (C.T.); (T.F.)
- Cardiology Department, Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania
| | - Liliana Prodan
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania; (F.B.); (I.M.); (C.T.); (T.F.)
- Pathophysiology Department, Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania
| | - Ciprian Tanasescu
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania; (F.B.); (I.M.); (C.T.); (T.F.)
- Clinical Surgical Department, Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania
| | - Teodora Filip
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania; (F.B.); (I.M.); (C.T.); (T.F.)
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Yaoting WMD, Huihui CMD, Ruizhong YMD, Jingzhi LMDP, Ji-Bin LMD, Chen L, Chengzhong PMD. Point-of-Care Ultrasound: New Concepts and Future Trends. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2021. [DOI: 10.37015/audt.2021.210023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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3
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Absence of coronary sinus tributaries in ischemic cardiomyopathy: An insight from multidetector computed tomography cardiac venographic study. J Cardiovasc Comput Tomogr 2016; 10:156-61. [DOI: 10.1016/j.jcct.2016.01.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/04/2016] [Accepted: 01/26/2016] [Indexed: 01/23/2023]
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4
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Tong L, Ramalli A, Tortoli P, Fradella G, Caciolli S, Luo J, D'hooge J. Wide-Angle Tissue Doppler Imaging at High Frame Rate Using Multi-Line Transmit Beamforming: An Experimental Validation In Vivo. IEEE TRANSACTIONS ON MEDICAL IMAGING 2016; 35:521-528. [PMID: 26394417 DOI: 10.1109/tmi.2015.2480061] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Color tissue Doppler imaging (TDI) is a well-established methodology to assess local myocardial motion/deformation. Typically, a frame rate of ∼ 200 Hz can be achieved by imaging a narrow sector (∼ 30°, covering one cardiac wall) at moderate line density, using a dedicated pulse sequence and multi-line acquisition. However, a wide angle field-of-view is required in some clinical applications to image the whole left ventricle, which implies a drop in temporal resolution. Hereto, the aim of this study was to propose a novel imaging sequence using a multi-line transmit (MLT) beamforming approach to achieve high frame rate color TDI while preserving a wide field-of-view (i.e., 90° sector). To this end, a color MLT-TDI sequence achieving a frame rate of 208 Hz with a 90°-sector was implemented on an ultrasound experimental scanner interleaved with a conventional color TDI sequence achieving the same frame rate but only with a 22.5°-sector. Using this setup, the septal wall of 9 healthy volunteers was imaged and the corresponding velocity was extracted. The M-mode velocity images and the velocity profiles obtained from the MLT-TDI images presented physiologic patterns, very similar to those from conventional TDI. Moreover, for the peak systolic/diastolic velocities, good agreement and strong correlation between MLT-TDI and conventional TDI were found. The results thus demonstrate the feasibility of the novel MLT based TDI methodology to achieve high frame rate color TDI without compromising the field-of-view. This may open the opportunity to simultaneously assess regional myocardial function of the whole left ventricle at high temporal resolution.
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Bank AJ, Kaufman CL, Burns KV, Parah JS, Johnson L, Kelly AS, Shroff SG, Kaiser DR. Intramural dyssynchrony and response to cardiac resynchronization therapy in patients with and without previous right ventricular pacing. Eur J Heart Fail 2014; 12:1317-24. [DOI: 10.1093/eurjhf/hfq162] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alan J. Bank
- St Paul Heart Clinic; 225 N. Smith Ave. #400 St Paul MN 55102 USA
- University of Minnesota; Minneapolis MN USA
| | | | - Kevin V. Burns
- St Paul Heart Clinic; 225 N. Smith Ave. #400 St Paul MN 55102 USA
| | - Joshua S. Parah
- St Paul Heart Clinic; 225 N. Smith Ave. #400 St Paul MN 55102 USA
| | - Lauren Johnson
- University of Pittsburgh; Pittsburgh PA USA
- CDRM Research, Medtronic Inc.; Minneapolis MN USA
| | - Aaron S. Kelly
- St Paul Heart Clinic; 225 N. Smith Ave. #400 St Paul MN 55102 USA
- University of Minnesota; Minneapolis MN USA
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Sadeghpour A, Hoghooghi A, Alizadehsani Z, Rezaei M, Aghapour S, Haghjoo M. Single beat determination of intraventricular systolic dyssynchrony in patients with atrial fibrillation and systolic dysfunction. Res Cardiovasc Med 2013; 2:85-9. [PMID: 25478499 PMCID: PMC4253764 DOI: 10.5812/cardiovascmed.8776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Revised: 12/09/2012] [Accepted: 12/19/2012] [Indexed: 11/16/2022] Open
Abstract
Background: Atrial fibrillation (AF) is the most common clinically significant cardiac arrhythmia. However, diagnosis of intraventricular dyssynchrony in patients with AF is difficult due to beat-to-beat variation. Additionally, evaluation of mechanical dyssynchrony in the traditional method is based on average of 5 to 10 beats, which is exhausting and time consuming. Single-beat evaluation of a beat with equal subsequent cardiac cycles has been proposed as an accurate method in patients with AF. Objectives: We proposed to evaluate intraventricular mechanical dyssynchrony by measuring time-to-peak systolic velocity between basolateral and basoseptal segments (septum to lateral wall delay) using Tissue Doppler Study (TDI) by two different methods. Materials and Methods: 31 patient (68 ± 10.3 years) with heart failure (EF < 35%) and AF rhythm, R-R cycle length more than 500 msec were evaluated. We found a target beat in which preceding R-R (R-R1) to pre-preceding R-R (R-R2) ratio was 1(RR1/RR2 = 1) then measured the intraventricular dyssynchrony in that cycle. Intraventricular dyssynchrony was also determined and averaged for 8 consecutive cardiac cycles. The values at RR1/RR2 = 1 were compared with the average of intraventricular dyssynchrony in eight cycles and the relationship between dyssynchrony were evaluated by paired T-test, linear Pearson correlation (r2), linear regression analysis. Results: The average of dyssynchrony in eight cycles showed a positive correlation with dyssynchrony in target beat RR1/RR2 = 1. Average of dyssynchrony in target beat was 46.77 msec, and average of 8 cycle was = 47.701, (P value = 0.776, Pearson linear correlation 0.769). Conclusions: Measurement of intraventricular dyssynchromy in basoseptal and basolateral segments in AF and heart failure patients in a single beat with RR1/RR2 = 1 , were very similar to the average value of eight cardiac cycle.
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Affiliation(s)
- Anita Sadeghpour
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Alireza Hoghooghi
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Tehran University Medical Science, Tehran, IR Iran
| | - Zahra Alizadehsani
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Tehran University Medical Science, Tehran, IR Iran
| | - Mohsen Rezaei
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Tehran University Medical Science, Tehran, IR Iran
| | - Sevil Aghapour
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Tehran University Medical Science, Tehran, IR Iran
| | - Majid Haghjoo
- Rajaie Cardiovascular Medical and Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Majid Haghjoo, Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Vali-Asr Ave, Niayesh Blvd, Tehran, IR Iran, Tel: +98-2123922163, Fax: +98-2122048174, E-mail:
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López-Alvarez J, Fonfara S, Pedro B, Stephenson H, Cripps PJ, Dukes-McEwan J. Assessment of mechanical ventricular synchrony in Doberman Pinschers with dilated cardiomyopathy. J Vet Cardiol 2011; 13:183-95. [DOI: 10.1016/j.jvc.2011.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Revised: 04/30/2011] [Accepted: 05/02/2011] [Indexed: 11/17/2022]
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8
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Burns KV, Kaufman CL, Kelly AS, Parah JS, Dengel DR, Bank AJ. Torsion and Dyssynchrony Differences Between Chronically Paced and Non-Paced Heart Failure Patients. J Card Fail 2011; 17:495-502. [DOI: 10.1016/j.cardfail.2011.02.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Revised: 02/22/2011] [Accepted: 02/24/2011] [Indexed: 11/27/2022]
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9
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Differences in left ventricular dyssynchrony between high septal pacing and apical pacing in patients with normal left ventricular systolic function. J Cardiol 2010; 56:44-50. [DOI: 10.1016/j.jjcc.2010.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Revised: 02/01/2010] [Accepted: 02/03/2010] [Indexed: 01/07/2023]
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10
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Evaluation of pacing site in dogs with naturally occurring complete heart block. J Vet Cardiol 2009; 11:79-88. [DOI: 10.1016/j.jvc.2009.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Revised: 05/17/2009] [Accepted: 06/10/2009] [Indexed: 11/22/2022]
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11
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Abstract
Multidetector CT (MDCT) with 64-slice capability continues to gain momentum for cardiovascular imaging. Beyond images of coronary arteries, it also provides reliable information on left ventricular structure and function, cardiac venous anatomy, the pulmonary venous system, and right ventricular function-all aspects important in the management of heart failure patients. Potential unique applications in heart failure include cardiac dyssynchrony evaluation, assessing cardiomyopathies, and post-transplant annual follow-up. This review details the multiple applications and limitations of MDCT in the heart failure population, including comparison with other commonly used imaging modalities such as echocardiography and MRI.
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12
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Chen H, Varghese T, Rahko PS, Zagzebski JA. Ultrasound frame rate requirements for cardiac elastography: experimental and in vivo results. ULTRASONICS 2009; 49:98-111. [PMID: 18657839 DOI: 10.1016/j.ultras.2008.05.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2008] [Revised: 05/15/2008] [Accepted: 05/31/2008] [Indexed: 05/26/2023]
Abstract
Cardiac elastography using radiofrequency echo signals can provide improved 2D strain information compared to B-mode image data, provided data are acquired at sufficient frame rates. In this paper, we evaluate ultrasound frame rate requirements for unbiased and robust estimation of tissue displacements and strain. Both tissue-mimicking phantoms under cyclic compressions at rates that mimic the contractions of the heart and in vivo results are presented. Sinusoidal compressions were applied to the phantom at frequencies ranging from 0.5 to 3.5 cycles/sec, with a maximum deformation of 5% of the phantom height. Local displacements and strains were estimated using both a two-step one-dimensional and hybrid two-dimensional cross-correlation method. Accuracy and repeatability of local strains were assessed as a function of the ultrasound frame rate based on signal-to-noise ratio values. The maximum signal-to-noise ratio obtained in a uniformly elastic phantom is 20 dB for both a 1.26 Hz and a 2 Hz compression frequency when the radiofrequency echo acquisition is at least 12 Hz and 20 Hz respectively. However, for compression frequencies of 2.8 Hz and 4 Hz the maximum signal-to-noise ratio obtained is around 16 dB even for a 40 Hz frame rate. Our results indicate that unbiased estimation of displacements and strain require ultrasound frame rates greater than ten times the compression frequency, although a frame rate of about two times the compression frequency is sufficient to estimate the compression frequency imparted to the tissue-mimicking phantom. In vivo results derived from short-axis views of the heart acquired from normal human volunteers also demonstrate this frame rate requirement for elastography.
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Affiliation(s)
- Hao Chen
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI 53706, USA
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13
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Schwartz DJ, Kop WJ, Park MH, Vesely MR, Li S, Mehra MR, Gottdiener JS. Evidence for early right ventricular and septal mechanical activation (interventricular dyssynchrony) in pulmonary hypertension. Am J Cardiol 2008; 102:1273-7. [PMID: 18940306 DOI: 10.1016/j.amjcard.2008.06.062] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Revised: 06/17/2008] [Accepted: 06/17/2008] [Indexed: 11/15/2022]
Abstract
This study sought to characterize mechanical activation in pulmonary arterial hypertension (PAH) using 2-dimensional echocardiography with tissue Doppler imaging. Whether pathologic alterations of the right ventricle in PAH affect interventricular dyssynchrony due to changes in mechanical activation of the septum and the right ventricle is unclear. We studied 20 patients with PAH (14 women, mean age 55 +/- 16 years) and 20 healthy controls (15 women, mean age 41 +/- 11 years) that underwent tissue Doppler imaging between July 2006 and May 2007. PAH was associated with accelerated right ventricular (RV) (p <0.0001) and septal (p = 0.022) activation times, but no differences were found in lateral wall activation times between groups (p = 0.35). Measures of ventricular dyssynchrony indicated that patients with PAH had significantly lower RV-lateral wall delays (patients 3.2 +/- 66.2 ms vs controls 56.7 +/- 52.0 ms, p = 0.007), reflecting a faster activation of the right ventricle relative to the lateral wall than controls. In conclusion, PAH is associated with interventricular dyssynchrony manifested by accelerated RV free wall and septal activation times. Whether such dyssynchrony should serve as a therapeutic target remains to be determined.
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Affiliation(s)
- Daniel J Schwartz
- Department of Internal Medicine, Division of Cardiology, University of Maryland Medical Systems, Baltimore, Maryland, USA.
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14
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Hina K, Kawamura H, Murakami T, Yamamoto K, Yamaji H, Murakami M, Hirohata S, Ogawa H, Sakane K, Kusachi S. Association of corrected QT dispersion with symptoms improvement in patients receiving cardiac resynchronization therapy. Heart Vessels 2008; 23:325-33. [PMID: 18810581 DOI: 10.1007/s00380-008-1056-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2007] [Accepted: 03/14/2008] [Indexed: 11/25/2022]
Abstract
Cardiac resynchronization therapy (CRT) is theoretically expected to affect repolarization as well as depolarization. We studied the effects of CRT on corrected QT (QTc) dispersion in association with symptomatic improvement. QTc dispersion was analyzed in 26 consecutive patients (67 +/- 6 years old, 18 men and 8 women) who underwent CRT. CRT responders and nonresponders were defined as patients showing and not showing > or = 1 class New York Heart Association symptomatic improvement 3 months after CRT, respectively. QTc interval, QRS width, and QTc dispersion were measured automatically from digital data using an analyzing system. There were 18 CRT responders and 8 nonresponders among the patients. CRT responders showed significantly larger QTc dispersion than CRT nonresponders before CRT (102 +/- 26 vs 40 +/- 12 ms, P < 0.01). A significant decrease in QTc dispersion by CRT was observed in responders (102 +/- 26 to 52 +/- 15 ms, P < 0.01). In contrast, QTc dispersion was not decreased by CRT in nonresponders (40 +/- 12 to 39 +/- 11 ms, not significant). The difference observed before CRT was thus abolished after CRT (52 +/- 15 vs 39 +/- 11 ms, not significant). Baseline values and changes in QRS width or QTc, as well as asynchrony of wall motion determined by tissue Doppler imaging, were not different between CRT responders and nonresponders before CRT. The present study with a small number of patients shows the potential utility of QTc dispersion for distinguishing CRT responders from CRT nonresponders before CRT, and warrants further study with a greater number of patients.
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Affiliation(s)
- Kazuyoshi Hina
- Department of Cardiology, Sakakibara Heart Institute of Okayama, Okayama, Japan
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15
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Li Y, Garson CD, Xu Y, French BA, Hossack JA. High frequency ultrasound imaging detects cardiac dyssynchrony in noninfarcted regions of the murine left ventricle late after reperfused myocardial infarction. ULTRASOUND IN MEDICINE & BIOLOGY 2008; 34:1063-75. [PMID: 18313202 PMCID: PMC2587444 DOI: 10.1016/j.ultrasmedbio.2007.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Revised: 11/22/2007] [Accepted: 12/13/2007] [Indexed: 05/22/2023]
Abstract
Cardiac dyssynchrony in the left ventricles of murine hearts late (> or =28 d) after reperfused myocardial infarction (post-MI) was assessed using high frequency 30 MHz B-mode ultrasound imaging. Nine post-MI and six normal C57Bl/6 mice were studied in both short- and long-axis views. Regional time to peak displacement (T(peak_d)) and time to peak strain (T(peak_s)) were calculated in 36 sectors along the myocardial circumference; then their standard deviations (SD_T(peak_d) and SD_T(peak_s)) were computed among noninfarcted myocardial regions for each mouse and were compared between the normal and post-MI mouse groups with Student's t-test. The comparison revealed that SD_T(peak_d) and SD_T(peak_s) were significantly larger in the post-MI hearts than in the normal hearts. The displacement uniformity ratio was determined to be 0.97 +/- 0.01 and 0.85 +/- 0.07 for radial and circumferential displacements in the normal hearts, respectively; and 0.59 +/- 0.17 and 0.64 +/- 0.24 in the post-MI hearts. In conclusion, this high resolution ultrasound image tracking method provides for the detection of cardiac dyssynchrony in the noninfarcted regions in the murine left ventricles late after MI by identifying the temporal and spatial disparity of regional myocardial contraction.
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Affiliation(s)
- Yinbo Li
- Department of Biomedical Engineering, University of Virginia (Charlottesville, VA, USA)
| | - Christopher D. Garson
- Department of Biomedical Engineering, University of Virginia (Charlottesville, VA, USA)
| | - Yaqin Xu
- Department of Biomedical Engineering, University of Virginia (Charlottesville, VA, USA)
| | - Brent A. French
- Department of Biomedical Engineering, University of Virginia (Charlottesville, VA, USA)
- Department of Medicine, University of Virginia (Charlottesville, VA, USA)
- Department of Radiology, University of Virginia (Charlottesville, VA, USA)
| | - John A. Hossack
- Department of Biomedical Engineering, University of Virginia (Charlottesville, VA, USA)
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Noninvasive imaging of cardiac venous anatomy with 64-slice multi-slice computed tomography and noninvasive assessment of left ventricular dyssynchrony by 3-dimensional tissue synchronization imaging in patients with heart failure scheduled for cardiac resynchronization therapy. Am J Cardiol 2008; 101:1023-9. [PMID: 18359325 DOI: 10.1016/j.amjcard.2007.11.052] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2007] [Revised: 11/18/2007] [Accepted: 11/18/2007] [Indexed: 11/19/2022]
Abstract
Objectives of this study were to perform a prospective head-to-head comparison between multi-slice computed tomography (MSCT) venography and invasive venography in cardiac resynchronization therapy (CRT) candidates as well as to evaluate the relation between left ventricular (LV) lead position and effect on LV dyssynchrony and immediate response to CRT. Twenty-one consecutive heart failure patients scheduled for CRT implantation were prospectively enrolled to undergo 64-slice MSCT to visualize the venous system, invasive venography during device implantation, and tri-plane tissue synchronization imaging (TSI) before and after implantation. Excellent agreement between MSCT and invasive venography was noted. No significant differences were observed between both techniques regarding vessel diameters. In 12 patients, a match was observed between the area of latest mechanical activation (on TSI) and LV lead position. These patients showed a significant decrease in LV dyssynchrony (43 +/- 7 ms to 11 +/- 9 ms, p <0.0001) with acute reduction in LV end-systolic volume (188 +/- 54 ml to 162 +/- 48 ml, p <0.01) and improvement in LV ejection fraction (22% +/- 9% to 34% +/- 9%, p <0.01). Patients with a mismatch between area of latest activation and LV lead position remained dyssynchronous without improvement in LV function. In conclusion, visualization of major tributaries of the coronary sinus was comparable between invasive venography and MSCT venography. Optimal LV lead positioning in a vein draining the area of latest mechanical activation (determined from tri-plane TSI) resulted in acute improvement of LV dyssynchrony and systolic function after CRT implantation.
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17
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Bank AJ, Burns KV, Kelly AS, Thelen AM, Kaufman CL, Adler SW. Echocardiographic Improvements with Pacemaker Optimization in the Chronic Post Cardiac Resynchronization Therapy Setting. Clin Med Cardiol 2008. [DOI: 10.4137/cmc.s515] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Alan J. Bank
- Department of Research, St. Paul Heart Clinic, St. Paul, MN
- School of Medicine, University of Minnesota, Minneapolis, MN
| | - Kevin V. Burns
- Department of Research, St. Paul Heart Clinic, St. Paul, MN
| | - Aaron S. Kelly
- Department of Research, St. Paul Heart Clinic, St. Paul, MN
- School of Medicine, University of Minnesota, Minneapolis, MN
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18
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Valzania C, Rocchi G, Biffi M, Martignani C, Bertini M, Diemberger I, Biagini E, Ziacchi M, Domenichini G, Saporito D, Rapezzi C, Branzi A, Boriani G. Left Ventricular versus Biventricular Pacing: A Randomized Comparative Study Evaluating Mid-Term Electromechanical and Clinical Effects. Echocardiography 2007; 25:141-8. [DOI: 10.1111/j.1540-8175.2007.00576.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Van de Veire NR, Bleeker GB, Ypenburg C, De Sutter J, Ajmone Marsan N, Holman ER, van der Wall EE, Schalij MJ, Bax JJ. Usefulness of triplane tissue Doppler imaging to predict acute response to cardiac resynchronization therapy. Am J Cardiol 2007; 100:476-82. [PMID: 17659932 DOI: 10.1016/j.amjcard.2007.03.051] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2006] [Revised: 03/05/2007] [Accepted: 03/05/2007] [Indexed: 11/20/2022]
Abstract
This study evaluated the value of triplane tissue Doppler imaging (TDI) to predict acute response after cardiac resynchronization therapy (CRT). Forty-nine patients scheduled for CRT underwent triplane echocardiography with simultaneous TDI acquisition before and 48 hours after implantation. A 3-dimensional left ventricular (LV) volume was generated and LV volumes and ejection fraction were calculated. A parametric imaging technique, tissue synchronization imaging, was applied to portray the area of latest mechanical activation. LV dyssynchrony was quantitatively analyzed by evaluating time from QRS onset to peak myocardial velocity in 12 LV segments from the triplane dataset. Acute response was defined as > or =15% decrease in LV end-systolic volume. Receiver-operating characteristic curves of dyssynchrony parameters were analyzed to identify predictors of response to CRT. Acute response was observed in 47% of patients. Responders had a significantly larger extent of LV dyssynchrony at baseline compared with nonresponders. Optimal prediction of acute response to CRT was obtained with the SD of time delays in all LV segments (sensitivity 91%, specificity 85%). In conclusion, 3-dimensional TDI echocardiography permits parametric and quantitative analyses of LV dyssynchrony and assessment of LV volumes and ejection fraction. LV dyssynchrony parameters, derived from the triplane TDI dataset, were highly predictive for acute volumetric response to CRT.
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Affiliation(s)
- Nico R Van de Veire
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
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20
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Butler J. The Emerging Role of Multi-Detector Computed Tomography in Heart Failure. J Card Fail 2007; 13:215-26. [PMID: 17448420 DOI: 10.1016/j.cardfail.2006.11.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2006] [Revised: 11/18/2006] [Accepted: 11/21/2006] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recent advances in cardiac multi-detector computed tomography (MDCT) technology now permits entire coronary tree evaluation in a single breath hold with submillimeter slice collimation and improved temporal resolution. METHODS AND RESULTS Besides excellent correlation with invasive angiogram for the detection of significant coronary occlusion, MDCT also provides reliable and reproducible data regarding various other cardiac anatomic and functional parameters that are pertinent to heart failure patients. These include left ventricular measurement (eg, ejection fraction, regional wall motion, dimensions, volumes), pulmonary vein anatomy and drainage, right ventricular function, and cardiac venous system, among many others. However, there are radiogenic and nonradiogenic risks associated with MDCT that should be considered before scanning the patients. CONCLUSIONS This review summarizes the existing literature of the various cardiac MDCT applications pertinent to heart failure patients.
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Van de Veire NR, Bleeker GB, De Sutter J, Ypenburg C, Holman ER, van der Wall EE, van der Wal EE, Schalij MJ, Bax JJ. Tissue synchronisation imaging accurately measures left ventricular dyssynchrony and predicts response to cardiac resynchronisation therapy. Heart 2007; 93:1034-9. [PMID: 17309912 PMCID: PMC1955031 DOI: 10.1136/hrt.2006.099424] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Tissue synchronisation imaging (TSI) is a new technique to assess left ventricular (LV) dyssynchrony. OBJECTIVES The value of using TSI to automatically assess LV dyssynchrony compared with manual assessment of LV dyssynchrony from colour-coded tissue Doppler imaging (TDI), and to evaluate the value of TSI to predict response to cardiac resynchronisation therapy (CRT). METHODS 60 symptomatic patients with heart failure with depressed LV ejection fraction (LVEF) and QRS >120 ms were evaluated clinically and echocardiographically at baseline and after 6 months of CRT. LV dyssynchrony was measured manually using velocity tracings from the colour-coded TDI and automatically using TSI. LV volumes and LVEF were assessed from two-dimensional echocardiography. Clinical responders had to exhibit an improvement in New York Heart Association functional class by > or =1 score and an improvement by > or =25% in 6 min walking distance after 6 months. Reverse LV remodelling was defined as a reduction of > or =15% LV end-systolic volume. RESULTS An excellent correlation was observed between LV dyssynchrony measured manually and automatically derived by TSI (r = 0.95, p<0.001). 34 patients showed clinical response after 6 months of CRT and 32 patients showed reverse remodelling. Baseline characteristics were comparable between responders and non-responders, except for more extensive LV dyssynchrony in the responders: 78 (26) vs 29 (29) ms (p<0.001) as assessed manually, and 79 (29) vs 28 (27) ms (p<0.001) as assessed with TSI. Using a cut-off value of 65 ms to define extensive LV dyssynchrony, TSI had a sensitivity of 81% with a specificity of 89% to predict reverse LV remodelling. CONCLUSION TSI allows automatic and reliable assessment of LV dyssynchrony and predicts reverse LV remodelling after CRT.
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Affiliation(s)
- Nico R Van de Veire
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
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Ruiz-Mateas F, Sancho-Tello MJ, Coma-Sanmartín R, Fidalgo-Andrés M, Martínez-Ferrere J, García-Calabozo R. Novedades en estimulación cardiaca 2006. Rev Esp Cardiol (Engl Ed) 2007; 60 Suppl 1:92-100. [PMID: 17352859 DOI: 10.1157/13099716] [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: 11/21/2022]
Abstract
This article summarizes progress in cardiac pacing that has taken place in the last year, such as the incorporation of navigation technology into programmers, systems for monitoring hemodynamic parameters, and new developments in patient follow-up, principally home monitoring and the use of treatment guidelines. In addition, the article covers recent findings in resynchronization therapy, paroxysmal atrial fibrillation, and the management of patients with pacemakers who need to undergo magnetic resonance imaging.
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Affiliation(s)
- Francisco Ruiz-Mateas
- Unidad de Estimulación Cardiaca, Unidad de Cardiología, Hospital Costa del Sol, Marbella, España
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Van de Veire NR, Schuijf JD, De Sutter J, Devos D, Bleeker GB, de Roos A, van der Wall EE, Schalij MJ, Bax JJ. Non-Invasive Visualization of the Cardiac Venous System in Coronary Artery Disease Patients Using 64-Slice Computed Tomography. J Am Coll Cardiol 2006; 48:1832-8. [PMID: 17084258 DOI: 10.1016/j.jacc.2006.07.042] [Citation(s) in RCA: 150] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2006] [Revised: 07/11/2006] [Accepted: 07/17/2006] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study was designed to evaluate the value of 64-slice computed tomography (CT) to visualize the cardiac veins and evaluate the relation between variations in venous anatomy and history of infarction. BACKGROUND Cardiac resynchronization therapy (CRT) is an attractive treatment for selected heart failure patients. Knowledge of venous anatomy may help in identifying candidates for successful left ventricular lead implantation. METHODS The 64-slice CT of 100 individuals (age 61 +/- 11 years, 68% men) was studied. Subjects were divided into 3 groups: 28 control patients, 38 patients with significant coronary artery disease (CAD), and 34 patients with a history of infarction. Presence of the following coronary sinus (CS) tributaries was evaluated: posterior interventricular vein (PIV), posterior vein of the left ventricle, and left marginal vein (LMV). Vessel diameters were also measured. RESULTS Coronary sinus and PIV were identified in all individuals. Posterior vein of the left ventricle was observed in 96% of control patients, 84% of CAD patients, and 82% of infarction patients. In patients with a history of infarction, a LMV was significantly less observed as compared with control patients and CAD patients (27% vs. 71% and 61%, respectively, p < 0.001). None of the patients with lateral infarction and only 22% of patients with anterior infarction had a LMV. Regarding quantitative data, no significant differences were observed between the groups. CONCLUSIONS Non-invasive evaluation of cardiac veins with 64-slice CT is feasible. There is considerable variation in venous anatomy. Patients with a history of infarction were less likely to have a LMV, which may hamper optimal left ventricular lead positioning in CRT implantation.
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Affiliation(s)
- Nico R Van de Veire
- Department of cardiology, Leiden University Medical Center, Leiden, The Netherlands.
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Abstract
Cardiac resynchronization therapy (CRT) is a well-accepted and effective therapy for treating patients with a wide QRS complex, significant left ventricular systolic dysfunction, and symptoms of advanced heart failure. However, approximately 25% to 30% of patients fail to respond to this therapy. Most large studies have used electrical dyssynchrony (wide QRS) as a main entrance criterion. Emerging data suggest that mechanical dyssynchrony may be a more important factor in selecting appropriate candidates for CRT. New echocardiographic (ECHO) imaging modalities such as tissue Doppler imaging, three-dimensional ECHO, and speckle tracking ECHO are able to quantify left ventricular mechanical dyssynchrony. These techniques are currently being used to assist in the selection of patients for CRT. Recently published and ongoing studies are addressing the use of CRT in patients who do not meet the standard criteria, such as patients with atrial fibrillation, mild to moderate heart failure, narrow QRS complex, and acute myocardial infarction.
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Affiliation(s)
- Alan J Bank
- Department of Research, St. Paul Heart Clinic,255 North Smith Avenue, Suite 100,St. Paul, MN 55102, USA.
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