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Lazăr-Höcher AI, Cozma D, Cirin L, Cozgarea A, Faur-Grigori AA, Catană R, Tudose DG, Târtea G, Crișan S, Gaiță D, Luca CT, Văcărescu C. A Comparative Analysis of Apical Rocking and Septal Flash: Two Views of the Same Systole? J Clin Med 2024; 13:3109. [PMID: 38892820 PMCID: PMC11172686 DOI: 10.3390/jcm13113109] [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: 03/28/2024] [Revised: 05/11/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024] Open
Abstract
Heart failure (HF) is a complex medical condition characterized by both electrical and mechanical dyssynchrony. Both dyssynchrony mechanisms are intricately linked together, but the current guidelines for cardiac resynchronization therapy (CRT) rely only on the electrical dyssynchrony criteria, such as the QRS complex duration. This possible inconsistency may result in undertreating eligible individuals who could benefit from CRT due to their mechanical dyssynchrony, even if they fail to fulfill the electrical criteria. The main objective of this literature review is to provide a comprehensive analysis of the practical value of echocardiography for the assessment of left ventricular (LV) dyssynchrony using parameters such as septal flash and apical rocking, which have proven their relevance in patient selection for CRT. The secondary objectives aim to offer an overview of the relationship between septal flash and apical rocking, to emphasize the primary drawbacks and benefits of using echocardiography for evaluation of septal flash and apical rocking, and to offer insights into potential clinical applications and future research directions in this area. Conclusion: there is an opportunity to render resynchronization therapy more effective for every individual; septal flash and apical rocking could be a very useful and straightforward echocardiography resource.
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Affiliation(s)
- Alexandra-Iulia Lazăr-Höcher
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.-I.L.-H.); (L.C.); (A.C.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania; (A.-A.F.-G.); (S.C.); (D.G.); (C.-T.L.); (C.V.)
| | - Dragoș Cozma
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania; (A.-A.F.-G.); (S.C.); (D.G.); (C.-T.L.); (C.V.)
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania;
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Liviu Cirin
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.-I.L.-H.); (L.C.); (A.C.)
| | - Andreea Cozgarea
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.-I.L.-H.); (L.C.); (A.C.)
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania
| | - Adelina-Andreea Faur-Grigori
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania; (A.-A.F.-G.); (S.C.); (D.G.); (C.-T.L.); (C.V.)
| | - Rafael Catană
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania;
| | - Dănuț George Tudose
- Institute of Cardiovascular Diseases C.C. Iliescu, Fundeni Clinical Institute, 258 Fundeni Street, 022328 Bucharest, Romania;
| | - Georgică Târtea
- Department of Physiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Simina Crișan
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania; (A.-A.F.-G.); (S.C.); (D.G.); (C.-T.L.); (C.V.)
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania;
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Dan Gaiță
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania; (A.-A.F.-G.); (S.C.); (D.G.); (C.-T.L.); (C.V.)
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania;
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Constantin-Tudor Luca
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania; (A.-A.F.-G.); (S.C.); (D.G.); (C.-T.L.); (C.V.)
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania;
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Cristina Văcărescu
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania; (A.-A.F.-G.); (S.C.); (D.G.); (C.-T.L.); (C.V.)
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania;
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
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Santos MR, Silva MS, Guerreiro SL, Gomes DA, Rocha BM, Cunha GL, Freitas PN, Abecasis JM, Santos AC, Saraiva CC, Mendes M, Ferreira AM. Assessment of myocardial strain patterns in patients with left bundle branch block using cardiac magnetic resonance. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024:10.1007/s10554-024-03049-3. [PMID: 38376720 DOI: 10.1007/s10554-024-03049-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/05/2024] [Indexed: 02/21/2024]
Abstract
Recently, a classification with four types of septal longitudinal strain patterns was described using echocardiography, suggesting a pathophysiological continuum of left bundle branch block (LBBB)-induced left ventricle (LV) remodeling. The aim of this study was to assess the feasibility of classifying these strain patterns using cardiovascular magnetic resonance (CMR), and to evaluate their association with LV remodeling and myocardial scar. Single center registry included LBBB patients with septal flash (SF) referred to CMR to assess the cause of LV systolic dysfunction. Semi-automated feature-tracking cardiac resonance (FT-CMR) was used to quantify myocardial strain and detect the four strain patterns. A total of 115 patients were studied (age 66 ± 11 years, 57% men, 28% with ischemic heart disease). In longitudinal strain analysis, 23 patients (20%) were classified in stage LBBB-1, 37 (32.1%) in LBBB-2, 25 (21.7%) in LBBB-3, and 30 (26%) in LBBB-4. Patients at higher stages had more prominent septal flash, higher LV volumes, lower LV ejection fraction, and lower absolute strain values (p < 0.05 for all). Late gadolinium enhancement (LGE) was found in 55% of the patients (n = 63). No differences were found between the strain patterns regarding the presence, distribution or location of LGE. Among patients with LBBB, there was a good association between strain patterns assessed by FT-CMR analysis and the degree of LV remodeling and LV dysfunction. This association seems to be independent from the presence and distribution of LGE.
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Affiliation(s)
- Marina Raquel Santos
- Hospital Dr. Nélio Mendonça, Funchal, Portugal.
- CHLO - Hospital de Santa Cruz, Lisbon, Portugal.
| | - Mariana Santos Silva
- CHLO - Hospital de Santa Cruz, Lisbon, Portugal
- Centro Hospitalar Barreiro/Montijo, Setúbal, Portugal
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Sisti N, Cardona A, Baldi E, Sciaccaluga C, Notaristefano F, Santoro A, Mandoli GE, Cameli M. Multimodality Imaging for Selecting Candidates for CRT: Do We Have a Single Alley to Increase Responders? Curr Probl Cardiol 2024; 49:102150. [PMID: 37863462 DOI: 10.1016/j.cpcardiol.2023.102150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 10/14/2023] [Indexed: 10/22/2023]
Abstract
Cardiac resynchronization therapy has evolved in recent years to provide a reduction of morbidity and mortality for many patients with heart failure. Its application and optimization is an evolving field and its use requires a multidisciplinary approach for patient and device selection, technical preprocedural planning, and optimization. While echocardiography has always been considered the first line for the evaluation of patients, additional imaging techniques have gained increasing evidence in recent years. Today different details about heart anatomy, function, dissynchrony can be investigated by magnetic resonance, cardiac computed tomography, nuclear imaging, and more, with the aim of obtaining clues to reach a maximal response from the electrical therapy. The purpose of this review is to provide a practical analysis of the single and combined use of different imaging techniques in the preoperative and perioperative phases of cardiac resynchronization therapy, underlining their main advantages, limitations, and information provided.
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Affiliation(s)
- Nicolò Sisti
- Department of Cardiology, Hospital of Gubbio, Gubbio, Italy.
| | - Andrea Cardona
- Division of Advanced Cardiovascular Diagnostics, Regional Healthcare Unit, Todi Hospital, Todi, Italy
| | - Enrico Baldi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Carlotta Sciaccaluga
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
| | | | - Amato Santoro
- Division of Cardiology, Cardio Thoracic and Vascular Department, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
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Sade LE, Joshi SS, Cameli M, Cosyns B, Delgado V, Donal E, Edvardsen T, Carvalho RF, Manka R, Podlesnikar T, Popescu BA, Hanzevacki JS, Sitges M, Dweck MR. Current clinical use of speckle-tracking strain imaging: insights from a worldwide survey from the European Association of Cardiovascular Imaging (EACVI). Eur Heart J Cardiovasc Imaging 2023; 24:1583-1592. [PMID: 37463125 DOI: 10.1093/ehjci/jead170] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 07/06/2023] [Indexed: 07/20/2023] Open
Abstract
AIMS Speckle-tracking echocardiography (STE) strain imaging has been a major advancement in myocardial function quantification. We aimed to explore current worldwide clinical application of STE. METHODS AND RESULTS Access, feasibility, access, and clinical implementation of STE were investigated with a worldwide open-access online survey of the European Association of Cardiovascular Imaging. Participants (429 respondents and 77 countries) from tertiary centres (46%), private clinics, or public hospitals (54%) using different vendors for data acquisition and analysis were represented. Despite almost universal access (98%) to STE, only 39% of the participants performed and reported STE results frequently (>50%). Incomplete training and time constraints were the main reasons for not using STE more regularly. STE was mainly used to assess the LV (99%) and less frequently the right ventricular (57%) and the left atrial (46%) function. Cardiotoxicity (88%) and cardiac amyloidosis (87%) were the most frequent reasons for the clinical use of LV STE. Left atrial STE was used most frequently for the diagnosis of diastolic dysfunction and right ventricular STE for the assessment of right ventricle (RV) function in pulmonary hypertension (51%). Frequency of STE use, adherence to optimal techniques, and clinical appropriateness of STE differed according to training experience and across vendors. Key suggestions outlined by respondents to increase the clinical use of STE included improved reproducibility (48%) and standardization of strain values across vendors (42%). CONCLUSION Although STE is now readily available, it is underutilized in the majority of centres. Structured training, improved reproducibility, and inter-vendor standardization may increase its uptake.
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Affiliation(s)
- Leyla Elif Sade
- Department of Cardiology, University of Pittsburgh Medical Center, Heart and Vascular Institute, 200 Lothrop Street, Ste E354.2, Pittsburgh, PA, 15232, USA
| | - Shruti S Joshi
- BHF Centre for Cardiovascular Science, Chancellor's Building, University of Edinburgh, Little France Crescent, Edinburgh EH16 4SB, UK
| | - Matteo Cameli
- Department of Cardiovascular Disease, University of Siena, Siena, Italy
| | - Bernard Cosyns
- Cardiology Department, Centrum voor Hart en Vaatziekten (CHVZ), Universitair ziekenhuis Brussel, Brussels, Belgium
| | - Victoria Delgado
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Erwan Donal
- Cardiologie, CHU de RENNES, LTSI UMR1099, INSERM, Universite´ de Rennes-1, Rennes, France
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet and University of Oslo, Norway
| | - Ricardo Fontes Carvalho
- Serviço de Cardiologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Gaia, Portugal
- Centro de Investigação Cardiovascular (UniC@RISE), Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Robert Manka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Tomaz Podlesnikar
- Department of Cardiac Surgery, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia
- Department of Cardiology, University Medical Centre Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy 'Carol Davila'-Euroecolab, Emergency Institute for Cardiovascular Diseases 'Prof. Dr. C. C. Iliescu', Bucharest, Romania Sos. Fundeni 258, sector 2, 022328 Bucharest, Romania
| | | | - Marta Sitges
- Cardiovascular Institute, Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBER, Centro de Investigación Biomédica en Red, Spain
| | - Marc R Dweck
- BHF Centre for Cardiovascular Science, Chancellor's Building, University of Edinburgh, Little France Crescent, Edinburgh EH16 4SB, UK
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Layec J, Decroocq M, Delelis F, Appert L, Guyomar Y, Riolet C, Dumortier H, Mailliet A, Tribouilloy C, Maréchaux S, Menet A. Dyssynchrony and Response to Cardiac Resynchronization Therapy in Heart Failure Patients With Unfavorable Electrical Characteristics. JACC Cardiovasc Imaging 2023:S1936-878X(23)00027-X. [PMID: 37038875 DOI: 10.1016/j.jcmg.2022.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 11/23/2022] [Accepted: 12/23/2022] [Indexed: 04/12/2023]
Abstract
BACKGROUND Among heart failure (HF) patients undergoing cardiac resynchronization therapy (CRT), those with unfavorable electrical characteristics (UEC) are less frequently CRT responders. OBJECTIVES In this study, the authors sought to evaluate the relationship between preprocedural echocardiographic parameters of electromechanical dyssynchrony (EMD) and outcome following CRT. METHODS Among 551 patients receiving CRT, 121 with UEC, defined as atypical left bundle branch, presence of right bundle branch block, or unspecified intraventricular conduction disturbance, were enrolled. Indices of EMD were presence of septal flash, apical rocking, septal deformation patterns, and global wasted work (GWW), determined with the use of speckle-tracking strain echocardiography. Endpoints were response to CRT, defined as a relative decrease in left ventricular end-systolic volume ≥15% at 9-month postoperative follow-up, and all-cause death or HF hospitalization during follow-up. RESULTS Among the 121 patients, 68 (56%) were CRT responders. In multivariate analysis, GWW ≥200 mm Hg% (adjusted odds ratio [aOR]: 4.17 [95% CI: 1.33-14.56]; P = 0.0182) and longitudinal strain septal contraction patterns 1 and 2 (aOR: 10.05 [95% CI: 2.82-43.97]; P < 0.001) were associated with CRT response. During a 46-month follow-up (IQR: 42-55 months), survival free from death or HF hospitalization increased with the number of positive criteria (87% for 2, 59% for 1, and 27% for 0). After adjustment for established predictors of outcome in patients receiving CRT, absence of either of the 2 criteria remained associated with a considerable increased risk of death and/or HF hospitalization (adjusted HR: 4.83 [95% CI: 1.84-12.68]; P = 0.001). CONCLUSIONS In patients with UEC, echocardiographic assessment of EMD may help to select patients who will derive benefit from CRT.
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Affiliation(s)
- Jeremy Layec
- Laboratoire ETHICS, Groupement des Hôpitaux de l'Institut Catholique de Lille, Service de Cardiologie, USIC, Université Catholique de Lille, Lille, France
| | - Marie Decroocq
- Laboratoire ETHICS, Groupement des Hôpitaux de l'Institut Catholique de Lille, Service de Cardiologie, USIC, Université Catholique de Lille, Lille, France
| | - Francois Delelis
- Laboratoire ETHICS, Groupement des Hôpitaux de l'Institut Catholique de Lille, Service de Cardiologie, USIC, Université Catholique de Lille, Lille, France
| | - Ludovic Appert
- Laboratoire ETHICS, Groupement des Hôpitaux de l'Institut Catholique de Lille, Service de Cardiologie, USIC, Université Catholique de Lille, Lille, France
| | - Yves Guyomar
- Laboratoire ETHICS, Groupement des Hôpitaux de l'Institut Catholique de Lille, Service de Cardiologie, USIC, Université Catholique de Lille, Lille, France
| | - Clémence Riolet
- Laboratoire ETHICS, Groupement des Hôpitaux de l'Institut Catholique de Lille, Service de Cardiologie, USIC, Université Catholique de Lille, Lille, France
| | - Hélène Dumortier
- Laboratoire ETHICS, Groupement des Hôpitaux de l'Institut Catholique de Lille, Service de Cardiologie, USIC, Université Catholique de Lille, Lille, France
| | - Amandine Mailliet
- Laboratoire ETHICS, Groupement des Hôpitaux de l'Institut Catholique de Lille, Service de Cardiologie, USIC, Université Catholique de Lille, Lille, France
| | - Christophe Tribouilloy
- Departement de Cardiologie, CHU Amiens, Amiens, France; UR UPJV 7517, Université Jules Verne de Picardie, Amiens, France
| | - Sylvestre Maréchaux
- Laboratoire ETHICS, Groupement des Hôpitaux de l'Institut Catholique de Lille, Service de Cardiologie, USIC, Université Catholique de Lille, Lille, France.
| | - Aymeric Menet
- Laboratoire ETHICS, Groupement des Hôpitaux de l'Institut Catholique de Lille, Service de Cardiologie, USIC, Université Catholique de Lille, Lille, France
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6
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Calle S, Duchenne J, Beela AS, Stankovic I, Puvrez A, Winter S, Fehske W, Aarones M, De Buyzere M, De Pooter J, Voigt JU, Timmermans F. Clinical and Experimental Evidence for a Strain-Based Classification of Left Bundle Branch Block-Induced Cardiac Remodeling. Circ Cardiovasc Imaging 2022; 15:e014296. [PMID: 36330792 DOI: 10.1161/circimaging.122.014296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Septal strain patterns measured by echocardiography reflect the severity of left bundle branch block (LBBB)-induced left ventricular (LV) dysfunction. We investigated whether these LBBB strain stages predicted the response to cardiac resynchronization therapy in an observational study and developed a sheep model of LBBB-induced cardiomyopathy. METHODS The clinical study enrolled cardiac resynchronization therapy patients who underwent echocardiographic examination with speckle-tracking strain analysis before cardiac resynchronization therapy implant. In an experimental sheep model with pacing-induced dyssynchrony, LV remodeling and strain were assessed at baseline, at 8 and 16 weeks. Septal strain curves were classified into 5 patterns (LBBB-0 to LBBB-4). RESULTS The clinical study involved 250 patients (age 65 [58; 72] years; 79% men; 89% LBBB) with a median LV ejection fraction of 25 [21; 30]%. Across the stages, cardiac resynchronization therapy resulted in a gradual volumetric response, ranging from no response in LBBB-0 patients (ΔLV end-systolic volume 0 [-12; 15]%) to super-response in LBBB-4 patients (ΔLV end-systolic volume -44 [-64; -18]%) (P<0.001). LBBB-0 patients had a less favorable long-term outcome compared with those in stage LBBB≥1 (log-rank P=0.003). In 13 sheep, acute right ventricular pacing resulted in LBBB-1 (23%) and LBBB-2 (77%) patterns. Over the course of 8-16 weeks, continued pacing resulted in progressive LBBB-induced dysfunction, coincident with a transition to advanced strain patterns (92% LBBB-2 and 8% LBBB-3 at week 8; 75% LBBB-3 and 25% LBBB-4 at week 16) (P=0.023). CONCLUSIONS The strain-based LBBB classification reflects a pathophysiological continuum of LBBB-induced remodeling over time and is associated with the extent of reverse remodeling in observational cardiac resynchronization therapy-eligible patients.
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Affiliation(s)
- Simon Calle
- Department of Cardiology, University Hospital Ghent, Belgium (S.C., M.D.B., J.D.P., F.T.)
| | - Jürgen Duchenne
- Department of Cardiovascular Sciences, KU Leuven, Belgium (J.D., A.S.B., I.S., A.P., J.-U.V.).,Department of Cardiovascular Diseases, University Hospital Leuven, Belgium (J.D., A.P., J.-U.V.)
| | - Ahmed S Beela
- Department of Cardiovascular Sciences, KU Leuven, Belgium (J.D., A.S.B., I.S., A.P., J.-U.V.).,Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht, the Netherlands (A.S.B.).,Department of Cardiovascular Diseases, Suez Canal University, Egypt (A.S.B.)
| | - Ivan Stankovic
- Department of Cardiovascular Sciences, KU Leuven, Belgium (J.D., A.S.B., I.S., A.P., J.-U.V.).,Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Serbia (I.S.)
| | - Alexis Puvrez
- Department of Cardiovascular Sciences, KU Leuven, Belgium (J.D., A.S.B., I.S., A.P., J.-U.V.).,Department of Cardiovascular Diseases, University Hospital Leuven, Belgium (J.D., A.P., J.-U.V.)
| | - Stefan Winter
- Department of Cardiology, St. Vinzenz Hospital, Germany (S.W., W.F.)
| | - Wolfgang Fehske
- Department of Cardiology, St. Vinzenz Hospital, Germany (S.W., W.F.)
| | - Marit Aarones
- Department of Medicine, Diakonhjemmet Hospital, Norway (M.A.H.)
| | - Marc De Buyzere
- Department of Cardiology, University Hospital Ghent, Belgium (S.C., M.D.B., J.D.P., F.T.)
| | - Jan De Pooter
- Department of Cardiology, University Hospital Ghent, Belgium (S.C., M.D.B., J.D.P., F.T.)
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, KU Leuven, Belgium (J.D., A.S.B., I.S., A.P., J.-U.V.).,Department of Cardiovascular Diseases, University Hospital Leuven, Belgium (J.D., A.P., J.-U.V.)
| | - Frank Timmermans
- Department of Cardiology, University Hospital Ghent, Belgium (S.C., M.D.B., J.D.P., F.T.)
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7
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Shoman KA, Eldamanhory HM, Fakhry EE, Badran HA. Role of Strauss ECG criteria as predictor of response in patients undergoing cardiac resynchronization therapy. Egypt Heart J 2022; 74:69. [PMID: 36178602 PMCID: PMC9525510 DOI: 10.1186/s43044-022-00308-3] [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: 06/06/2022] [Accepted: 09/21/2022] [Indexed: 11/28/2022] Open
Abstract
Background Cardiac resynchronization therapy (CRT) is a standard treatment in patients with heart failure; however, approximately 20–40% of recipients of (CRT) do not respond to it based on the current patients’ selection criteria. The purpose of this study was to identify the baseline parameters that predict the CRT response and how the ECG morphology can affect the outcome. The study aimed to evaluate the Strauss ECG criteria as a predictor of response in patients undergoing cardiac resynchronization therapy.
Results Out of 70 patients, 3 patients missed the 6-month follow-up after CRT implantation, so the study enrolled 67 patients that have been classified according to ECG morphology of LBBB to 37 patients with non-Strauss ECG criteria—one of whom died after 4 months—and 30 patients with Strauss ECG criteria. The number of responders in the study was 50 patients with percentage 75.8%; 52% of CRT responder (26 patients) had non-Strauss ECG criteria, while 48% of CRT responders (24 patients) had Strauss ECG criteria with P value = 0.463. While there was no statistical significance of overall CRT response nor 6-month hospitalization and mortality between patients of Strauss and non-Strauss ECG criteria, there was a significant improvement in NYHA class, EF assessed by biplane Simpson’s, end-systolic volume, global longitudinal strain and global circumferential strain by speckle tracking echocardiography in patients with Strauss ECG criteria of LBBB. Conclusions There is no statistical significance in overall CRT response nor the 6-month hospitalization and mortality after 6 months of follow-up between patients with Strauss and non-Strauss ECG criteria of LBBB; however, patients with Strauss ECG criteria have better improvement in NYHA class, echocardiographic parameters such as EF and ESV and speckle tracking parameters (GLS and GCS).
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8
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Classic pattern dyssynchrony is associated with outcome in patients with Fontan circulation. J Am Soc Echocardiogr 2022; 35:513-522. [DOI: 10.1016/j.echo.2022.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 01/08/2022] [Accepted: 01/21/2022] [Indexed: 11/24/2022]
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9
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Riolet C, Menet A, Mailliet A, Binda C, Altes A, Appert L, Castel AL, Delelis F, Viart G, Guyomar Y, Le Goffic C, Decroocq M, Ennezat PV, Graux P, Tribouilloy C, Marechaux S. Clinical Significance of Global Wasted Work in Patients with Heart Failure Receiving Cardiac Resynchronization Therapy. J Am Soc Echocardiogr 2021; 34:976-986. [PMID: 34157400 DOI: 10.1016/j.echo.2021.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/14/2021] [Accepted: 06/14/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The relationship between myocardial work assessment using pressure-strain loops by echocardiography before cardiac resynchronization therapy (CRT) and response to CRT has been recently revealed. Among myocardial work parameters, the impact of left ventricular myocardial global wasted work (GWW) on response to CRT and outcome following CRT has been seldom studied. Hence, the authors evaluated the relationship between preprocedural GWW and outcome in a large prospective cohort of patients with heart failure (HF) and reduced ejection fraction receiving CRT. METHODS The study included 249 patients with HF. Myocardial work indices including GWW were calculated using speckle-tracking strain two-dimensional echocardiography using pressure-strain loops. End points of the study were (1) response to CRT, defined as left ventricular reverse remodeling and/or absence of hospitalization for HF, and (2) all-cause death during follow-up. RESULTS Median follow-up duration was 48 months (interquartile range, 43-54 months). Median preoperative GWW was 281 mm Hg% (interquartile range, 184-388 mm Hg%). Preoperative GWW was associated with CRT response (area under the curve, 0.74; P < .0001), and a 200 mm Hg% threshold discriminated CRT nonresponders from responders with 85% specificity and 50% sensitivity, even after adjustment for known predictors of CRT response (adjusted odds ratio, 4.03; 95% CI, 1.91-8.68; P < .001). After adjustment for established predictors of outcome in patients with HF with reduced ejection fraction receiving CRT, GWW < 200 mm Hg% remained associated with a relative increased risk for all-cause death compared with GWW ≥ 200 mm Hg% (adjusted hazard ratio, 2.0; 95% CI, 1.1-3.9; P = .0245). Adding GWW to a baseline model including known predictors of outcome in CRT resulted in an improvement of this model (χ2 to improve 4.85, P = .028). The relationship between GWW and CRT response and outcome was stronger in terms of size effect and statistical significance than for other myocardial work indices. CONCLUSIONS Low preoperative GWW (<200 mm Hg%) is associated with absence of CRT response in CRT candidates and with a relative increased risk for all-cause death. GWW appears to be a promising parameter to improve selection for CRT of patients with HF with reduced ejection fraction.
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Affiliation(s)
- Clemence Riolet
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'Échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France
| | - Aymeric Menet
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'Échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France
| | - Amandine Mailliet
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'Échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France
| | - Camille Binda
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'Échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France
| | - Alexandre Altes
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'Échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France
| | - Ludovic Appert
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'Échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France
| | - Anne Laure Castel
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'Échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France
| | - François Delelis
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'Échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France
| | - Guillaume Viart
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'Échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France
| | - Yves Guyomar
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'Échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France
| | - Caroline Le Goffic
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'Échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France
| | - Marie Decroocq
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'Échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France
| | | | - Pierre Graux
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'Échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France
| | - Christophe Tribouilloy
- EA 7517 MP3CV Jules Verne University of Picardie, Amiens, France; Centre Hospitalier Universitaire d'Amiens, Amiens, France
| | - Sylvestre Marechaux
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'Échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France; EA 7517 MP3CV Jules Verne University of Picardie, Amiens, France.
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10
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Lumens J, Koopsen T, Beela AS. What Do We Gain From Septal Strain? JACC Cardiovasc Imaging 2021; 14:1703-1706. [PMID: 34147452 DOI: 10.1016/j.jcmg.2021.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/12/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Joost Lumens
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Tijmen Koopsen
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Ahmed S Beela
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Cardiovascular diseases, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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11
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A Strain-Based Staging Classification of Left Bundle Branch Block-Induced Cardiac Remodeling. JACC Cardiovasc Imaging 2021; 14:1691-1702. [PMID: 33865764 DOI: 10.1016/j.jcmg.2021.02.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/15/2021] [Accepted: 02/11/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES This study speculated that longitudinal strain curves in left bundle branch block (LBBB) could be shaped by the degree of LBBB-induced cardiac remodeling. BACKGROUND LBBB independently affects left ventricular (LV) structure and function, but large individual variability may exist in LBBB-induced adverse remodeling. METHODS Consecutive patients with LBBB with septal flash (LBBB-SF) underwent thorough echocardiographic assessment, including speckle tracking-based strain analysis. Four major septal longitudinal strain patterns (LBBB-1 through LBBB-4) were discerned and staged on the basis of: 1) correlation analysis with echocardiographic indexes of cardiac remodeling, including the extent of SF; 2) strain pattern analysis in cardiac resynchronization therapy (CRT) super-responders; and 3) strain pattern analysis in patients with acute procedural-induced LBBB. RESULTS The study enrolled 237 patients with LBBB-SF (mean age: 67 ± 13 years; 57% men). LBBB-1 was observed in 60 (26%), LBBB-2 in 118 (50%), LBBB-3 in 29 (12%), and LBBB-4 in 26 (11%) patients. Patients at higher LBBB stages had larger end-diastolic volumes, lower LV ejection fractions, longer QRS duration, increased mechanical dyssynchrony, and more prominent SF compared with less advanced stages (p < 0.001 for all). Among CRT super-responders (n = 30; mean age: 63 ± 10 years), an inverse transition from stages LBBB-3 and -4 (pre-implant) to stages LBBB-1 and -2 (pace-off, median follow-up of 66 months [interquartile range: 32 to 78 months]) was observed (p < 0.001). Patients with acute LBBB (n = 27; mean age: 83 ± 5.1 years) only presented with a stage LBBB-1 (72%) or -2 pattern (24%). CONCLUSIONS The proposed classification suggests a pathophysiological continuum of LBBB-induced LV remodeling and may be valuable to assess the attribution of LBBB to the extent of LV remodeling and dysfunction.
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12
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Haji K, Marwick TH. Clinical Utility of Echocardiographic Strain and Strain Rate Measurements. Curr Cardiol Rep 2021; 23:18. [PMID: 33594493 DOI: 10.1007/s11886-021-01444-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 01/28/2023]
Abstract
PURPOSE OF REVIEW Assessment of left ventricular function is pivotal in many decisions, but ejection fraction has fundamental limitations for assessment of mild dysfunction, and especially for repeated assessments. Myocardial deformation imaging using speckle-tracking is widely available on modern echocardiography systems, and is now feasible as a clinical, rather than purely a research tool. Strain can be measured in all cardiac chambers, most commonly as a systolic parameter, although it can be measured in diastole. Generally, speckle tracking is more effective at measuring strain than strain-rate, which requires a higher temporal resolution. The purpose of this review is to help clinicians understand the main situations where strain provides incremental value to standard echocardiographic measurements. RECENT FINDINGS The normal range of LV global longitudinal strain (GLS) has now been defined as -18% and lower (ie more negative), abnormal as -16% or higher (ie less negative), with -16 to -18% being borderline. The variation between different vendors is now small for global parameters, but regional strain measurement remains unreliable - and therefore its use for stress echocardiography remains problematic. The most valuable indications for measuring strain are subclinical LV dysfunction (eg., GLS in HFpEF, stage B heart failure, aortic stenosis, mitral regurgitation), RV dysfunction (RV strain in pulmonary hypertension), atrial fibrillation (LA strain) and sequential follow-up (cardiotoxicity). Strain measurements have clinical utility in a number of settings and should be considered as part of the standard echocardiogram.
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Affiliation(s)
- Kawa Haji
- Baker Heart and Diabetes Institute, PO Box 6492, Melbourne, Victoria, 3004, Australia.,Cardiology Department, Western Health, Melbourne, Australia.,Departments of Cardiometabolic Health and Medicine, University of Melbourne, Melbourne, Australia
| | - Thomas H Marwick
- Baker Heart and Diabetes Institute, PO Box 6492, Melbourne, Victoria, 3004, Australia. .,Cardiology Department, Western Health, Melbourne, Australia. .,Departments of Cardiometabolic Health and Medicine, University of Melbourne, Melbourne, Australia.
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13
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Riolet C, Menet A, Verdun S, Altes A, Appert L, Guyomar Y, Delelis F, Ennezat PV, Guerbaai RA, Graux P, Tribouilloy C, Marechaux S. Clinical and prognostic implications of phenomapping in patients with heart failure receiving cardiac resynchronization therapy. Arch Cardiovasc Dis 2021; 114:197-210. [PMID: 33431324 DOI: 10.1016/j.acvd.2020.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/23/2020] [Accepted: 07/01/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite having an indication for cardiac resynchronization therapy according to current guidelines, patients with heart failure with reduced ejection fraction who receive cardiac resynchronization therapy do not consistently derive benefit from it. AIM To determine whether unsupervised clustering analysis (phenomapping) can identify distinct phenogroups of patients with differential outcomes among cardiac resynchronization therapy recipients from routine clinical practice. METHODS We used unsupervised hierarchical cluster analysis of phenotypic data after data reduction (55 clinical, biological and echocardiographic variables) to define new phenogroups among 328 patients with heart failure with reduced ejection fraction from routine clinical practice enrolled before cardiac resynchronization therapy. Clinical outcomes and cardiac resynchronization therapy response rate were studied according to phenogroups. RESULTS Although all patients met the recommended criteria for cardiac resynchronization therapy implantation, phenomapping analysis classified study participants into four phenogroups that differed distinctively in clinical, biological, electrocardiographic and echocardiographic characteristics and outcomes. Patients from phenogroups 1 and 2 had the most improved outcome in terms of mortality, associated with cardiac resynchronization therapy response rates of 81% and 78%, respectively. In contrast, patients from phenogroups 3 and 4 had cardiac resynchronization therapy response rates of 39% and 59%, respectively, and the worst outcome, with a considerably increased risk of mortality compared with patients from phenogroup 1 (hazard ratio 3.23, 95% confidence interval 1.9-5.5 and hazard ratio 2.49, 95% confidence interval 1.38-4.50, respectively). CONCLUSIONS Among patients with heart failure with reduced ejection fraction with an indication for cardiac resynchronization therapy from routine clinical practice, phenomapping identifies subgroups of patients with differential clinical, biological and echocardiographic features strongly linked to divergent outcomes and responses to cardiac resynchronization therapy. This approach may help to identify patients who will derive most benefit from cardiac resynchronization therapy in "individualized" clinical practice.
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Affiliation(s)
- Clémence Riolet
- Cardiology Department, Lille Catholic Hospitals, Lille Catholic University, 59160 Lomme, France
| | - Aymeric Menet
- Cardiology Department, Lille Catholic Hospitals, Lille Catholic University, 59160 Lomme, France
| | - Stéphane Verdun
- Biostatistics Department-Delegations for Clinical Research and Innovation, Lille Catholic Hospitals, Lille Catholic University, 59160 Lille, France
| | - Alexandre Altes
- Cardiology Department, Lille Catholic Hospitals, Lille Catholic University, 59160 Lomme, France
| | - Ludovic Appert
- Cardiology Department, Lille Catholic Hospitals, Lille Catholic University, 59160 Lomme, France
| | - Yves Guyomar
- Cardiology Department, Lille Catholic Hospitals, Lille Catholic University, 59160 Lomme, France
| | - François Delelis
- Cardiology Department, Lille Catholic Hospitals, Lille Catholic University, 59160 Lomme, France
| | | | - Raphaelle A Guerbaai
- Department of Public Health (DPH), Faculty of Medicine, Basel University, 4056 Basel, Switzerland
| | - Pierre Graux
- Cardiology Department, Lille Catholic Hospitals, Lille Catholic University, 59160 Lomme, France
| | - Christophe Tribouilloy
- Amiens University Hospital, 80080 Amiens, France; Laboratory MP3CV-EA 7517, University Centre for Health Research, Picardy University, 80000 Amiens, France
| | - Sylvestre Marechaux
- Cardiology Department, Lille Catholic Hospitals, Lille Catholic University, 59160 Lomme, France; Laboratory MP3CV-EA 7517, University Centre for Health Research, Picardy University, 80000 Amiens, France.
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14
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Ross S, Nestaas E, Kongsgaard E, Odland HH, Haland TF, Hopp E, Haugaa KH, Edvardsen T. Septal contraction predicts acute haemodynamic improvement and paced QRS width reduction in cardiac resynchronization therapy. Eur Heart J Cardiovasc Imaging 2020; 21:845-852. [PMID: 31925420 DOI: 10.1093/ehjci/jez315] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 11/08/2019] [Accepted: 12/10/2019] [Indexed: 11/13/2022] Open
Abstract
AIMS Three distinct septal contraction patterns typical for left bundle branch block may be assessed using echocardiography in heart failure patients scheduled for cardiac resynchronization therapy (CRT). The aim of this study was to explore the association between these septal contraction patterns and the acute haemodynamic and electrical response to biventricular pacing (BIVP) in patients undergoing CRT implantation. METHODS AND RESULTS Thirty-eight CRT candidates underwent speckle tracking echocardiography prior to device implantation. The patients were divided into two groups based on whether their septal contraction pattern was indicative of dyssynchrony (premature septal contraction followed by various amount of stretch) or not (normally timed septal contraction with minimal stretch). CRT implantation was performed under invasive left ventricular (LV) pressure monitoring and we defined acute CRT response as ≥10% increase in LV dP/dtmax. End-diastolic pressure (EDP) and QRS width served as a diastolic and electrical parameter, respectively. LV dP/dtmax improved under BIVP (737 ± 177 mmHg/s vs. 838 ± 199 mmHg/s, P < 0.001) and 26 patients (68%) were defined as acute CRT responders. Patients with premature septal contraction (n = 27) experienced acute improvement in systolic (ΔdP/dtmax: 18.3 ± 8.9%, P < 0.001), diastolic (ΔEDP: -30.6 ± 29.9%, P < 0.001) and electrical (ΔQRS width: -23.3 ± 13.2%, P < 0.001) parameters. No improvement under BIVP was observed in patients (n = 11) with normally timed septal contraction (ΔdP/dtmax: 4.0 ± 7.8%, P = 0.12; ΔEDP: -8.8 ± 38.4%, P = 0.47 and ΔQRS width: -0.9 ± 11.4%, P = 0.79). CONCLUSION Septal contraction patterns are an excellent predictor of acute CRT response. Only patients with premature septal contraction experienced acute systolic, diastolic, and electrical improvement under BIVP.
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Affiliation(s)
- Stian Ross
- Department of Cardiology, Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Sognsvannveien 20, Pb 4950 Nydalen, 0424 Oslo, Norway.,University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Pb 1072 Blindern, 0316 Oslo Norway
| | - Eirik Nestaas
- Department of Cardiology, Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Sognsvannveien 20, Pb 4950 Nydalen, 0424 Oslo, Norway.,University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Pb 1072 Blindern, 0316 Oslo Norway.,Department of Pediatrics, Vestfold Hospital Trust, Pb 2168, 3103 Tonsberg, Norway
| | - Erik Kongsgaard
- Department of Cardiology, Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Sognsvannveien 20, Pb 4950 Nydalen, 0424 Oslo, Norway.,University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Pb 1072 Blindern, 0316 Oslo Norway
| | - Hans H Odland
- Department of Cardiology, Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Sognsvannveien 20, Pb 4950 Nydalen, 0424 Oslo, Norway.,University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Pb 1072 Blindern, 0316 Oslo Norway
| | - Trine F Haland
- Department of Cardiology, Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Sognsvannveien 20, Pb 4950 Nydalen, 0424 Oslo, Norway.,University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Pb 1072 Blindern, 0316 Oslo Norway
| | - Einar Hopp
- Department of Cardiology, Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Sognsvannveien 20, Pb 4950 Nydalen, 0424 Oslo, Norway.,Division of Radiology and Nuclear Medicine, Oslo University Hospital, Rikshospitalet, Sognsvannveien 20, Pb 4950 Nydalen, 0424 Oslo, Norway
| | - Kristina H Haugaa
- Department of Cardiology, Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Sognsvannveien 20, Pb 4950 Nydalen, 0424 Oslo, Norway.,University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Pb 1072 Blindern, 0316 Oslo Norway
| | - Thor Edvardsen
- Department of Cardiology, Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Sognsvannveien 20, Pb 4950 Nydalen, 0424 Oslo, Norway.,University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Pb 1072 Blindern, 0316 Oslo Norway
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15
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Song MK, Kim NY, Bae EJ, Kim GB, Kwak JG, Kim WH, Lee JR. Long-term Follow-up of Epicardial Pacing and Left Ventricular Dysfunction in Children With Congenital Heart Block. Ann Thorac Surg 2020; 109:1913-1920. [DOI: 10.1016/j.athoracsur.2019.09.063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 09/03/2019] [Accepted: 09/18/2019] [Indexed: 01/21/2023]
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16
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Kuznetsov VA, Soldatova AM, Enina TN, Krinochkin DV, Dyachkov SM. [Does the lack of left ventricular reverse remodeling always mean non - response to cardiac resynchronization therapy?]. TERAPEVT ARKH 2019; 91:10-15. [PMID: 32598583 DOI: 10.26442/00403660.2019.12.000102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Indexed: 11/22/2022]
Abstract
AIM To evaluate clinical, morphological, functional features and mortality level in patients with different value of left ventricular reverse remodeling after cardiac resynchronization therapy (CRT). MATERIALS AND METHODS The study enrolled 112 patients (mean age 54.6±9.9 years, 83.5% men) with left ventricular ejection fraction (LVEF) І35%, NYHA functional class II-IV. We enrolled patients with QRS width >120 ms or QRS.
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Affiliation(s)
- V A Kuznetsov
- Tyumen Cardiology Research Center - Branch of Tomsk National Research Medical Center, Russian Academy of Science
| | - A M Soldatova
- Tyumen Cardiology Research Center - Branch of Tomsk National Research Medical Center, Russian Academy of Science
| | - T N Enina
- Tyumen Cardiology Research Center - Branch of Tomsk National Research Medical Center, Russian Academy of Science
| | - D V Krinochkin
- Tyumen Cardiology Research Center - Branch of Tomsk National Research Medical Center, Russian Academy of Science
| | - S M Dyachkov
- Tyumen Cardiology Research Center - Branch of Tomsk National Research Medical Center, Russian Academy of Science
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17
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Dupuis LJ, Arts T, Prinzen FW, Delhaas T, Lumens J. Linking cross-bridge cycling kinetics to response to cardiac resynchronization therapy: a multiscale modelling study. Europace 2019; 20:iii87-iii93. [PMID: 30476050 DOI: 10.1093/europace/euy230] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 09/18/2018] [Indexed: 11/12/2022] Open
Abstract
Aims Cardiac resynchronization therapy (CRT) is currently the most widely used treatment for heart failure patients with left bundle branch block (LBBB). In recent years, the presence of septal rebound stretch (SRS) has been found to be a positive indicator for CRT response although the mechanism is unknown. Methods and results In an attempt to understand the relation between cellular mechanics and global pump function in CRT patients, we utilize the CircAdapt closed-loop cardiovascular system model in combination with the MechChem model of cardiac sarcomere contraction. Left bundle branch block has been simulated with increasing delay in left ventricular free wall and septal wall activation. In addition to the electrical dyssynchrony, myocardial mechanical function was diminished by decreasing the cross-bridge cycling rate. Our results have shown that a decrease in the cross-bridge cycling rate in addition to LBBB resulted in a decrease in SRS with a concomitant decreased response to resynchronization. Conclusions The results of our multiscale modelling study suggest that, while greater SRS during systole clearly indicates electrical dyssynchrony, it also predicts mechanical viability and healthy cross-bridge cycling rates in the myocardium. Hence, SRS positively indicates response to CRT.
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Affiliation(s)
- Lauren J Dupuis
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht University, Universiteitssingel 50., P.O. Box 616, ER Maastricht, The Netherlands
| | - Theo Arts
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht University, Universiteitssingel 50., P.O. Box 616, ER Maastricht, The Netherlands
| | - Frits W Prinzen
- Department of Physiology, CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Tammo Delhaas
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht University, Universiteitssingel 50., P.O. Box 616, ER Maastricht, The Netherlands
| | - Joost Lumens
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht University, Universiteitssingel 50., P.O. Box 616, ER Maastricht, The Netherlands
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18
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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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19
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Fixsen LS, de Lepper AGW, Strik M, van Middendorp LB, Prinzen FW, van de Vosse FN, Houthuizen P, Lopata RGP. Echocardiographic Assessment of Left Bundle Branch-Related Strain Dyssynchrony: A Comparison With Tagged MRI. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:2063-2074. [PMID: 31060858 DOI: 10.1016/j.ultrasmedbio.2019.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 03/22/2019] [Accepted: 03/25/2019] [Indexed: 06/09/2023]
Abstract
Recent studies have shown the efficacy of myocardial strain estimated using speckle tracking echocardiography (STE) in predicting response to cardiac resynchronisation therapy. This study focuses on circumferential strain patterns, comparing STE-acquired strains to tagged-magnetic resonance imaging (MRI-T). Second, the effect of regularisation was examined. Two-dimensional parasternal ultrasound (US) and MRI-T data were acquired in the left ventricular short-axis view of canines before (n = 8) and after (n = 9) left bunch branch block (LBBB) induction. US-based strain analysis was performed on Digital Imaging and Communications in Medicine data at the mid-level using three overall methods ("Commercial software," "Basic block-matching," "regularised block-matching"). Moreover, three regularisation approaches were implemented and compared. MRI-T analysis was performed using SinMod. Normalised regional circumferential strain curves, based on standard six or septal/lateral segments, were analysed and cross-correlated with MRI-T data. Systolic strain (SS) and septal rebound stretch (SRS) were calculated and compared. Overall agreement of normalised circumferential strain was good between all methods on a global and regional level. All STE methods showed a bias (≥4% strain) toward higher SS estimates. Pre-LBBB, septal and lateral segment correlation was excellent between the Basic (mean ρ = 0.96) and regularised (mean ρ = 0.97) methods and MRI-T. The Commercial method showed a significant discrepancy between the two walls (septal ρ = 0.94, lateral ρ = 0.68). Correlation with MRI-T reduced between pre- and post-LBBB (Commercial ρ = 0.79, Basic ρ = 0.82, mean regularised ρ = 0.86). Septal strain patterns and SRS varied with the STE software and type of regularisation, with all STE methods estimating non-zero SRS values pre-LBBB. Absolute values showed moderate agreement, with a bias for higher strain from STE. SRS varied with the type of software and extra regularisation applied. Open efforts are needed to understand the underlying causes of differences between STE methods before standardisation can be achieved. This is particularly important given the apparent clinical value of strain-based parameters such as SRS.
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Affiliation(s)
- Louis S Fixsen
- Cardiovascular Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
| | | | - Marc Strik
- Department of Physiology, Cardiovascular Research Institute Maastricht, University of Maastricht, Maastricht, The Netherlands
| | - Lars B van Middendorp
- Department of Physiology, Cardiovascular Research Institute Maastricht, University of Maastricht, Maastricht, The Netherlands
| | - Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht, University of Maastricht, Maastricht, The Netherlands
| | - Frans N van de Vosse
- Cardiovascular Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Patrick Houthuizen
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Richard G P Lopata
- Cardiovascular Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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20
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Emerek K, Friedman DJ, Sørensen PL, Hansen SM, Larsen JM, Risum N, Thøgersen AM, Graff C, Atwater BD, Kisslo J, Søgaard P. The Association of a classical left bundle Branch Block Contraction Pattern by vendor-independent strain echocardiography and outcome after cardiac resynchronization therapy. Cardiovasc Ultrasound 2019; 17:10. [PMID: 31113440 PMCID: PMC6530090 DOI: 10.1186/s12947-019-0160-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 05/16/2019] [Indexed: 02/05/2023] Open
Abstract
Background The association of a Classical left bundle branch block (LBBB) contraction pattern and better outcome after cardiac resynchronization therapy (CRT) has only been studied using vendor-specific software for echocardiographic speckle-tracked longitudinal strain analysis. The purpose of this study was to assess whether a Classical LBBB contraction pattern on longitudinal strain analysis using vendor-independent software is associated with clinical outcome in CRT recipients with LBBB. Methods This was a retrospective cohort study including CRT recipients with LBBB, heart failure, and left ventricular (LV) ejection fraction ≤35%. Speckle-tracked echocardiographic longitudinal strain analysis was performed retrospectively on echocardiograms using vendor-independent software. The presence of a Classical LBBB contraction pattern was determined by consensus of two readers. The primary end point was a composite of time to death, heart transplantation or LV assist device implantation. Secondary outcome was ≥15% reduction in LV end-systolic volume. Intra- and inter-reader agreement of the longitudinal strain contraction pattern was assessed by calculating Cohen’s κ. Results Of 283 included patients, 113 (40%) were women, mean age was 66 ± 11 years, and 136 (48%) had ischemic heart disease. A Classical LBBB contraction pattern was present in 196 (69%). The unadjusted hazard ratio for reaching the primary end point was 1.93 (95% confidence interval, 1.36–2.76, p < 0.001) when comparing patients without to patients with a Classical LBBB contraction pattern. Adjusted for ischemic heart disease and QRS duration < 150 milliseconds the hazard ratio was 1.65 (95% confidence interval, 1.12–2.43, p = 0.01). Of the 123 (43%) patients with a follow-up echocardiogram, 64 of 85 (75%) of patients with a Classical LBBB contraction pattern compared to 13 of 38 (34%) without, had ≥15% reduction in LV end-systolic volume (p < 0.001). Cohen’s κ were 0.86 (95% confidence interval, 0.71–1.00) and 0.42 (95% confidence interval, 0.30–0.54) for intra- and inter-reader agreement, respectively. Conclusion Using vendor-independent strain software, a Classical LBBB contraction pattern is associated with better outcome in CRT recipients with LBBB, but inter-reader agreement for the classification of contraction pattern is only moderate.
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Affiliation(s)
- Kasper Emerek
- Department of Medicine, Division of Cardiology, Duke University Hospital, Durham, NC, USA. .,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Daniel J Friedman
- Department of Medicine, Division of Cardiology, Duke University Hospital, Durham, NC, USA
| | - Peter L Sørensen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Steen M Hansen
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Jacob M Larsen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Niels Risum
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | | | - Claus Graff
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Brett D Atwater
- Department of Medicine, Division of Cardiology, Duke University Hospital, Durham, NC, USA
| | - Joseph Kisslo
- Department of Medicine, Division of Cardiology, Duke University Hospital, Durham, NC, USA
| | - Peter Søgaard
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
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21
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Appert L, Menet A, Altes A, Ennezat PV, Bardet-Bouchery H, Binda C, Guyomar Y, Delelis F, Castel AL, Le Goffic C, Guerbaai RA, Graux P, Tribouilloy C, Maréchaux S. Clinical Significance of Electromechanical Dyssynchrony and QRS Narrowing in Patients With Heart Failure Receiving Cardiac Resynchronization Therapy. Can J Cardiol 2019; 35:27-34. [DOI: 10.1016/j.cjca.2018.10.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 10/18/2018] [Accepted: 10/29/2018] [Indexed: 12/28/2022] Open
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22
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Bonhorst D, Guerreiro S, Fonseca C, Cardim N, Macedo F, Adragão P. Real-life data on heart failure before and after implantation of resynchronization and/or defibrillation devices – The Síncrone study. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.repce.2018.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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23
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Bonhorst D, Guerreiro S, Fonseca C, Cardim N, Macedo F, Adragão P. Implantação de dispositivos de ressincronização e/ou desfibrilhação em doentes com insuficiência cardíaca: dados da vida real ‐ o Estudo Síncrone. Rev Port Cardiol 2019; 38:33-41. [DOI: 10.1016/j.repc.2018.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 03/12/2018] [Accepted: 04/08/2018] [Indexed: 10/27/2022] Open
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24
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Terricabras M, Khaykin Y. Speckle Tracking for Cardiac Resynchronization Therapy Implantation: Have We Found the Perfect Match? Can J Cardiol 2019; 35:12-14. [PMID: 30595175 DOI: 10.1016/j.cjca.2018.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 11/24/2022] Open
Affiliation(s)
- Maria Terricabras
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Yaariv Khaykin
- Southlake Regional Health Centre, Newmarket, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
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25
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Fulati Z, Liu Y, Sun N, Kang Y, Su Y, Chen H, Shu X. Speckle tracking echocardiography analyses of myocardial contraction efficiency predict response for cardiac resynchronization therapy. Cardiovasc Ultrasound 2018; 16:30. [PMID: 30453975 PMCID: PMC6245808 DOI: 10.1186/s12947-018-0148-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 10/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In patients with left ventricular (LV) dysssynchrony, contraction that doesn't fall into ejection period (LVEj) results in a waste of energy due to inappropriate contraction timing, which was now widely treated by cardiac resynchronization therapy(CRT). Myocardial Contraction Efficiency was defined as the ratio of Efficient Contraction Time (ECTR) and amplitude of efficient contraction (ECR) during LVEj against that in the entire cardiac cycle. This study prospectively investigated whether efficiency indexes could predict CRT outcome. METHODS Our prospective pilot study including 70 CRT candidates, parameters of myocardial contraction timing and contractility were measured by speckle tracking echocardiography (STE) and efficiency indexes were calculated accordingly at baseline and at 6-month follow-up. Primary outcome events were predefined as death or HF hospitalization, and secondary outcome events were defined as all-cause death during the follow-up. 16-segement Standard deviation of time to onset strain (TTO-16SD) and time to peak strain (TTP-16SD) were included as the dyssynchrony indexes. RESULTS According to LV end systolic volume (LVESV) and LV eject fraction(LVEF) values at 6-month follow-up, subjects were classified into responder and non-responder groups, ECR (OR 0.87, 95%CI 0.78-0.97, P < 0.05) and maximum longitudinal strain (MLS) (OR 2.22, 95%CI 1.36-3.61, P < 0.01) were the two independent predictors for CRT response, Both TTO-16SD and TTP-16SD failed to predict outcome. Patients with poorer myocardial contraction efficiency and better contractility are more likely to benefit from CRT. CONCLUSIONS STE can evaluate left ventricular contraction efficiency and contractility to predict CRT response. When analyzing myocardial strain by STE, contraction during LVEj should be highlighted.
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Affiliation(s)
- Zibire Fulati
- Department of Echocardiography, Shanghai Institute of Medical Imaging; Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Yang Liu
- Department of Echocardiography, Shanghai Institute of Medical Imaging; Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Ning Sun
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Yu Kang
- Department of Cardiology, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Yangang Su
- Department of Cardiology; Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Haiyan Chen
- Department of Echocardiography, Shanghai Institute of Medical Imaging; Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
| | - Xianhong Shu
- Department of Echocardiography, Shanghai Institute of Medical Imaging; Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
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26
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Kuznetsov VA, Soldatova AM, Kasprzak JD, Krinochkin DV, Melnikov NN. Echocardiographic markers of dyssynchrony as predictors of super-response to cardiac resynchronisation therapy - a pilot study. Cardiovasc Ultrasound 2018; 16:24. [PMID: 30285762 PMCID: PMC6167795 DOI: 10.1186/s12947-018-0140-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 08/21/2018] [Indexed: 01/05/2023] Open
Abstract
Background Some patients with congestive heart failure have greater improvement of cardiac remodelling after cardiac resynchronisation therapy (CRT) and they are identified as super-responders (SRs). It remains unclear if echocardiographic markers of dyssynchrony could accuratelly predict super-response to CRT. The aim of this study is to evaluate potential echocardiographic predictors associated with super-response to CRT. Methods Fifthy nine CRT patients (mean age 52.9 ± 9.0 years, 88% men) with congestive heart failure (54% ischaemic and 46% non-ischaemic aetiology) II-IV NYHA functional class were enrolled. To assess mechanical dyssynchrony we evaluated interventricular mechanical delay, the maximum delay between peak systolic velocities of the septal and posterior walls of left ventricle, duration of left ventricular pre-ejection period (LVPEP), left ventricular and interventricular dyssynchrony by tissue Doppler imaging and systolic dyssynchrony index by 3D echocardiography. After six months the patients were assessed for response and classified as SRs (reduction in left ventricular end-systolic volume (LVESV) ≥30%, n = 20) and non-SRs (reduction in LVESV < 30%, n = 39) and baseline data were analyzed to identify the predictors. Results Both groups demonstrated significant improvement in NYHA functional class, increase in left ventricular ejection fraction and reduction in LVESV. All parameters of mechanical dyssynchrony at baseline were significantly higher in SR group. Multiple logistic regression analysis showed that LVPEP (HR 1.031; 95% CI 1.007–1.055; p = 0.011) was an independent predictor for CRT super-response. In ROC curve analysis LVPEP with a cut-off value of 147 ms demonstrated 73.7% sensitivity and 75% specificity (AUC = 0.753; p = 0.002) for the prediction of super-response to CRT. Conclusion Greater mechanical dyssynchrony is associated with super-response to CRT in patients with congestive heart failure. It is probable that an LVPEP > 147 ms can be used as independent predictor of super-response.
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Affiliation(s)
- V A Kuznetsov
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk, Russia, Melnikaite st. 111, Tyumen, 625026, Russia
| | - A M Soldatova
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk, Russia, Melnikaite st. 111, Tyumen, 625026, Russia.
| | - J D Kasprzak
- Department of Cardiology, Medical University of Lodz, Bieganski Hospital, Kniaziewicza 1/5, 91-347, Lodz, Poland
| | - D V Krinochkin
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk, Russia, Melnikaite st. 111, Tyumen, 625026, Russia
| | - N N Melnikov
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk, Russia, Melnikaite st. 111, Tyumen, 625026, Russia
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27
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Donal E, Delgado V, Magne J, Bucciarelli-Ducci C, Leclercq C, Cosyns B, Sitges M, Edvardsen T, Sade E, Stankovic I, Agricola E, Galderisi M, Lancellotti P, Hernandez A, Plein S, Muraru D, Schwammenthal E, Hindricks G, Popescu BA, Habib G. Rational and design of EuroCRT: an international observational study on multi-modality imaging and cardiac resynchronization therapy. Eur Heart J Cardiovasc Imaging 2018; 18:1120-1127. [PMID: 28329299 DOI: 10.1093/ehjci/jex021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 02/01/2017] [Indexed: 01/06/2023] Open
Abstract
Aims Assessment of left ventricular (LV) volumes and ejection fraction (LVEF) with cardiac imaging is important in the selection of patients for cardiac resynchronization therapy (CRT). Several observational studies have explored the role of imaging-derived LV dyssynchrony parameters to predict the response to CRT, but have yielded inconsistent results, precluding the inclusion of imaging-derived LV dyssynchrony parameters in current guidelines for selection of patients for CRT. Methods The EuroCRT is a large European multicentre prospective observational study led by the European Association of Cardiovascular Imaging. We aim to explore if combing the value of cardiac magnetic resonance (CMR) and echocardiography could be beneficial for selecting heart failure patients for CRT in terms of improvement in long-term survival, clinical symptoms, LV function, and volumes. Speckle tracking echocardiography will be used to assess LV dyssynchrony and wasted cardiac work whereas myocardial scar will be assessed with late gadolinium contrast enhanced CMR. All data will be measured in core laboratories. The study will be conducted in European centres with known expertise in both CRT and multimodality cardiac imaging.
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Affiliation(s)
- Erwan Donal
- Cardiology, Rennes University Hospital, INSERM 1414 Clinical Investigation Center, Innovative Technology, 2 Rue Henri Le Guilloux, CHU Pontchaillou, Rennes F-35000, France.,LTSI, Université de Rennes-INSERM, UMR 1099, Rennes, France
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Julien Magne
- CHU Limoges, Hôpital Dupuytren, Cardiologie, Limoges, France.,INSERM 1094, Faculté de médecine de Limoges, 2, rue Marcland, 87000 Limoges, France
| | - Chiara Bucciarelli-Ducci
- Bristol Heart Institute, Bristol NIHR Cardiovascular Biomedical Research Unity, University of Bristol, Bristol, UK
| | - Christophe Leclercq
- Cardiology, Rennes University Hospital, INSERM 1414 Clinical Investigation Center, Innovative Technology, 2 Rue Henri Le Guilloux, CHU Pontchaillou, Rennes F-35000, France.,LTSI, Université de Rennes-INSERM, UMR 1099, Rennes, France
| | | | - Marta Sitges
- Cardiovascular Institute, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital and University of Oslo, Norway
| | | | - Ivan Stankovic
- Department of Cardiology, University Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Eustachio Agricola
- Cardiothoracic Department, San Raffaele University Hospital, IRCCS, 20132 Milan, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomeducal Sciences, Federico II University Hospital, Naples, Italy
| | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU SartTilman, Liège, Belgium.,Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
| | | | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre (MCRC), Leeds Institute of Cardiovascular and Metabolic Medicine University of Leeds, Clarendon Way, Leeds, UK
| | - Denisa Muraru
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua 35128, Italy
| | | | - Gerhard Hindricks
- Department of Electrophysiology, University of Leipzig-Heart Center, Leipzig, Germany
| | - Bogdan A Popescu
- University of Medicine and Pharmacy "Carol Davila"-Euroecolab, Institute of Cardiovascular Diseases, Bucharest, Romania
| | - Gilbert Habib
- LTSI, Université de Rennes-INSERM, UMR 1099, Rennes, France.,Department of Cardiology, Aix-Marseille Université, 13284 Marseille, France
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28
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Mele D, Bertini M, Malagù M, Nardozza M, Ferrari R. Current role of echocardiography in cardiac resynchronization therapy. Heart Fail Rev 2018; 22:699-722. [PMID: 28714039 DOI: 10.1007/s10741-017-9636-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cardiac resynchronization therapy (CRT) is an established treatment for patients with heart failure and left ventricular systolic dysfunction. Patients are usually assessed by echocardiography, which provides a number of anatomical and functional information used for cardiac dyssynchrony assessment, prognostic stratification, identification of the optimal site of pacing in the left ventricle, optimization of the CRT device, and patient follow-up. Compared to other cardiac imaging techniques, echocardiography has the advantage to be non-invasive, repeatable, and safe, without exposure to ionizing radiation or nefrotoxic contrast. In this article, we review current evidence about the role of echocardiography before, during, and after the implantation of a CRT device.
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Affiliation(s)
- Donato Mele
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy. .,Noninvasive Cardiology Unit, Azienda Ospedaliero-Universitaria, Via Aldo Moro 8, 44124, Ferrara, Cona, Italy.
| | - Matteo Bertini
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy
| | - Michele Malagù
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy
| | - Marianna Nardozza
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy
| | - Roberto Ferrari
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy.,Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, RA, Italy
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29
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Rösner A, Khalapyan T, Dalen H, McElhinney DB, Friedberg MK, Lui GK. Classic-Pattern Dyssynchrony in Adolescents and Adults With a Fontan Circulation. J Am Soc Echocardiogr 2018; 31:211-219. [DOI: 10.1016/j.echo.2017.10.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Indexed: 11/25/2022]
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30
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van Everdingen WM, Maass AH, Vernooy K, Meine M, Allaart CP, De Lange FJ, Teske AJ, Geelhoed B, Rienstra M, Van Gelder IC, Vos MA, Cramer MJ. Comparison of strain parameters in dyssynchronous heart failure between speckle tracking echocardiography vendor systems. Cardiovasc Ultrasound 2017; 15:25. [PMID: 29047378 PMCID: PMC5648447 DOI: 10.1186/s12947-017-0116-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 10/12/2017] [Indexed: 01/08/2023] Open
Abstract
Background Although mechanical dyssynchrony parameters derived by speckle tracking echocardiography (STE) may predict response to cardiac resynchronization therapy (CRT), comparability of parameters derived with different STE vendors is unknown. Methods In the MARC study, echocardiographic images of heart failure patients obtained before CRT implantation were prospectively analysed with vendor specific STE software (GE EchoPac and Philips QLAB) and vendor-independent software (TomTec 2DCPA). Response was defined as change in left ventricular (LV) end-systolic volume between examination before and six-months after CRT implantation. Basic longitudinal strain and mechanical dyssynchrony parameters (septal to lateral wall delay (SL-delay), septal systolic rebound stretch (SRSsept), and systolic stretch index (SSI)) were obtained from either separate septal and lateral walls, or total LV apical four chamber. Septal strain patterns were categorized in three types. The coefficient of variation and intra-class correlation coefficient (ICC) were analysed. Dyssynchrony parameters were associated with CRT response using univariate regression analysis and C-statistics. Results Two-hundred eleven patients were analysed. GE-cohort (n = 123): age 68 years (interquartile range (IQR): 61–73), 67% male, QRS-duration 177 ms (IQR: 160–192), LV ejection fraction: 26 ± 7%. Philips-cohort (n = 88): age 67 years (IQR: 59–74), 60% male, QRS-duration: 179 ms (IQR: 166–193), LV ejection fraction: 27 ± 8. LV derived peak strain was comparable in the GE- (GE: -7.3 ± 3.1%, TomTec: −6.4 ± 2.8%, ICC: 0.723) and Philips-cohort (Philips: −7.7 ± 2.7%, TomTec: −7.7 ± 3.3%, ICC: 0.749). SL-delay showed low ICC values (GE vs. TomTec: 0.078 and Philips vs. TomTec: 0.025). ICC’s of SRSsept and SSI were higher but only weak (GE vs. TomTec: SRSsept: 0.470, SSI: 0.467) (Philips vs. QLAB: SRSsept: 0.419, SSI: 0.421). Comparability of septal strain patterns was low (Cohen’s kappa, GE vs. TomTec: 0.221 and Philips vs. TomTec: 0.279). Septal strain patterns, SRSsept and SSI were associated with changes in LV end-systolic volume for all vendors. SRSsept and SSI had relative varying C-statistic values (range: 0.530–0.705) and different cut-off values between vendors. Conclusions Although global longitudinal strain analysis showed fair comparability, assessment of dyssynchrony parameters was vendor specific and not applicable outside the context of the implemented platform. While the standardization taskforce took an important step for global peak strain, further standardization of STE is still warranted. Electronic supplementary material The online version of this article (10.1186/s12947-017-0116-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wouter M van Everdingen
- Department of Cardiology, University Medical Centre Utrecht, P.O. Box 855500, 3508, GA, Utrecht, The Netherlands.
| | - Alexander H Maass
- Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Mathias Meine
- Department of Cardiology, University Medical Centre Utrecht, P.O. Box 855500, 3508, GA, Utrecht, The Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Frederik J De Lange
- Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Arco J Teske
- Department of Cardiology, University Medical Centre Utrecht, P.O. Box 855500, 3508, GA, Utrecht, The Netherlands
| | - Bastiaan Geelhoed
- Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Michiel Rienstra
- Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Isabelle C Van Gelder
- Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Marc A Vos
- Department of Medical Physiology, University of Utrecht, Utrecht, The Netherlands
| | - Maarten J Cramer
- Department of Cardiology, University Medical Centre Utrecht, P.O. Box 855500, 3508, GA, Utrecht, The Netherlands
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van Everdingen WM, Zweerink A, Nijveldt R, Salden OAE, Meine M, Maass AH, Vernooy K, De Lange FJ, van Rossum AC, Croisille P, Clarysse P, Geelhoed B, Rienstra M, Van Gelder IC, Vos MA, Allaart CP, Cramer MJ. Comparison of strain imaging techniques in CRT candidates: CMR tagging, CMR feature tracking and speckle tracking echocardiography. Int J Cardiovasc Imaging 2017; 34:443-456. [PMID: 29043465 PMCID: PMC5847211 DOI: 10.1007/s10554-017-1253-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 09/29/2017] [Indexed: 01/22/2023]
Abstract
Parameters using myocardial strain analysis may predict response to cardiac resynchronization therapy (CRT). As the agreement between currently available strain imaging modalities is unknown, three different modalities were compared. Twenty-seven CRT-candidates, prospectively included in the MARC study, underwent cardiac magnetic resonance (CMR) imaging and echocardiographic examination. Left ventricular (LV) circumferential strain was analysed with CMR tagging (CMR-TAG), CMR feature tracking (CMR-FT), and speckle tracking echocardiography (STE). Basic strain values and parameters of dyssynchrony and discoordination obtained with CMR-FT and STE were compared to CMR-TAG. Agreement of CMR-FT and CMR-TAG was overall fair, while agreement between STE and CMR-TAG was often poor. For both comparisons, agreement on discoordination parameters was highest, followed by dyssynchrony and basic strain parameters. For discoordination parameters, agreement on systolic stretch index was highest, with fair intra-class correlation coefficients (ICC) (CMR-FT: 0.58, STE: 0.55). ICC of septal systolic rebound stretch (SRSsept) was poor (CMR-FT: 0.41, STE: 0.30). Internal stretch factor of septal and lateral wall (ISFsep-lat) showed fair ICC values (CMR-FT: 0.53, STE: 0.46), while the ICC of the total LV (ISFLV) was fair for CMR-FT (0.55) and poor for STE (ICC: 0.32). The CURE index had a fair ICC for both comparisons (CMR-FT: 0.49, STE 0.41). Although comparison of STE to CMR-TAG was limited by methodological differences, agreement between CMR-FT and CMR-TAG was overall higher compared to STE and CMR-TAG. CMR-FT is a potential clinical alternative for CMR-TAG and STE, especially in the detection of discoordination in CRT-candidates.
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Affiliation(s)
| | - Alwin Zweerink
- Department of Cardiology, and Institute for Cardiovascular Research (ICaR-VU), VU University Medical Centre, Amsterdam, The Netherlands
| | - Robin Nijveldt
- Department of Cardiology, and Institute for Cardiovascular Research (ICaR-VU), VU University Medical Centre, Amsterdam, The Netherlands
| | - Odette A. E. Salden
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Mathias Meine
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Alexander H. Maass
- Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Albert C. van Rossum
- Department of Cardiology, and Institute for Cardiovascular Research (ICaR-VU), VU University Medical Centre, Amsterdam, The Netherlands
| | - Pierre Croisille
- Université Lyon, UJM-Saint-Etienne, INSA, CNRS UMR 5520, INSERM U1206, CREATIS, 42023 Saint-Etienne, France
| | - Patrick Clarysse
- Université Lyon, UJM-Saint-Etienne, INSA, CNRS UMR 5520, INSERM U1206, CREATIS, 42023 Saint-Etienne, France
| | - Bastiaan Geelhoed
- Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Michiel Rienstra
- Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Isabelle C. Van Gelder
- Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Marc A. Vos
- Department of Medical Physiology, University of Utrecht, Utrecht, The Netherlands
| | - Cornelis P. Allaart
- Department of Cardiology, and Institute for Cardiovascular Research (ICaR-VU), VU University Medical Centre, Amsterdam, The Netherlands
| | - Maarten J. Cramer
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
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van Everdingen WM, Walmsley J, Cramer MJ, van Hagen I, De Boeck BW, Meine M, Delhaas T, Doevendans PA, Prinzen FW, Lumens J, Leenders GE. Echocardiographic Prediction of Cardiac Resynchronization Therapy Response Requires Analysis of Both Mechanical Dyssynchrony and Right Ventricular Function: A Combined Analysis of Patient Data and Computer Simulations. J Am Soc Echocardiogr 2017; 30:1012-1020.e2. [DOI: 10.1016/j.echo.2017.06.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Indexed: 10/19/2022]
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Wei L, Lu YY, Hua YM, Zhou KY, Ye QH, Wang C, Wang X, Yan S, Liu JF. [Changes in electrocardiographic parameters in children with complete left bundle branch block early after transcatheter closure of ventricular septal defect]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2017; 19:663-667. [PMID: 28606233 PMCID: PMC7390289 DOI: 10.7499/j.issn.1008-8830.2017.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 03/08/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To observe the changes in electrocardiographic parameters in children with complete left bundle branch block (CLBBB) after the transcatheter closure of simple ventricular septal defect (VSD). METHODS A total of 21 children with CLBBB early after transcatheter closure of perimembranous VSD were recruited. Another 21 children without any type of arrhythmia after transcatheter closure of perimembranous VSD were enrolled as the control group. The sex, age, and the size of occluder were matched between the two groups. The changes in the following indices were compared between the two groups: left ventricular voltage, QT interval, corrected QT interval (QTc), QT dispersion (QTd), corrected QT dispersion (QTcd), JT dispersion (JTd), and corrected JT dispersion (JTcd) on the electrocardiogram before transcatheter closure and at 1, 3, 5, 30 days after transcatheter closure. RESULTS Left ventricular voltage and JTcd changed with operation time in the CLBBB and control groups (P<0.05). There were interaction effects between time and grouping in the changes in left ventricular voltage and QTd (P<0.05). There was a significant difference in JTcd between the CLBBB and control groups (P<0.05). There was also a significant difference in left ventricular voltage between the CLBBB and control groups at 3 and 5 days after the transcatheter closure (P<0.05). CONCLUSIONS There are significant differences in electrocardiographic left ventricular voltage and JTcd between VSD children with and without CLBBB early after transcatheter closure. JTcd might be useful in predicting the development of CLBBB early after transcatheter closure of VSD.
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Affiliation(s)
- Li Wei
- Department of Pediatrics, West China Second University Hospital/Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu 610041, China.
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Surkova E, Badano LP, Bellu R, Aruta P, Sambugaro F, Romeo G, Migliore F, Muraru D. Left bundle branch block: from cardiac mechanics to clinical and diagnostic challenges. Europace 2017; 19:1251-1271. [DOI: 10.1093/europace/eux061] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 02/14/2017] [Indexed: 12/15/2022] Open
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Menet A, Bernard A, Tribouilloy C, Leclercq C, Gevaert C, Guyomar Y, Guerbaai RA, Delelis F, Castel AL, Graux P, Ennezat PV, Donal E, Maréchaux S. Clinical significance of septal deformation patterns in heart failure patients receiving cardiac resynchronization therapy. Eur Heart J Cardiovasc Imaging 2016; 18:1388-1397. [DOI: 10.1093/ehjci/jew289] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 10/28/2016] [Indexed: 11/13/2022] Open
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Abstract
Heart failure with reduced ejection fraction (HFrEF) represents at least half of the cases of heart failure, which is a syndrome defined as the inability of the heart to supply the body's tissues with an adequate amount of blood under conditions of normal cardiac filling pressure. HFrEF is responsible for high costs and rates of mortality, morbidity, and hospital admissions, mainly in developed countries. Thus, the need for better diagnostic methods and therapeutic approaches and consequently better outcomes is clear. In this article, we review the principal aspects of pathophysiology and diagnosis of HFrEF, with focus on emerging biomarkers and on recent echocardiographic methods for the assessment of left ventricular function. Furthermore, we discuss several major developments in pharmacological and nonpharmacological treatment of HFrEF in the last years, including cardiac resynchronization therapy, implantable cardioverter defibrillators, and the recent and promising drug LCZ696, focusing on current indications, unanswered questions, and other relevant aspects.
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Mada RO, Lysyansky P, Duchenne J, Beyer R, Mada C, Muresan L, Rosianu H, Serban A, Winter S, Fehske W, Stankovic I, Voigt JU. New Automatic Tools to Identify Responders to Cardiac Resynchronization Therapy. J Am Soc Echocardiogr 2016; 29:966-972. [DOI: 10.1016/j.echo.2016.06.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Indexed: 10/21/2022]
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Forsha D, Risum N, Smith PB, Kanter RJ, Samad Z, Barker P, Kisslo J. Frequent Activation Delay-Induced Mechanical Dyssynchrony and Dysfunction in the Systemic Right Ventricle. J Am Soc Echocardiogr 2016; 29:1074-1083. [PMID: 27624591 DOI: 10.1016/j.echo.2016.08.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with systemic right ventricles frequently experience progressive heart failure and conduction abnormalities leading to abnormal ventricular activation. Activation delay-induced mechanical dyssynchrony can contribute to ventricular failure and is identified by a classic strain pattern of paradoxical opposing wall motion that is an excellent predictor of response to cardiac resynchronization therapy in adults with left bundle branch block. The specific aims of this study were to compare right ventricular (RV) mechanics in an adult systemic right ventricle population versus control subjects, evaluate the feasibility of this RV strain pattern analysis, and determine the frequency of the classic pattern. METHODS Young adults (n = 25) with d-transposition of the great arteries, status post Mustard or Senning palliation (TGA-MS), were ambispectively enrolled and compared with healthy young adults (n = 30) who were prospectively enrolled. All subjects were imaged using novel three-apical view (18-segment) RV longitudinal speckle-tracking strain analysis (EchoPAC) and electrocardiographic data. RESULTS Patients with TGA-MS had diminished RV global peak systolic strain compared with control subjects (-12.0 ± 4.0% vs -23.3 ± 2.3%, P < .001). Most patients with TGA-MS had intrinsic or left ventricular paced right bundle branch block. A classic pattern was present in 11 of 25 subjects (44%), but this pattern would have been missed in four of 11 based only on the RV four-chamber (six-segment) model. Only three subjects underwent cardiac resynchronization therapy. Both subjects who had the classic pattern responded to cardiac resynchronization therapy, whereas the one nonresponder did not have the classic pattern. CONCLUSION Systemic right ventricles demonstrated decreased function and increased mechanical dyssynchrony. The classic pattern of activation delay-induced mechanical dyssynchrony was frequently seen in this TGA-MS population and associated with activation delays. This comprehensive RV approach demonstrated incremental value.
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Affiliation(s)
- Daniel Forsha
- Ward Family Heart Center, Children's Mercy Hospital, Kansas City, Missouri.
| | - Niels Risum
- Department of Cardiology, Hvidorve Hospital, Hvidorve, Denmark
| | - P Brian Smith
- Duke Clinical Research Institute, Durham, North Carolina
| | - Ronald J Kanter
- Division of Pediatric Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Zainab Samad
- Division of Cardiovascular Disease, Duke University Medical Center, Durham, North Carolina
| | - Piers Barker
- Division of Pediatric Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Joseph Kisslo
- Division of Cardiovascular Disease, Duke University Medical Center, Durham, North Carolina
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Marechaux S, Menet A, Guyomar Y, Ennezat PV, Guerbaai RA, Graux P, Tribouilloy C. Role of echocardiography before cardiac resynchronization therapy: new advances and current developments. Echocardiography 2016; 33:1745-1752. [DOI: 10.1111/echo.13334] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Sylvestre Marechaux
- Lille North of France University/Catholic University Hospital/Catholic School of Medicine; Cardiology Department; Lille Catholic University; Lille France
- INSERM U 1088; University of Picardie; Amiens France
| | - Aymeric Menet
- Lille North of France University/Catholic University Hospital/Catholic School of Medicine; Cardiology Department; Lille Catholic University; Lille France
- INSERM U 1088; University of Picardie; Amiens France
| | - Yves Guyomar
- Lille North of France University/Catholic University Hospital/Catholic School of Medicine; Cardiology Department; Lille Catholic University; Lille France
| | | | - Raphaëlle Ashley Guerbaai
- Cardiology Department; Grenoble University Hospital; Grenoble France
- Cardiovascular and Thoracic Department; Amiens University Hospital; Amiens France
| | - Pierre Graux
- Lille North of France University/Catholic University Hospital/Catholic School of Medicine; Cardiology Department; Lille Catholic University; Lille France
| | - Christophe Tribouilloy
- INSERM U 1088; University of Picardie; Amiens France
- Cardiovascular and Thoracic Department; Amiens University Hospital; Amiens France
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40
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Maréchaux S. The Wolff-Parkinson-White Syndrome: A Test Bed for the Assessment of Myocardial Dyssynchrony? Circ Cardiovasc Imaging 2016; 9:CIRCIMAGING.116.005112. [PMID: 27307557 DOI: 10.1161/circimaging.116.005112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sylvestre Maréchaux
- From the Université Lille Nord de France/GCS-Groupement des hôpitaux de l'institut Catholique de Lille/Faculté Libre de Médecine, Cardiology Department, Université Catholique de Lille, 59000 Lille, France, and INSERM U 1088, Université de Picardie, Amiens, France.
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41
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Menet A, Bardet-Bouchery H, Guyomar Y, Graux P, Delelis F, Castel AL, Heuls S, Cuvelier E, Gevaert C, Ennezat PV, Tribouilloy C, Maréchaux S. Prognostic importance of postoperative QRS widening in patients with heart failure receiving cardiac resynchronization therapy. Heart Rhythm 2016; 13:1636-43. [PMID: 27236025 DOI: 10.1016/j.hrthm.2016.05.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Landmark reports have suggested that patients with QRS widening immediately after cardiac resynchronization therapy (CRT) experienced less frequently reverse left ventricular remodeling during follow-up. OBJECTIVE We sought to investigate the relationship between postoperative QRS widening relative to baseline and mortality in a prospective cohort of heart failure patients receiving CRT. METHODS A 12-lead electrocardiogram was recorded for 237 heart failure patients (New York Heart Association class II to IV, left ventricular ejection fraction ≤35%, and QRS width ≥120 ms) before and immediately after CRT device implantation. The relationships between QRS widening, all-cause and cardiovascular mortality, and echocardiographic response to CRT were studied. RESULTS During a median follow-up of 24 months, 39 patients died. Fifty patients (21%) experienced QRS widening after CRT [QRS(+) group]. During follow-up, all-cause mortality was higher in QRS(+) patients than in QRS(-) patients (36-month survival free from death 81% ± 7% vs 64% ± 16%; log rank, P = .029). After adjustment for important prognostic confounders, QRS(+) patients remained associated with an excess overall mortality (adjusted hazard ratio [HR] 2.67; 95% confidence interval 1.07-6.65; P = .035) and cardiovascular mortality (adjusted hazard ratio 3.63; 95% confidence interval 1.13-11.65; P = .03). QRS(+) patients were less frequent responders to CRT than were QRS(-) patients (20 [47%] vs 136 [83%]; P < .0001). CONCLUSION Postoperative QRS widening relative to baseline after CRT is associated with a considerable increased mortality risk during follow-up. Whether QRS narrowing should be achieved to optimize CRT placement, and thereby increase the rate of CRT responders and improve outcome, deserves further research.
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Affiliation(s)
- Aymeric Menet
- GCS-Groupement des hôpitaux de l'institut Catholique de Lille/Faculté Libre de Médecine, Département de Cardiologie, Université Catholique de Lille, Lille, France; INSERM U 1088, Université de Picardie, Amiens, France
| | - Hélène Bardet-Bouchery
- GCS-Groupement des hôpitaux de l'institut Catholique de Lille/Faculté Libre de Médecine, Département de Cardiologie, Université Catholique de Lille, Lille, France; Centre Hospitalier de la région de Saint Omer, Saint Omer, France
| | - Yves Guyomar
- GCS-Groupement des hôpitaux de l'institut Catholique de Lille/Faculté Libre de Médecine, Département de Cardiologie, Université Catholique de Lille, Lille, France
| | - Pierre Graux
- GCS-Groupement des hôpitaux de l'institut Catholique de Lille/Faculté Libre de Médecine, Département de Cardiologie, Université Catholique de Lille, Lille, France
| | - François Delelis
- GCS-Groupement des hôpitaux de l'institut Catholique de Lille/Faculté Libre de Médecine, Département de Cardiologie, Université Catholique de Lille, Lille, France
| | - Anne-Laure Castel
- GCS-Groupement des hôpitaux de l'institut Catholique de Lille/Faculté Libre de Médecine, Département de Cardiologie, Université Catholique de Lille, Lille, France
| | - Sébastien Heuls
- GCS-Groupement des hôpitaux de l'institut Catholique de Lille/Faculté Libre de Médecine, Département de Cardiologie, Université Catholique de Lille, Lille, France
| | - Estelle Cuvelier
- GCS-Groupement des hôpitaux de l'institut Catholique de Lille/Faculté Libre de Médecine, Département de Cardiologie, Université Catholique de Lille, Lille, France
| | - Cécile Gevaert
- GCS-Groupement des hôpitaux de l'institut Catholique de Lille/Faculté Libre de Médecine, Département de Cardiologie, Université Catholique de Lille, Lille, France
| | | | - Christophe Tribouilloy
- INSERM U 1088, Université de Picardie, Amiens, France; Pôle Cardiovasculaire et Thoracique, Centre Hospitalier Universitaire Amiens, Amiens, France
| | - Sylvestre Maréchaux
- GCS-Groupement des hôpitaux de l'institut Catholique de Lille/Faculté Libre de Médecine, Département de Cardiologie, Université Catholique de Lille, Lille, France; INSERM U 1088, Université de Picardie, Amiens, France.
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Smiseth OA, Torp H, Opdahl A, Haugaa KH, Urheim S. Myocardial strain imaging: how useful is it in clinical decision making? Eur Heart J 2016; 37:1196-207. [PMID: 26508168 PMCID: PMC4830908 DOI: 10.1093/eurheartj/ehv529] [Citation(s) in RCA: 530] [Impact Index Per Article: 66.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/13/2015] [Accepted: 09/21/2015] [Indexed: 01/19/2023] Open
Abstract
Myocardial strain is a principle for quantification of left ventricular (LV) function which is now feasible with speckle-tracking echocardiography. The best evaluated strain parameter is global longitudinal strain (GLS) which is more sensitive than left ventricular ejection fraction (LVEF) as a measure of systolic function, and may be used to identify sub-clinical LV dysfunction in cardiomyopathies. Furthermore, GLS is recommended as routine measurement in patients undergoing chemotherapy to detect reduction in LV function prior to fall in LVEF. Intersegmental variability in timing of peak myocardial strain has been proposed as predictor of risk of ventricular arrhythmias. Strain imaging may be applied to guide placement of the LV pacing lead in patients receiving cardiac resynchronization therapy. Strain may also be used to diagnose myocardial ischaemia, but the technology is not sufficiently standardized to be recommended as a general tool for this purpose. Peak systolic left atrial strain is a promising supplementary index of LV filling pressure. The strain imaging methodology is still undergoing development, and further clinical trials are needed to determine if clinical decisions based on strain imaging result in better outcome. With this important limitation in mind, strain may be applied clinically as a supplementary diagnostic method.
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Affiliation(s)
- Otto A Smiseth
- Division of Cardiovascular and Pulmonary Diseases, Department of Cardiology and Institute for Surgical Research, Center for Heart Failure Research, Center for Cardiological Innovation and KG Jebsen Cardiac Research Centre Oslo, Oslo University Hospital, University of Oslo, Rikshospitalet, N-0027 Oslo, Norway
| | - Hans Torp
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, 7489 Trondheim, Norway
| | - Anders Opdahl
- Division of Cardiovascular and Pulmonary Diseases, Department of Cardiology and Institute for Surgical Research, Center for Heart Failure Research, Center for Cardiological Innovation and KG Jebsen Cardiac Research Centre Oslo, Oslo University Hospital, University of Oslo, Rikshospitalet, N-0027 Oslo, Norway
| | - Kristina H Haugaa
- Division of Cardiovascular and Pulmonary Diseases, Department of Cardiology and Institute for Surgical Research, Center for Heart Failure Research, Center for Cardiological Innovation and KG Jebsen Cardiac Research Centre Oslo, Oslo University Hospital, University of Oslo, Rikshospitalet, N-0027 Oslo, Norway
| | - Stig Urheim
- Division of Cardiovascular and Pulmonary Diseases, Department of Cardiology and Institute for Surgical Research, Center for Heart Failure Research, Center for Cardiological Innovation and KG Jebsen Cardiac Research Centre Oslo, Oslo University Hospital, University of Oslo, Rikshospitalet, N-0027 Oslo, Norway
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Khan SG, Klettas D, Kapetanakis S, Monaghan MJ. Clinical utility of speckle-tracking echocardiography in cardiac resynchronisation therapy. Echo Res Pract 2016; 3:R1-R11. [PMID: 27249816 PMCID: PMC5402657 DOI: 10.1530/erp-15-0032] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 03/08/2016] [Indexed: 11/08/2022] Open
Abstract
Cardiac resynchronisation therapy (CRT) can profoundly improve outcome in selected patients with heart failure; however, response is difficult to predict and can be absent in up to one in three patients. There has been a substantial amount of interest in the echocardiographic assessment of left ventricular dyssynchrony, with the ultimate aim of reliably identifying patients who will respond to CRT. The measurement of myocardial deformation (strain) has conventionally been assessed using tissue Doppler imaging (TDI), which is limited by its angle dependence and ability to measure in a single plane. Two-dimensional speckle-tracking echocardiography is a technique that provides measurements of strain in three planes, by tracking patterns of ultrasound interference ('speckles') in the myocardial wall throughout the cardiac cycle. Since its initial use over 15 years ago, it has emerged as a tool that provides more robust, reproducible and sensitive markers of dyssynchrony than TDI. This article reviews the use of two-dimensional and three-dimensional speckle-tracking echocardiography in the assessment of dyssynchrony, including the identification of echocardiographic parameters that may hold predictive potential for the response to CRT. It also reviews the application of these techniques in guiding optimal LV lead placement pre-implant, with promising results in clinical improvement post-CRT.
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Affiliation(s)
- Sitara G Khan
- King's College London British Heart Foundation Centre, London, UK Department of Cardiology, King's College Hospital, London, UK
| | | | | | - Mark J Monaghan
- King's College London British Heart Foundation Centre, London, UK Department of Cardiology, King's College Hospital, London, UK
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Forsha D, Slorach C, Chen CK, Sherman A, Mertens L, Barker P, Kisslo J, Friedberg MK. Patterns of Mechanical Inefficiency in Pediatric Dilated Cardiomyopathy and Their Relation to Left Ventricular Function and Clinical Outcomes. J Am Soc Echocardiogr 2016; 29:226-36. [DOI: 10.1016/j.echo.2015.11.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Indexed: 01/04/2023]
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Abstract
Echocardiography is used in cardiac resynchronisation therapy (CRT) to assess cardiac function, and in particular left ventricular (LV) volumetric status, and prediction of response. Despite its widespread applicability, LV volumes determined by echocardiography have inherent measurement errors, interobserver and intraobserver variability, and discrepancies with the gold standard magnetic resonance imaging. Echocardiographic predictors of CRT response are based on mechanical dyssynchrony. However, parameters are mainly tested in single-centre studies or lack feasibility. Speckle tracking echocardiography can guide LV lead placement, improving volumetric response and clinical outcome by guiding lead positioning towards the latest contracting segment. Results on optimisation of CRT device settings using echocardiographic indices have so far been rather disappointing, as results suffer from noise. Defining response by echocardiography seems valid, although re-assessment after 6 months is advisable, as patients can show both continuous improvement as well as deterioration after the initial response. Three-dimensional echocardiography is interesting for future implications, as it can determine volume, dyssynchrony and viability in a single recording, although image quality needs to be adequate. Deformation patterns from the septum and the derived parameters are promising, although validation in a multicentre trial is required. We conclude that echocardiography has a pivotal role in CRT, although clinicians should know its shortcomings.
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Cardiac resynchronization therapy: Identifying an activation delay by regional strain analysis. J Electrocardiol 2015; 48:779-82. [DOI: 10.1016/j.jelectrocard.2015.07.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Indexed: 11/19/2022]
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Feneon D, Behaghel A, Bernard A, Fournet M, Mabo P, Daubert JC, Leclercq C, Donal E. Left atrial function, a new predictor of response to cardiac resynchronization therapy? Heart Rhythm 2015; 12:1800-6. [DOI: 10.1016/j.hrthm.2015.04.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Indexed: 10/23/2022]
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Pluijmert M, Lumens J, Potse M, Delhaas T, Auricchio A, Prinzen FW. Computer Modelling for Better Diagnosis and Therapy of Patients by Cardiac Resynchronisation Therapy. Arrhythm Electrophysiol Rev 2015; 4:62-7. [PMID: 26835103 PMCID: PMC4711552 DOI: 10.15420/aer.2015.4.1.62] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 01/20/2015] [Indexed: 11/04/2022] Open
Abstract
Mathematical or computer models have become increasingly popular in biomedical science. Although they are a simplification of reality, computer models are able to link a multitude of processes to each other. In the fields of cardiac physiology and cardiology, models can be used to describe the combined activity of all ion channels (electrical models) or contraction-related processes (mechanical models) in potentially millions of cardiac cells. Electromechanical models go one step further by coupling electrical and mechanical processes and incorporating mechano-electrical feedback. The field of cardiac computer modelling is making rapid progress due to advances in research and the ever-increasing calculation power of computers. Computer models have helped to provide better understanding of disease mechanisms and treatment. The ultimate goal will be to create patient-specific models using diagnostic measurements from the individual patient. This paper gives a brief overview of computer models in the field of cardiology and mentions some scientific achievements and clinical applications, especially in relation to cardiac resynchronisation therapy (CRT).
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Affiliation(s)
- Marieke Pluijmert
- Department of Biomedical Engineering, Cardiovascular Research Institute, Maastricht, The Netherlands;
| | - Joost Lumens
- Department of Biomedical Engineering, Cardiovascular Research Institute, Maastricht, The Netherlands;
| | - Mark Potse
- Centre for Computational Medicine in Cardiology, Universita della Svizzera Intaliana, Lugano, Switzerland;
| | - Tammo Delhaas
- Department of Biomedical Engineering, Cardiovascular Research Institute, Maastricht, The Netherlands;
| | - Angelo Auricchio
- Centre for Computational Medicine in Cardiology, Universita della Svizzera Intaliana, Lugano, Switzerland;
- Fondazione Cardiocentro Ticino, Lugano, Switzerland;
| | - Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute, Maastricht, The Netherlands
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Seo Y, Ishizu T, Kawamura R, Yamamoto M, Kuroki K, Igarashi M, Sekiguchi Y, Nogami A, Aonuma K. Three-Dimensional Propagation Imaging of Left Ventricular Activation by Speckle-Tracking Echocardiography to Predict Responses to Cardiac Resynchronization Therapy. J Am Soc Echocardiogr 2015; 28:606-14. [DOI: 10.1016/j.echo.2015.02.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Indexed: 11/30/2022]
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Lalani GG, Birgersdotter-Green U. Cardiac resynchronisation therapy in patients with chronic heart failure. Heart 2015; 101:1008-14. [PMID: 25882504 DOI: 10.1136/heartjnl-2014-306835] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 03/18/2015] [Indexed: 11/04/2022] Open
Abstract
Cardiac resynchronisation therapy (CRT) is common treatment for congestive heart failure (HF) with decreased LV function and wide QRS complex. Its foundations are set in the understanding of the pathophysiology of ventricular dyssynchrony. Over the last several decades, CRT has evolved through changes in implantation techniques, device and lead design, imaging modalities and our growing clinical experience. This review article will discuss the vast clinical experience that has led to current guidelines recommendations for CRT in patients with mild-to-severe HF. In addition, the article will also discuss recent evidence of benefits of CRT in patients beyond the guidelines. The article will also address the issue of non-responders, optimisation of CRT, postimplant evaluation and remote monitoring.
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