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Monge García MI, Jian Z, Hatib F, Settles JJ, Cecconi M, Pinsky MR. Relationship between intraventricular mechanical dyssynchrony and left ventricular systolic and diastolic performance: An in vivo experimental study. Physiol Rep 2023; 11:e15607. [PMID: 36808901 PMCID: PMC9937795 DOI: 10.14814/phy2.15607] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/13/2023] [Accepted: 01/23/2023] [Indexed: 02/19/2023] Open
Abstract
Left ventricular mechanical dyssynchrony (LVMD) refers to the nonuniformity in mechanical contraction and relaxation timing in different ventricular segments. We aimed to determine the relationship between LVMD and LV performance, as assessed by ventriculo-arterial coupling (VAC), LV mechanical efficiency (LVeff ), left ventricular ejection fraction (LVEF), and diastolic function during sequential experimental changes in loading and contractile conditions. Thirteen Yorkshire pigs submitted to three consecutive stages with two opposite interventions each: changes in afterload (phenylephrine/nitroprusside), preload (bleeding/reinfusion and fluid bolus), and contractility (esmolol/dobutamine). LV pressure-volume data were obtained with a conductance catheter. Segmental mechanical dyssynchrony was assessed by global, systolic, and diastolic dyssynchrony (DYS) and internal flow fraction (IFF). Late systolic LVMD was related to an impaired VAC, LVeff , and LVEF, whereas diastolic LVMD was associated with delayed LV relaxation (logistic tau), decreased LV peak filling rate, and increased atrial contribution to LV filling. The hemodynamic factors related to LVMD were contractility, afterload, and heart rate. However, the relationship between these factors differed throughout the cardiac cycle. LVMD plays a significant role in LV systolic and diastolic performance and is associated with hemodynamic factors and intraventricular conduction.
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Affiliation(s)
| | | | | | | | - Maurizio Cecconi
- Department Anaesthesia and Intensive Care Units, Humanitas Research HospitalHumanitas UniversityMilanItaly
| | - Michael R. Pinsky
- Department of Critical Care MedicineUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
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Böhm M, Butler J, Mahfoud F, Filippatos G, Ferreira JP, Pocock SJ, Slawik J, Brueckmann M, Linetzky B, Schüler E, Wanner C, Zannad F, Packer M, Anker SD. Heart failure outcomes according to heart rate and effects of empagliflozin in patients of the EMPEROR-Preserved trial. Eur J Heart Fail 2022; 24:1883-1891. [PMID: 36087309 PMCID: PMC9828798 DOI: 10.1002/ejhf.2677] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 08/27/2022] [Indexed: 01/12/2023] Open
Abstract
AIMS Empagliflozin reduces cardiovascular death (CVD) or heart failure hospitalization (HHF) in patients with heart failure and preserved ejection fraction (HFpEF). Treatment effects and safety in relation to resting heart rate (RHR) have not been studied. METHODS AND RESULTS The interplay of RHR and empagliflozin effects in EMPEROR-Preserved was evaluated. We grouped patients (n = 5988) according to their baseline RHR (<70 bpm [n = 2650], 70-75 bpm [n = 967], >75 bpm [n = 1736]) and explored the influence of RHR on CVD or HHF (primary outcome) and its components in sinus rhythm or atrial fibrillation/flutter (AF) and adverse events. We studied the efficacy of empagliflozin across the RHR spectrum. Compared to placebo, empagliflozin did not change heart rate over time. The primary outcome (p for trend = 0.0004) and its components CVD (p trend = 0.0002), first HHF (p for trend = 0.0099) and all-cause death (p < 0.0001) increased with RHR only in sinus rhythm but not AF. The risk increase with RHR was similar in patients with heart failure and mildly reduced ejection fraction (left ventricular ejection fraction [LVEF] 40-49%) and HFpEF (LVEF ≥50%). Baseline RHR had no influence on the effect of empagliflozin on the primary outcomes (p for trend = 0.20), first HHF (p for trend = 0.49). There were no clinically relevant differences in adverse events between empagliflozin and placebo across the RHR groups. CONCLUSION Resting heart rate associates with outcomes only in sinus rhythm but not in AF. Empagliflozin reduced outcomes over the entire RHR spectrum without increase of adverse events.
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Affiliation(s)
- Michael Böhm
- Klinik für Innere Medizin IIIUniversitätsklinikum des Saarlandes, Saarland UniversitySaarlandGermany
- Cape Heart InstituteCape TownSouth Africa
| | - Javed Butler
- Department of MedicineUniversity of Mississippi School of MedicineJacksonMSUSA
- Baylor Scott and White Research InstituteDallasTexasUSA
| | - Felix Mahfoud
- Klinik für Innere Medizin IIIUniversitätsklinikum des Saarlandes, Saarland UniversitySaarlandGermany
| | - Gerasimos Filippatos
- National and Kapodistrian University of Athens School of MedicineAthens University Hospital AttikonAthensGreece
| | - João Pedro Ferreira
- Centre d'Investigation Clinique‐ Plurithématique Inserm CIC‐P 1433Université de LorraineNancyFrance
- France Inserm U1116, CHRU Nancy BraboisF‐CRIN INI‐CRCT (Cardiovascular and Renal Clinical Trialists)NancyFrance
| | - Stuart J. Pocock
- Department of Medical StatisticsLondon School of Hygiene & Tropical MedicineLondonUK
| | - Jonathan Slawik
- Klinik für Innere Medizin IIIUniversitätsklinikum des Saarlandes, Saarland UniversitySaarlandGermany
| | - Martina Brueckmann
- Boehringer Ingelheim InternationalIngelheimGermany
- First Department of Medicine, Faculty of Medicine MannheimUniversity of HeidelbergMannheimGermany
| | - Bruno Linetzky
- Eli Lilly Interamerica Inc, Suc ArgentinaBuenos AiresArgentina
| | | | - Christoph Wanner
- Medizinische Klinik und Poliklinik 1, Schwerpunkt NephrologieUniversitätsklinikum WürzburgWürzburgGermany
| | - Faiez Zannad
- Centre d'Investigation Clinique‐ Plurithématique Inserm CIC‐P 1433Université de LorraineNancyFrance
- France Inserm U1116, CHRU Nancy BraboisF‐CRIN INI‐CRCT (Cardiovascular and Renal Clinical Trialists)NancyFrance
| | - Milton Packer
- Baylor University Medical CenterDallasTXUSA
- Imperial CollegeLondonUK
| | - Stefan D. Anker
- Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site BerlinCharité Universitätsmedizin BerlinBerlinGermany
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Shipulin VV, Andreev SL, Pryakhin AS, Mochula AV, Maltseva AN, Sazonova SI, Shipulin VM, Massalha S, Zavadovsky KV. Low-dose dobutamine stress gated blood pool SPECT assessment of left ventricular contractile reserve in ischemic cardiomyopathy: a feasibility study. Eur J Nucl Med Mol Imaging 2022; 49:2219-2231. [PMID: 35150293 DOI: 10.1007/s00259-022-05714-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/28/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE The purpose of the present study was to evaluate the feasibility of gated blood pool single-photon emission computed tomography (GBPS) with low-dose dobutamine (LDD) stress test, performed on a single-photon emission computed tomography (SPECT) camera equipped with cadmium-zinc-telluride (CZT) solid-state detectors, in assessing of left ventricle (LV) contractile reserve in patients with ischemic cardiomyopathy (ICM). METHODS A total of 52 patients (age 59 ± 7.2 years, 47 men and 5 women) with ICM and a control group of 10 patients without obstructive coronary artery lesion underwent GBPS and transthoracic echocardiography (TTE) at rest and during LDD stress test (5, 10, 15 µg/kg/min). The duration of each GBPS step was 5 min. Stress-induced changes in LV ejection fraction (ΔLVEF), peak ejection rate, LV volumes, and mechanical dyssynchrony (phase histogram standard deviation, phase histogram bandwidth and entropy) obtained with GBPS were estimated. RESULTS All GBPS indices except end-diastolic volume showed significant dynamics during stress test in both groups. The majority of parameters in ICM patients showed significant changes at a dobutamine dose of 10 µg/kg/min as compared to the rest study. Seventeen percent of ICM patients, but none from the control group, showed a decrease in LVEF during stress, accompanied by a significant increase in entropy. The intra- and inter-observer reproducibility was excellent for both rest and stress studies. There was a moderate correlation (r = 0.5, p = 0.01) between GBPS and TTE, with a mean difference value of - 1.7 (95% confidence interval - 9.8; 6.4; p = 0.06) in ΔLVEF. CONCLUSION Low-dose dobutamine stress GBPS performed with high-efficiency CZT-SPECT cameras can be performed for evaluating stress-induced changes in LV contractility and dyssynchrony with lower acquisition time. A dobutamine dose of 10 µg/kg/min can potentially suffice to detect stress-induced changes in patients with ICM during GBPS. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04508608 (August 7, 2020).
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Affiliation(s)
- Vladimir V Shipulin
- Nuclear Medicine Department, Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Russian Federation, Kievskaya str. 111a, Tomsk, 634012, Russia
| | - Sergey L Andreev
- Cardiovascular Surgery Department, Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Russian Federation, Kievskaya str. 111a, Tomsk, 634012, Russia
| | - Andrew S Pryakhin
- Cardiovascular Surgery Department, Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Russian Federation, Kievskaya str. 111a, Tomsk, 634012, Russia
| | - Andrew V Mochula
- Nuclear Medicine Department, Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Russian Federation, Kievskaya str. 111a, Tomsk, 634012, Russia
| | - Alina N Maltseva
- Nuclear Medicine Department, Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Russian Federation, Kievskaya str. 111a, Tomsk, 634012, Russia
| | - Svetlana I Sazonova
- Nuclear Medicine Department, Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Russian Federation, Kievskaya str. 111a, Tomsk, 634012, Russia
| | - Vladimir M Shipulin
- Administrative Department, Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Russian Federation, Kievskaya str. 111a, Tomsk, 634012, Russia
| | - Samia Massalha
- Department of Cardiology, Rambam HealthCare Campus, Haifa, Israel.,Department of Nuclear Medicine, Rambam HealthCare Campus, Haifa, Israel
| | - Konstantin V Zavadovsky
- Nuclear Medicine Department, Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Russian Federation, Kievskaya str. 111a, Tomsk, 634012, Russia.
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Hornung A, Vollmer D, Wiegand G, Apitz C, Latus H, Hofbeck M, Sieverding L. A Comprehensive Functional Analysis in Patients after Atrial Switch Surgery. Thorac Cardiovasc Surg 2021; 69:e32-e40. [PMID: 33851400 PMCID: PMC8045928 DOI: 10.1055/s-0041-1726307] [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] [Indexed: 12/02/2022]
Abstract
Background Long-term course after atrial switch operation is determined by
increasing right ventricular (RV) insufficiency. The aim of our study was to investigate
subtle functional parameters by invasive measurements with conductance technique and
noninvasive examinations with cardiac magnetic resonance imaging (CMR). Methods We used invasive (pressure–volume loops under baseline conditions and
dobutamine) and noninvasive techniques (CMR with feature tracking [FT] method) to evaluate
RV function. All patients had cardiopulmonary exercise testing (CPET). Results From 2011 to 2013, 16 patients aged 28.2 ± 7.3 (22–50) years after atrial
switch surgery (87.5% Senning and 12.5% Mustard) were enrolled in this prospective study.
All patients were in New York Heart Association (NYHA) class I to II and presented mean
peak oxygen consumption of 30.1 ± 5.7 (22.7–45.5) mL/kg/min. CMR-derived end-diastolic
volume was 110 ± 22 (78–156) mL/m 2 and RV ejection fraction 41 ± 8% (25–52%).
CMR-FT revealed lower global systolic longitudinal, radial, and circumferential strain for
the systemic RV compared with the subpulmonary left ventricle. End-systolic elastance
(Ees) was overall reduced (compared with data from the literature) and showed significant
increase under dobutamine (0.80 ± 0.44 to 1.89 ± 0.72 mm Hg/mL, p ≤ 0.001), whereas
end-diastolic elastance (Eed) was not significantly influenced (0.11 ± 0.70 to
0.13 ± 0.15 mm Hg/mL, p = 0.454). We found no relevant relationship between
load-independent conductance indices and strain or CPET parameters. Conductance analysis
revealed significant mechanical dyssynchrony, higher during diastole (mean 30 ± 4%
baseline, 24 ± 6% dobutamine) than during systole (mean 17 ± 6% baseline, 19 ± 7%
dobutamine). Conclusions Functional assessment of a deteriorating systemic RV remains
demanding. Conductance indices as well as the CMR-derived strain parameters showed overall
reduced values, but a significant relationship was not present (including CPET). Our
conductance analysis revealed intraventricular and predominantly diastolic RV
dyssynchrony.
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Affiliation(s)
- Andreas Hornung
- Department Pediatric Cardiology, Pulmonology and Intensive Care, University Children's Hospital Tuebingen, Tuebingen, Germany
| | - Daniela Vollmer
- Department Pediatric Cardiology, Pulmonology and Intensive Care, University Children's Hospital Tuebingen, Tuebingen, Germany
| | - Gesa Wiegand
- Department Pediatric Cardiology, Pulmonology and Intensive Care, University Children's Hospital Tuebingen, Tuebingen, Germany
| | - Christian Apitz
- Department Pediatric Cardiology, University Children's Hospital Ulm, Ulm, Germany
| | - Heiner Latus
- Department Pediatric Cardiology and Congenital Heart Disease, German Heart Center, Munich, Germany
| | - Michael Hofbeck
- Department Pediatric Cardiology, Pulmonology and Intensive Care, University Children's Hospital Tuebingen, Tuebingen, Germany
| | - Ludger Sieverding
- Department Pediatric Cardiology, Pulmonology and Intensive Care, University Children's Hospital Tuebingen, Tuebingen, Germany
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Naar J, Mortensen L, Winter R, Johnson J, Shahgaldi K, Manouras A, Braunschweig F, Ståhlberg M. Heart rate and dyssynchrony in patients with cardiac resynchronization therapy: a pilot study. SCAND CARDIOVASC J 2017; 51:143-152. [PMID: 28335644 DOI: 10.1080/14017431.2017.1308007] [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: 10/19/2022]
Abstract
OBJECTIVES The objective of this pilot study was to describe the impact of paced heart rate on left ventricular (LV) mechanical dyssynchrony in synchronous compared to dyssynchronous pacing modes in patients with heart failure. METHODS Echocardiography was performed in 14 cardiac resynchronization therapy (CRT) patients at paced heart rates of 70 and 90 bpm in synchronous- (CRT), and dyssynchronous (atrial pacing + wide QRS activation) pacing modes. LV dyssynchrony was quantified using the 12-segment standard deviation model (Ts-SD) derived from Tissue Doppler Imaging. In addition, cardiac cycle intervals were assessed using cardiac state diagrams and stroke volume (SV) and filling pressure were estimated. RESULTS Ts-SD decreased significantly with CRT at 90 bpm (25 ± 12 ms) compared to 70 bpm (35 ± 15 ms, p = .01), but remained unchanged with atrial pacing at different paced heart rates (p = .96). The paced heart rate dependent reduction in Ts-SD was consistent when Ts-SD was indexed to average Ts and systolic time interval. Cardiac state diagram derived analysis of cardiac cycle intervals demonstrated a significant reduction of the pre-ejection interval and an increase in diastole with CRT compared to atrial pacing. SV was maintained at the higher paced heart rate with CRT pacing but decreased with atrial pacing. DISCUSSION Due to the small sample size in this pilot study general and firm conclusions are difficult to render. However, the data suggest that pacing at higher heart rates acutely reduces remaining LV dyssynchrony during CRT, but not during atrial pacing with dyssynchronous ventricular activation. These results need confirmation in a larger patient cohort.
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Affiliation(s)
- Jan Naar
- a Department of Cardiology , Na Homolce Hospital , Prague , Czech Republic.,b Department of Cardiology , Karolinska University Hospital , Stockholm , Sweden
| | - Lars Mortensen
- b Department of Cardiology , Karolinska University Hospital , Stockholm , Sweden.,c Department of Medicine, Karolinska Institutet , Stockholm , Sweden
| | - Reidar Winter
- d Department of Medical Engineering, School of Technology and Health , KTH, Royal Institute of Technology , Stockholm , Sweden
| | - Jonas Johnson
- d Department of Medical Engineering, School of Technology and Health , KTH, Royal Institute of Technology , Stockholm , Sweden
| | - Kambiz Shahgaldi
- e Department of Clinical Physiology , Sunderby Hospital , Luleå , Sweden
| | - Aristomenis Manouras
- b Department of Cardiology , Karolinska University Hospital , Stockholm , Sweden
| | - Frieder Braunschweig
- b Department of Cardiology , Karolinska University Hospital , Stockholm , Sweden
| | - Marcus Ståhlberg
- b Department of Cardiology , Karolinska University Hospital , Stockholm , Sweden
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Mochizuki Y, Suzuki R, Teshima T, Matsumoto H, Panthee N, Sugiura S, Hisada T, Koyama H. Usefulness of dyssynchrony indices based on two-dimensional speckle tracking echocardiography in a canine model of left bundle branch block. J Vet Cardiol 2016; 18:358-366. [DOI: 10.1016/j.jvc.2016.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 05/05/2016] [Accepted: 07/29/2016] [Indexed: 10/21/2022]
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Kitai T, Tang WHW. Pathophysiologic Insights into Heart Rate Reduction in Heart Failure: Implications in the Use of Beta-Blockers and Ivabradine. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2016; 18:13. [DOI: 10.1007/s11936-015-0435-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chan YH, Kuo CT, Wu LS, Wang CL, Yeh YH, Hsu LA, Ho WJ. Combined Global Longitudinal Strain and Intraventricular Mechanical Dyssynchrony Predicts Long-Term Outcome in Patients With Systolic Heart Failure. Circ J 2016; 80:177-85. [DOI: 10.1253/circj.cj-15-0953] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yi-Hsin Chan
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital
- College of Medicine, Chang Gung University
| | - Chi-Tai Kuo
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital
- College of Medicine, Chang Gung University
| | - Lung-Sheng Wu
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital
- College of Medicine, Chang Gung University
| | - Chun-Li Wang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital
- College of Medicine, Chang Gung University
| | - Yung-Hsin Yeh
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital
- College of Medicine, Chang Gung University
| | - Lung-An Hsu
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital
- College of Medicine, Chang Gung University
| | - Wan-Jing Ho
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital
- College of Medicine, Chang Gung University
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Choi WG, Kim SH, Kim SH, Park SD, Baek YS, Shin SH, Woo SI, Kim DH, Park KS, Kwan J. Response of functional mitral regurgitation during dobutamine infusion in relation to changes in left ventricular dyssynchrony and mitral valve geometry. Yonsei Med J 2014; 55:592-8. [PMID: 24719124 PMCID: PMC3990066 DOI: 10.3349/ymj.2014.55.3.592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 06/20/2013] [Accepted: 07/15/2013] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Functional mitral regurgitation (FMR) and myocardial dyssynchrony commonly occur in patients with dilated cardiomyopathy (DCM). The aim of this study was to elucidate changes in FMR in relation to those in left ventricular (LV) dyssynchrony as well as geometric parameters of the mitral valve (MV) in DCM patients during dobutamine infusion. MATERIALS AND METHODS Twenty-nine DCM patients (M:F=15:14; age: 62±15 yrs) with FMR underwent echocardiography at baseline and during peak dose (30 or 40 ug/min) of dobutamine infusion. Using 2D echocardiography, LV end-diastolic volume, end-systolic volume (LVESV), ejection fraction (EF), and effective regurgitant orifice area (ERO) were estimated. Dyssynchrony indices (DIs), defined as the standard deviation of time interval-to-peak myocardial systolic contraction of eight LV segments, were measured. Using the multi-planar reconstructive mode from commercially available 3D image analysis software, MV tenting area (MVTa) was measured. All geometrical measurements were corrected (c) by the height of each patient. RESULTS During dobutamine infusion, EF (28±8% vs. 39±11%, p=0.001) improved along with significant decrease in cLVESV (80.1±35.2 mm³/m vs. 60.4±31.1 mm³/m, p=0.001); cMVTa (1.28±0.48 cm²/m vs. 0.79±0.33 cm²/m, p=0.001) was significantly reduced; and DI (1.31±0.51 vs. 1.58±0.68, p=0.025) showed significant increase. Despite significant deterioration of LV dyssynchrony during dobutamine infusion, ERO (0.16±0.09 cm² vs. 0.09±0.08 cm², p=0.001) significantly improved. On multivariate analysis, ΔcMVTa and ΔEF were found to be the strongest independent determinants of ΔERO (R²=0.443, p=0.001). CONCLUSION Rather than LV dyssynchrony, MV geometry determined by LV geometry and systolic pressure, which represents the MV closing force, may be the primary determinant of MR severity.
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Affiliation(s)
- Woong Gil Choi
- Division of Cardiology, Department of Internal Medicine, Konkuk University College of Medicine, Chungju, Korea
| | - Soo Hyun Kim
- Division of Cardiology, Department of Internal Medicine, Konkuk University College of Medicine, Chungju, Korea
| | - Soo Han Kim
- Division of Cardiology, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Sang Don Park
- Division of Cardiology, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Young Soo Baek
- Division of Cardiology, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Sung Hee Shin
- Division of Cardiology, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Sung Il Woo
- Division of Cardiology, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Dae Hyeok Kim
- Division of Cardiology, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Keum Soo Park
- Division of Cardiology, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Jun Kwan
- Division of Cardiology, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
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Salimian S, Thibault B, Finnerty V, Grégoire J, Harel F. The effects of dobutamine stress on cardiac mechanical synchrony determined by phase analysis of gated SPECT myocardial perfusion imaging in a canine model. J Nucl Cardiol 2014; 21:375-83. [PMID: 24402711 DOI: 10.1007/s12350-013-9847-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 12/02/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Precise identification of left ventricular (LV) systolic mechanical dyssynchrony may be useful in optimizing the response to cardiac resynchronization therapy in heart failure (HF) patients. However, LV dyssynchrony is mostly measured at rest; patients often suffer from the HF symptoms during exercise. OBJECTIVES Our objective was to examine the impacts of stress on LV synchronism with phase analysis of gated SPECT myocardial perfusion imaging (GMPS) within a normal animal cohort. METHODS Stress was induced with different levels of dobutamine infusion in six healthy canine subjects. Hemodynamic properties were assessed by LV pressure measurements. Also, LV mechanical synchronism (coordination of LV septal and lateral wall at the time of contraction) was determined by phase analysis of GMPS using commercially available QGS software and in-house MHI4MPI software, with the thickening- and displacement-based method. Synchrony indexes in MHI4MPI included the septal-to-lateral delay and homogeneity index, derived from each of the two methods. Also, bandwidth, SD, and entropy (synchrony indexes) of the QGS software were assessed. RESULTS LVEF increased from 36.7% ± 8.7% at rest to 53.67% ± 12.34% at 20 μg · kg(-1) · minute(-1) (P < .001). Also, cardiac output increased from 3.67 ± 1.0 L · minute(-1) at rest to 8.4 ± 2.6 L · minute(-1) at 10 μg · kg(-1) · minute(-1) (P < .001). The same trend was observed for dP/dt max which increased from 1,247 ± 382.7 at rest to 5,062 ± 1,800 mm Hg · s(-1) at 10 μg · kg(-1) · minute(-1) (P < .01). Entropy decreased from 55.2% ± 8% at baseline to 43.5% ± 8.5% at 5 and 43.0% ± 3.7% at 10 μg · kg(-1) · minute(-1) dobutamine (P < .01). Thickening homogeneity index showed a difference from 91.7% ± 5.53% at rest to 98.2% ± 0.75% at 20 μg · kg(-1) · minute(-1) (P < .05). CONCLUSIONS Dobutamine stimulation could amplify the ventricular synchronism, and the thickening-based approach is more accurate than wall displacement for assessment of mechanical dyssynchrony in GMPS.
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Affiliation(s)
- Samaneh Salimian
- Department of Nuclear Medicine, Montreal Heart Institute and Université de Montréal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada
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Chattopadhyay S, Alamgir MF, Nikitin NP, Fraser AG, Clark AL, Cleland JG. The effect of pharmacological stress on intraventricular dyssynchrony in left ventricular systolic dysfunction. Eur J Heart Fail 2014; 10:412-20. [DOI: 10.1016/j.ejheart.2008.02.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2007] [Revised: 12/03/2007] [Accepted: 02/04/2008] [Indexed: 10/22/2022] Open
Affiliation(s)
| | | | | | | | - Andrew L. Clark
- Department of Cardiology; University of Hull; Kingston-upon-Hull UK
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Melero-Ferrer JL, Sánchez-Lázaro IJ, Almenar-Bonet L, Martínez-Dolz L, Buendía-Fuentes F, Portolés-Sanz M, Rivera-Otero M, Salvador-Sanz A. Impact of basal heart rate on long-term prognosis of heart transplant patients. Transpl Int 2013; 26:502-7. [PMID: 23489468 DOI: 10.1111/tri.12082] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Revised: 11/05/2012] [Accepted: 02/06/2013] [Indexed: 11/27/2022]
Abstract
Previous studies in patients with heart failure have shown that an elevated basal heart rate (HR) is associated with a poor outcome. Our aim with this study was to investigate if this relationship is also present in heart transplantation (HTx) recipients. From 2003 until 2010, 256 HTx performed in our center were recruited. Patients who required pacemaker, heart-lung transplants, pediatrics, retransplants, and those patients with a survival of less than 1 year were excluded. The final number included in the analysis was 191. Using the HR obtained by EKG during elective admission at 1 year post-HTx and the survival rate, an ROC-curve was performed. The best point under the curve was achieved with 101 beats per minute (bpm), so patients were divided in two groups according to their HR. A comparison between survival curves of both groups was performed (Kaplan-Meier). Subsequently, a multivariate analysis considering HR and other variables with influence on survival according to the literature was carried out. A total of 136 patients were included in the group with HR ≤100 bpm, and 55 in the one with HR >100 bpm. There were no basal differences in both groups except for primary graft failure, which was more frequent in the >100 bpm group (30.9 vs. 17%, P = 0.033). Patients with ≤100 bpm had a better long prognosis (P < 0.001). The multivariate analysis proved that high HR was an independent predictor of mortality. Our study shows that HR should be considered as a prognosis factor in HTx patients.
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Affiliation(s)
- Josep L Melero-Ferrer
- Unidad de Insuficiencia Cardíaca y Trasplante, Servicio de Cardiología, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain.
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Takamura T, Dohi K, Onishi K, Sakurai Y, Ichikawa K, Tsuji A, Ota S, Tanabe M, Yamada N, Nakamura M, Nobori T, Ito M. Reversible Left Ventricular Regional Non-Uniformity Quantified by Speckle-Tracking Displacement and Strain Imaging in Patients with Acute Pulmonary Embolism. J Am Soc Echocardiogr 2011; 24:792-802. [PMID: 21481566 DOI: 10.1016/j.echo.2011.03.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Indexed: 11/17/2022]
MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Disease Progression
- Echocardiography, Doppler/methods
- Female
- Follow-Up Studies
- Humans
- Image Interpretation, Computer-Assisted
- Male
- Middle Aged
- Pulmonary Embolism/complications
- Pulmonary Embolism/diagnostic imaging
- Pulmonary Embolism/physiopathology
- Reproducibility of Results
- Retrospective Studies
- Ventricular Dysfunction, Left/diagnostic imaging
- Ventricular Dysfunction, Left/etiology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Right/diagnostic imaging
- Ventricular Dysfunction, Right/etiology
- Ventricular Dysfunction, Right/physiopathology
- Ventricular Function, Left
- Young Adult
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Affiliation(s)
- Takeshi Takamura
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
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Al-Jaroudi W, Iqbal F, Heo J, Iskandrian AE. Relation between heart rate and left ventricular mechanical dyssynchrony in patients with end-stage renal disease. Am J Cardiol 2011; 107:1235-40. [PMID: 21296324 DOI: 10.1016/j.amjcard.2010.12.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Revised: 12/15/2010] [Accepted: 12/15/2010] [Indexed: 11/28/2022]
Abstract
The effect of heart rate (HR) on left ventricular (LV) mechanical dyssynchrony has not been studied by phase analysis of myocardial perfusion imaging and has yielded conflicting results by echocardiography. We measured indexes of LV dyssynchrony by automated analysis of gated single-photon emission computed tomography in 140 patients with end-stage renal disease (ESRD) and 133 subjects with normal renal function (control group). Patients with abnormal perfusion pattern or QRS duration >120 ms were excluded. HR at time of acquisition of gated images was recorded. LV ejection fraction (EF), volumes, mass, and 2 indexes of dyssynchrony, phase SD and bandwidth, were derived. Almost 50% of patients in each group had an abnormal LVEF (<50%). HR at rest ranged from 48 to 113 beats/min (75 ± 13). Patients with abnormal LVEF had a higher phase SD (30 ± 13° vs 22 ± 11° and 28 ± 16° vs 15 ± 6° for the ESRD and control groups, respectively, p <0.001 each) and higher histographic bandwidth (88 ± 44° vs 62 ± 33° and 80 ± 49° vs 43 ± 14° for the ESRD and control groups, p <0.001 each). Patients with ESRD and normal LVEF had higher SD and bandwidth than the control group (22 ± 11° vs 15 ± 6° and 62 ± 33° vs 43 ± 14°, respectively, p <0.001 each). The control and ESRD groups were divided into tertiles based on HR. The phase SD and bandwidth were similar in the first (slowest HR) and third (highest HR) tertiles in every group (p = NS). There were no significant correlations between phase SD or bandwidth and HR in either group. In conclusion, within the HR range examined in this cross-sectional study, there was no relation between HR at rest and LV dyssynchrony.
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Affiliation(s)
- Wael Al-Jaroudi
- Division of Cardiovascular Medicine, Section of Cardiovascular Imaging, Cleveland Clinic, Cleveland, Ohio, USA.
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Kim MS, Kim HK, Chang SA, Kim SY, Cho GY, Kim YJ, Sohn DW, Oh BH, Park YB. Impact of Preload Alteration on Left Ventricular Mechanical Dyssynchrony Using Tissue Velocity Imaging Echocardiography. Echocardiography 2011; 28:196-202. [DOI: 10.1111/j.1540-8175.2010.01288.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Böhm M, Swedberg K, Komajda M, Borer JS, Ford I, Dubost-Brama A, Lerebours G, Tavazzi L. Heart rate as a risk factor in chronic heart failure (SHIFT): the association between heart rate and outcomes in a randomised placebo-controlled trial. Lancet 2010; 376:886-94. [PMID: 20801495 DOI: 10.1016/s0140-6736(10)61259-7] [Citation(s) in RCA: 645] [Impact Index Per Article: 46.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Raised resting heart rate is a marker of cardiovascular risk. We postulated that heart rate is also a risk factor for cardiovascular events in heart failure. In the SHIFT trial, patients with chronic heart failure were treated with the selective heart-rate-lowering agent ivabradine. We aimed to test our hypothesis by investigating the association between heart rate and events in this patient population. METHODS We analysed cardiovascular outcomes in the placebo (n=3264) and ivabradine groups (n=3241) of this randomised trial, divided by quintiles of baseline heart rate in the placebo group. The primary composite endpoint was cardiovascular death or hospital admission for worsening heart failure. In the ivabradine group, heart rate achieved at 28 days was also analysed in relation to subsequent outcomes. Analysis adjusted to change in heart rate was used to study heart-rate reduction as mechanism for risk reduction by ivabradine directly. FINDINGS In the placebo group, patients with the highest heart rates (>or=87 beats per min [bpm], n=682, 286 events) were at more than two-fold higher risk for the primary composite endpoint than were patients with the lowest heart rates (70 to <72 bpm, n=461, 92 events; hazard ratio [HR] 2.34, 95% CI 1.84-2.98, p<0.0001). Risk of primary composite endpoint events increased by 3% with every beat increase from baseline heart rate and 16% for every 5-bpm increase. In the ivabradine group, there was a direct association between heart rate achieved at 28 days and subsequent cardiac outcomes. Patients with heart rates lower than 60 bpm at 28 days on treatment had fewer primary composite endpoint events during the study (n=1192; event rate 17.4%, 95% CI 15.3-19.6) than did patients with higher heart rates. The effect of ivabradine is accounted for by heart-rate reduction, as shown by the neutralisation of the treatment effect after adjustment for change of heart rate at 28 days (HR 0.95, 0.85-1.06, p=0.352). INTERPRETATION Our analysis confirms that high heart rate is a risk factor in heart failure. Selective lowering of heart rates with ivabradine improves cardiovascular outcomes. Heart rate is an important target for treatment of heart failure. FUNDING Servier, France.
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Affiliation(s)
- Michael Böhm
- Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany.
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Kurita T, Onishi K, Dohi K, Takamura T, Fujimoto N, Tanigawa T, Imanaka-Yoshida K, Wada H, Nobori T, Ito M. Conventional therapy with an ACE inhibitor diminishes left ventricular dyssynchrony during the progression of heart failure. Int J Cardiol 2010; 140:48-54. [DOI: 10.1016/j.ijcard.2008.10.047] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2007] [Revised: 07/16/2008] [Accepted: 10/29/2008] [Indexed: 11/29/2022]
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Impact of right ventricular pacing on three-dimensional global left ventricular dyssynchrony in children and young adults with congenital and acquired heart block associated with congenital heart disease. Am J Cardiol 2009; 104:700-6. [PMID: 19699348 DOI: 10.1016/j.amjcard.2009.04.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2009] [Revised: 04/16/2009] [Accepted: 04/16/2009] [Indexed: 11/23/2022]
Abstract
The aim of this study was to determine the effect of long-term right ventricular pacing on left ventricular (LV) mechanical dyssynchrony in children and young adults with congenital and acquired heart block. Eighteen patients aged 19 +/- 7 years with congenital heart block (group I), 9 aged 21 +/- 11 years with acquired heart block after congenital heart surgery (group II), and 15 healthy control subjects (group III) were studied. The LV volumes, ejection fractions, and systolic dyssynchrony index (SDI) values, as determined using 3-dimensional echocardiography, were compared among groups. Groups I (6.68 +/- 2.44%) and II (9.43 +/- 4.44%) had significantly greater SDI values than group III (3.88 +/- 0.63%) (p = 0.011 and p <0.001, respectively). The prevalence of LV mechanical dyssynchrony (SDI >5.14%, mean + 2 SDs of controls) in groups I and II was 72% and 67%, respectively. In 27 patients with right ventricular pacing, LV SDI values were correlated negatively with the LV ejection fractions (r = -0.74, p <0.001). The times to minimum regional volume were significantly longer in lateral, posterior, and inferior segments in group I and septal and inferior segments in group II compared to those in group III (p <0.05). Compared to patients without LV dyssynchrony, patients with LV dyssynchrony had lower LV ejection fractions (p <0.001), had shorter RR intervals (p <0.001), and tended to have dual-chamber pacing (p = 0.088) but had similar durations of pacing, QRS durations, and positions of pacing wires (epicardial vs endocardial). In conclusion, permanent right ventricular pacing in childhood has a negative effect on LV systolic function through the induction of mechanical dyssynchrony, the magnitude and pattern of which differ between congenital and acquired heart block.
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A'roch R, Steendijk P, Oldner A, Weitzberg E, Konrad D, Johansson G, Haney M. Left ventricular mechanical dyssynchrony is load independent at rest and during endotoxaemia in a porcine model. Acta Physiol (Oxf) 2009; 196:375-83. [PMID: 19302073 DOI: 10.1111/j.1748-1716.2009.01962.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AIM In diseased or injured states, the left ventricle displays higher degrees of mechanical dyssynchrony. We aimed at assessing mechanical dyssynchrony ranges in health related to variation in load as well as during acute endotoxin-induced ventricular injury. METHODS In 16 juvenile anaesthetized pigs, a five-segment conductance catheter was placed in the left ventricle as well as a balloon-tipped catheter in the inferior vena cava. Mechanical dyssynchrony during systole, including dyssynchrony time in per cent during systole and internal flow fraction during systole, were measured at rest and during controlled pre-load reduction sequences, as well as during 3 h of endotoxin infusion (0.25 microg kg(-)1 h(-1)). RESULTS Systolic dyssynchrony and internal flow fraction did not change during the course of acute beat-to-beat pre-load alteration. Endotoxin-produced acute pulmonary hypertension by left ventricular dyssynchrony measures was not changed during the early peak of pulmonary hypertension. Endotoxin ventricular injury led to progressive increases in systolic mechanical segmental dyssynchrony (7.9 +/- 1.2-13.0 +/- 1.3%) and ventricular systolic internal flow fraction (7.1 +/- 2.4-16.6 +/- 2.8%), respectively for baseline and then at hour 3. There was no localization of dyssynchrony changes to segment or region in the ventricular long axis during endotoxin infusion. CONCLUSION These results suggest that systolic mechanical dyssynchrony measures may be load independent in health and during acute global ventricular injury by endotoxin. More study is needed to validate ranges in health and disease for parameters of mechanical dyssynchrony.
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Affiliation(s)
- R A'roch
- Anesthesia and Intensive Care Medicine, University Hospital of Umeå, Umeå, Sweden.
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Restoration of cardiac function by setting the ventricular pacing at a lower range in an infant with congenital complete atrioventricular block and dilated cardiomyopathy. Int J Cardiol 2008; 131:e38-40. [DOI: 10.1016/j.ijcard.2007.07.061] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2007] [Accepted: 07/07/2007] [Indexed: 11/17/2022]
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Plehn G, Vormbrock J, Butz T, Christ M, Trappe HJ, Meissner A. Different effect of exercise on left ventricular diastolic time and interventricular dyssynchrony in heart failure patients with and without left bundle branch block. Int J Med Sci 2008; 5:333-40. [PMID: 19002270 PMCID: PMC2581821 DOI: 10.7150/ijms.5.333] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Accepted: 11/03/2008] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND In patients with idiopathic dilated cardiomyopathy (IDCM) a prolongation of left ventricular (LV) systole at the expense of diastolic time was demonstrated. Our study was aimed to evaluate the effect of exercise on heart rate corrected diastolic time in controls, IDCM with and without LBBB, and patients with LBBB and normal LV function. METHODS 47 patients with IDCM, 30 without LBBB, and 17 with LBBB as well as 11 with isolated LBBB were studied during exercise using a combined hemodynamic-radionuclide angiographic approach. The phases of the cardiac cycle were derived with high temporal resolution from the ventricular time-activity curve. The loss of diastolic time per beat (LDT) was quantified using a regression equation obtained from a control group (n=24). RESULTS A significant LDT was demonstrated at rest and during peak exercise in IDCM patients with LBBB (39.1+/-32 and 37.3+/-30 ms; p < 0.001). In IDCM patients with normal activation LDT was unaffected at baseline, but elevated during peak exercise. This response was paralleled by an increase in interventricular mechanical dyssynchrony. CONCLUSION During exercise an abnormal shortening of LV diastolic time is a common characteristic of heart failure patients which can be explained by the high prevalence of mechanical dyssynchrony.
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Affiliation(s)
- Gunnar Plehn
- Department of Cardiology and Angiology, Marienhospital Herne, University of Bochum, Germany.
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Dohi K, Onishi K, Gorcsan J, López-Candales A, Takamura T, Ota S, Yamada N, Ito M. Role of radial strain and displacement imaging to quantify wall motion dyssynchrony in patients with left ventricular mechanical dyssynchrony and chronic right ventricular pressure overload. Am J Cardiol 2008; 101:1206-12. [PMID: 18394460 DOI: 10.1016/j.amjcard.2007.11.077] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2007] [Revised: 11/27/2007] [Accepted: 11/27/2007] [Indexed: 12/01/2022]
Abstract
Left ventricular (LV) deformation with ventricular septal shift is one of the most distinctive echocardiographic observations in patients with chronic right ventricular (RV) pressure overload (PO). However, little is known about the effects of RVPO on LV performance and regional synchrony. Accordingly, our objective was to test the hypothesis that chronic RVPO affects regional wall motion, synchronicity, and global LV function using a novel speckle-tracking approach to quantify and characterize regional LV wall motion dyssynchrony. Displacement and strain imaging echocardiographic studies were performed in 20 patients with RVPO from pulmonary arterial hypertension or pulmonic stenosis (mean age 53 +/- 16 years, New York Heart Association class 2.6 +/- 0.7, and peak RV systolic pressure 73 +/- 28 mm Hg) and 20 age-matched normal subjects (mean age 47 +/- 16 years). Segmental signals from 6 segments around the mid-LV short axis were defined as dyssynchronous if their changes were opposite to that of the global LV signal at each time frame, and overall LV dyssynchrony was calculated as the percentage of dyssynchrony in all 6 segments within the specified time interval from onset of QRS to the end of isovolumic relaxation. RVPO was associated with a large degree of regional dyssynchrony with paradoxical ventricular septal motion observed by displacement imaging (21 +/- 6%, p <0.05 vs control group), which was closely associated with LV eccentricity index (r = 0.79, p <0.05) and LV myocardial performance index with linear regression (r = 0.76, p <0.05). In contrast, strain imaging showed uniform segmental radial thickening in the RVPO group, which was similar to the control group, and suggests that there was no intrinsic LV contractile dyssynchrony. In conclusion, LV wall motion dyssynchrony assessed by displacement imaging, not intrinsic contractile dyssynchrony by strain imaging, coexists with LV chamber deformation with ventricular septal shift and is closely associated with impairment of LV performance.
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Affiliation(s)
- Kaoru Dohi
- Mie University Graduate School of Medicine, Tsu, Japan.
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