1
|
Sakatani T, Kasahara T, Irie D, Tsubakimoto Y, Matsuo A, Fujita H, Inoue K. Prognostic value of left ventricular mechanical dyssynchrony induced by exercise stress in patients with normal myocardial perfusion single-photon emission computed tomography. J Nucl Cardiol 2022; 29:1-10. [PMID: 33083982 DOI: 10.1007/s12350-020-02389-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 09/17/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Left ventricular mechanical dyssynchrony (LVMD) induced by exercise stress was reported to be clinically useful in detecting multivessel coronary artery diseases. The aim of this study was to compare the prognostic value of LVMD induced by pharmacological stress with that induced by exercise stress. METHODS We retrospectively examined 918 consecutive patients who underwent exercise (N = 310) or pharmacological stress (N = 608) 99mTc-tetrofosmin single-photon emission computed tomography (SPECT) with normal myocardial perfusion. LVMD was evaluated by phase analysis as the indices of phase bandwidth and phase standard deviation (PSD). RESULTS During the follow-up period (2.2 ± 1.9 years), 74 major cardiac events (MCEs) occurred (7 cases of cardiac death, 17 cases of heart failure, and 50 cases of coronary intervention). In global patients, the indices of LVMD on rest images were significantly greater in patients with MCEs (bandwidth (°): 51 ± 31 vs 37 ± 21, P = .001, PSD: 14 ± 9 vs 10 ± 6, P = .001). The exercise stress bandwidth was significantly higher in patients with MCEs (62 ± 37° vs 42 ± 21°, P = .026), as was the pharmacological stress bandwidth (57 ± 35° vs 43 ± 24°, P = .006). Multivariate analysis demonstrated the exercise stress bandwidth to be an independent predictor of MCEs (HR 1.017, CI 1.003 to 1.032, P = .019), but the pharmacological stress bandwidth had no influence on MCEs. CONCLUSIONS LVMD induced by exercise stress was an independent predictor of MCEs in patients with normal perfusion SPECT, whereas that induced by pharmacological stress had no association with further events.
Collapse
Affiliation(s)
- Tomohiko Sakatani
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-Cho, Kamigyo-Ku, Kyoto, 602-8026, Japan.
| | - Takeru Kasahara
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-Cho, Kamigyo-Ku, Kyoto, 602-8026, Japan
| | - Daisuke Irie
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-Cho, Kamigyo-Ku, Kyoto, 602-8026, Japan
| | - Yoshinori Tsubakimoto
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-Cho, Kamigyo-Ku, Kyoto, 602-8026, Japan
| | - Akiko Matsuo
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-Cho, Kamigyo-Ku, Kyoto, 602-8026, Japan
| | - Hiroshi Fujita
- Department of Cardiology, North Medical Center, Kyoto Prefectural University of Medicine, 481 Otokoyama, Yosano-cho, Kyoto, 629-2261, Japan
| | - Keiji Inoue
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-Cho, Kamigyo-Ku, Kyoto, 602-8026, Japan
| |
Collapse
|
2
|
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).
Collapse
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.
| |
Collapse
|
3
|
Vasodilator Strain Stress Echocardiography in Suspected Coronary Microvascular Angina. J Clin Med 2022; 11:jcm11030711. [PMID: 35160163 PMCID: PMC8836360 DOI: 10.3390/jcm11030711] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 01/25/2022] [Indexed: 12/19/2022] Open
Abstract
Background: In patients with Ischemia and non-obstructive coronary artery stenosis (INOCA) wall motion is rarely abnormal during stress echocardiography (SE). Our aim was to determine if patients with INOCA and reduced coronary flow velocity reserve (CVFR) have altered cardiac mechanics using two-dimensional speckle-tracking echocardiography (2DSTE) during SE. Methods: In a prospective, multicenter, international study, we recruited 135 patients with INOCA. Overall, we performed high dose (0.84 mg/kg) dipyridamole SE with combined assessment of CVFR and 2DSTE. The population was divided in patients with normal CVFR (>2, group 1, n = 95) and abnormal CVFR (≤2, group 2, n = 35). Clinical and 2DSTE parameters were compared between groups. Results: Feasibility was high for CFVR (98%) and 2DSTE (97%). A total of 130 patients (mean age 63 ± 12 years, 67 women) had complete flow and strain data. The two groups showed similar 2DSTE values at rest. At peak SE, Group 1 patients showed lower global longitudinal strain (p < 0.007), higher mechanical dispersion (p < 0.0005), lower endocardial (p < 0.001), and epicardial (p < 0.0002) layer specific strain. Conclusions: In patients with INOCA, vasodilator SE with simultaneous assessment of CFVR and strain is highly feasible. Coronary microvascular dysfunction is accompanied by an impairment of global and layer-specific deformation indices during stress.
Collapse
|
4
|
Legallois D, Marie PY, Franken PR, Djaballah W, Agostini D, Manrique A. Comparison of the dyssynchrony parameters recorded with gated SPECT in ischemic cardiomyopathy according to their repeatability at rest and to their ability to detect a synchrony reserve under dobutamine infusion. J Nucl Cardiol 2020; 27:2247-2257. [PMID: 30515748 DOI: 10.1007/s12350-018-01546-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 11/10/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study aimed to determine whether the repeatability of dyssynchrony assessment using gated myocardial perfusion SPECT (GSPECT) allows the detection of synchrony reserve during low-dose dobutamine infusion. METHODS AND RESULTS Sixty-one patients with ischemic cardiomyopathy and LV ejection fraction < 50% were prospectively included in 10 centers. Each patient underwent two consecutive rest GSPECT with 99mTc-labeled tracer (either tetrofosmin or sestamibi) to assess the repeatability of LV function and dyssynchrony parameters, followed by a GSECT acquisition during low-dose dobutamine infusion. LV dyssynchrony was assessed using QGS software through histogram bandwidth (BW), standard deviation of the phase (SD), and entropy. Repeatability was assessed with Lin's concordance correlation coefficient (CCC). Entropy showed a higher CCC (0.80) compared to BW (0.68) and SD (0.75). On average, dobutamine infusion yielded to improve both BW (P = .049) and entropy (P = .04) although significant improvements, setting outside the 95% confidence interval of the repeatability analysis, were documented in only 6 and 4 patients for BW and entropy, respectively. CONCLUSIONS A synchrony reserve may be documented in patients with ischemic cardiomyopathy through the recording of BW and entropy with low-dose dobutamine GSPECT, with the additional advantage of a higher repeatability for entropy.
Collapse
Affiliation(s)
- Damien Legallois
- Normandie Université, UNICAEN, Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, FHU REMOD-VHF, 14000, Caen, France
- Department of Cardiology, CHU de Caen, 14000, Caen, France
| | | | | | | | - Denis Agostini
- Normandie Université, UNICAEN, Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, FHU REMOD-VHF, 14000, Caen, France
- Department of Nuclear Medicine, CHU de Caen, 14000, Caen, France
| | - Alain Manrique
- Normandie Université, UNICAEN, Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, FHU REMOD-VHF, 14000, Caen, France.
- Department of Nuclear Medicine, CHU de Caen, 14000, Caen, France.
- Investigations chez l'Homme, GIP Cyceron PET Center, Campus Jules Horowitz, BP 5229, 14074, Caen, France.
| |
Collapse
|
5
|
Salimian S. Left ventricular mechanical dyssynchrony under stress: Isn't it time to conduct a prospective multicenter study? J Nucl Cardiol 2020; 27:2258-2260. [PMID: 30656574 DOI: 10.1007/s12350-019-01599-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 12/28/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Samaneh Salimian
- Department of Biomedical Sciences, University of Montreal, Montreal, QC, Canada.
| |
Collapse
|
6
|
Muser D, Tioni C, Shah R, Selvanayagam JB, Nucifora G. Prevalence, Correlates, and Prognostic Relevance of Myocardial Mechanical Dispersion as Assessed by Feature-Tracking Cardiac Magnetic Resonance After a First ST-Segment Elevation Myocardial Infarction. Am J Cardiol 2017. [PMID: 28648394 DOI: 10.1016/j.amjcard.2017.05.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Postinfarction mechanical dispersion (MD), that is, the regional heterogeneity of myocardial contraction throughout the cardiac cycle, has detrimental effects on left ventricular (LV) function and is related to the occurrence of heart failure and ventricular arrhythmias. However, its prevalence, pathophysiological determinants, and clinical utility are still unknown. The aim of the present study is to clarify these issues. In total, 130 consecutive patients (mean age 60 ± 12 years, 75% male) with a first ST-segment elevation myocardial infarction (STEMI) were included. Cardiac magnetic resonance (CMR) with late gadolinium enhancement imaging was performed to assess LV function, infarct size, and microvascular obstruction. Feature-tracking analysis was applied to cine-CMR short-axis images to assess MD, defined as the SD of the time-to-peak circumferential strain of the LV segments expressed as percent cardiac cycle. For comparison purpose, 40 control subjects similar in age and gender to the STEMI group were also included. Patients were followed-up for a median of 95 months; the outcome event was defined as a composite of cardiovascular death, aborted sudden cardiac death, and hospitalization for heart failure. STEMI patients had significantly higher MD compared with controls (12.0 ± 5.35% vs 3.85 ± 0.99%, p <0.001). At multivariate analysis, heart rate (β = 0.20, p = 0.008), LV end-systolic volume index (β = 0.37, p <0.001), and infarct size (β = 0.23, p = 0.017) were significantly and independently related to MD. The outcome event occurred in 26 (20%) patients. At multivariate Cox proportional hazards analysis, MD was significantly and independently related to the outcome event (p <0.001). MD provided significant incremental value over the other clinical and CMR variables in predicting the outcome event (p <0.001 for the chi-square change). In conclusion, MD after STEMI is a marker of the extent of myocardial damage; its assessment by feature-tracking CMR provides significant, independent, and incremental long-term prognostic information.
Collapse
Affiliation(s)
- Daniele Muser
- Cardiothoracic Department, University Hospital "Santa Maria della Misericordia", Udine, Italy
| | - Chiara Tioni
- Cardiothoracic Department, University Hospital "Santa Maria della Misericordia", Udine, Italy; Postgraduate School of Cardiovascular Sciences, University of Trieste, Trieste, Italy
| | - Ranjit Shah
- Department of Heart Health, South Australian Health & Medical Research Institute, Adelaide, South Australia, Australia; School of Medicine, Flinders University, Bedford Park, Adelaide, South Australia, Australia; Department of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia
| | - Joseph B Selvanayagam
- Department of Heart Health, South Australian Health & Medical Research Institute, Adelaide, South Australia, Australia; School of Medicine, Flinders University, Bedford Park, Adelaide, South Australia, Australia; Department of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia
| | - Gaetano Nucifora
- Department of Heart Health, South Australian Health & Medical Research Institute, Adelaide, South Australia, Australia; School of Medicine, Flinders University, Bedford Park, Adelaide, South Australia, Australia; Northwest Heart Centre, Wythenshawe Hospital, University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom.
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Salimian S, Thibault B, Finnerty V, Grégoire J, Harel F. Phase analysis of gated blood pool SPECT for multiple stress testing assessments of ventricular mechanical dyssynchrony in a tachycardia-induced dilated cardiomyopathy canine model. J Nucl Cardiol 2017; 24:145-157. [PMID: 26686363 DOI: 10.1007/s12350-015-0338-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 11/06/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Stress-induced dyssynchrony has been shown to be independently correlated with clinical outcomes in patients with dilated cardiomyopathy (DCM) and narrow QRS complexes. However, the extent to which stress levels affect inter- and intraventricular dyssynchrony parameters remains unknown. METHODS Ten large dogs were submitted to tachycardia-induced DCM by pacing the right ventricular apex for 3-4 weeks to reach a target ejection fraction (EF) of 35% or less. Stress was then induced in DCM dogs by administering intravenous dobutamine up to a maximum of 20 μg·kg-1·min-1. Hemodynamic and ventricular dyssynchrony data were analyzed by left ventricular (LV) pressure measurements and gated blood pool SPECT (GBPS) imaging. In order to assess mechanical dyssynchrony in DCM subjects and compare it with that of 8 normal counterparts, we extracted the following data: count-based indices of LV contraction homogeneity index (CHI), entropy and phase standard deviation, and interventricular dyssynchrony index. RESULTS A significant LV intraventricular dyssynchrony (CHI: 96.4 ± 1.3% in control vs 78.6% ± 10.9% in DCM subjects) resulted in an intense LV dysfunction in DCM subjects (EF: 49.5% ± 8.4% in control vs 22.6% ± 6.0% in DCM), compared to control subjects. However, interventricular dyssynchrony did not vary significantly between the two groups. Under stress, DCM subjects showed a significant improvement in ventricular functional parameters at each level (EF: 22.6% ± 6.0% at rest vs 48.1% ± 5.8% at maximum stress). All intraventricular dyssynchrony indices showed a significant increase in magnitude of synchrony from baseline to stress levels of greater than or equal to 5 μg·kg-1·min-1 dobutamine. There were individual differences in the magnitude and pattern of change in interventricular dyssynchrony during the various levels of stress. CONCLUSIONS Based on GBPS analyses, different levels of functional stress, even in close intervals, can have a significant impact on hemodynamic and intraventricular dyssynchrony parameters in a DCM model with narrow QRS complex.
Collapse
MESH Headings
- Animals
- Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography/methods
- Cardiomyopathy, Dilated/diagnostic imaging
- Cardiomyopathy, Dilated/etiology
- Cardiomyopathy, Dilated/physiopathology
- Dogs
- Exercise Test/methods
- Gated Blood-Pool Imaging/methods
- Image Interpretation, Computer-Assisted/methods
- Reproducibility of Results
- Sensitivity and Specificity
- Tachycardia, Ventricular/complications
- Tachycardia, Ventricular/diagnostic imaging
- Tachycardia, Ventricular/physiopathology
- Ventricular Dysfunction, Left/diagnostic imaging
- Ventricular Dysfunction, Left/etiology
- Ventricular Dysfunction, Left/physiopathology
Collapse
Affiliation(s)
- Samaneh Salimian
- Department of Nuclear Medicine, Montreal Heart Institute and University of Montreal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada
| | - Bernard Thibault
- Department of Medicine, Montreal Heart Institute and University of Montreal, Montreal, QC, Canada
| | - Vincent Finnerty
- Department of Nuclear Medicine, Montreal Heart Institute and University of Montreal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada
| | - Jean Grégoire
- Department of Nuclear Medicine, Montreal Heart Institute and University of Montreal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada
| | - François Harel
- Department of Nuclear Medicine, Montreal Heart Institute and University of Montreal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada.
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Sénéchal M. What is the best therapeutic strategy in patients with low flow, low-gradient aortic stenosis, and wide QRS? Eur J Heart Fail 2014; 16:598-600. [PMID: 24782294 DOI: 10.1002/ejhf.96] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 03/20/2014] [Indexed: 11/07/2022] Open
Affiliation(s)
- Mario Sénéchal
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Canada
| |
Collapse
|
11
|
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.
Collapse
Affiliation(s)
- Samaneh Salimian
- Department of Nuclear Medicine, Montreal Heart Institute and Université de Montréal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada
| | | | | | | | | |
Collapse
|
12
|
Garnier F, Eicher JC, Jazayeri S, Bertaux G, Bouchot O, Aho LS, Wolf JE, Laurent G. Usefulness and limitations of contractile reserve evaluation in patients with low-flow, low-gradient aortic stenosis eligible for cardiac resynchronization therapy. Eur J Heart Fail 2014; 16:648-54. [DOI: 10.1002/ejhf.78] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 02/03/2014] [Accepted: 02/07/2014] [Indexed: 11/10/2022] Open
Affiliation(s)
- Fabien Garnier
- Department of Cardiology, Unité de Rythmologie et Insuffisance Cardiaque; University Hospital; Dijon France
| | - Jean-Christophe Eicher
- Department of Cardiology, Unité de Rythmologie et Insuffisance Cardiaque; University Hospital; Dijon France
| | - Saed Jazayeri
- Department of Cardiovascular Surgery; University Hospital; Dijon France
| | - Géraldine Bertaux
- Department of Cardiology, Unité de Rythmologie et Insuffisance Cardiaque; University Hospital; Dijon France
| | - Olivier Bouchot
- Department of Cardiovascular Surgery; University Hospital; Dijon France
- Laboratoire LE2I UMR CNRS 5158; Université de Bourgogne; Dijon France
| | - Ludwig-Serge Aho
- Department of Hygiene and Epidemiology; University Hospital; Dijon France
| | - Jean-Eric Wolf
- Department of Cardiology, Unité de Rythmologie et Insuffisance Cardiaque; University Hospital; Dijon France
- Laboratoire LE2I UMR CNRS 5158; Université de Bourgogne; Dijon France
| | - Gabriel Laurent
- Department of Cardiology, Unité de Rythmologie et Insuffisance Cardiaque; University Hospital; Dijon France
- Laboratoire LE2I UMR CNRS 5158; Université de Bourgogne; Dijon France
| |
Collapse
|
13
|
Lee APW, Zhang Q, Looi JL, Sun JP, Fang F, Liu YT, Liang YJ, Xie JM, Li RJ, Yu CM. Left ventricular systolic dyssynchrony in acute decompensated heart failure. Int J Cardiol 2013; 168:4285-6. [PMID: 23701936 DOI: 10.1016/j.ijcard.2013.04.200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 04/20/2013] [Indexed: 01/19/2023]
Affiliation(s)
- Alex Pui-Wai Lee
- Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Stankovic I, Aarones M, Smith HJ, Voros G, Kongsgaard E, Neskovic AN, Willems R, Aakhus S, Voigt JU. Dynamic relationship of left-ventricular dyssynchrony and contractile reserve in patients undergoing cardiac resynchronization therapy. Eur Heart J 2013; 35:48-55. [DOI: 10.1093/eurheartj/eht294] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
15
|
Low-dose dobutamine induces left ventricular mechanical dyssynchrony in patients with dilated cardiomyopathy and a narrow QRS: A study using real-time three-dimensional echocardiography. J Cardiol 2013; 61:275-80. [DOI: 10.1016/j.jjcc.2012.12.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Revised: 11/29/2012] [Accepted: 12/04/2012] [Indexed: 02/04/2023]
|
16
|
|
17
|
Marcus KA, Janoušek J, Barends ME, Weijers G, de Korte CL, Kapusta L. Synchronicity of systolic deformation in healthy pediatric and young adult subjects: a two-dimensional strain echocardiography study. Am J Physiol Heart Circ Physiol 2012; 302:H196-205. [DOI: 10.1152/ajpheart.00740.2011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Two-dimensional speckle tracking echocardiography (2DSTE) offers valuable information in the echocardiographic assessment of ventricular myocardial function. It enables the quantification and timing of systolic ventricular myocardial deformation. In addition, 2DSTE can be used to identify mechanical dyssynchrony, which is an important parameter in predicting the response to cardiac resynchronization therapy for heart failure. Detailed knowledge of normal timing of systolic deformation and its degree of synchronicity in children is lacking. We aimed to establish the normal timing of left ventricular myocardial systolic deformation using 2DSTE in a large cohort of healthy children and young adults. Transthoracic echocardiograms were acquired in 195 healthy subjects (139 children and 56 young adult <40 yr of age) and were retrospectively analyzed. Time to peak systolic longitudinal, circumferential, and radial strain was determined by means of speckle tracking. Strong, statistically significant relations between age as well as various anthropometric variables (e.g., heart rate) and timing of systolic deformation ( P < 0.0001) were present. The extent of dyssynchronous deformation increased with age. This is the first report that establishes reference values per cardiac segment for time to peak systolic myocardial strain values in all three directions assessed with 2DSTE in a large pediatric and young adult cohort. We emphasize the need for using age-specific reference values as well as heart rate correction for the adequate interpretation of 2DSTE measurements.
Collapse
Affiliation(s)
- Karen A. Marcus
- Children's Heart Centre, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Jan Janoušek
- Kardiocentrum and Cardiovascular Research Center, University Hospital Motol, Prague, Czech Republic
| | - Marlieke E. Barends
- Children's Heart Centre, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Gert Weijers
- Clinical Physics Laboratory, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; and
| | - Chris L. de Korte
- Clinical Physics Laboratory, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; and
| | - Livia Kapusta
- Children's Heart Centre, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- Pediatric Cardiology Unit, Edith Wolfson Medical Center, Holon, Israel
| |
Collapse
|
18
|
|
19
|
Choi WG, Kim SH, Park SD, Baek YS, Shin SH, Woo SI, Kim DH, Park KS, Lee WH, Kwan J. Role of dyssynchrony on functional mitral regurgitation in patients with idiopathic dilated cardiomyopathy: a comparison study with geometric parameters of mitral apparatus. J Cardiovasc Ultrasound 2011; 19:69-75. [PMID: 21860720 PMCID: PMC3150699 DOI: 10.4250/jcu.2011.19.2.69] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Revised: 05/19/2011] [Accepted: 05/25/2011] [Indexed: 11/22/2022] Open
Abstract
Background Functional mitral regurgitation (FMR) occurs commonly in patients with dilated cardiomyopathy (DCM). This study was conducted to explore the role of left ventricular (LV) dyssynchrony in developing FMR in patients with DCM in comparison with geometric parameters of the mitral apparatus. Methods Twenty patients without FMR and 33 patients with FMR [effective regurgitant orifice area (ERO) = 0.17 ± 0.10 cm2] were enrolled. MR severity was estimated with ERO area. Dyssynchrony indices (DI) were measured using the standard deviations of time to peak myocardial systolic velocity between eight segments. Using real time 3D echocardiography, mitral valve tenting area (MVTa), anterior (APMD) and posterior papillary muscle distances (PPMD), LV sphericity, and tethering angle of anterior (Aα) and posterior leaflets (Pα) were estimated. All geometrical measurements were corrected (c) by the height of each patient. Results The patient with FMR had significantly higher cDI, cMVTa, cAPMD and cPPMD, LV sphericity, Aα, and Pα than the patients without FMR (all p < 0.05). With multiple logistic regression analysis, cMVTa (p = 0.017) found to be strongest predictor of FMR development. In patients with FMR, cMVTa (r = 0.868), cAPMD (r = 0.801), cPPMD (r = 0.742), Aα (r = 0.454), LV sphericity (r = 0.452), and DI (r = 0.410) showed significant correlation with ERO. On multivariate regression analysis, cMVTa and cAPMD (p < 0.001, p = 0.022, respectively) remained the strongest determinants of the degree of ERO and cAPMD (p < 0.001) remained the strongest determinant of the degree of cMVTa. Conclusion Displacement of anterior papillary muscle and consequent mitral valve tenting seem to play a major role in developing FMR in DCM, while LV dyssynchrony seems to have no significant role.
Collapse
Affiliation(s)
- Woong Gil Choi
- Division of Cardiology, Department of Internal Medicine, Konkuk University College of Medicine, Chungju, Korea
| | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
|
21
|
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.
Collapse
Affiliation(s)
- Wael Al-Jaroudi
- Division of Cardiovascular Medicine, Section of Cardiovascular Imaging, Cleveland Clinic, Cleveland, Ohio, USA.
| | | | | | | |
Collapse
|
22
|
BOGAARD MARGOTD, KIRKELS JHANS, HAUER RICHARDN, LOH PETER, DOEVENDANS PIETERA, MEINE MATHIAS. Should We Optimize Cardiac Resynchronization Therapy During Exercise? J Cardiovasc Electrophysiol 2010; 21:1307-16. [DOI: 10.1111/j.1540-8167.2010.01815.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
23
|
Konstantino Y, Zimetbaum PJ, Hsing J, Kramer DB, Chang JD. Cardiac resynchronization therapy for low-flow, low-gradient aortic stenosis. Eur J Heart Fail 2010; 12:889-92. [PMID: 20494924 DOI: 10.1093/eurjhf/hfq085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Low-flow, low-gradient aortic stenosis is a heterogeneous entity that encompasses truly severe aortic stenosis as well as mild-to-moderate aortic stenosis in which aortic valve orifice area is severely reduced primarily due to left ventricular (LV) contractile dysfunction. Under such circumstances the capacity of the LV to generate stroke-work is severely compromised. In this case report, we describe a patient with severe LV dysfunction and ventricular dyssynchrony due to right ventricular pacing who presented with decompensated heart failure in the setting of low-flow, low-gradient aortic stenosis. We discuss the management of this high-operative-risk patient, who ultimately underwent upgrading of his dual chamber pacemaker to a biventricular pacemaker with significant echocardiographic, haemodynamic, and clinical improvement.
Collapse
Affiliation(s)
- Yuval Konstantino
- The Cardiovascular Institute, Beth Israel Deaconess Medical Center, Baker 4, 185 Pilgrim Road, Boston, MA 02215, USA.
| | | | | | | | | |
Collapse
|
24
|
Lancellotti P, Szymanski C, Moonen M, Garweg C, O'Connor K, Tribouilloy C, Pierard LA. Dynamic left ventricular dyssynchrony: a potential cause of no contractile reserve in patients with low-gradient aortic stenosis. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2009; 10:880-3. [DOI: 10.1093/ejechocard/jep079] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
25
|
|
26
|
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.
Collapse
Affiliation(s)
- Gunnar Plehn
- Department of Cardiology and Angiology, Marienhospital Herne, University of Bochum, Germany.
| | | | | | | | | | | |
Collapse
|
27
|
|
28
|
Cleland J, Freemantle N, Ghio S, Fruhwald F, Shankar A, Marijanowski M, Verboven Y, Tavazzi L. Predicting the Long-Term Effects of Cardiac Resynchronization Therapy on Mortality From Baseline Variables and the Early Response. J Am Coll Cardiol 2008; 52:438-45. [DOI: 10.1016/j.jacc.2008.04.036] [Citation(s) in RCA: 165] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2007] [Revised: 03/06/2008] [Accepted: 04/03/2008] [Indexed: 11/25/2022]
|