1
|
Antoniou CK, Manolakou P, Magkas N, Konstantinou K, Chrysohoou C, Dilaveris P, Gatzoulis KA, Tousoulis D. Cardiac Resynchronisation Therapy and Cellular Bioenergetics: Effects Beyond Chamber Mechanics. Eur Cardiol 2019; 14:33-44. [PMID: 31131035 PMCID: PMC6523053 DOI: 10.15420/ecr.2019.2.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Cardiac resynchronisation therapy is a cornerstone in the treatment of advanced dyssynchronous heart failure. However, despite its widespread clinical application, precise mechanisms through which it exerts its beneficial effects remain elusive. Several studies have pointed to a metabolic component suggesting that, both in concert with alterations in chamber mechanics and independently of them, resynchronisation reverses detrimental changes to cellular metabolism, increasing energy efficiency and metabolic reserve. These actions could partially account for the existence of responders that improve functionally but not echocardiographically. This article will attempt to summarise key components of cardiomyocyte metabolism in health and heart failure, with a focus on the dyssynchronous variant. Both chamber mechanics-related and -unrelated pathways of resynchronisation effects on bioenergetics – stemming from the ultramicroscopic level – and a possible common underlying mechanism relating mechanosensing to metabolism through the cytoskeleton will be presented. Improved insights regarding the cellular and molecular effects of resynchronisation on bioenergetics will promote our understanding of non-response, optimal device programming and lead to better patient care.
Collapse
Affiliation(s)
| | - Panagiota Manolakou
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens Athens, Greece
| | - Nikolaos Magkas
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens Athens, Greece
| | - Konstantinos Konstantinou
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens Athens, Greece
| | - Christina Chrysohoou
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens Athens, Greece
| | - Polychronis Dilaveris
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens Athens, Greece
| | - Konstantinos A Gatzoulis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens Athens, Greece
| | - Dimitrios Tousoulis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens Athens, Greece
| |
Collapse
|
2
|
Kirn B, Walmsley J, Lumens J. Uniqueness of local myocardial strain patterns with respect to activation time and contractility of the failing heart: a computational study. Biomed Eng Online 2018; 17:182. [PMID: 30518387 PMCID: PMC6280493 DOI: 10.1186/s12938-018-0614-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 11/27/2018] [Indexed: 01/26/2023] Open
Abstract
Background Myocardial deformation measured by strain is used to detect electro-mechanical abnormalities in cardiac tissue. Estimation of myocardial properties from regional strain patterns when multiple pathologies are present is therefore a promising application of computer modelling. However, if different tissue properties lead to indistinguishable strain patterns (‘degeneracy’), the applicability of any such method will be limited. We investigated whether estimation of local activation time (AT) and contractility from myocardial strain patterns is theoretically possible. Methods For four different global cardiac pathologies local myocardial strain patterns for 1025 combinations of AT and contractility were simulated with a computational model (CircAdapt). For each strain pattern, a cohort of similar patterns was found within estimated measurement error using the sum of least-squared differences. Cohort members came from (1) the same pathology only, and (2) all four pathologies. Uncertainty was calculated as accuracy and precision of cohort members in parameter space. Connectedness within the cohorts was also studied. Results We found that cohorts drawn from one pathology had parameters with adjacent values although their distribution was neither constant nor symmetrical. In comparison cohorts drawn from four pathologies had disconnected components with drastically different parameter values and accuracy and precision values up to three times higher. Conclusions Global pathology must be known when extracting AT and contractility from strain patterns, otherwise degeneracy occurs causing unacceptable uncertainty in derived parameters. Electronic supplementary material The online version of this article (10.1186/s12938-018-0614-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Borut Kirn
- Department of Physiology, Medical Faculty, University of Ljubljana, Zaloska 4, 1000, Ljubljana, Slovenia.
| | - John Walmsley
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Joost Lumens
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands
| |
Collapse
|
3
|
Sieniewicz BJ, Gould J, Porter B, Sidhu BS, Behar JM, Claridge S, Niederer S, Rinaldi CA. Optimal site selection and image fusion guidance technology to facilitate cardiac resynchronization therapy. Expert Rev Med Devices 2018; 15:555-570. [PMID: 30019954 PMCID: PMC6178093 DOI: 10.1080/17434440.2018.1502084] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 07/12/2018] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Cardiac resynchronization therapy (CRT) has emerged as one of the few effective treatments for heart failure. However, up to 50% of patients derive no benefit. Suboptimal left ventricle (LV) lead position is a potential cause of poor outcomes while targeted lead deployment has been associated with enhanced response rates. Image-fusion guidance systems represent a novel approach to CRT delivery, allowing physicians to both accurately track and target a specific location during LV lead deployment. AREAS COVERED This review will provide a comprehensive evaluation of how to define the optimal pacing site. We will evaluate the evidence for delivering targeted LV stimulation at sites displaying favorable viability or advantageous mechanical or electrical properties. Finally, we will evaluate several emerging image-fusion guidance systems which aim to facilitate optimal site selection during CRT. EXPERT COMMENTARY Targeted LV lead deployment is associated with reductions in morbidity and mortality. Assessment of tissue characterization and electrical latency are critical and can be achieved in a number of ways. Ultimately, the constraints of coronary sinus anatomy have forced the exploration of novel means of delivering CRT including endocardial pacing which hold promise for the future of CRT delivery.
Collapse
Affiliation(s)
- Benjamin J. Sieniewicz
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
- Cardiology Department, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Justin Gould
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
- Cardiology Department, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Bradley Porter
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
- Cardiology Department, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Baldeep S Sidhu
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
- Cardiology Department, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Jonathan M Behar
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
- Cardiology Department, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Simon Claridge
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
- Cardiology Department, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Steve Niederer
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
| | - Christopher A. Rinaldi
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
- Cardiology Department, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
4
|
Mele D, Bertini M, Malagù M, Nardozza M, Ferrari R. Current role of echocardiography in cardiac resynchronization therapy. Heart Fail Rev 2018; 22:699-722. [PMID: 28714039 DOI: 10.1007/s10741-017-9636-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cardiac resynchronization therapy (CRT) is an established treatment for patients with heart failure and left ventricular systolic dysfunction. Patients are usually assessed by echocardiography, which provides a number of anatomical and functional information used for cardiac dyssynchrony assessment, prognostic stratification, identification of the optimal site of pacing in the left ventricle, optimization of the CRT device, and patient follow-up. Compared to other cardiac imaging techniques, echocardiography has the advantage to be non-invasive, repeatable, and safe, without exposure to ionizing radiation or nefrotoxic contrast. In this article, we review current evidence about the role of echocardiography before, during, and after the implantation of a CRT device.
Collapse
Affiliation(s)
- Donato Mele
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy. .,Noninvasive Cardiology Unit, Azienda Ospedaliero-Universitaria, Via Aldo Moro 8, 44124, Ferrara, Cona, Italy.
| | - Matteo Bertini
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy
| | - Michele Malagù
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy
| | - Marianna Nardozza
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy
| | - Roberto Ferrari
- Centro Cardiologico Universitario and LTTA Centre, University of Ferrara, Ferrara, Italy.,Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, RA, Italy
| |
Collapse
|
5
|
Wang Q, Chen KY, Yu F, Su H, An CS, Hu Y, Yang DM, Xu J, Yan J. Abnormal diastolic function underlies the different beneficial effects of cardiac resynchronization therapy on ischemic and non-ischemic cardiomyopathy. Clinics (Sao Paulo) 2017; 72:432-437. [PMID: 28793004 PMCID: PMC5525162 DOI: 10.6061/clinics/2017(07)08] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 05/17/2017] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES: To investigate the association between diastolic function and the different beneficial effects of cardiac resynchronization therapy in patients with heart failure due to different causes. METHODS: The 104 enrolled patients were divided into an ischemic cardiomyopathy group (n=27) and a non-ischemic cardiomyopathy group (n=77) according to the cause of heart failure. Before implantation, left ventricular diastolic function was evaluated in all patients using echocardiography. After six months of follow-up, the beneficial effects of cardiac resynchronization therapy were evaluated using a combination of clinical symptoms and echocardiography parameters. RESULTS: The ischemic cardiomyopathy group included significantly more patients with restrictive filling than the non-ischemic cardiomyopathy group. The response rate after the implantation procedure was significantly higher in the non-ischemic cardiomyopathy group than in the ischemic cardiomyopathy group. Degrees of improvement in echocardiography parameters were significantly greater in the non-ischemic cardiomyopathy group than in the ischemic cardiomyopathy group. Multivariate regression analysis showed that a restrictive filling pattern was an independent factor that influenced responses to cardiac resynchronization therapy. CONCLUSIONS: This study again confirmed that the etiology of heart failure affects the beneficial effects of cardiac resynchronization therapy and a lower degree of improvement in ventricular systolic function and remodelling was observed in ischemic cardiomyopathy patients than in non-ischemic cardiomyopathy patients. In addition, systolic heart failure patients with severe diastolic dysfunction had poor responses to cardiac resynchronization therapy. Ischemic cardiomyopathy patients exhibited more severe diastolic dysfunction than non-ischemic cardiomyopathy patients, which may be a reason for the reduced beneficial effect of cardiac resynchronization therapy.
Collapse
Affiliation(s)
- Qi Wang
- Department of Cardiology, Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
- # These authors contributed equally
| | - Kang-Yu Chen
- Department of Cardiology, Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
- # These authors contributed equally
| | - Fei Yu
- Department of Cardiology, Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| | - Hao Su
- Department of Cardiology, Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| | - Chun-Sheng An
- Department of Cardiology, Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| | - Yang Hu
- Department of Cardiology, Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| | - Dong-Mei Yang
- Department of Cardiology, Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| | - Jian Xu
- Department of Cardiology, Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| | - Ji Yan
- Department of Cardiology, Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
- Cardiovascular Institute of Anhui, Hefei, China
- *Corresponding author. E-mail:
| |
Collapse
|
6
|
Hipólito Reis A. Universal response to cardiac resynchronization therapy: A challenge still to be overcome. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2017.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
7
|
Reis AH. Resposta universal à terapêutica de ressincronização cardíaca – um desafio por resolver. Rev Port Cardiol 2017; 36:427-430. [DOI: 10.1016/j.repc.2017.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
8
|
Kloosterman M, Damman K, Van Veldhuisen DJ, Rienstra M, Maass AH. The importance of myocardial contractile reserve in predicting response to cardiac resynchronization therapy. Eur J Heart Fail 2017; 19:862-869. [DOI: 10.1002/ejhf.768] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 12/23/2016] [Accepted: 12/28/2016] [Indexed: 11/09/2022] Open
Affiliation(s)
- Mariëlle Kloosterman
- Department of Cardiology; University of Groningen, University Medical Center Groningen; PO Box 30.001 9700 RB Groningen the Netherlands
| | - Kevin Damman
- Department of Cardiology; University of Groningen, University Medical Center Groningen; PO Box 30.001 9700 RB Groningen the Netherlands
| | - Dirk J. Van Veldhuisen
- Department of Cardiology; University of Groningen, University Medical Center Groningen; PO Box 30.001 9700 RB Groningen the Netherlands
| | - Michiel Rienstra
- Department of Cardiology; University of Groningen, University Medical Center Groningen; PO Box 30.001 9700 RB Groningen the Netherlands
| | - Alexander H. Maass
- Department of Cardiology; University of Groningen, University Medical Center Groningen; PO Box 30.001 9700 RB Groningen the Netherlands
| |
Collapse
|
9
|
Is speckle tracking actually helpful for cardiac resynchronization therapy? J Echocardiogr 2016; 14:53-60. [PMID: 26767529 DOI: 10.1007/s12574-016-0275-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 12/09/2015] [Accepted: 12/28/2015] [Indexed: 10/22/2022]
Abstract
What is the specific role of echocardiography in cardiac resynchronization therapy (CRT)? CRT has proven to be highly effective for improving symptoms and survival of patients with advanced heart failure (HF) and wide QRS. However, a significant minority of patients do not respond favorably to CRT on the basis of standard clinical selection criteria, including the electrocardiographic QRS width. Subsequently, echocardiographic assessment of left ventricular (LV) dyssynchrony has been considered useful for CRT for selected responders, but findings by multicenter studies suggest that its predictive value was not sufficiently robust to replace routine selection criteria for CRT. A more recent approach, however, using speckle-tracking echocardiography yields more accurate quantification of regional wall contraction. Speckle-tracking approaches have therefore generated a great deal of interest about their clinical applications for CRT. Although reports on speckle tracking have not been included in any recommendations as to whether patients should undergo CRT based on the current guidelines, speckle tracking can play an important supplementary part in CRT on the basis of a case-by-case clinical decision for challenging cases. Here, we review the strengths of speckle-tracking methods, and their current potential for clinical use in CRT.
Collapse
|
10
|
Huntjens PR, Walmsley J, Ploux S, Bordachar P, Prinzen FW, Delhaas T, Lumens J. Influence of left ventricular lead position relative to scar location on response to cardiac resynchronization therapy: a model study. Europace 2014; 16 Suppl 4:iv62-iv68. [DOI: 10.1093/europace/euu231] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
11
|
Mafi Rad M, Blaauw Y, Dinh T, Pison L, Crijns HJ, Prinzen FW, Vernooy K. Different regions of latest electrical activation during left bundle-branch block and right ventricular pacing in cardiac resynchronization therapy patients determined by coronary venous electro-anatomic mapping. Eur J Heart Fail 2014; 16:1214-22. [DOI: 10.1002/ejhf.178] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 08/10/2014] [Accepted: 08/29/2014] [Indexed: 11/12/2022] Open
Affiliation(s)
- Masih Mafi Rad
- Maastricht University Medical Centre; Department of Cardiology; PO Box 5800 6202 AZ Maastricht the Netherlands
| | - Yuri Blaauw
- Maastricht University Medical Centre; Department of Cardiology; PO Box 5800 6202 AZ Maastricht the Netherlands
| | - Trang Dinh
- Maastricht University Medical Centre; Department of Cardiology; PO Box 5800 6202 AZ Maastricht the Netherlands
| | - Laurent Pison
- Maastricht University Medical Centre; Department of Cardiology; PO Box 5800 6202 AZ Maastricht the Netherlands
| | - Harry J. Crijns
- Maastricht University Medical Centre; Department of Cardiology; PO Box 5800 6202 AZ Maastricht the Netherlands
| | - Frits W. Prinzen
- Maastricht University, Cardiovascular Research Institute Maastricht (CARIM); Department of Physiology; PO Box 616 6200 MD Maastricht the Netherlands
| | - Kevin Vernooy
- Maastricht University Medical Centre; Department of Cardiology; PO Box 5800 6202 AZ Maastricht the Netherlands
| |
Collapse
|
12
|
Mafi Rad M, Blaauw Y, Dinh T, Pison L, Crijns HJ, Prinzen FW, Vernooy K. Left ventricular lead placement in the latest activated region guided by coronary venous electroanatomic mapping. Europace 2014; 17:84-93. [DOI: 10.1093/europace/euu221] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
13
|
Lim P, Donal E, Lafitte S, Derumeaux G, Habib G, Réant P, Thivolet S, Lellouche N, Grimm RA, Gueret P. Multicentre study using strain delay index for predicting response to cardiac resynchronization therapy (MUSIC study). Eur J Heart Fail 2014; 13:984-91. [DOI: 10.1093/eurjhf/hfr073] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Pascal Lim
- Cardiovascular department; Henri Mondor University Hospital (APHP and INSERM U841); Créteil France
| | - Erwan Donal
- Pontchaillou University Hospital; Rennes France
| | | | | | | | | | | | - Nicolas Lellouche
- Cardiovascular department; Henri Mondor University Hospital (APHP and INSERM U841); Créteil France
| | | | - Pascal Gueret
- Cardiovascular department; Henri Mondor University Hospital (APHP and INSERM U841); Créteil France
| |
Collapse
|
14
|
Rogers DP, Lambiase PD, Lowe MD, Chow AW. A randomized double-blind crossover trial of triventricular versus biventricular pacing in heart failure. Eur J Heart Fail 2014; 14:495-505. [DOI: 10.1093/eurjhf/hfs004] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Dominic P.S. Rogers
- The Heart Hospital; Institute of Cardiovascular Medicine, UCLH; London W1G 8PH UK
| | - Pier D. Lambiase
- The Heart Hospital; Institute of Cardiovascular Medicine, UCLH; London W1G 8PH UK
| | - Martin D. Lowe
- The Heart Hospital; Institute of Cardiovascular Medicine, UCLH; London W1G 8PH UK
| | - Anthony W.C. Chow
- The Heart Hospital; Institute of Cardiovascular Medicine, UCLH; London W1G 8PH UK
| |
Collapse
|
15
|
Sohinki D, Ho J, Srinivasan N, Collins LJ, Obel OA. Outcomes after atrioventricular node ablation and biventricular pacing in patients with refractory atrial fibrillation and heart failure: a comparison between non-ischaemic and ischaemic cardiomyopathy. Europace 2014; 16:880-6. [DOI: 10.1093/europace/eut392] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
16
|
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
| | | |
Collapse
|
17
|
Sonne C, Bott-Flugel L, Hauck S, Hadamitzky M, Lesevic H, Demetz G, Braun D, Wolf P, Hausleiter J, Schömig A, Kolb C. Three-dimensional echocardiographic optimization improves outcome in cardiac resynchronization therapy compared to ECG optimization: a randomized comparison. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 37:312-20. [PMID: 24164640 DOI: 10.1111/pace.12281] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 07/06/2013] [Accepted: 08/12/2013] [Indexed: 11/30/2022]
Abstract
AIMS There is little consensus on optimal atrioventricular (AV) and ventricular-to-ventricular (VV) intervals in cardiac resynchronization therapy (CRT). The aim of this study was to examine a novel combination of Doppler echocardiography (DE) and three-dimensional echocardiography (3DE) for individualized AV- and VV-interval optimization compared to conventional electrocardiogram (ECG) optimization. METHODS In this double-blind, randomized controlled trial, 77 patients (male: 57, age: 68 ± 10 years) with severely reduced ejection fraction (EF), New York Heart Association (NYHA) class III or IV, and wide QRS complex (>120 ms) have been included. Patients were randomized to either AV- and VV-interval optimization using DE and 3DE (group 1, n = 39) or ECG (group 2, n = 38). 3DE was performed in all patients for the evaluation of left ventricular (LV) dimensions, EF and systolic dyssynchrony index (SDI), and NYHA class obtained before CRT and after 3 months. Primary endpoint of the study was clinical response to CRT, defined as a reduction of NYHA class by ≥1 score. Secondary endpoints were change of EF, LV volumes, and SDI. RESULTS There were significantly more responders in group 1 (82%) than in group 2 (58%, P = 0.021). Similarly, group 1 showed a larger increase in EF (7.0 ± 6.0% vs 3.4 ± 5.6%, P = 0.015) and a more pronounced reduction of SDI (-4.5 ± 5.9% vs -1.5 ± 5.6%, P = 0.039) than group 2. CONCLUSION Compared with conventional ECG optimization, this novel echocardiographic optimization protocol resulted in a significantly higher response rate, improved LV systolic function, and may be used to select the optimal AV and VV intervals in CRT.
Collapse
Affiliation(s)
- Carolin Sonne
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Tas MH, Aksakal E, Gurlertop Y, Simsek Z, Gundogdu F, Sevimli S, Bakirci EM, Karakelleoglu S. Assesment of myocardial ischemia by combination of tissue synchronisation imaging and dobutamine stress echocardiography. Korean Circ J 2013; 43:384-90. [PMID: 23882287 PMCID: PMC3717421 DOI: 10.4070/kcj.2013.43.6.384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 04/25/2013] [Accepted: 05/14/2013] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Dobutamine stress echocardiography (DSE) is an important non-invasive imaging method for evaluating ischemia. However, wall motion interpretation can be impaired by the experience level of the interpreter and the subjectivity of the visual assessment. In our study we aimed to combine DSE and tissue syncronisation imaging to increase sensitivity for detecting ischemia. SUBJECTS AND METHODS 50 patients with indications for DSE were included in the study. In 25 patients we found DSE positive for ischemia and in the other 25 patients we found it to be negative. The negative group was accepted as the control group. There was no significant difference in terms of risk factors and echocardiographic parameters between the two groups, except for wall motion scores. In both groups, left ventricular dyssychrony was accepted as the difference between time to peak systolic velocity (Ts) in the reciprocal four couple of non-apical segments at rest and during peak stress. Timings were corrected for heart rate. We compared the differences of the dyssynchronisation value at rest and during peak stress to determine the distinctions within the groups and between the groups of DSE positive and negative patients. RESULTS We found that stress and ischemia did not create any significant difference over the left intraventricular dyssynchrony with DSE, although at the segmenter level it prolonged the time to peak systolic velocity (p<0.05). These alterations did not show any significant difference between positive and negative DSE groups. CONCLUSION As a result, this segmenter dyssynchrony and the time to peak systolic velocity, which is corrected for heart rate, did not enhance any new value over DSE for detecting ischemia.
Collapse
|
19
|
Maximal Electric Separation–Guided Placement of Right Ventricular Lead Improves Responders in Cardiac Resynchronization Defibrillator Therapy. Circ Arrhythm Electrophysiol 2012; 5:927-32. [DOI: 10.1161/circep.111.967208] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
20
|
Sonne C, Bott-Flügel L, Hauck S, Lesevic H, Barthel P, Michalk F, Hoppe K, Hausleiter J, Schömig A, Kolb C. Acute beneficial hemodynamic effects of a novel 3D-echocardiographic optimization protocol in cardiac resynchronization therapy. PLoS One 2012; 7:e30964. [PMID: 22319598 PMCID: PMC3272028 DOI: 10.1371/journal.pone.0030964] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 12/29/2011] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Post-implantation therapies to optimize cardiac resynchronization therapy (CRT) focus on adjustments of the atrio-ventricular (AV) delay and ventricular-to-ventricular (VV) interval. However, there is little consensus on how to achieve best resynchronization with these parameters. The aim of this study was to examine a novel combination of doppler echocardiography (DE) and three-dimensional echocardiography (3DE) for individualized optimization of device based AV delays and VV intervals compared to empiric programming. METHODS 25 recipients of CRT (male: 56%, mean age: 67 years) were included in this study. Ejection fraction (EF), the primary outcome parameter, and left ventricular (LV) dimensions were evaluated by 3DE before CRT (baseline), after AV delay optimization while pacing the ventricles simultaneously (empiric VV interval programming) and after individualized VV interval optimization. For AV delay optimization aortic velocity time integral (AoVTI) was examined in eight different AV delays, and the AV delay with the highest AoVTI was programmed. For individualized VV interval optimization 3DE full-volume datasets of the left ventricle were obtained and analyzed to derive a systolic dyssynchrony index (SDI), calculated from the dispersion of time to minimal regional volume for all 16 LV segments. Consecutively, SDI was evaluated in six different VV intervals (including LV or right ventricular preactivation), and the VV interval with the lowest SDI was programmed (individualized optimization). RESULTS EF increased from baseline 23±7% to 30±8 (p<0.001) after AV delay optimization and to 32±8% (p<0.05) after individualized optimization with an associated decrease of end-systolic volume from a baseline of 138±60 ml to 115±42 ml (p<0.001). Moreover, individualized optimization significantly reduced SDI from a baseline of 14.3±5.5% to 6.1±2.6% (p<0.001). CONCLUSIONS Compared with empiric programming of biventricular pacemakers, individualized echocardiographic optimization with the integration of 3-dimensional indices into the optimization protocol acutely improved LV systolic function and decreased ESV and can be used to select the optimal AV delay and VV interval in CRT.
Collapse
Affiliation(s)
- Carolin Sonne
- Klinik für Herz- und Kreislauferkrankungen des Erwachsenen, Deutsches Herzzentrum München, Technische Universität München, Faculty of Medicine, Munich, Germany. carolinsonne.gmx.de
| | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Xu YZ, Cha YM, Feng D, Powell BD, Wiste HJ, Hua W, Chareonthaitawee P. Impact of Myocardial Scarring on Outcomes of Cardiac Resynchronization Therapy: Extent or Location? J Nucl Med 2011; 53:47-54. [DOI: 10.2967/jnumed.111.095448] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
|
22
|
Auger D, Schalij MJ, Bax JJ, Delgado V. [Three-dimensional imaging in cardiac resynchronization therapy]. Rev Esp Cardiol 2011; 64:1035-44. [PMID: 21943554 DOI: 10.1016/j.recesp.2011.06.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 06/03/2011] [Indexed: 01/25/2023]
Abstract
Cardiac resynchronization therapy improves clinical symptoms and prognosis of heart failure patients. However, it has been shown that up to 40% of patients do not respond to this therapy. Three main determinants of cardiac resynchronization therapy response have been identified: left ventricular dyssynchrony, left ventricular lead position, and extent and location of myocardial scar tissue. Two-dimensional echocardiography is the first imaging technique to evaluate patients who may be candidates for cardiac resynchronization therapy. However, a multimodality approach based on 3-dimensional imaging techniques may provide a more comprehensive evaluation of these patients by combining the assessment of the aforementioned pathophysiological determinants of cardiac resynchronization therapy response.
Collapse
Affiliation(s)
- Dominique Auger
- Department of Cardiology, Leiden University Medical Centre, Leiden, Países Bajos
| | | | | | | |
Collapse
|
23
|
van Bommel RJ, Marsan NA, Delgado V, Borleffs CJW, van Rijnsoever EP, Schalij MJ, Bax JJ. Cardiac Resynchronization Therapy as a Therapeutic Option in Patients With Moderate-Severe Functional Mitral Regurgitation and High Operative Risk. Circulation 2011; 124:912-9. [DOI: 10.1161/circulationaha.110.009803] [Citation(s) in RCA: 164] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background—
Functional mitral regurgitation (MR) is a common finding in heart failure patients with dilated cardiomyopathy and has important prognostic implications. However, the increased operative risk of these patients may result in low referral or high denial rate for mitral valve surgery. Cardiac resynchronization therapy (CRT) has been shown to have a favorable effect on MR. Aims of this study were to (1) evaluate CRT as a therapeutic option in heart failure patients with functional MR and high operative risk and (2) investigate the effect of MR improvement after CRT on prognosis.
Methods and Results—
A total of 98 consecutive patients with moderate-severe functional MR and high operative risk underwent CRT according to current guidelines. Echocardiography was performed at baseline and 6-month follow-up; severity of MR was graded according to a multiparametric approach. Significant improvement of MR was defined as a reduction ≥1 grade. All-cause mortality was assessed during follow-up (median 32 [range 6.0 to 116] months). Thirteen patients (13%) died before 6-months follow-up. In the remaining 85 patients, significant reduction in MR was observed in all evaluated parameters. In particular, 42 patients (49%) improved ≥1 grade of MR and were considered MR improvers. Survival was superior in MR improvers compared to MR nonimprovers (log rank
P
<0.001). Mitral regurgitation improvement was an independent prognostic factor for survival (hazard ratio 0.35, confidence interval 0.13 to 0.94;
P
=0.043).
Conclusions—
Cardiac resynchronization therapy is a potential therapeutic option in heart failure patients with moderate-severe functional MR and high risk for surgery. Improvement in MR results in superior survival after CRT.
Collapse
Affiliation(s)
- Rutger J. van Bommel
- From the Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Nina Ajmone Marsan
- From the Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Victoria Delgado
- From the Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - C. Jan Willem Borleffs
- From the Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Eva P.M. van Rijnsoever
- From the Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Martin J. Schalij
- From the Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jeroen J. Bax
- From the Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| |
Collapse
|
24
|
Blendea D, Singh JP. Lead positioning strategies to enhance response to cardiac resynchronization therapy. Heart Fail Rev 2011; 16:291-303. [PMID: 21184174 DOI: 10.1007/s10741-010-9212-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Left ventricular lead position is one of the main determinants of CRT response. There are several approaches in LV lead positioning that include favoring an optimal anatomical position or targeting either the segment with maximal mechanical dyssynchrony or a region with maximal electrical delay. The conventional LV lead implantation faces several technical difficulties that may prevent the obtaining of a stable position and good performance of the LV lead without phrenic nerve stimulation. In addition, implant of the LV pacing lead in areas with myocardial scar may result in less than optimal cardiac resynchronization. Several strategies have been proposed to overcome all these obstacles including multimodality cardiac imaging to help in preprocedural or intraprocedural identification of the latest activated areas of the LV and the potential anatomical constraints. In selected patients, the surgical implant may be a solution to overcome these constraints. In the future, LV endocardial or epicardial multisite pacing may deliver an enhanced response to CRT.
Collapse
Affiliation(s)
- Dan Blendea
- Cardiac Arrhythmia Service, Massachusetts General Hospital Heart Center, Harvard Medical School, Boston, MA, USA
| | | |
Collapse
|
25
|
Kindermann M, Mahfoud F, Ukena C, Fröhlig G. [Cardiac resynchronization therapy: preoperative screening. How can we reliably predict response to CRT?]. Herzschrittmacherther Elektrophysiol 2011; 20:131-42. [PMID: 19672672 DOI: 10.1007/s00399-009-0053-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cardiac resynchronization therapy (CRT) is an established therapy for patients with advanced heart failure, depressed left ventricular function, and wide QRS complex. However, about 30 to 45% of patients do not respond to CRT. Assuming that the main therapeutic action of CRT is the correction of dyssynchronous myocardial contraction, a plethora of echocardiographic dyssynchrony parameters have been proposed to improve the prediction of response to CRT. However, one multicenter study has recently questioned the utility of any of these indexes. This review delineates the various causes of non-response to CRT, explains the different levels and mechanisms of dyssynchrony and gives a critical overview of currently available echocardiographic techniques for assessment of dyssynchrony. Based upon a discussion of the evidence coming from randomized multicenter studies and against the background of national and international cardiac societies' guideline recommendations on CRT, a rational basis for the evaluation of patients for CRT is proposed.
Collapse
Affiliation(s)
- M Kindermann
- Klinik für Innere Medizin III, Kardiologie, Angiologie, Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str. 100, 66421, Homburg/Saar, Deutschland.
| | | | | | | |
Collapse
|
26
|
Ellenbogen KA, Kron J. Cardiac resynchronization therapy: location matters. J Am Coll Cardiol 2011; 58:491-2. [PMID: 21777746 DOI: 10.1016/j.jacc.2010.10.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Accepted: 10/05/2010] [Indexed: 10/17/2022]
Affiliation(s)
- Kenneth A Ellenbogen
- Department of Medicine, Virginia Commonwealth University Medical Center, Richmond, VA 23298, USA.
| | | |
Collapse
|
27
|
Friehling M, Chen J, Saba S, Bazaz R, Schwartzman D, Adelstein EC, Garcia E, Follansbee W, Soman P. A prospective pilot study to evaluate the relationship between acute change in left ventricular synchrony after cardiac resynchronization therapy and patient outcome using a single-injection gated SPECT protocol. Circ Cardiovasc Imaging 2011; 4:532-9. [PMID: 21772007 DOI: 10.1161/circimaging.111.965459] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There are ongoing efforts to optimize patient selection criteria for cardiac resynchronization therapy (CRT). In this regard, the relationship between acute change in left ventricular synchrony (LV) after CRT and patient outcome remains undefined. METHODS AND RESULTS A novel protocol was designed to evaluate acute change in left LV synchrony after CRT using phase analysis of standard gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging with a single injection of radiotracer and prospectively applied to 44 patients undergoing CRT. Immediately after CRT, 18 (41%), 11 (25%), and 15 (34%) patients had an improvement, no change, or a worsening in LV synchrony. An algorithm incorporating the presence of baseline dyssynchrony, myocardial scar burden, and lead concordance predicted acute improvement or no change in LV synchrony with 72% sensitivity, 93% specificity, 96% positive predictive value, and 64% negative predictive value and had 96% negative predictive value for acute deterioration in synchrony. Over a follow-up period of 9.6 ± 6.8 months, patients who had an acute deterioration in synchrony after CRT had a higher composite event rate of death, heart failure hospitalizations, appropriate defibrillator discharges, and CRT device deactivation for worsening heart failure symptoms, compared with patients who had an improvement or no change [hazard ratio, 4.6 (1.3 to 16.0); log rank test; P=0.003]. CONCLUSIONS In this single-center pilot study, phase analysis of gated SPECT was successfully used to predict acute change in LV synchrony and patient outcome after CRT.
Collapse
Affiliation(s)
- Mati Friehling
- Cardiovascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Baseline asynchrony, assessed circumferentially using temporal uniformity of strain, besides coincidence between site of latest mechanical activation and presumed left ventricular lead position, predicts favourable prognosis after resynchronization therapy. Int J Cardiovasc Imaging 2011; 28:1011-21. [DOI: 10.1007/s10554-011-9908-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Accepted: 06/07/2011] [Indexed: 10/18/2022]
|
29
|
Dependency of Cardiac Resynchronization Therapy on Myocardial Viability at the LV Lead Position. JACC Cardiovasc Imaging 2011; 4:366-74. [DOI: 10.1016/j.jcmg.2011.01.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Revised: 01/03/2011] [Accepted: 01/07/2011] [Indexed: 11/24/2022]
|
30
|
Turschner O, Ritscher G, Simon H, Rittger H, Brachmann J, Sinha AM. Criteria for patient selection in cardiac resynchronization therapy. Future Cardiol 2010; 6:871-80. [PMID: 21142642 DOI: 10.2217/fca.10.100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Since the implementation of cardiac resynchronization therapy (CRT) the prognosis of patients with severe heart failure has been improved owing to a reduction in morbidity and mortality rates, as several multicenter trials have shown. However, several patients treated by CRT still lack improvement or even deteriorate during therapy. In some of them, this might be due to the severity and progression of chronic heart failure. In others, the criteria for the indication of CRT and/or optimized device programming might have not been met. Thus, one important option to improve CRT outcome is to improve CRT patient selection. A lot of publications describing various methods identifying a positive or negative prediction of CRT have been released. In summary, decision making based on all these partly contradictory publications indicate a strong need for guidelines for the use of such expensive therapy. The purpose of this article is to give an overview of CRT and summarize the different methods and the limitations of CRT patient selection parameters. With the focus of the different guidelines, this article tries to give an appropriate overview and aid decision making in CRT patients, including a short view of possible new indications.
Collapse
Affiliation(s)
- Oliver Turschner
- Department of Cardiology, Klinikum Coburg, Germany, Medizinische Klinik II, Klinikum Coburg, Ketschendorfer Str. 33, 96450 Coburg, Germany
| | | | | | | | | | | |
Collapse
|
31
|
Uebleis C, Ulbrich M, Tegtmeyer R, Schuessler F, Haserueck N, Siebermair J, Becker C, Nekolla S, Cumming P, Bartenstein P, Kääb S, Hacker M. Electrocardiogram-gated 18F-FDG PET/CT hybrid imaging in patients with unsatisfactory response to cardiac resynchronization therapy: initial clinical results. J Nucl Med 2010; 52:67-71. [PMID: 21149479 DOI: 10.2967/jnumed.110.078709] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED The present study aimed to distinguish responders to cardiac resynchronization therapy (CRT) from nonresponders, using electrocardiogram-gated 18F-FDG PET/CT. METHODS Seven consecutive CRT nonresponders were included in the study, along with 7 age- and sex-matched CRT responders, serving as reference material. Therapy response was defined as clinical improvement (≥1 New York Heart Association class) and evidence of reverse remodeling. Besides PET/CT, we measured brain natriuretic peptide levels and assessed dyssynchrony using transthoracic echocardiography. RESULTS Compared with nonresponders, CRT responders showed significant differences in the declines of left-ventricular end-systolic volume and brain natriuretic peptide and in left-ventricular dyssynchrony (global left-ventricular entropy), extent of the myocardial scar burden, and biventricular pacemaker leads positioned within viable myocardial regions. Among the nonresponders, further therapy management was guided by the PET/CT results in 4 of 7 patients. CONCLUSION Cardiac hybrid imaging using gated 18F-FDG PET/CT enabled the identification of potential reasons for nonresponse to CRT therapy, which can guide subsequent therapy.
Collapse
Affiliation(s)
- Christopher Uebleis
- Department of Nuclear Medicine, Ludwig-Maximilian's University, Munich, Germany
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Sénéchal M, Lancellotti P, Magne J, Garceau P, Champagne J, Blier L, Molin F, Philippon F, Marie M, O’Hara G, Dubois M. Contractile Reserve Assessed Using Dobutamine Echocardiography Predicts Left Ventricular Reverse Remodeling after Cardiac Resynchronization Therapy: Prospective Validation in Patients with Left Ventricular Dyssynchrony. Echocardiography 2010; 27:668-76. [DOI: 10.1111/j.1540-8175.2009.01106.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|
33
|
Norisada K, Kawai H, Tanaka H, Tatsumi K, Onishi T, Fukuzawa K, Yoshida A, Hirata KI. Myocardial Contractile Function in the Region of the Left Ventricular Pacing Lead Predicts the Response to Cardiac Resynchronization Therapy Assessed by Two-Dimensional Speckle Tracking Echocardiography. J Am Soc Echocardiogr 2010; 23:181-9. [DOI: 10.1016/j.echo.2009.11.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2009] [Indexed: 10/19/2022]
|
34
|
Bertini M, Delgado V, den Uijl DW, Nucifora G, Ng AC, van Bommel RJ, Borleffs CJW, Boriani G, Schalij MJ, Bax JJ. Prediction of Cardiac Resynchronization Therapy Response. Circ Cardiovasc Imaging 2010; 3:86-93. [DOI: 10.1161/circimaging.109.882324] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Left ventricular (LV) fibrosis is important for the response to cardiac resynchronization therapy (CRT). Calibrated integrated backscatter derived by 2D echocardiography quantifies myocardial ultrasound reflectivity, which may provide a surrogate of LV fibrosis. The aim of the study was first, to investigate the relation of myocardial ultrasound reflectivity assessed with calibrated integrated backscatter on CRT response, and second, to explore the “myocardial ultrasound reflectivity–CRT response” relation in patients with ischemic and nonischemic heart failure (HF).
Methods and Results—
One hundred fifty-nine patients with HF referred for CRT underwent an extensive echocardiographic evaluation at baseline and at 6-month follow-up. LV dyssynchrony was derived from speckle-tracking analysis. Calibrated integrated backscatter was obtained from the parasternal long-axis view. The mean value of calibrated integrated backscatter of the anteroseptal and posterior wall was used to estimate myocardial ultrasound reflectivity. CRT response was defined as reduction ≥15% of LV end-systolic volume. At baseline, LV dyssynchrony was significantly larger in responders as compared with nonresponders (188�96 ms versus 115�68 ms,
P
<0.001), and CRT responders showed less myocardial ultrasound reflectivity as compared with nonresponders (−20.8�3.0 dB versus −17.0�3.0 dB,
P
<0.001). In multivariable logistic regression analysis, independent predictors for CRT response were LV dyssynchrony, renal function, and myocardial ultrasound reflectivity. Importantly, myocardial ultrasound reflectivity provided an incremental value to CRT response (χ
2
change=40,
P
<0.001). Considering patients with ischemic HF, the only independent predictor of CRT response was myocardial ultrasound reflectivity, whereas in patients with nonischemic HF, independent predictors of LV reverse remodeling were myocardial ultrasound reflectivity, LV dyssynchrony, and renal function.
Conclusions—
Assessment of myocardial ultrasound reflectivity is important in the prediction of CRT response in ischemic and nonischemic patients.
Collapse
Affiliation(s)
- Matteo Bertini
- From the Department of Cardiology (M.B., V.D., D.W.d.U., G.N., A.C.T.N., R.J.v.B., C.J.W.B., M.J.S., J.J.B.), Leiden University Medical Center, Leiden, The Netherlands; and the Department of Cardiology (M.B., G.B.), University of Bologna, Bologna, Italy
| | - Victoria Delgado
- From the Department of Cardiology (M.B., V.D., D.W.d.U., G.N., A.C.T.N., R.J.v.B., C.J.W.B., M.J.S., J.J.B.), Leiden University Medical Center, Leiden, The Netherlands; and the Department of Cardiology (M.B., G.B.), University of Bologna, Bologna, Italy
| | - Dennis W. den Uijl
- From the Department of Cardiology (M.B., V.D., D.W.d.U., G.N., A.C.T.N., R.J.v.B., C.J.W.B., M.J.S., J.J.B.), Leiden University Medical Center, Leiden, The Netherlands; and the Department of Cardiology (M.B., G.B.), University of Bologna, Bologna, Italy
| | - Gaetano Nucifora
- From the Department of Cardiology (M.B., V.D., D.W.d.U., G.N., A.C.T.N., R.J.v.B., C.J.W.B., M.J.S., J.J.B.), Leiden University Medical Center, Leiden, The Netherlands; and the Department of Cardiology (M.B., G.B.), University of Bologna, Bologna, Italy
| | - Arnold C.T. Ng
- From the Department of Cardiology (M.B., V.D., D.W.d.U., G.N., A.C.T.N., R.J.v.B., C.J.W.B., M.J.S., J.J.B.), Leiden University Medical Center, Leiden, The Netherlands; and the Department of Cardiology (M.B., G.B.), University of Bologna, Bologna, Italy
| | - Rutger J. van Bommel
- From the Department of Cardiology (M.B., V.D., D.W.d.U., G.N., A.C.T.N., R.J.v.B., C.J.W.B., M.J.S., J.J.B.), Leiden University Medical Center, Leiden, The Netherlands; and the Department of Cardiology (M.B., G.B.), University of Bologna, Bologna, Italy
| | - C. Jan Willem Borleffs
- From the Department of Cardiology (M.B., V.D., D.W.d.U., G.N., A.C.T.N., R.J.v.B., C.J.W.B., M.J.S., J.J.B.), Leiden University Medical Center, Leiden, The Netherlands; and the Department of Cardiology (M.B., G.B.), University of Bologna, Bologna, Italy
| | - Giuseppe Boriani
- From the Department of Cardiology (M.B., V.D., D.W.d.U., G.N., A.C.T.N., R.J.v.B., C.J.W.B., M.J.S., J.J.B.), Leiden University Medical Center, Leiden, The Netherlands; and the Department of Cardiology (M.B., G.B.), University of Bologna, Bologna, Italy
| | - Martin J. Schalij
- From the Department of Cardiology (M.B., V.D., D.W.d.U., G.N., A.C.T.N., R.J.v.B., C.J.W.B., M.J.S., J.J.B.), Leiden University Medical Center, Leiden, The Netherlands; and the Department of Cardiology (M.B., G.B.), University of Bologna, Bologna, Italy
| | - Jeroen J. Bax
- From the Department of Cardiology (M.B., V.D., D.W.d.U., G.N., A.C.T.N., R.J.v.B., C.J.W.B., M.J.S., J.J.B.), Leiden University Medical Center, Leiden, The Netherlands; and the Department of Cardiology (M.B., G.B.), University of Bologna, Bologna, Italy
| |
Collapse
|
35
|
Birnie D, deKemp RA, Ruddy TD, Tang AS, Guo A, Williams K, Wassenar R, Lalonde M, Beanlands RS. Effect of lateral wall scar on reverse remodeling with cardiac resynchronization therapy. Heart Rhythm 2009; 6:1721-6. [DOI: 10.1016/j.hrthm.2009.08.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Accepted: 08/09/2009] [Indexed: 10/20/2022]
|
36
|
Recent advances in cardiac resynchronization therapy: echocardiographic modalities, patient selection, optimization, non-responders—all you need to know for more efficient CRT. Int J Cardiovasc Imaging 2009; 26:177-91. [DOI: 10.1007/s10554-009-9523-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2009] [Accepted: 10/16/2009] [Indexed: 12/24/2022]
|
37
|
Morgan JM, Delgado V. Lead positioning for cardiac resynchronization therapy: techniques and priorities. Europace 2009; 11 Suppl 5:v22-8. [DOI: 10.1093/europace/eup306] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
38
|
Chung EH, Mounsey JP. Delayed dyssynchronous LV contraction in patients with ischemic cardiomyopathy and narrow QRS complexes is not accompanied by delayed electrical activation: an explanation for lack of CRT success in this group? J Cardiovasc Electrophysiol 2009; 21:78-80. [PMID: 19804541 DOI: 10.1111/j.1540-8167.2009.01619.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
39
|
Sénéchal M, Lancellotti P, Garceau P, Champagne J, Dubois M, Magne J, Blier L, Molin F, Philippon F, Dumesnil JG, Pierard L, O'Hara G. Usefulness and limitation of dobutamine stress echocardiography to predict acute response to cardiac resynchronization therapy. Echocardiography 2009; 27:50-7. [PMID: 19725852 DOI: 10.1111/j.1540-8175.2009.00962.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND It has been hypothesized that a long-term response to cardiac resynchronization therapy (CRT) could correlate with myocardial viability in patients with left ventricular (LV) dysfunction. Contractile reserve and viability in the region of the pacing lead have not been investigated in regard to acute response after CRT. METHODS Fifty-one consecutive patients with advanced heart failure, LV ejection fraction <or= 35%, QRS duration > 120 ms, and intraventricular asynchronism >or= 50 ms were prospectively included. The week before CRT implantation, the presence of viability was evaluated using dobutamine stress echocardiography. Acute responders were defined as a >or=15% increase in LV stroke volume. RESULTS The average of viable segments was 5.8 +/- 1.9 in responders and 3.9 +/- 3 in nonresponders (P = 0.03). Viability in the region of the pacing lead had an excellent sensitivity (96%), but a low specificity (56%) to predict acute response to CRT. Mitral regurgitation (MR) was reduced in 21 patients (84%) with acute response. The presence of MR was a poor predictor of response (sensibility 93% and specificity 17%). However, combining the presence of MR and viability in the region of the pacing lead yields a sensibility (89%) and a specificity (70%) to predict acute response to CRT. CONCLUSION Myocardial viability is an important factor influencing acute hemodynamic response to CRT. In acute responders, significant MR reduction is frequent. The combined presence of MR and viability in the region of the pacing lead predicts acute response to CRT with the best accuracy.
Collapse
Affiliation(s)
- Mario Sénéchal
- Department of Cardiology, Institut de Cardiologie de Québec, Hôpital Laval, Québec, Canada.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Lim P, Mitchell-Heggs L, Buakhamsri A, Thomas JD, Grimm RA. Impact of left ventricular size on tissue Doppler and longitudinal strain by speckle tracking for assessing wall motion and mechanical dyssynchrony in candidates for cardiac resynchronization therapy. J Am Soc Echocardiogr 2009; 22:695-701. [PMID: 19501329 DOI: 10.1016/j.echo.2009.04.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Indexed: 11/18/2022]
Abstract
BACKGROUND Myocardial dysfunction and left ventricular (LV) geometry deformation may reduce the accuracy of tissue Doppler imaging (TDI) in assessing myocardial contractility. METHODS In 92 patients with heart failure who underwent cardiac resynchronization therapy (CRT), we assessed the impact of LV end-diastolic volume on the accuracy of peak longitudinal velocity (TDI) and strain (epsilon(L) by speckle tracking) to assess regional wall motion and LV dyssynchrony. RESULTS Peak-epsilon correlated to normal (-13% +/- 6%, n = 259), hypokinetic (-10% +/- 5%, n = 347), and akinetic (-7% +/- 5%, n = 498, P < .0001) wall motion independent of LV size. In contrast, velocity failed to distinguish normal from dysfunctional segments in patients with severe LV dilatation (end-diastolic volume > 250 mL). The 12 standard deviation of time to peak systolic velocity and the opposing septal-lateral wall delay by strain and TDI failed to predict response to CRT, whereas the 12 segment standard deviation of time to peak epsilon correlated to end-systolic volume reduction (r = -0.39, P < .001). CONCLUSION Accuracy of TDI in assessing LV wall regional motion is limited in severely dilated ventricles and probably affects LV dyssynchrony measurement.
Collapse
Affiliation(s)
- Pascal Lim
- Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | | | | | | | | |
Collapse
|
41
|
|
42
|
Lancellotti P, Senechal M, Moonen M, Donal E, Magne J, Nellessen E, Attena E, Cosyns B, Melon P, Pierard L. Myocardial contractile reserve during exercise predicts left ventricular reverse remodelling after cardiac resynchronization therapy. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2009; 10:663-8. [DOI: 10.1093/ejechocard/jep033] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
43
|
Wikstrom G, Blomström-Lundqvist C, Andren B, Lönnerholm S, Blomström P, Freemantle N, Remp T, Cleland JGF. The effects of aetiology on outcome in patients treated with cardiac resynchronization therapy in the CARE-HF trial. Eur Heart J 2009; 30:782-8. [PMID: 19168870 PMCID: PMC2663726 DOI: 10.1093/eurheartj/ehn577] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Revised: 11/06/2008] [Accepted: 12/04/2008] [Indexed: 01/08/2023] Open
Abstract
AIMS Cardiac dyssynchrony is common in patients with heart failure, whether or not they have ischaemic heart disease (IHD). The effect of the underlying cause of cardiac dysfunction on the response to cardiac resynchronization therapy (CRT) is unknown. This issue was addressed using data from the CARE-HF trial. METHODS AND RESULTS Patients (n = 813) were grouped by heart failure aetiology (IHD n = 339 vs. non-IHD n = 473), and the primary composite (all-cause mortality or unplanned hospitalization for a major cardiovascular event) and principal secondary (all-cause mortality) endpoints analysed. Heart failure severity and the degree of dyssynchrony were compared between the groups by analysing baseline clinical and echocardiographic variables. Patients with IHD were more likely to be in NYHA class IV (7.5 vs. 4.0%; P = 0.03) and to have higher NT-proBNP levels (2182 vs. 1725 pg/L), indicating more advanced heart failure. The degree of dyssynchrony was more pronounced in patients without IHD (assessed using mean QRS duration, interventricular mechanical delay, and aorta-pulmonary pre-ejection time). Left ventricular ejection fraction and left ventricular end-systolic volume improved to a lesser extent in the IHD group (4.53 vs. 8.50% and -35.68 vs. -58.52 cm(3)). Despite these differences, CRT improved all-cause mortality, NYHA class, and hospitalization rates to a similar extent in patients with or without IHD. CONCLUSION The benefits of CRT in patients with or without IHD were similar in relative terms in the CARE-HF study but as patients with IHD had a worse prognosis, the benefit in absolute terms may be greater.
Collapse
Affiliation(s)
- Gerhard Wikstrom
- Department of Cardiology, Institute of Medical Sciences, Akademiska Hospital, University of Uppsala, Uppsala, Sweden.
| | | | | | | | | | | | | | | |
Collapse
|
44
|
D'Andrea A, Caso P, Scarafile R, Riegler L, Salerno G, Castaldo F, Gravino R, Cocchia R, Del Viscovo L, Limongelli G, Di Salvo G, Ascione L, Iengo R, Cuomo S, Santangelo L, Calabrò R. Effects of global longitudinal strain and total scar burden on response to cardiac resynchronization therapy in patients with ischaemic dilated cardiomyopathy. Eur J Heart Fail 2009; 11:58-67. [DOI: 10.1093/eurjhf/hfn010] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Affiliation(s)
- Antonello D'Andrea
- Department of Cardiology; Second University of Naples; Martucci 35 80121 Naples Italy
| | - Pio Caso
- Department of Cardiology; Monaldi Hospital; Naples Italy
| | - Raffaella Scarafile
- Department of Cardiology; Second University of Naples; Martucci 35 80121 Naples Italy
| | - Lucia Riegler
- Department of Cardiology; Second University of Naples; Martucci 35 80121 Naples Italy
| | - Gemma Salerno
- Department of Cardiology; Second University of Naples; Martucci 35 80121 Naples Italy
| | - Francesca Castaldo
- Department of Cardiology; Second University of Naples; Martucci 35 80121 Naples Italy
| | - Rita Gravino
- Department of Cardiology; Second University of Naples; Martucci 35 80121 Naples Italy
| | - Rosangela Cocchia
- Department of Cardiology; Second University of Naples; Martucci 35 80121 Naples Italy
| | - Luca Del Viscovo
- Dipartimento di Internistica Clinica e Sperimentale-Sezione Scientifica di Diagnostica per Immagini; Second University of Naples; Naples Italy
| | - Giuseppe Limongelli
- Department of Cardiology; Second University of Naples; Martucci 35 80121 Naples Italy
| | - Giovanni Di Salvo
- Department of Cardiology; Second University of Naples; Martucci 35 80121 Naples Italy
| | - Luigi Ascione
- Department of Interventional Cardiology; Santa Maria di Loreto Hospital; Naples Italy
| | - Raffaele Iengo
- Department of Interventional Cardiology; Santa Maria di Loreto Hospital; Naples Italy
| | - Sergio Cuomo
- Department of Cardiology; Second University of Naples; Martucci 35 80121 Naples Italy
| | - Lucio Santangelo
- Department of Cardiology; Second University of Naples; Martucci 35 80121 Naples Italy
| | - Raffaele Calabrò
- Department of Cardiology; Second University of Naples; Martucci 35 80121 Naples Italy
| |
Collapse
|
45
|
Moonen M, Senechal M, Cosyns B, Melon P, Nellessen E, Pierard L, Lancellotti P. Impact of contractile reserve on acute response to cardiac resynchronization therapy. Cardiovasc Ultrasound 2008; 6:65. [PMID: 19117517 PMCID: PMC2615753 DOI: 10.1186/1476-7120-6-65] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2008] [Accepted: 12/31/2008] [Indexed: 11/29/2022] Open
Abstract
Background Cardiac resynchronization therapy (CRT) provides benefit for congestive heart failure, but still 30% of patients failed to respond to such therapy. This lack of response may be due to the presence of significant amount of scar or fibrotic tissue at myocardial level. This study sought to investigate the potential impact of myocardial contractile reserve as assessed during exercise echocardiography on acute response following CRT implantation. Methods Fifty-one consecutive patients with heart failure (LV ejection fraction 27% ± 5%, 67% ischemic cardiomyopathy) underwent exercise Doppler echocardiography before CRT implantation to assess global contractile reserve (improvement in LV ejection fraction) and local contractile reserve in the region of the LV pacing lead (assessed by radial strain using speckle tracking analysis). Responders were defined by an increase in stroke volume ≥ 15% after CRT. Results Compared with nonresponders, responders (25 patients) showed a greater exercise-induced increase in LV ejection fraction, a higher degree of mitral regurgitation and a significant extent of LV dyssynchrony. The presence of contractile reserve was directly related to the acute increase in stroke volume (r = 0.48, p < 0.001). Baseline myocardial deformation as well as contractile reserve in the LV pacing lead region was greater in responders during exercise than in nonresponders (p < 0.0001). Conclusion The present study showed that response to CRT largely depends not only on the extent of LV dyssynchrony and the severity of mitral regurgitation but also on the presence of contractile reserve.
Collapse
Affiliation(s)
- Marie Moonen
- Department of Cardiology, CHU Sart Tilman, Liege, Belgium.
| | | | | | | | | | | | | |
Collapse
|
46
|
Van Kriekinge SD, Nishina H, Ohba M, Berman DS, Germano G. Automatic global and regional phase analysis from gated myocardial perfusion SPECT imaging: application to the characterization of ventricular contraction in patients with left bundle branch block. J Nucl Med 2008; 49:1790-7. [PMID: 18927331 DOI: 10.2967/jnumed.108.055160] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED Although many patients with heart failure benefit from cardiac resynchronization therapy (CRT), predicting which patients will respond to CRT remains challenging. Recent evidence suggests that the analysis of mechanical dyssynchrony using gated myocardial perfusion SPECT (MPS) may be an effective tool. The aim of this study was to evaluate global and regional gated MPS dyssynchrony measurements by comparing parameters obtained from patients with a low likelihood (LLk) of conduction abnormalities and coronary artery disease and patients with left bundle branch block (LBBB). METHODS A total of 86 consecutive patients with LLk and 72 consecutive patients with LBBB, all without prior myocardial infarction or sternotomy, were studied using gated MPS. Global (histogram SD [sigma], bandwidth [beta], and entropy [epsilon]) and regional (wall- and segment-based differences of means [Deltamicro(W) and Deltamicro(S), respectively] or modes [DeltaM(W) and DeltaM(S), respectively]) dyssynchrony measures were calculated by Fourier harmonic phase-angle analysis of local myocardial count variations over the cardiac cycle for each patient, and then unpaired t tests were used to determine which parameters were sex-specific and how well they discriminated between the LLk and LBBB populations. Receiver-operating-characteristic analysis was also performed to calculate the area under the curve (AUC), sensitivity (Ss), specificity (Sp), and optimal threshold (Th). RESULTS Global parameters were found to be sex-specific, whereas regional differences were sex-independent. All parameters studied showed statistically significant differences between the groups (all global, P < 0.05; all regional, P < 0.0001). Receiver-operating-characteristic analysis yielded higher AUC, Ss, and Sp for epsilon and regional parameters (epsilon: AUC = 0.95/0.96, Ss = 94%/88%, Sp = 89%/91%, and Th = 53.9%/60.6% for women/men; Deltamicro(W): AUC = 0.93, Ss = 88%, Sp = 86%, and Th = 10.5 degrees ; Deltamicro(S): AUC = 0.94, Ss = 90%, Sp = 94%, and Th = 9.2 degrees ; DeltaM(W): AUC = 0.95, Ss = 90%, Sp = 94%, and Th = 15 degrees ; and DeltaM(S): AUC = 0.95, Ss = 88%, Sp = 90%, and Th = 10.5 degrees ) than for global parameters (sigma: AUC = 0.75/0.67, Ss = 81%/66%, Sp = 63%/64%, and Th = 16.5 degrees /22.2 degrees for women/men; beta: AUC = 0.80/0.72, Ss = 71%/71%, Sp = 79%/64%, and Th = 69 degrees /81 degrees for women/men). CONCLUSION The computed parameters all discriminate effectively between LLk and LBBB populations. Measurements that are less dependent on the shape of the phase-angle distribution histogram provided higher sensitivity and specificity for this purpose. Further study is needed to evaluate these parameters for the purpose of predicting response to CRT.
Collapse
Affiliation(s)
- Serge D Van Kriekinge
- Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
| | | | | | | | | |
Collapse
|
47
|
Bilchick KC, Lardo AC. Cardiac resynchronization therapy: Application of imaging to optimize patient selection and assess response. Curr Heart Fail Rep 2008; 5:119-27. [DOI: 10.1007/s11897-008-0020-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
48
|
Ascione L, Muto C, Iengo R, Celentano E, Accadia M, Rumolo S, D'Andrea A, Carreras G, Canciello M, Tuccillo B. End-Diastolic Wall Thickness as a Predictor of Reverse Remodelling After Cardiac Resynchronization Therapy: A Two-Dimensional Echocardiographic Study. J Am Soc Echocardiogr 2008; 21:1055-61. [DOI: 10.1016/j.echo.2008.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2008] [Indexed: 10/21/2022]
|
49
|
Lim P, Buakhamsri A, Popovic ZB, Greenberg NL, Patel D, Thomas JD, Grimm RA. Longitudinal strain delay index by speckle tracking imaging: a new marker of response to cardiac resynchronization therapy. Circulation 2008; 118:1130-7. [PMID: 18725491 DOI: 10.1161/circulationaha.107.750190] [Citation(s) in RCA: 150] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND In heart failure patients with left ventricular dyssynchrony, contractility in delayed segments does not fully contribute to end-systolic function. We quantified this reserve of contraction related to mechanical dyssynchrony to predict response to cardiac resynchronization therapy by the strain delay index, which was defined as the sum of the difference between peak and end-systolic strain across 16 segments. METHODS AND RESULTS In 100 heart failure patients (ejection fraction=26+/-9%, QRS=154+/-29 ms, 94% in New York Heart Association class III), we studied left ventricular dyssynchrony before cardiac resynchronization therapy by the strain delay index using longitudinal strain by 2D speckle tracking and by the SD of time to peak myocardial velocity in 12 segments. The optimal cutoff value of the strain delay index to predict response to cardiac resynchronization therapy was determined in a retrospective group (n=65) and then confirmed in a validation group (n=35). Left ventricular end-systolic volume reduction at 3 months >15% (responder) occurred in 64 of 100 patients. In the retrospective group, the strain delay index but not the SD of time to peak myocardial velocity was greater in responders (n=42/65) than nonresponders (35+/-8% versus 19+/-7%, P<0.0001), and the optimal cutoff value to identify response to cardiac resynchronization therapy was 25%. In the validation group, strain delay index > or =25% identified 82% (18/22) of responders and 92% (12/13) of nonresponders. Among the entire population (n=100), strain delay index correlated with reverse remodeling in both the ischemic (r=-0.68, P<0.0001) and nonischemic (r=-0.68, P<0.0001) population. CONCLUSIONS Use of the strain delay index with longitudinal strain by speckle tracking has a strong predictive value for predicting response to cardiac resynchronization therapy in both ischemic and nonischemic patients.
Collapse
Affiliation(s)
- Pascal Lim
- Assistance Publique-Hôpitaux de Paris, Department of Cardiovascular Medicine, INSERM U841, Henri Mondor Hospital, Creteil, France
| | | | | | | | | | | | | |
Collapse
|
50
|
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]
|