1
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Zhu M, Wang Y, Cheng Y, Su Y, Chen H, Shu X. The value of non-invasive myocardial work indices derived from left ventricular pressure-strain loops in predicting the response to cardiac resynchronization therapy. Quant Imaging Med Surg 2021; 11:1406-1420. [PMID: 33816178 DOI: 10.21037/qims-20-754] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Non-invasive left ventricular (LV) pressure-strain loops (PSLs), which are generated by combining LV longitudinal strain with brachial artery blood pressure, provide a novel method of quantifying global and segmental myocardial work (MW) indices with potential advantages over conventional echocardiographic strain data, which suffers from being load-dependent. This method has been recently introduced in echocardiographic software, enhancing the efficiency of MW calculations. This study aimed to evaluate the role of non-invasive MW indices derived from LV PSLs in predicting cardiac resynchronization therapy (CRT) response. Methods A total of 106 heart failure (HF) patients scheduled for CRT were included in the MW analysis. Global and segmental (septal and lateral at the mid-ventricular level) MW indices were assessed before CRT and at a 6-month follow-up. Response to CRT was defined as ≥15% reduction in LV end-systolic volume and ≥1 NYHA functional class improvement at 6-month follow-up compared to baseline. Results CRT response was observed in 78 (74%) patients. At baseline, the global work index (GWI) and global constructive work (GCW) were significantly higher in CRT responders than in non-responders (both P<0.05). Furthermore, responders exhibited significantly higher mid lateral MW and mid lateral constructive work (CW) (both P<0.001), but significantly lower mid septal MWI and mid septal myocardial work efficiency (MWE) than non-responders (all P<0.01). Baseline mid septal MWE (OR 0.975, 95% CI: 0.959-0.990, P=0.002) and mid lateral MWI (OR 1.003, 95% CI: 1.002-1.004, P<0.001) were identified as independent predictors of CRT response in multivariate regression analysis. Mid septal MWE ≤42% combined with mid lateral MWI ≥740 mmHg% predicted CRT response, with an optimal sensitivity of 79% and specificity of 82% [area under the receiver operating characteristic curve (AUC) =0.830, P<0.001]. Conclusions Assessment of MW indices before CRT could identify the marked imbalance in LV MW distribution and can be widely used as a reliable complementary tool for guiding patient selection for CRT in clinical practice.
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Affiliation(s)
- Mengruo Zhu
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yanan Wang
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yufei Cheng
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yangang Su
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Haiyan Chen
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xianhong Shu
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China.,Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
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2
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The Current Role of Viability Imaging to Guide Revascularization and Therapy Decisions in Patients With Heart Failure and Reduced Left Ventricular Function. Can J Cardiol 2019; 35:1015-1029. [DOI: 10.1016/j.cjca.2019.04.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 04/25/2019] [Accepted: 04/28/2019] [Indexed: 12/20/2022] Open
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3
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Sieniewicz BJ, Jackson T, Claridge S, Pereira H, Gould J, Sidhu B, Porter B, Niederer S, Yao C, Rinaldi CA. Optimization of CRT programming using non-invasive electrocardiographic imaging to assess the acute electrical effects of multipoint pacing. J Arrhythm 2019; 35:267-275. [PMID: 31007792 PMCID: PMC6457383 DOI: 10.1002/joa3.12153] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 12/13/2018] [Indexed: 12/07/2022] Open
Abstract
AIM Quadripolar lead technology and multi-point pacing (MPP) are important clinical adjuncts in cardiac resynchronization therapy (CRT) pacing aimed at reducing the rate of non-response to therapy. Mixed results have been achieved using MPP and it is critical to identify which patients require this approach and how to configure their MPP stimulation, in order to achieve optimal electrical resynchronization. METHODS & RESULTS We sought to investigate whether electrocardiographic imaging (ECGi), using the CARDIOINSIGHT ™ inverse ECG mapping system, could identify alterations in electrical resynchronization during different methods of device optimization. In no patient did a single form of programming optimization provide the best electrical response. The effects of utilizing MPP were idiosyncratic and highly patient specific. ECGi activation maps were clearly able to discern changes in bulk LV activation during differing MPP programming. In two of the five subjects, MPP resulted in more rapid activation of the left ventricle compared to standard CRT; however, in the remaining three patients, the use of MPP did not appear to acutely improve electrical resynchronization. Crucially, this cohort showed evidence of extensive LV scarring which was well visualized using both CMR and ECGi voltage mapping. CONCLUSIONS Our work suggests a potential role for ECGi in the optimization of non-responders to CRT, as it allows the fusion of activation maps and scar analysis above and beyond interrogation of the 12 lead ECG.
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Affiliation(s)
- Benjamin J. Sieniewicz
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondonUK
- Cardiology DepartmentGuys and St Thomas’ NHS Foundation TrustLondonUK
| | - Tom Jackson
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondonUK
- Cardiology DepartmentGuys and St Thomas’ NHS Foundation TrustLondonUK
| | - Simon Claridge
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondonUK
- Cardiology DepartmentGuys and St Thomas’ NHS Foundation TrustLondonUK
| | - Helder Pereira
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondonUK
| | - Justin Gould
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondonUK
- Cardiology DepartmentGuys and St Thomas’ NHS Foundation TrustLondonUK
| | - Baldeep Sidhu
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondonUK
- Cardiology DepartmentGuys and St Thomas’ NHS Foundation TrustLondonUK
| | - Bradley Porter
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondonUK
- Cardiology DepartmentGuys and St Thomas’ NHS Foundation TrustLondonUK
| | - Steve Niederer
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondonUK
| | - Cheng Yao
- CardioInsight Technologies, MedtronicMinneapolisMinnesota
| | - Christopher A. Rinaldi
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondonUK
- Cardiology DepartmentGuys and St Thomas’ NHS Foundation TrustLondonUK
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4
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Kutyifa V, Kosztin A, Klein HU, Biton Y, Nagy VK, Solomon SD, McNitt S, Zareba W, Goldenberg I, Roka A, Moss AJ, Merkely B, Singh JP. Left Ventricular Lead Location and Long-Term Outcomes in Cardiac Resynchronization Therapy Patients. JACC Clin Electrophysiol 2018; 4:1410-1420. [PMID: 30466845 DOI: 10.1016/j.jacep.2018.07.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/03/2018] [Accepted: 07/12/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The authors aimed to evaluate the association of left ventricular (LV) lead location and long-term outcomes in MADIT-CRT (Multicenter Automatic Defibrillator Implantation With Cardiac Resynchronization Therapy). BACKGROUND There is limited data on the association of lead location with long-term clinical outcomes in patients with cardiac resynchronization therapy with defibrillator (CRT-D). METHODS The LV lead location was classified in 797 patients with CRT-D, in 569 patients with left bundle branch block (LBBB), in 228 patients with non-LBBB, and in 505 patients with an implantable cardioverter-defibrillator (ICD) only. Leads were classified into apical (n = 83) and non-apical (n = 486); with the non-apical LV leads further categorized into anterior (n = 99) and posterior/lateral (n = 387) within LBBB. All-cause mortality and heart failure (HF) events were assessed using Kaplan-Meier and Cox analyses. RESULTS In CRT-D patients with LBBB and posterior/lateral LV lead location, there was an association with a significant reduction in long-term all-cause mortality (hazard ratio [HR]: 0.54, 95% confidence interval [CI]: 0.37 to 0.79; p = 0.001), and HF events (HR: 0.44, 95% CI: 0.33 to 0.60; p < 0.001) compared to an ICD only, accompanied with better LV reverse remodeling. CRT-D patients with LBBB and an anterior LV lead location were shown to be associated with a significant reduction in HF events compared to an ICD only (anterior HR: 0.50, 95% CI: 0.30 to 0.82; p = 0.006); however, no association with mortality reduction was observed from CRT-D versus an ICD only. CRT-D was not associated with improved outcomes in non-LBBB patients, regardless of LV lead location. CONCLUSIONS In mild HF patients with LBBB and an implanted CRT-D, lateral/posterior, and anterior LV lead locations are similarly associated with reduction in the risk of HF or death events compared to ICD alone. Mortality benefit derived from CRT-D is associated only with patients with lateral/posterior LV lead location. An apical LV lead location should be avoided due to the early risk of death whenever possible. (Multicenter Automatic Defibrillator Implantation With Cardiac Resynchronization Therapy [MADIT-CRT], NCT00180271; Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy Post Approval Registry [MADIT-CRT-PAR], NCT01294449; and MADIT-CRT Long-Term International Follow-Up Registry - Europe, NCT02060110).
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Affiliation(s)
- Valentina Kutyifa
- University of Rochester Medical Center, Rochester, New York; Semmelweis University, Heart Center, Budapest, Hungary.
| | - Annamaria Kosztin
- Semmelweis University, Heart Center, Budapest, Hungary; Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Helmut U Klein
- University of Rochester Medical Center, Rochester, New York
| | - Yitschak Biton
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Scott D Solomon
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Scott McNitt
- University of Rochester Medical Center, Rochester, New York
| | | | | | - Attila Roka
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Arthur J Moss
- University of Rochester Medical Center, Rochester, New York
| | - Bela Merkely
- Semmelweis University, Heart Center, Budapest, Hungary
| | - Jagmeet P Singh
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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5
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Mihos CG, Yucel E, Capoulade R, Orencole MP, Upadhyay GA, Santana O, Singh JP, Picard MH. Effects of cardiac resynchronization therapy after inferior myocardial infarction on secondary mitral regurgitation and mitral valve geometry. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:114-121. [DOI: 10.1111/pace.13255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 11/06/2017] [Accepted: 11/28/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Christos G. Mihos
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital; Harvard Medical School; Boston MA USA
- Echocardiography Laboratory, Columbia University Division of Cardiology; Mount Sinai Heart Institute; Miami Beach FL USA
| | - Evin Yucel
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital; Harvard Medical School; Boston MA USA
| | - Romain Capoulade
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital; Harvard Medical School; Boston MA USA
| | - Mary P. Orencole
- Cardiac Arrhythmia Service, Massachusetts General Hospital; Harvard Medical School; Boston MA USA
| | | | - Orlando Santana
- Echocardiography Laboratory, Columbia University Division of Cardiology; Mount Sinai Heart Institute; Miami Beach FL USA
| | - Jagmeet P. Singh
- Cardiac Arrhythmia Service, Massachusetts General Hospital; Harvard Medical School; Boston MA USA
| | - Michael H. Picard
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital; Harvard Medical School; Boston MA USA
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6
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Hirose M, Matsushita N. Mechanical stretch and endothelial to mesenchymal transition – importance of integrin β1. Circ J 2014; 79:53-4. [PMID: 25452103 DOI: 10.1253/circj.cj-14-1237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Masamichi Hirose
- Department of Molecular and Cellular Pharmacology, School of Pharmaceutical Sciences, Iwate Medical University
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7
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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
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8
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Lim SP, Mc Ardle BA, Beanlands RS, Hessian RC. Myocardial Viability: It is Still Alive. Semin Nucl Med 2014; 44:358-74. [DOI: 10.1053/j.semnuclmed.2014.07.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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9
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Lalonde M, Wells RG, Birnie D, Ruddy TD, Wassenaar R. Development and optimization of SPECT gated blood pool cluster analysis for the prediction of CRT outcome. Med Phys 2014; 41:072506. [DOI: 10.1118/1.4883881] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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10
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Lalonde M, Birnie D, Ruddy TD, deKemp RA, Beanlands RSB, Wassenaar R, Wells RG. SPECT gated blood pool phase analysis of lateral wall motion for prediction of CRT response. Int J Cardiovasc Imaging 2014; 30:559-69. [DOI: 10.1007/s10554-013-0360-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 12/31/2013] [Indexed: 10/25/2022]
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11
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BOSE ABHISHEK, KANDALA JAGDESH, UPADHYAY GAURAVA, RIEDL LINDSAY, AHMADO IMAD, PADMANABHAN RAM, GEWIRTZ HENRY, MULLIGAN LAWRENCEJ, SINGH JAGMEETP. Impact of Myocardial Viability and Left Ventricular Lead Location on Clinical Outcome in Cardiac Resynchronization Therapy Recipients with Ischemic Cardiomyopathy. J Cardiovasc Electrophysiol 2014; 25:507-513. [DOI: 10.1111/jce.12348] [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: 10/03/2013] [Revised: 11/29/2013] [Accepted: 12/04/2013] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | | | - IMAD AHMADO
- Nuclear Cardiology Service; Division of Cardiology; Massachusetts General Hospital; Boston Massachusetts USA
| | - RAM PADMANABHAN
- Nuclear Cardiology Service; Division of Cardiology; Massachusetts General Hospital; Boston Massachusetts USA
| | - HENRY GEWIRTZ
- Nuclear Cardiology Service; Division of Cardiology; Massachusetts General Hospital; Boston Massachusetts USA
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12
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Birnie DH, Ha A, Higginson L, Sidhu K, Green M, Philippon F, Thibault B, Wells G, Tang A. Impact of QRS Morphology and Duration on Outcomes After Cardiac Resynchronization Therapy. Circ Heart Fail 2013; 6:1190-8. [DOI: 10.1161/circheartfailure.113.000380] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
The impact of QRS morphology and duration on the effectiveness of cardiac resynchronization therapy (CRT) has been usually assessed separately. The interaction between these 2 simple ECG parameters and their effect on CRT has not been systematically assessed in a large-scale clinical trial.
Methods and Results—
The Resynchronization–Defibrillation for Ambulatory Heart Failure Trial showed that implantable cardioverter defibrillator-CRT was associated with a significant reduction in the primary end point of all-cause mortality or heart failure hospitalization. For this substudy, we excluded patients in atrial fibrillation and those with a previous pacemaker. All baseline ECGs were reviewed by a panel of 3 experienced electrocardiographers. A total of 1483 patients were included in this study. Of these, 1175 had left bundle-branch block (LBBB) and 308 had non-LBBB. In patients with LBBB receiving implantable cardioverter defibrillator-CRT, there was a reduction in the primary outcome and in each individual component of the primary outcome. Furthermore, there was continuous relationship between QRS duration and extent of benefit. In patients with non-LBBB and QRS ≥160 ms, the hazard ratio for the primary outcome was 0.52 (0.29–0.96;
P
=0.033); in patients with QRS <160 ms, the hazard ratio was 1.38 (0.88–2.14;
P
=0.155).
Conclusions—
In patients with LBBB, there was a continuous relationship between broader QRS and greater benefit from implantable cardioverter defibrillator-CRT. However, our data do not support the use of implantable cardioverter defibrillator-CRT in patients with non-LBBB, especially when the QRS duration is <160 ms. There may be some delayed benefit when the QRS is ≥160 ms, but this needs further investigation.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00251251.
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Affiliation(s)
- David H. Birnie
- From the Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (D.H.B., L.H., M.G., G.W., A.T.); the Division of Cardiology, University Health Network, Toronto, Ontario, Canada (A.H.); the Division of Cardiology, Island Medical Program, University of British Columbia, British Columbia, Canada (A.T., K.S.); the Division of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada (F.P.); and the Division of Cardiology, Montreal Heart
| | - Andrew Ha
- From the Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (D.H.B., L.H., M.G., G.W., A.T.); the Division of Cardiology, University Health Network, Toronto, Ontario, Canada (A.H.); the Division of Cardiology, Island Medical Program, University of British Columbia, British Columbia, Canada (A.T., K.S.); the Division of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada (F.P.); and the Division of Cardiology, Montreal Heart
| | - Lyall Higginson
- From the Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (D.H.B., L.H., M.G., G.W., A.T.); the Division of Cardiology, University Health Network, Toronto, Ontario, Canada (A.H.); the Division of Cardiology, Island Medical Program, University of British Columbia, British Columbia, Canada (A.T., K.S.); the Division of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada (F.P.); and the Division of Cardiology, Montreal Heart
| | - Kiran Sidhu
- From the Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (D.H.B., L.H., M.G., G.W., A.T.); the Division of Cardiology, University Health Network, Toronto, Ontario, Canada (A.H.); the Division of Cardiology, Island Medical Program, University of British Columbia, British Columbia, Canada (A.T., K.S.); the Division of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada (F.P.); and the Division of Cardiology, Montreal Heart
| | - Martin Green
- From the Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (D.H.B., L.H., M.G., G.W., A.T.); the Division of Cardiology, University Health Network, Toronto, Ontario, Canada (A.H.); the Division of Cardiology, Island Medical Program, University of British Columbia, British Columbia, Canada (A.T., K.S.); the Division of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada (F.P.); and the Division of Cardiology, Montreal Heart
| | - François Philippon
- From the Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (D.H.B., L.H., M.G., G.W., A.T.); the Division of Cardiology, University Health Network, Toronto, Ontario, Canada (A.H.); the Division of Cardiology, Island Medical Program, University of British Columbia, British Columbia, Canada (A.T., K.S.); the Division of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada (F.P.); and the Division of Cardiology, Montreal Heart
| | - Bernard Thibault
- From the Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (D.H.B., L.H., M.G., G.W., A.T.); the Division of Cardiology, University Health Network, Toronto, Ontario, Canada (A.H.); the Division of Cardiology, Island Medical Program, University of British Columbia, British Columbia, Canada (A.T., K.S.); the Division of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada (F.P.); and the Division of Cardiology, Montreal Heart
| | - George Wells
- From the Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (D.H.B., L.H., M.G., G.W., A.T.); the Division of Cardiology, University Health Network, Toronto, Ontario, Canada (A.H.); the Division of Cardiology, Island Medical Program, University of British Columbia, British Columbia, Canada (A.T., K.S.); the Division of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada (F.P.); and the Division of Cardiology, Montreal Heart
| | - Anthony Tang
- From the Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (D.H.B., L.H., M.G., G.W., A.T.); the Division of Cardiology, University Health Network, Toronto, Ontario, Canada (A.H.); the Division of Cardiology, Island Medical Program, University of British Columbia, British Columbia, Canada (A.T., K.S.); the Division of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada (F.P.); and the Division of Cardiology, Montreal Heart
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13
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Detection of regional low myocardial perfusion helps predict a response to cardiac resynchronization therapy in patients with non-ischemic cardiomyopathy: Results of the Find Index by Nuclear Imaging for Dyssynchrony (FIND) study. J Arrhythm 2013. [DOI: 10.1016/j.joa.2012.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Daubert JC, Saxon L, Adamson PB, Auricchio A, Berger RD, Beshai JF, Breithard O, Brignole M, Cleland J, DeLurgio DB, Dickstein K, Exner DV, Gold M, Grimm RA, Hayes DL, Israel C, Leclercq C, Linde C, Lindenfeld J, Merkely B, Mont L, Murgatroyd F, Prinzen F, Saba SF, Shinbane JS, Singh J, Tang AS, Vardas PE, Wilkoff BL, Zamorano JL, Anand I, Blomström-Lundqvist C, Boehmer JP, Calkins H, Cazeau S, Delgado V, Estes NAM, Haines D, Kusumoto F, Leyva P, Ruschitzka F, Stevenson LW, Torp-Pedersen CT. 2012 EHRA/HRS expert consensus statement on cardiac resynchronization therapy in heart failure: implant and follow-up recommendations and management. Europace 2013; 14:1236-86. [PMID: 22930717 DOI: 10.1093/europace/eus222] [Citation(s) in RCA: 201] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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15
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Daubert JC, Saxon L, Adamson PB, Auricchio A, Berger RD, Beshai JF, Breithard O, Brignole M, Cleland J, Delurgio DB, Dickstein K, Exner DV, Gold M, Grimm RA, Hayes DL, Israel C, Leclercq C, Linde C, Lindenfeld J, Merkely B, Mont L, Murgatroyd F, Prinzen F, Saba SF, Shinbane JS, Singh J, Tang AS, Vardas PE, Wilkoff BL, Zamorano JL. 2012 EHRA/HRS expert consensus statement on cardiac resynchronization therapy in heart failure: implant and follow-up recommendations and management. Heart Rhythm 2012; 9:1524-76. [PMID: 22939223 DOI: 10.1016/j.hrthm.2012.07.025] [Citation(s) in RCA: 186] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Indexed: 11/30/2022]
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Birnie D, de Kemp RA, Tang AS, Ruddy TD, Gollob MH, Guo A, Williams K, Thomson K, DaSilva JN, Beanlands RS. Reduced septal glucose metabolism predicts response to cardiac resynchronization therapy. J Nucl Cardiol 2012; 19:73-83. [PMID: 22160630 DOI: 10.1007/s12350-011-9483-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Accepted: 11/05/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND Up to 50% of patients do not respond to Cardiac Resynchronization Therapy (CRT). Recent work has focused on quantifying mechanical dyssynchrony and left ventricular scar. Septal reverse-mismatch (R-MM) (reduced FDG uptake vs perfusion) has been observed in patients with cardiomyopathy and prolonged QRS duration. We hypothesized that a greater quantity of septal R-MM would indicate a greater potential for reversibility of the cardiomyopathy, when the dyssynchrony is improved with CRT. Therefore, this study's objective was to assess whether greater septal R-MM pattern predicts response to CRT. METHODS AND RESULTS Forty-nine patients had pre-implant Rubidium-82 and Fluorine-18-fluorodeoxyglucose PET scanning. Total and regional left ventricular scar size and extent of R-MM were calculated. Response to CRT was defined as ≥10% improvement in left ventricular end-systolic volume or ≥5% absolute ejection fraction improvement. In the non-ischemic cardiomyopathy subset non-responders had significantly less septal R-MM than responders (13.1% compared to 27.1%, P = .012). There were correlations between the extent of septal R-MM and the increase in ejection fraction (r = 0.692, P = .0004) and reduction in left ventricular end-systolic volume (r = -0.579, P = .004). For each 5% absolute increase in extent of septal R-MM the odds ratio of being a responder was 2.17 (95% CI 1.15, 4.11, P = .017). Extent of septal R-MM displayed high sensitivity and specificity (area under curve = 0.855, P = .017) to predict response. CONCLUSIONS In patients with non-ischemic cardiomyopathy, greater extent of septal glucose metabolic R-MM pattern, predicted response to CRT. This parameter may be useful for identifying patients who benefit from CRT.
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Affiliation(s)
- David Birnie
- University of Ottawa Heart Institute, 40 Ruskin Road, Ottawa, ON K1Y 4W7, Canada.
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Perrin MJ, Green MS, Redpath CJ, Nery PB, Keren A, Beanlands RS, Birnie DH. Greater response to cardiac resynchronization therapy in patients with true complete left bundle branch block: a PREDICT substudy. Europace 2011; 14:690-5. [DOI: 10.1093/europace/eur381] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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18
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Hsing JM, Selzman KA, Leclercq C, Pires LA, McLaughlin MG, McRae SE, Peterson BJ, Zimetbaum PJ. Paced Left Ventricular QRS Width and ECG Parameters Predict Outcomes After Cardiac Resynchronization Therapy. Circ Arrhythm Electrophysiol 2011; 4:851-7. [DOI: 10.1161/circep.111.962605] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
For patients with symptomatic New York Heart Association class III or IV, ejection fraction ≤35%, and QRS ≥130 ms, cardiac resynchronization therapy (CRT) has become an established treatment option. However, use of these implant criteria fails to result in clinical or echocardiographic improvement in 30% to 45% of CRT patients.
Methods and Results—
The Predictors of Response to CRT (PROSPECT)-ECG is a substudy of the prospective observational PROSPECT trial. ECGs collected before, during, and after CRT implantation were analyzed. Primary outcomes were improvement in clinical composite score (CCS) and reduction of left ventricular end systolic volume (LVESV) of >15% after 6 months. Age, sex, cause of cardiomyopathy, myocardial infarction location, right ventricular function, mitral regurgitation, preimplantation QRS width, preimplantation PR interval, preimplantation right ventricular–paced QRS width, preimplantation axis categories, LV-paced QRS width, postimplantation axis categories, difference between biventricular (Bi-V) pacing and preimplantation QRS width, and QRS bundle branch morphological features were analyzed univariably in logistic regression models to predict outcomes. All significant predictors (α=0.1), age, and sex were used for multivariable analyses. Cardiomyopathy cause interaction and subanalyses were also performed. In multivariable analyses, only QRS left bundle branch morphological features predicted both CCS (odds ratio [OR]=2.46,
P
=0.02) and LVESV (OR=2.89,
P
=0.048) response. The difference between Bi-V and preimplantation QRS width predicted CCS improvement (OR=0.89,
P
=0.04). LV-paced QRS width predicted LVESV reduction (OR=0.86,
P
=0.01). Specifically, an LV-paced QRS width of ≤200 ms was predictive of nonischemic LVESV reduction (OR=5.12,
P
=0.01).
Conclusions—
Baseline left bundle branch QRS morphological features, LV-paced QRS width, and the difference between Bi-V and preimplantation QRS width can predict positive outcomes after CRT and may represent a novel intraprocedural method to optimize coronary sinus lead placement.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00253357.
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Affiliation(s)
- Jeff M. Hsing
- From the Department of Medicine (J.M.H., M.G.M., P.J.Z.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass; Department of Medicine (K.A.S.), George E. Wahlen VA Hospital, University of Utah, Salt Lake City; Department de Cardiologie (C.L.), Centre Cafrdio-pneumologique, Centre Hospitalier Universitaire Pontchaillou, Rennes, France; Department of Medicine (L.A.P.), St John Hospital and Medical Center, Detroit, MI; and Medtronic Inc (S.E.M., B.J.P.), Minneapolis, Minn
| | - Kimberly A. Selzman
- From the Department of Medicine (J.M.H., M.G.M., P.J.Z.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass; Department of Medicine (K.A.S.), George E. Wahlen VA Hospital, University of Utah, Salt Lake City; Department de Cardiologie (C.L.), Centre Cafrdio-pneumologique, Centre Hospitalier Universitaire Pontchaillou, Rennes, France; Department of Medicine (L.A.P.), St John Hospital and Medical Center, Detroit, MI; and Medtronic Inc (S.E.M., B.J.P.), Minneapolis, Minn
| | - Christophe Leclercq
- From the Department of Medicine (J.M.H., M.G.M., P.J.Z.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass; Department of Medicine (K.A.S.), George E. Wahlen VA Hospital, University of Utah, Salt Lake City; Department de Cardiologie (C.L.), Centre Cafrdio-pneumologique, Centre Hospitalier Universitaire Pontchaillou, Rennes, France; Department of Medicine (L.A.P.), St John Hospital and Medical Center, Detroit, MI; and Medtronic Inc (S.E.M., B.J.P.), Minneapolis, Minn
| | - Luis A. Pires
- From the Department of Medicine (J.M.H., M.G.M., P.J.Z.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass; Department of Medicine (K.A.S.), George E. Wahlen VA Hospital, University of Utah, Salt Lake City; Department de Cardiologie (C.L.), Centre Cafrdio-pneumologique, Centre Hospitalier Universitaire Pontchaillou, Rennes, France; Department of Medicine (L.A.P.), St John Hospital and Medical Center, Detroit, MI; and Medtronic Inc (S.E.M., B.J.P.), Minneapolis, Minn
| | - Michael G. McLaughlin
- From the Department of Medicine (J.M.H., M.G.M., P.J.Z.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass; Department of Medicine (K.A.S.), George E. Wahlen VA Hospital, University of Utah, Salt Lake City; Department de Cardiologie (C.L.), Centre Cafrdio-pneumologique, Centre Hospitalier Universitaire Pontchaillou, Rennes, France; Department of Medicine (L.A.P.), St John Hospital and Medical Center, Detroit, MI; and Medtronic Inc (S.E.M., B.J.P.), Minneapolis, Minn
| | - Scott E. McRae
- From the Department of Medicine (J.M.H., M.G.M., P.J.Z.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass; Department of Medicine (K.A.S.), George E. Wahlen VA Hospital, University of Utah, Salt Lake City; Department de Cardiologie (C.L.), Centre Cafrdio-pneumologique, Centre Hospitalier Universitaire Pontchaillou, Rennes, France; Department of Medicine (L.A.P.), St John Hospital and Medical Center, Detroit, MI; and Medtronic Inc (S.E.M., B.J.P.), Minneapolis, Minn
| | - Brett J. Peterson
- From the Department of Medicine (J.M.H., M.G.M., P.J.Z.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass; Department of Medicine (K.A.S.), George E. Wahlen VA Hospital, University of Utah, Salt Lake City; Department de Cardiologie (C.L.), Centre Cafrdio-pneumologique, Centre Hospitalier Universitaire Pontchaillou, Rennes, France; Department of Medicine (L.A.P.), St John Hospital and Medical Center, Detroit, MI; and Medtronic Inc (S.E.M., B.J.P.), Minneapolis, Minn
| | - Peter J. Zimetbaum
- From the Department of Medicine (J.M.H., M.G.M., P.J.Z.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass; Department of Medicine (K.A.S.), George E. Wahlen VA Hospital, University of Utah, Salt Lake City; Department de Cardiologie (C.L.), Centre Cafrdio-pneumologique, Centre Hospitalier Universitaire Pontchaillou, Rennes, France; Department of Medicine (L.A.P.), St John Hospital and Medical Center, Detroit, MI; and Medtronic Inc (S.E.M., B.J.P.), Minneapolis, Minn
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19
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Altman RK, McCarty D, Chen-Tournoux AA, Tournoux FB, Riedl L, Orencole M, Park MY, Picard MH, Singh JP. Usefulness of low-dose dobutamine echocardiography to predict response and outcome in patients undergoing cardiac resynchronization therapy. Am J Cardiol 2011; 108:252-7. [PMID: 21550579 DOI: 10.1016/j.amjcard.2011.03.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 03/07/2011] [Accepted: 03/11/2011] [Indexed: 11/18/2022]
Abstract
A substantial proportion of patients who meet the current guidelines for cardiac resynchronization therapy (CRT) fail to respond to this pacing modality. Although appropriate patient selection and left ventricular (LV) lead location have been ascribed as determinants of CRT response, the interaction among contractile reserve, dynamics of dyssynchrony, and lead location is not well understood. The present study prospectively evaluated the effect of contractile reserve and dobutamine-induced changes in LV synchrony, in relation to the LV lead location, as predictors of the response to CRT. In the present study, 31 patients were prospectively evaluated and underwent low-dose dobutamine echocardiography. The dobutamine-induced increase in ejection fraction (contractile reserve [CR]) was measured, and the most mechanically delayed segment was identified to classify patients into 2 groups. Group 1 had a CR of >20% and a LV lead position concordant with the mechanically delayed segment. Group 2 included the remaining patients (i.e., low CR, discordant LV lead position, or both). Patients in group 1 were significantly more likely to have an echocardiographic response at 6 months (80% of group 1 vs 29% of group 2, p = 0.018) and had an improved 2-year heart failure hospitalization-free survival rate (90% in group 1 vs 33% in group 2, p = 0.006). In conclusion, low-dose dobutamine echocardiography provides information that can help to predict responders to CRT. The response rates and heart failure hospitalization-free survival were improved in those patients with a CR >20% and an LV lead tip concordant with the most delayed mechanical segment.
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Affiliation(s)
- Robert K Altman
- Cardiac Arrhythmia Service, Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, USA
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20
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Mylonas I, Beanlands RSB. Radionuclide Imaging of Viable Myocardium: Is it Underutilized? CURRENT CARDIOVASCULAR IMAGING REPORTS 2011; 4:251-261. [PMID: 21654910 PMCID: PMC3085107 DOI: 10.1007/s12410-011-9074-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Coronary artery disease is the major cause of heart failure in North America. Viability assessment is important as it aims to identify patients who stand to benefit from coronary revascularization. Radionuclide modalities currently used in the assessment of viability include (201)Tl SPECT, (99m)Tc-based SPECT imaging, and (18)F-fluorodexoyglucose ((18)F-FDG)-PET imaging. Different advances have been made in the last year to improve the sensitivity and specificity of these modalities. In addition, the optimum amount of viable (yet dysfunctional) myocardium is important to identify in patients, as a risk-benefit ratio must be considered. Patients with predominantly viable/hibernating myocardium can benefit from revascularization from a mortality and morbidity standpoint. However, in patients with minimal viability (predominantly scarred myocardium), revascularization risk may certainly be too high to justify revascularization without expected benefit. Understanding different radionuclide modalities and new developments in the assessment of viability in ischemic heart failure patients is the focus of this discussion.
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Affiliation(s)
- Ilias Mylonas
- National Cardiac PET Centre, Molecular Function and Imaging Program, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario Canada
| | - Rob S. B. Beanlands
- National Cardiac PET Centre, Molecular Function and Imaging Program, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario Canada
- Saul and Edna Goldfarb Chair in Cardiac Imaging National Cardiac PET Centre, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7 Canada
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21
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22
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Needleman M, Berger RD. Response to cardiac resynchronization therapy: Substrate matters. Heart Rhythm 2011; 8:383-4. [DOI: 10.1016/j.hrthm.2010.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Indexed: 11/25/2022]
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23
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Current world literature. Curr Opin Cardiol 2011; 26:165-73. [PMID: 21307667 DOI: 10.1097/hco.0b013e328344b569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Mielniczuk LM, Birnie D, Ziadi MC, deKemp RA, DaSilva JN, Burwash I, Tang AT, Davies RA, Haddad H, Guo A, Aung M, Williams K, Ukkonen H, Beanlands RS. Relation Between Right Ventricular Function and Increased Right Ventricular [
18
F]Fluorodeoxyglucose Accumulation in Patients With Heart Failure. Circ Cardiovasc Imaging 2011; 4:59-66. [DOI: 10.1161/circimaging.109.905984] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Left heart failure is characterized by alterations in metabolic substrate utilization, and metabolic modulation may be a future strategy in the management of heart failure. Little is known about cardiac metabolism in the right ventricle and how it relates to other measures of right ventricular (RV) function. This study was designed to measure glucose metabolism in the right ventricle, as estimated by [
18
F]fluorodeoxyglucose (FDG) positron emission tomography imaging and to determine the relation between RV function and FDG uptake in patients with heart failure.
Methods and Results—
A total of 68 patients underwent cardiac [
18
F]FDG positron emission tomography scanning with measurement of RV FDG uptake as a standardized uptake value. Perfusion imaging was acquired at rest with rubidium-82 or [
13
N]ammonia. RV function was determined by equilibrium radionuclide ventriculography. Relative RV FDG uptake was determined as the ratio of RV to LV standardized uptake value. Fifty-five percent of these patients had ischemic cardiomyopathy. The mean LV and RV ejection fractions were 21±7% and 35±10%, respectively. There was a correlation between RV ejection fraction and the ratio of RV to LV FDG uptake whether the entire LV myocardium (
r
=−0.40,
P
<0.001) or LV free wall (
r
=−0.43,
P
<0.001) was used. This relation persisted in the subgroup with nonischemic cardiomyopathy (
r
=−0.37,
P
=0.04). RV FDG uptake was weakly related to increased RV systolic pressure but not related to LV size, function, or FDG uptake. The correlation between RV ejection fraction and RV/LV FDG was maintained after partial-volume correction (
r
=−0.68,
P
<0.001).
Conclusions—
RV dysfunction is associated with an increase in RV FDG uptake, the magnitude of which may be correlated with severity.
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Affiliation(s)
- Lisa M. Mielniczuk
- From the Division of Cardiology (L.M.M., D.BM.C.Z., R.A.d.K., J.N.D.S., I.B., R.A.D., H.H., A.G., M.A., K.W., R.S.B.B.), University of Ottawa Heart Institute, Ottawa, and Division of Cardiology (A.T.T.), University of Victoria, Victoria, Canada; and Division of Cardiology (H.U.), Turku University Hospital, Turku, Finland
| | - David Birnie
- From the Division of Cardiology (L.M.M., D.BM.C.Z., R.A.d.K., J.N.D.S., I.B., R.A.D., H.H., A.G., M.A., K.W., R.S.B.B.), University of Ottawa Heart Institute, Ottawa, and Division of Cardiology (A.T.T.), University of Victoria, Victoria, Canada; and Division of Cardiology (H.U.), Turku University Hospital, Turku, Finland
| | - Maria C. Ziadi
- From the Division of Cardiology (L.M.M., D.BM.C.Z., R.A.d.K., J.N.D.S., I.B., R.A.D., H.H., A.G., M.A., K.W., R.S.B.B.), University of Ottawa Heart Institute, Ottawa, and Division of Cardiology (A.T.T.), University of Victoria, Victoria, Canada; and Division of Cardiology (H.U.), Turku University Hospital, Turku, Finland
| | - Robert A. deKemp
- From the Division of Cardiology (L.M.M., D.BM.C.Z., R.A.d.K., J.N.D.S., I.B., R.A.D., H.H., A.G., M.A., K.W., R.S.B.B.), University of Ottawa Heart Institute, Ottawa, and Division of Cardiology (A.T.T.), University of Victoria, Victoria, Canada; and Division of Cardiology (H.U.), Turku University Hospital, Turku, Finland
| | - Jean N. DaSilva
- From the Division of Cardiology (L.M.M., D.BM.C.Z., R.A.d.K., J.N.D.S., I.B., R.A.D., H.H., A.G., M.A., K.W., R.S.B.B.), University of Ottawa Heart Institute, Ottawa, and Division of Cardiology (A.T.T.), University of Victoria, Victoria, Canada; and Division of Cardiology (H.U.), Turku University Hospital, Turku, Finland
| | - Ian Burwash
- From the Division of Cardiology (L.M.M., D.BM.C.Z., R.A.d.K., J.N.D.S., I.B., R.A.D., H.H., A.G., M.A., K.W., R.S.B.B.), University of Ottawa Heart Institute, Ottawa, and Division of Cardiology (A.T.T.), University of Victoria, Victoria, Canada; and Division of Cardiology (H.U.), Turku University Hospital, Turku, Finland
| | - Anthony T. Tang
- From the Division of Cardiology (L.M.M., D.BM.C.Z., R.A.d.K., J.N.D.S., I.B., R.A.D., H.H., A.G., M.A., K.W., R.S.B.B.), University of Ottawa Heart Institute, Ottawa, and Division of Cardiology (A.T.T.), University of Victoria, Victoria, Canada; and Division of Cardiology (H.U.), Turku University Hospital, Turku, Finland
| | - Ross A. Davies
- From the Division of Cardiology (L.M.M., D.BM.C.Z., R.A.d.K., J.N.D.S., I.B., R.A.D., H.H., A.G., M.A., K.W., R.S.B.B.), University of Ottawa Heart Institute, Ottawa, and Division of Cardiology (A.T.T.), University of Victoria, Victoria, Canada; and Division of Cardiology (H.U.), Turku University Hospital, Turku, Finland
| | - Haissam Haddad
- From the Division of Cardiology (L.M.M., D.BM.C.Z., R.A.d.K., J.N.D.S., I.B., R.A.D., H.H., A.G., M.A., K.W., R.S.B.B.), University of Ottawa Heart Institute, Ottawa, and Division of Cardiology (A.T.T.), University of Victoria, Victoria, Canada; and Division of Cardiology (H.U.), Turku University Hospital, Turku, Finland
| | - Ann Guo
- From the Division of Cardiology (L.M.M., D.BM.C.Z., R.A.d.K., J.N.D.S., I.B., R.A.D., H.H., A.G., M.A., K.W., R.S.B.B.), University of Ottawa Heart Institute, Ottawa, and Division of Cardiology (A.T.T.), University of Victoria, Victoria, Canada; and Division of Cardiology (H.U.), Turku University Hospital, Turku, Finland
| | - May Aung
- From the Division of Cardiology (L.M.M., D.BM.C.Z., R.A.d.K., J.N.D.S., I.B., R.A.D., H.H., A.G., M.A., K.W., R.S.B.B.), University of Ottawa Heart Institute, Ottawa, and Division of Cardiology (A.T.T.), University of Victoria, Victoria, Canada; and Division of Cardiology (H.U.), Turku University Hospital, Turku, Finland
| | - Kathryn Williams
- From the Division of Cardiology (L.M.M., D.BM.C.Z., R.A.d.K., J.N.D.S., I.B., R.A.D., H.H., A.G., M.A., K.W., R.S.B.B.), University of Ottawa Heart Institute, Ottawa, and Division of Cardiology (A.T.T.), University of Victoria, Victoria, Canada; and Division of Cardiology (H.U.), Turku University Hospital, Turku, Finland
| | - Heikki Ukkonen
- From the Division of Cardiology (L.M.M., D.BM.C.Z., R.A.d.K., J.N.D.S., I.B., R.A.D., H.H., A.G., M.A., K.W., R.S.B.B.), University of Ottawa Heart Institute, Ottawa, and Division of Cardiology (A.T.T.), University of Victoria, Victoria, Canada; and Division of Cardiology (H.U.), Turku University Hospital, Turku, Finland
| | - Rob S.B. Beanlands
- From the Division of Cardiology (L.M.M., D.BM.C.Z., R.A.d.K., J.N.D.S., I.B., R.A.D., H.H., A.G., M.A., K.W., R.S.B.B.), University of Ottawa Heart Institute, Ottawa, and Division of Cardiology (A.T.T.), University of Victoria, Victoria, Canada; and Division of Cardiology (H.U.), Turku University Hospital, Turku, Finland
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25
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Ghosh N, Rimoldi OE, Beanlands RSB, Camici PG. Assessment of myocardial ischaemia and viability: role of positron emission tomography. Eur Heart J 2010; 31:2984-95. [PMID: 20965888 DOI: 10.1093/eurheartj/ehq361] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
In developed countries, coronary artery disease (CAD) continues to be a major cause of death and disability. Over the past two decades, positron emission tomography (PET) imaging has become more widely accessible for the management of ischemic heart disease. Positron emission tomography has also emerged as an important alternative perfusion imaging modality in the context of recent shortages of molybdenum-99/technetium-99m ((99m)Tc). The clinical application of PET in ischaemic heart disease falls into two main categories: first, it is a well-established modality for evaluation of myocardial blood flow (MBF); second, it enables assessment of myocardial metabolism and viability in patients with ischaemic left ventricular dysfunction. The combined study of MBF and metabolism by PET has led to a better understanding of the pathophysiology of ischaemic heart disease. While there are potential future applications of PET for plaque and molecular imaging, as well as some clinical use in inflammatory conditions, this article provides an overview of the physical and biological principles behind PET imaging and its main clinical applications in cardiology, namely the assessment of MBF and metabolism.
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Affiliation(s)
- Nina Ghosh
- National Cardiac PET Centre, Division of Cardiology and the Molecular Function and Imaging Program, University of Ottawa Heart Institute, Ottawa, ONT, Canada
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26
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Evidence of scar tissue: contra-indication to cardiac resynchronization therapy? Int J Cardiovasc Imaging 2010; 27:59-63. [PMID: 20614190 PMCID: PMC3035785 DOI: 10.1007/s10554-010-9664-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Accepted: 06/25/2010] [Indexed: 11/06/2022]
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