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Fan L, Namani R, Choy JS, Awakeem Y, Kassab GS, Lee LC. Role of coronary flow regulation and cardiac-coronary coupling in mechanical dyssynchrony associated with right ventricular pacing. Am J Physiol Heart Circ Physiol 2020; 320:H1037-H1054. [PMID: 33356963 DOI: 10.1152/ajpheart.00549.2020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Mechanical dyssynchrony (MD) affects left ventricular (LV) mechanics and coronary perfusion. To understand the multifactorial effects of MD, we developed a computational model that bidirectionally couples the systemic circulation with the LV and coronary perfusion with flow regulation. In the model, coronary flow in the left anterior descending (LAD) and left circumflex (LCX) arteries affects the corresponding regional contractility based on a prescribed linear LV contractility-coronary flow relationship. The model is calibrated with experimental measurements of LV pressure and volume, as well as LAD and LCX flow rate waveforms acquired under regulated and fully dilated conditions from a swine under right atrial (RA) pacing. The calibrated model is applied to simulate MD. The model can simultaneously reproduce the reduction in mean LV pressure (39.3%), regulated flow (LAD: 7.9%; LCX: 1.9%), LAD passive flow (21.6%), and increase in LCX passive flow (15.9%). These changes are associated with right ventricular pacing compared with RA pacing measured in the same swine only when LV contractility is affected by flow alterations with a slope of 1.4 mmHg/mL2 in a contractility-flow relationship. In sensitivity analyses, the model predicts that coronary flow reserve (CFR) decreases and increases in the LAD and LCX with increasing delay in LV free wall contraction. These findings suggest that asynchronous activation associated with MD impacts 1) the loading conditions that further affect the coronary flow, which may explain some of the changes in CFR, and 2) the coronary flow that reduces global contractility, which contributes to the reduction in LV pressure.NEW & NOTEWORTHY A computational model that couples the systemic circulation of the left ventricular (LV) and coronary perfusion with flow regulation is developed to study the effects of mechanical dyssynchrony. The delayed contraction in the LV free wall with respect to the septum has a significant effect on LV function and coronary flow reserve.
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Affiliation(s)
- Lei Fan
- Department of Mechanical Engineering, Michigan State University, East Lansing, Michigan
| | - Ravi Namani
- Department of Mechanical Engineering, Michigan State University, East Lansing, Michigan
| | - Jenny S Choy
- California Medical Innovation Institute, San Diego, California
| | - Yousif Awakeem
- California Medical Innovation Institute, San Diego, California
| | | | - Lik Chuan Lee
- Department of Mechanical Engineering, Michigan State University, East Lansing, Michigan
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Fan L, Namani R, Choy JS, Kassab GS, Lee LC. Effects of Mechanical Dyssynchrony on Coronary Flow: Insights From a Computational Model of Coupled Coronary Perfusion With Systemic Circulation. Front Physiol 2020; 11:915. [PMID: 32922304 PMCID: PMC7457036 DOI: 10.3389/fphys.2020.00915] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/08/2020] [Indexed: 01/01/2023] Open
Abstract
Mechanical dyssynchrony affects left ventricular (LV) mechanics and coronary perfusion. Due to the confounding effects of their bi-directional interactions, the mechanisms behind these changes are difficult to isolate from experimental and clinical studies alone. Here, we develop and calibrate a closed-loop computational model that couples the systemic circulation, LV mechanics, and coronary perfusion. The model is applied to simulate the impact of mechanical dyssynchrony on coronary flow in the left anterior descending artery (LAD) and left circumflex artery (LCX) territories caused by regional alterations in perfusion pressure and intramyocardial pressure (IMP). We also investigate the effects of regional coronary flow alterations on regional LV contractility in mechanical dyssynchrony based on prescribed contractility-flow relationships without considering autoregulation. The model predicts that LCX and LAD flows are reduced by 7.2%, and increased by 17.1%, respectively, in mechanical dyssynchrony with a systolic dyssynchrony index of 10% when the LAD's IMP is synchronous with the arterial pressure. The LAD flow is reduced by 11.6% only when its IMP is delayed with respect to the arterial pressure by 0.07 s. When contractility is sensitive to coronary flow, mechanical dyssynchrony can affect global LV mechanics, IMPs and contractility that in turn, further affect the coronary flow in a feedback loop that results in a substantial reduction of dPLV/dt, indicative of ischemia. Taken together, these findings imply that regional IMPs play a significant role in affecting regional coronary flows in mechanical dyssynchrony and the changes in regional coronary flow may produce ischemia when contractility is sensitive to the changes in coronary flow.
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Affiliation(s)
- Lei Fan
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, United States
| | - Ravi Namani
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, United States
| | - Jenny S Choy
- California Medical Innovation Institute, San Diego, CA, United States
| | - Ghassan S Kassab
- California Medical Innovation Institute, San Diego, CA, United States
| | - Lik Chuan Lee
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, United States
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Claridge S, Briceno N, Chen Z, De Silva K, Modi B, Jackson T, Behar JM, Niederer S, Rinaldi CA, Perera D. Changes in contractility determine coronary haemodynamics in dyssynchronous left ventricular heart failure, not vice versa. IJC HEART & VASCULATURE 2018; 19:8-13. [PMID: 29946557 PMCID: PMC6016072 DOI: 10.1016/j.ijcha.2018.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 03/07/2018] [Accepted: 03/11/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Biventricular pacing has been shown to increase both cardiac contractility and coronary flow acutely but the causal relationship is unclear. We hypothesised that changes in coronary flow are secondary to changes in cardiac contractility. We sought to examine this relationship by modulating coronary flow and cardiac contractility. METHODS Contractility and lusitropy were altered by varying the location of pacing in 8 patients. Coronary autoregulation was transiently disabled with intracoronary adenosine. Simultaneous coronary flow velocity, coronary pressure and left ventricular pressure data were measured in the different pacing settings with and without hyperaemia and wave intensity analysis performed. RESULTS Multisite pacing was effective at altering left ventricular contractility and lusitropy (pos. dp/dtmax -13% to +10% and neg. dp/dtmax -15% to +17% compared to baseline). Intracoronary adenosine decreased microvascular resistance (362.5 mm Hg/s/m to 156.7 mm Hg/s/m, p < 0.001) and increased LAD flow velocity (22 cm/s vs 45 cm/s, p < 0.001) but did not acutely change contractility or lusitropy. The magnitude of the dominant accelerating wave, the Backward Expansion Wave, was proportional to the degree of contractility as well as lusitropy (r = 0.47, p < 0.01 and r = -0.50, p < 0.01). Perfusion efficiency (the proportion of accelerating waves) increased at hyperaemia (76% rest vs 81% hyperaemia, p = 0.04). Perfusion efficiency correlated with contractility and lusitropy at rest (r = 0.43 & -0.50 respectively, p = 0.01) and hyperaemia (r = 0.59 & -0.6, p < 0.01). CONCLUSIONS Acutely increasing coronary flow with adenosine in patients with systolic heart failure does not increase contractility. Changes in coronary flow with biventricular pacing are likely to be a consequence of enhanced cardiac contractility from resynchronization and not vice versa.
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Affiliation(s)
- Simon Claridge
- Department of Imaging Sciences, King's College, London, United Kingdom
| | - Natalia Briceno
- NIHR Biomedical Research Centre, School of Cardiovascular Medicine and Sciences, King's College London, United Kingdom
| | - Zhong Chen
- Department of Imaging Sciences, King's College, London, United Kingdom
| | - Kalpa De Silva
- NIHR Biomedical Research Centre, School of Cardiovascular Medicine and Sciences, King's College London, United Kingdom
| | - Bhavik Modi
- NIHR Biomedical Research Centre, School of Cardiovascular Medicine and Sciences, King's College London, United Kingdom
| | - Tom Jackson
- Department of Imaging Sciences, King's College, London, United Kingdom
| | - Jonathan M. Behar
- Department of Imaging Sciences, King's College, London, United Kingdom
| | - Steven Niederer
- Department of Imaging Sciences, King's College, London, United Kingdom
| | | | - Divaka Perera
- NIHR Biomedical Research Centre, School of Cardiovascular Medicine and Sciences, King's College London, United Kingdom
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Restoration of ventricular septal hypoperfusion by cardiac resynchronization therapy in patients with permanent right ventricular pacing. Int J Cardiol 2016; 224:353-359. [PMID: 27673691 DOI: 10.1016/j.ijcard.2016.09.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 09/02/2016] [Accepted: 09/15/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Pacing from the right ventricular apex (RVA) is associated with cardiac dysfunction and shows electrophysiological features similar to left bundle branch block in which left ventricular (LV) mechanical dyssynchrony impairs septal coronary artery perfusion. METHODS A total of 62 non-ischemic patients with an implanted pacemaker at the RVA with a pacing rate of >95% were studied. LV septal coronary perfusion as indicated by the LV septal perfusion index was measured by electrocardiography (ECG)-gated single-photon emission computed tomography for all patients at baseline and for patients who were upgraded to CRT at 6months after CRT. Relationships among LV septal perfusion index, QRS duration, and LV ejection fraction were analyzed. RESULTS Among the patients with permanent RVA pacing, 28 of 62 (45%) had impaired septal perfusion (i.e., septal perfusion index <0.9). The LV septal perfusion index was significantly correlated with both QRS duration (r=-0.763, p<0.001) and LV ejection fraction (r=0.462, p=0.001). Eleven patients were upgraded to CRT. CRT significantly improved the LV septal perfusion index from 0.63 (SD=0.13) to 0.89 (SD=0.19) (p<0.001)and cardiac function: LV end-systolic volume from 102.3mL (SD=70.0) to 179.7mL (SD=118.4) (p=0.002) and LV ejection fraction from 22.5 (SD=8.9%) to 38.4% (SD=13.9%) (p=0.001). CONCLUSIONS Nearly half of the non-ischemic patients with permanent RVA pacing presenting with prolonged QRS duration and LV dysfunction developed LV septal hypoperfusion. Both septal perfusion and LV function improved in patients who were upgraded to CRT.
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Calvagna GM, Vasquez L, Patanè F, Sansone F, Ceresa F, Tassone L, Patanè S. The safety and effectiveness of closure access leading venous advanced gain new ability. Int J Cardiol 2016; 207:39-43. [PMID: 26788821 DOI: 10.1016/j.ijcard.2016.01.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 01/02/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Giuseppe Mario Calvagna
- Cardiologia Ospedale San Vincenzo, Taormina (Me) Azienda Sanitaria Provinciale di Messina, 98039, Taormina, (Messina), Italy.
| | - Ludovico Vasquez
- Cardiologia Ospedale San Vincenzo, Taormina (Me) and Cardiologia Presidio Ospedaliero "G. Fogliani", Milazzo (ME) Azienda Sanitaria Provinciale di Messina, Italy
| | - Francesco Patanè
- Cardiochirurgia Ospedale Papardo Messina, Azienda Ospedaliera Ospedali Riuniti Papardo Piemonte, 98158 Messina, Italy
| | - Fabrizio Sansone
- Cardiochirurgia Ospedale Papardo Messina, Azienda Ospedaliera Ospedali Riuniti Papardo Piemonte, 98158 Messina, Italy
| | - Fabrizio Ceresa
- Cardiochirurgia Ospedale Papardo Messina, Azienda Ospedaliera Ospedali Riuniti Papardo Piemonte, 98158 Messina, Italy
| | - Laura Tassone
- Cardiochirurgia Ospedale Papardo Messina, Azienda Ospedaliera Ospedali Riuniti Papardo Piemonte, 98158 Messina, Italy
| | - Salvatore Patanè
- Cardiologia Ospedale San Vincenzo, Taormina (Me) Azienda Sanitaria Provinciale di Messina, 98039, Taormina, (Messina), Italy
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Calvagna GM, Patanè S, Ceresa F, Fontana A, Sicuso G, Vinci E, Muscio G, Vasquez L, Patanè F. Inadvertent implantation of a pacemaker lead in the left ventricle: A new challenge in cardiology. Int J Cardiol 2016; 202:914-7. [PMID: 26479958 DOI: 10.1016/j.ijcard.2015.10.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 10/04/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Giuseppe Mario Calvagna
- Cardiologia Ospedale San Vincenzo - Taormina (Me) Azienda Sanitaria Provinciale di Messina, 98039, Taormina (Messina), Italy.
| | - Salvatore Patanè
- Cardiologia Ospedale San Vincenzo - Taormina (Me) Azienda Sanitaria Provinciale di Messina, 98039, Taormina (Messina), Italy
| | - Fabrizio Ceresa
- Cardiochirurgia Ospedale Papardo Messina, Azienda Ospedaliera Ospedali Riuniti Papardo Piemonte, 98158 Messina, Italy
| | - Alessandro Fontana
- Cardiologia Ospedale San Vincenzo - Taormina (Me) Azienda Sanitaria Provinciale di Messina, 98039, Taormina (Messina), Italy
| | | | - Eugenio Vinci
- UOC Cardiologia Ospedale Umberto I° ASP Siracusa, Italy
| | | | - Ludovico Vasquez
- Cardiologia Ospedale San Vincenzo - Taormina (Me) and Cardiologia Presidio Ospedaliero "G. Fogliani" - Milazzo (ME) Azienda Sanitaria Provinciale di Messina, Italy
| | - Francesco Patanè
- Cardiochirurgia Ospedale Papardo Messina, Azienda Ospedaliera Ospedali Riuniti Papardo Piemonte, 98158 Messina, Italy
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Claridge S, Chen Z, Jackson T, De Silva K, Behar J, Sohal M, Webb J, Hyde E, Lumley M, Asrress K, Williams R, Bostock J, Ali M, Gill J, O'Neill M, Razavi R, Niederer S, Perera D, Rinaldi CA. Effects of Epicardial and Endocardial Cardiac Resynchronization Therapy on Coronary Flow: Insights From Wave Intensity Analysis. J Am Heart Assoc 2015; 4:JAHA.115.002626. [PMID: 26679935 PMCID: PMC4845290 DOI: 10.1161/jaha.115.002626] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background The increase in global coronary flow seen with conventional biventricular pacing is mediated by an increase in the dominant backward expansion wave (BEW). Little is known about the determinants of flow in the left‐sided epicardial coronary arteries beyond this or the effect of endocardial pacing stimulation on coronary physiology. Methods and Results Eleven patients with a chronically implanted biventricular pacemaker underwent an acute hemodynamic and electrophysiological study. Five of 11 patients also took part in a left ventricular endocardial pacing protocol at the same time. Conventional biventricular pacing, delivered epicardially from the coronary sinus, resulted in a 9% increase in flow (average peak velocity) in the left anterior descending artery (LAD), mediated by a 13% increase in the area under the BEW (P=0.004). Endocardial pacing resulted in a 27% increase in LAD flow, mediated by a 112% increase in the area under the forward compression wave (FCW) and a 43% increase in the area under the BEW (P=0.048 and P=0.036, respectively). There were no significant changes in circumflex parameters. Conventional biventricular pacing resulted in homogenization of timing of coronary flow compared with baseline (mean difference in time to peak in the LAD versus circumflex artery: FCW 39 ms [baseline] versus 3 ms [conventional biventricular pacing], P=0.008; BEW 47 ms [baseline] versus 8 ms [conventional biventricular pacing], P=0.004). Conclusions Epicardial and endocardial pacing result in increased coronary flow in the left anterior descending artery and homogenization of the timing of waves that determine flow in the LAD and the circumflex artery. The increase in both the FCW and the BEW with endocardial pacing may be the result of a more physiological activation pattern than that of epicardial pacing, which resulted in an increase of only the BEW.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Motin Ali
- Guy's and St Thomas’ Hospital TrustLondonUK
| | - Jaswinder Gill
- Guy's and St Thomas’ Hospital Trust and King's CollegeLondonUK
| | - Mark O'Neill
- Guy's and St Thomas’ Hospital Trust and King's CollegeLondonUK
| | - Reza Razavi
- Guy's and St Thomas’ Hospital Trust and King's CollegeLondonUK
| | | | - Divaka Perera
- Guy's and St Thomas’ Hospital Trust and King's CollegeLondonUK
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Calvagna GM, Ceresa F, Morgante A, Patanè S. Transvenous extraction of a left subclavian dialysis catheter: A new challenge in cardiology. Int J Cardiol 2015; 185:144-7. [PMID: 25795205 DOI: 10.1016/j.ijcard.2015.03.085] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 03/07/2015] [Indexed: 12/16/2022]
Affiliation(s)
- Giuseppe Mario Calvagna
- Cardiologia Ospedale San Vincenzo-Taormina (Me), Azienda Sanitaria Provinciale di Messina, 98039 Taormina, Messina, Italy.
| | - Fabrizio Ceresa
- Cardiochirurgia Ospedale Papardo Messina, Azienda Ospedaliera Ospedali Riuniti Papardo Piemonte, 98158 Messina, Italy
| | - Alessandro Morgante
- Cardiochirurgia Ospedale Papardo Messina, Azienda Ospedaliera Ospedali Riuniti Papardo Piemonte, 98158 Messina, Italy
| | - Salvatore Patanè
- Cardiologia Ospedale San Vincenzo-Taormina (Me), Azienda Sanitaria Provinciale di Messina, 98039 Taormina, Messina, Italy
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Calvagna GM, Patanè S, Romeo P, Condorelli S, Vasquez L. Transvenous recovery of an intracardiac fractured port-A catheter fragment. Int J Cardiol 2015; 185:214-7. [PMID: 25797680 DOI: 10.1016/j.ijcard.2015.03.087] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 03/07/2015] [Indexed: 11/18/2022]
Affiliation(s)
- Giuseppe Mario Calvagna
- Cardiologia Ospedale San Vincenzo - Taormina (Me), Azienda Sanitaria Provinciale di Messina, 98039 Taormina, Messina, Italy.
| | - Salvatore Patanè
- Cardiologia Ospedale San Vincenzo - Taormina (Me), Azienda Sanitaria Provinciale di Messina, 98039 Taormina, Messina, Italy
| | - Placido Romeo
- Radiologia Ospedale San Vincenzo - Taormina (Me), Azienda Sanitaria Provinciale di Messina, 98039 Taormina, Messina, Italy
| | - Sonja Condorelli
- UOC Oncologia Presidio di Caltagirone, Azienda Sanitaria Provinciale di Catania, Italy
| | - Ludovico Vasquez
- Cardiologia Ospedale San Vincenzo - Taormina (Me), Azienda Sanitaria Provinciale di Messina, 98039 Taormina, Messina, Italy; Cardiologia Presidio Ospedaliero "G. Fogliani" - Milazzo (ME), Azienda Sanitaria Provinciale di Messina, Italy
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Calvagna GM, Patanè S. A complete bicameral pacemaker pocket decubitus. Int J Cardiol 2015; 181:340-3. [PMID: 25555273 DOI: 10.1016/j.ijcard.2014.12.080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 12/21/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Giuseppe Mario Calvagna
- Cardiologia Ospedale San Vincenzo-Taormina (Me) Azienda Sanitaria Provinciale di Messina, 98039 Taormina, (Messina), Italy.
| | - Salvatore Patanè
- Cardiologia Ospedale San Vincenzo-Taormina (Me) Azienda Sanitaria Provinciale di Messina, 98039 Taormina, (Messina), Italy
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Itoh M, Shinke T, Yoshida A, Kozuki A, Takei A, Fukuzawa K, Kiuchi K, Imamura K, Fujiwara R, Suzuki A, Nakanishi T, Yamashita S, Matsumoto A, Otake H, Nagoshi R, Shite J, Hirata KI. Reduction in coronary microvascular resistance through cardiac resynchronization and its impact on chronic reverse remodelling of left ventricle in patients with non-ischaemic cardiomyopathy. Europace 2015; 17:1407-14. [PMID: 25662988 DOI: 10.1093/europace/euu361] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 11/17/2014] [Indexed: 11/13/2022] Open
Abstract
AIMS Left bundle branch block (LBBB) induces mechanical dyssynchrony, thereby compromising the coronary circulation in non-ischaemic cardiomyopathy. We sought to examine the effects of cardiac resynchronization therapy (CRT) on coronary flow dynamics and left ventricular (LV) function. METHODS AND RESULTS Twenty-two patients with non-ischaemic cardiomyopathy (New York Heart Association class, III or IV; LV ejection fraction, ≤35%; QRS duration, ≥130 ms) were enrolled. One week after implantation of the CRT device, coronary flow velocity and pressure in the left anterior descending coronary artery (LAD) and left circumflex coronary artery (LCx) were measured invasively, before and after inducing hyperemia by adenosine triphosphate administration, with two programming modes: sequential atrial and biventricular pacing (BiV) and atrial pacing in patients with LBBB or sequential atrial and right ventricular pacing in patients with complete atrioventricular block (Control). We assessed hyperemic microvascular resistance (HMR, mean distal pressure divided by hyperemic average peak velocity) and the relationship between the change in HMR and mid-term LV reverse remodelling. Hyperemic microvascular resistance was lower during BiV than during Control (LAD: 1.76 ± 0.47 vs. 1.54 ± 0.45, P < 0.001; LCx: 1.92 ± 0.42 vs. 1.73 ± 0.31, P = 0.003). The CRT-induced change in HMR of the LCx correlated with the percentage change in LV ejection fraction (R = -0.598, P = 0.011) and LV end-systolic volume (R = 0.609, P = 0.010) before and 6 months after CRT. CONCLUSION Cardiac resynchronization therapy improves coronary flow circulation by reducing microvascular resistance, which might be associated with LV reverse remodelling.
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Affiliation(s)
- Mitsuaki Itoh
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017 Japan
| | - Toshiro Shinke
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017 Japan
| | - Akihiro Yoshida
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017 Japan
| | - Amane Kozuki
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017 Japan
| | - Asumi Takei
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017 Japan
| | - Koji Fukuzawa
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017 Japan
| | - Kunihiko Kiuchi
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017 Japan
| | - Kimitake Imamura
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017 Japan
| | - Ryudo Fujiwara
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017 Japan
| | - Atsushi Suzuki
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017 Japan
| | - Tomoyuki Nakanishi
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017 Japan
| | - Soichiro Yamashita
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017 Japan
| | - Akinori Matsumoto
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017 Japan
| | - Hiromasa Otake
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017 Japan
| | - Ryoji Nagoshi
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017 Japan
| | - Junya Shite
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017 Japan
| | - Ken-ichi Hirata
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017 Japan
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Calvagna GM, Patanè S. Transvenous pacemaker lead extraction by femoral approach. Int J Cardiol 2015; 180:145-8. [PMID: 25438236 DOI: 10.1016/j.ijcard.2014.11.128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 11/23/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Giuseppe Mario Calvagna
- Cardiologia Ospedale San Vincenzo-Taormina (Me) Azienda Sanitaria Provinciale di Messina, 98039 Taormina, Messina, Italy.
| | - Salvatore Patanè
- Cardiologia Ospedale San Vincenzo-Taormina (Me) Azienda Sanitaria Provinciale di Messina, 98039 Taormina, Messina, Italy
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15
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A subcutaneous finger cardioverter-defibrillator system removal under local anesthesia. Int J Cardiol 2015; 179:42-5. [PMID: 25464407 DOI: 10.1016/j.ijcard.2014.10.053] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 10/20/2014] [Indexed: 12/17/2022]
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16
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Calvagna GM, Patanè S. Cardiac rehabilitation in pacing venous occlusions. Int J Cardiol 2015; 179:248-51. [PMID: 25464458 DOI: 10.1016/j.ijcard.2014.11.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 11/03/2014] [Indexed: 12/19/2022]
Affiliation(s)
- Giuseppe Mario Calvagna
- Cardiologia Ospedale San Vincenzo - Taormina (Me) Azienda Sanitaria Provinciale di Messina, 98039 Taormina, Messina, Italy.
| | - Salvatore Patanè
- Cardiologia Ospedale San Vincenzo - Taormina (Me) Azienda Sanitaria Provinciale di Messina, 98039 Taormina, Messina, Italy
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17
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Cardiac rehabilitation in pacing patient complications: an increasing scenario requiring a collaborative vision of a multi-disciplinary treatment team. Int J Cardiol 2015; 178:168-70. [DOI: 10.1016/j.ijcard.2014.10.145] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 10/22/2014] [Indexed: 02/06/2023]
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18
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Cardiac perforation of the right ventricle: A rare complication of pacemaker implantation. The importance of a collaborative vision of a multi-disciplinary treatment team. Int J Cardiol 2014; 177:621-4. [DOI: 10.1016/j.ijcard.2014.09.097] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 09/20/2014] [Indexed: 02/08/2023]
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19
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Calvagna GM, Ceresa F, Patanè S. Pocket infection as a complication of a subcutaneous implantable cardioverter-defibrillator. Int J Cardiol 2014; 177:616-8. [DOI: 10.1016/j.ijcard.2014.09.119] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 09/20/2014] [Indexed: 12/15/2022]
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20
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Intravascular recovery of electrode fragments as a possible complication of transvenous removal intervention. Int J Cardiol 2014; 177:560-3. [DOI: 10.1016/j.ijcard.2014.08.115] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Accepted: 08/18/2014] [Indexed: 01/18/2023]
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21
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Claridge S, Chen Z, Jackson T, Sammut E, Sohal M, Behar J, Razavi R, Niederer S, Rinaldi CA. Current concepts relating coronary flow, myocardial perfusion and metabolism in left bundle branch block and cardiac resynchronisation therapy. Int J Cardiol 2014; 181:65-72. [PMID: 25482281 DOI: 10.1016/j.ijcard.2014.11.194] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 11/18/2014] [Accepted: 11/24/2014] [Indexed: 11/16/2022]
Abstract
Cardiac resynchronisation therapy (CRT) improves mortality and symptoms in heart failure patients with electromechanically dyssynchronous ventricles. There is a 50% non-response rate and reproducible biomarkers to predict non-response have not been forthcoming. Therefore, there has been increasing interest in the pathophysiological effects of dyssynchrony particularly focusing on coronary flow, myocardial perfusion and metabolism. Studies suggest that dyssynchronous electrical activation effects coronary flow throughout the coronary vasculature from the epicardial arteries to the microvascular bed and that these changes can be corrected by CRT. The effect of both electrical and mechanical dyssynchrony on myocardial perfusion is unclear with some studies suggesting there is a reduction in septal perfusion whilst others propose that there is an increase in lateral perfusion. Better understanding of these effects offers the possibility for better prediction of non-response. CRT appears to improve homogeneity in myocardial perfusion where heterogeneity is described in the initial substrate. Novel approaches to the identification of non-responders via metabolic phenotyping both invasively and non-invasively have been encouraging. There remains a need for further research to clarify the interaction of coronary flow with perfusion and metabolism in patients who undergo CRT.
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Affiliation(s)
- Simon Claridge
- Guy's and St Thomas' Hospital, UK; King's College London, UK.
| | | | | | | | | | - Jonathan Behar
- Guy's and St Thomas' Hospital, UK; King's College London, UK
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22
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Superior vena cava obstruction as late complication of biventricular pacemaker implantation: Surgical replacement of the malfunctioning previous leads. Int J Cardiol 2014; 176:e83-5. [DOI: 10.1016/j.ijcard.2014.07.164] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 07/26/2014] [Indexed: 11/20/2022]
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23
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Calvagna GM, Ceresa F, Patanè S. Subcutaneous implantable cardioverter-defibrillator in a young woman. Int J Cardiol 2014; 175:e30-2. [DOI: 10.1016/j.ijcard.2014.04.119] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 04/09/2014] [Indexed: 11/26/2022]
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24
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Calvagna GM, Patanè S. Transvenous pacemaker lead extraction in infective endocarditis. Int J Cardiol 2014; 176:511-3. [PMID: 25085380 DOI: 10.1016/j.ijcard.2014.07.049] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Accepted: 07/05/2014] [Indexed: 01/17/2023]
Affiliation(s)
- Giuseppe Mario Calvagna
- Cardiologia Ospedale San Vincenzo - Taormina (Me) Azienda Sanitaria Provinciale di Messina, 98039 Taormina (Messina), Italy.
| | - Salvatore Patanè
- Cardiologia Ospedale San Vincenzo - Taormina (Me) Azienda Sanitaria Provinciale di Messina, 98039 Taormina (Messina), Italy
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25
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Calvagna GM, Torrisi G, Giuffrida C, Patanè S. Pacemaker, implantable cardioverter defibrillator, CRT, CRT-D, psychological difficulties and quality of life. Int J Cardiol 2014; 174:378-80. [DOI: 10.1016/j.ijcard.2014.03.187] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 03/29/2014] [Indexed: 11/15/2022]
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26
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Scarano M, Pezzuoli F, Torrisi G, Calvagna G, Patanè S. Cardiovascular implantable electronic device infective endocarditis. Int J Cardiol 2014; 173:e38-9. [DOI: 10.1016/j.ijcard.2014.03.075] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 03/12/2014] [Indexed: 11/16/2022]
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27
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Severe staphylococcal sepsis in patient with permanent pacemaker. Int J Cardiol 2014; 172:e498-501. [DOI: 10.1016/j.ijcard.2014.01.048] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 01/10/2014] [Indexed: 11/19/2022]
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