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Dutta A, Alqabbani RRM, Hagendorff A, Tayal B. Understanding the Application of Mechanical Dyssynchrony in Patients with Heart Failure Considered for CRT. J Cardiovasc Dev Dis 2024; 11:64. [PMID: 38392278 PMCID: PMC10888548 DOI: 10.3390/jcdd11020064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/16/2024] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
Over the past two decades of CRT use, the failure rate has remained around 30-35%, despite several updates in the guidelines based on the understanding from multiple trials. This review article summarizes the role of mechanical dyssynchrony in the selection of heart failure patients for cardiac resynchronization therapy. Understanding the application of mechanical dyssynchrony has also evolved during these past two decades. There is no role of lone mechanical dyssynchrony in the patient selection for CRT. However, mechanical dyssynchrony can complement the electrocardiogram and clinical criteria and improve patient selection by reducing the failure rate. An oversimplified approach to mechanical dyssynchrony assessment, such as just estimating time-to-peak delays between segments, should not be used. Instead, methods that can identify the underlying pathophysiology of HF and are representative of a substrate to CRT should be applied.
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Affiliation(s)
- Abhishek Dutta
- Department of Cardiology, Nazareth Hospital, Philadelphia, PA 19020, USA
| | - Rakan Radwan M Alqabbani
- Department of Internal Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Andreas Hagendorff
- Department of Cardiology, Leipzig University Hospital, 04103 Leipzig, Germany
| | - Bhupendar Tayal
- Harrington and Heart and Vascular Center, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
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Sisti N, Cardona A, Baldi E, Sciaccaluga C, Notaristefano F, Santoro A, Mandoli GE, Cameli M. Multimodality Imaging for Selecting Candidates for CRT: Do We Have a Single Alley to Increase Responders? Curr Probl Cardiol 2024; 49:102150. [PMID: 37863462 DOI: 10.1016/j.cpcardiol.2023.102150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 10/14/2023] [Indexed: 10/22/2023]
Abstract
Cardiac resynchronization therapy has evolved in recent years to provide a reduction of morbidity and mortality for many patients with heart failure. Its application and optimization is an evolving field and its use requires a multidisciplinary approach for patient and device selection, technical preprocedural planning, and optimization. While echocardiography has always been considered the first line for the evaluation of patients, additional imaging techniques have gained increasing evidence in recent years. Today different details about heart anatomy, function, dissynchrony can be investigated by magnetic resonance, cardiac computed tomography, nuclear imaging, and more, with the aim of obtaining clues to reach a maximal response from the electrical therapy. The purpose of this review is to provide a practical analysis of the single and combined use of different imaging techniques in the preoperative and perioperative phases of cardiac resynchronization therapy, underlining their main advantages, limitations, and information provided.
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Affiliation(s)
- Nicolò Sisti
- Department of Cardiology, Hospital of Gubbio, Gubbio, Italy.
| | - Andrea Cardona
- Division of Advanced Cardiovascular Diagnostics, Regional Healthcare Unit, Todi Hospital, Todi, Italy
| | - Enrico Baldi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Carlotta Sciaccaluga
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
| | | | - Amato Santoro
- Division of Cardiology, Cardio Thoracic and Vascular Department, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
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Huang J, Guo L, Zhang W, Li R, He B. Left bundle branch potential predicts better electrical synchrony in bradycardia patients receiving left bundle branch pacing. BMC Cardiovasc Disord 2022; 22:376. [PMID: 35986250 PMCID: PMC9389707 DOI: 10.1186/s12872-022-02812-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 08/10/2022] [Indexed: 11/25/2022] Open
Abstract
Background Left bundle branch pacing (LBBP) is a novel physiological pacing technology. We aim to explore the relation between LBB potential (LBB Po) and left ventricular (LV) electrical/mechanical synchrony in bradycardia patients without heart failure (HF) receiving LBBP. Methods A total of 62 patients undergoing LBBP were categorized by LBB Po: the LBB Po positive (+) group and the LBB Po negative (−) group. The perioperative electrocardiographic and echocardiography parameters related to cardiac synchrony were analyzed. Results There were 42 (67.74%) patients in the LBB Po (+) group and 20 patients in the LBB Po (−) group. Paced QRS duration (113.50 ± 17.65 ms vs. 123.40 ± 13.18 ms, P = 0.031) and stimulus left ventricular activation time (71.76 ± 3.53 ms vs. 74.45 ± 3.12 ms, P = 0.005) were shorter in the LBB Po (+) group than in the LBB Po (−) group. No significant differences in the LV mechanical synchrony (Ts-SD-12, 36.55 ± 19.76 vs. 39.95 ± 16.04, P = 0.505; PSD, 51.14 ± 17.69 vs. 45.65 ± 10.55, P = 0.205) between the two groups. There was not statistically difference in ventricular lead parameters measured intraoperative between the two groups. Compared with the LBB Po (−) group, the LBB Po (+) group showed a dramatically higher total procedure duration time (93.52 ± 9.18 min vs. 86.25 ± 10.54 min, p = 0.007) and fluoroscopy time for ventricle lead implantation (18.95 ± 3.43 min vs. 14.00 ± 3.16 min, p < 0.001). Conclusions The appearance of LBB Po may suggest better electrical synchrony during LBBP, but similar in LV mechanical synchrony. However, the total operation duration and fluoroscopy time of ventricular lead implantation in the LBB Po (+) group were longer. Therefore, it may be unnecessary to deliberately recognize the LBB Po when it is difficult to detect LBB Po and meet the LBBP criterion.
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Athayde GAT, Borges BCC, Pinheiro AO, Souza AL, Oliveira CP, Martins SAM, Teixeira RA, Siqueira SF, Porter TR, Mathias Junior W, Martinelli Filho M. Myocardial function reclassification: Echocardiographic strain patterns in patients with chronic Chagas cardiomyopathy and intraventricular dyssynchrony. Int J Cardiol 2021; 348:102-107. [PMID: 34890764 DOI: 10.1016/j.ijcard.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/03/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND We aimed to identify, among Chronic Chagas Cardiomyopathy (CCC) patients with left ventricular dysfunction (LVD) and non-left bundle branch block (non-LBBB), subgroups with different functional and mechanical patterns of global longitudinal strain (GLS) and intraventricular dyssynchrony (IVD) at rest and after exercise stress test, and reclassify them using a new echocardiographic approach. METHODOLOGY In this single-center cross-sectional study, 40 patients with CCC, left ventricular ejection fraction (LVEF) ≤ 35% and non-LBBB underwent rest echocardiography and then treadmill exercise stress echocardiography with GLS and IVD analysis. The sample was divided into four groups, based on GLS and IVD significant variation between rest and exercise: GLS + IVD+ (9 patients); GLS + IVD- (9 patients); GLS-IVD+ (10 patients); GLS-IVD- (10 patients). RESULTS At rest, median LVEF was 28% (21.3%-33%) and GLS (-7% (-5%/-9.3%), were not different among groups. The average response of GLS was an increase of 0.74% over rest values, and the average response of IVD was a decrease of 6.9 ms. Group GLS-IVD+ presented more dyssynchrony at rest (p = 0.01). Left atrial (LA) volume (higher in GLS-IVD-) (p = 0.022) and TAPSE (higher in GLS + IVD+) (p = 0.015) were also different among groups at baseline. Of the 40 patients evaluated, 27 (67.5%) had very severe LVD (GLS < -8%). In addition, among these patients, 11 patients had contractile reserve after undergoing stress echocardiography. CONCLUSIONS In patients with CCC, severe LVD and non-LBBB, the evaluation of GLS and IVD between rest and exercise was able to reclassify myocardial function and to identify subgroups with contractile reserve and significant dyssynchronopathy.
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Affiliation(s)
- Guilherme A T Athayde
- Cardiac Stimulation Clinical Unit, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Bruno C C Borges
- Echocardiography Unit, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Andreia O Pinheiro
- Cardiac Stimulation Clinical Unit, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Aline L Souza
- Cardiac Stimulation Clinical Unit, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Camila P Oliveira
- Cardiac Stimulation Clinical Unit, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Sergio A M Martins
- Cardiac Stimulation Clinical Unit, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ricardo A Teixeira
- Cardiac Stimulation Clinical Unit, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Sergio F Siqueira
- Cardiac Stimulation Clinical Unit, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.
| | - Thomas Richard Porter
- Echocardiography Laboratory of the University of Nebraska Medical Center, Omaha, NE, USA.
| | - Wilson Mathias Junior
- Echocardiography Unit, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Martino Martinelli Filho
- Cardiac Stimulation Clinical Unit, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.
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Azazy AS, Soliman M, Yaseen R, Mena M, Sakr H. Left ventricular dyssynchrony assessment using tissue synchronization imaging in acute myocardial infarction. Avicenna J Med 2021; 9:48-54. [PMID: 31143697 PMCID: PMC6530268 DOI: 10.4103/ajm.ajm_168_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives: To assess left ventricular (LV) dyssynchrony in patients with ST elevation myocardial infarction (STEMI). Background: Mechanical synchronization disorder leads to a decrease in LV ejection fraction (LVEF) and stroke volume, an abnormal distribution of wall tension, and increase in workload during cardiac contraction. Methods: We enrolled 56 participants, 36 with acute STEMI and 20 healthy controls. The automatically color-coded time to peak myocardial velocity was measured using a 6mm sample volume, manually positioned within the two-dimensional-tissue strain image of the 12 basal and middle LV segments. Results: A significant delay was found between the septal-lateral and septal-posterior walls in patients with STEMI compared to patients in the control group (36.36 vs. −6.0ms, P = 0.036; and 42.7 vs. 23.94ms, P = 0.042, respectively). Furthermore, all segment maximum differences and all segment standard deviation (SD; dyssynchrony index) were found to be significantly higher in the STEMI group (131.28 vs. 95.45ms, P = 0.013; and 44.47 vs. 26.45ms, P = 0.001, respectively). A significant delay between the septal-lateral walls and septal-posterior walls, all segment maximum difference, and all segment SD (dyssynchrony index) were found in patients with complicated STEMI (70.89 vs. 15.83ms, P = 0.038; 57.44 vs. 19.06ms, P = 0.040; 138.11 vs. 100.0ms, P = 0.035; and 45.44 vs. 32.50ms, P = 0.021, respectively). There was a significant negative correlation between tissue synchronization imaging parameters and LVEF, and a positive correlation with LV end systolic dimension. Conclusion: Patients with acute STEMI showed significant LV dyssynchrony, which was an independent predictor of inhospital complications.
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Affiliation(s)
- Ahmed S Azazy
- Department of Cardiology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Mahmoud Soliman
- Department of Cardiology, Meoufiya University Hospital, Meoufiya, Egypt
| | - Rehab Yaseen
- Department of Cardiology, Meoufiya University Hospital, Meoufiya, Egypt
| | - Morad Mena
- Department of Cardiology, Meoufiya University Hospital, Meoufiya, Egypt
| | - Haitham Sakr
- Department of Cardiology, King Saud Medical City, Riyadh, Saudi Arabia
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Ali O, Shenoy M, Alani A, Alani M, Williams K. Are SPECT MPI measures of dyssynchrony dyssynchronous? J Nucl Cardiol 2021; 28:1128-1135. [PMID: 31933153 DOI: 10.1007/s12350-019-02024-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 12/19/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Assessment of left ventricular mechanical dyssynchrony (LVMD) from gated SPECT myocardial perfusion imaging (MPI) aims to aid selection of patients for cardiac resynchronization therapy (CRT), using either the standard deviation of left ventricular phase (PSD) ≥ 43° or phase histogram bandwidth (HBW) of > 38° and > 30.6° in males and females, respectively. We observed dyssynchrony parameters might be affected by test type and alignment. METHODS We reviewed 242 patients who underwent gated SPECT MPI with use of the Emory Cardiac Toolbox comparing PSD and HBW at rest and stress for Pearson correlation, and substitutability with Bland-Altman analysis. RESULTS There is statistically significant difference in the mean PSD and HBW during rest vs stress (33.4 ± 17.4° vs 20.7 ± 13.5° and 97.7 ± 59.6° vs 59.4 ± 45.4°, respectively, P < 0.001). Proper valve plane alignment rendered smaller values (i.e., less dyssynchrony) in both phase SD and HBW (16.8 ± 13.5) vs (22.2 ± 14.7) (P = 0.011), and (47.0 ± 38.2) vs (60.7 ± 48.0) (P = 0.023), respectively. CONCLUSION Proper alignment and test type, particularly low-dose rest vs high-dose stress, should be considered when assessing LVMD using SPECT MPI.
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Affiliation(s)
- Omaima Ali
- Department of Cardiology, Penn State Health Milton S Hershey Medical Center, Hershey, USA.
| | - Maithili Shenoy
- Department of Cardiology, Ascension St Vincent's Healthcare, Jacksonville, USA
| | - Anas Alani
- Department of Cardiology, University of California San Diego Medical Center Hillcrest, San Diego, USA
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7
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Chango Azanza DX, Munín MA, Raggio I, Perea G, Carbajales J. [Different phenotypes of mitral regurgitation in patients with right apical ventricular pacing: an echocardiographic approach in a heterogeneity of clinical scenarios]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2021; 2:112-120. [PMID: 38274564 PMCID: PMC10809778 DOI: 10.47487/apcyccv.v2i2.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/26/2021] [Indexed: 01/27/2024]
Abstract
The presence of mitral regurgitation (MR) in patients with right ventricular apical pacing can be the result of multiple phenomena. On the one hand, this stimulation causes an asynchronous activation of the left ventricle (LV) and the papillary muscles, leading to a deterioration of the LV ejection fraction and causing an inadequate closure of the valve apparatus. However, there is a wide heterogeneity of ischemic and non-ischemic myocardial conditions that can coexist with mechanical alteration of the LV and the mitral valve leading to or worsening MR in these patients, which can make the etiological determination of valvular regurgitation difficult. Transthoracic echocardiography study allows comprehensive evaluation of mitral valve regurgitation and ventricular function parameters and mechanical asynchrony as a result of artificial pacing. The comprehensive study of these phenomena is relevant in clinical decision-making to define those patients who benefit from cardiac resynchronization therapy to alleviate symptomatic MR.
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Affiliation(s)
- Diego Xavier Chango Azanza
- Departamento de Cardiología. Hospital General de Agudos «Ramos Mejía». Buenos Aires, Argentina. Departamento de CardiologíaHospital General de Agudos «Ramos MejíaBuenos AiresArgentina
| | - Martín Alejandro Munín
- Departamento de Ultrasonido Cardiovascular. Centro de Educación Médica e Investigaciones Clínicas «Norberto Quirno» CEMIC. Buenos Aires, Argentina.Departamento de Ultrasonido CardiovascularCentro de Educación Médica e Investigaciones Clínicas «Norberto Quirno» CEMICBuenos AiresArgentina
| | - Ignacio Raggio
- Departamento de Ultrasonido Cardiovascular. Centro de Educación Médica e Investigaciones Clínicas «Norberto Quirno» CEMIC. Buenos Aires, Argentina.Departamento de Ultrasonido CardiovascularCentro de Educación Médica e Investigaciones Clínicas «Norberto Quirno» CEMICBuenos AiresArgentina
| | - Gabriel Perea
- Departamento de Ultrasonido Cardiovascular. Centro de Educación Médica e Investigaciones Clínicas «Norberto Quirno» CEMIC. Buenos Aires, Argentina.Departamento de Ultrasonido CardiovascularCentro de Educación Médica e Investigaciones Clínicas «Norberto Quirno» CEMICBuenos AiresArgentina
| | - Justo Carbajales
- Departamento de Cardiología. Hospital General de Agudos «Ramos Mejía». Buenos Aires, Argentina. Departamento de CardiologíaHospital General de Agudos «Ramos MejíaBuenos AiresArgentina
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Parolin M, Dassie F, Vettor R, Steeds RP, Maffei P. Electrophysiological features in acromegaly: re-thinking the arrhythmic risk? J Endocrinol Invest 2021; 44:209-221. [PMID: 32632903 DOI: 10.1007/s40618-020-01343-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/22/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Acromegaly is disease associated with a specific cardiomyopathy. Hitherto, it has been widely understood that acromegaly carries an increased risk of arrhythmia. PURPOSE In this review we show that evidences are limited to a small number of case-control studies that reported increased rates of premature ventricular beats (PVB) but no more significant arrhythmia. In contrast, there are several studies that have reported impaired preclinical markers of arrhythmia, including reduced heart rate variability, increased late potentials, QT interval dispersion, impaired heart rate recovery after physical exercise and left ventricular dysynchrony. Whilst these markers are associated with an adverse cardiovascular prognosis in the general population, they do not have a high independent positive predictive accuracy for arrhythmia. In acromegaly, case reports have described sudden cardiac death, ventricular tachyarrhythmia and advanced atrio-ventricular block that required implantation of a cardio-defibrillator or permanent pacemaker. Treatment with somatostatin analogues can reduce cardiac dysrhythmia in some cases by reducing heart rate, PVBs and QT interval. Pegvisomant reduces mean heart rate. Pasireotide is associated with QT prolongation. In the absence of good quality data on risk of arrhythmia in acromegaly, the majority of position statements and guidelines suggest routine 12-lead electrocardiography (ECG) and transthoracic echocardiography (TTE) in every patient at diagnosis and then follow up dependent on initial findings.
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Affiliation(s)
- M Parolin
- Department of Medicine (DIMED), University of Padua, Clinica Medica 3, via Giustiniani 2, 35128, Padova, Italy.
| | - F Dassie
- Department of Medicine (DIMED), University of Padua, Clinica Medica 3, via Giustiniani 2, 35128, Padova, Italy
| | - R Vettor
- Department of Medicine (DIMED), University of Padua, Clinica Medica 3, via Giustiniani 2, 35128, Padova, Italy
| | - R P Steeds
- University Hospital Birmingham and University of Birmingham, Cardiology, Birmingham, West Midlands, UK
| | - P Maffei
- Department of Medicine (DIMED), University of Padua, Clinica Medica 3, via Giustiniani 2, 35128, Padova, Italy
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Olsen CR, Mentz RJ, Anstrom KJ, Page D, Patel PA. Clinical applications of machine learning in the diagnosis, classification, and prediction of heart failure. Am Heart J 2020; 229:1-17. [PMID: 32905873 DOI: 10.1016/j.ahj.2020.07.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/08/2020] [Indexed: 12/25/2022]
Abstract
Machine learning and artificial intelligence are generating significant attention in the scientific community and media. Such algorithms have great potential in medicine for personalizing and improving patient care, including in the diagnosis and management of heart failure. Many physicians are familiar with these terms and the excitement surrounding them, but many are unfamiliar with the basics of these algorithms and how they are applied to medicine. Within heart failure research, current applications of machine learning include creating new approaches to diagnosis, classifying patients into novel phenotypic groups, and improving prediction capabilities. In this paper, we provide an overview of machine learning targeted for the practicing clinician and evaluate current applications of machine learning in the diagnosis, classification, and prediction of heart failure.
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Affiliation(s)
- Cameron R Olsen
- Division of Cardiology, Duke University Medical Center, Durham, NC.
| | - Robert J Mentz
- Division of Cardiology, Duke University Medical Center, Durham, NC
| | - Kevin J Anstrom
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
| | - David Page
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
| | - Priyesh A Patel
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, NC
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Wang XP, Xing CY, Zhang JX, Zhou JH, Li YC, Yang HY, Zhang PF, Zhang W, Huang Y, Long JG, Gao F, Zhang X, Li J. Time-restricted feeding alleviates cardiac dysfunction induced by simulated microgravity via restoring cardiac FGF21 signaling. FASEB J 2020; 34:15180-15196. [PMID: 32954538 DOI: 10.1096/fj.202001246rr] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 08/28/2020] [Accepted: 09/03/2020] [Indexed: 11/11/2022]
Abstract
Dietary restriction has been well-described to improve health metrics, but whether it could benefit pathophysiological adaptation to extreme environment, for example, microgravity, remains unknown. Here, we investigated the effects of a daily rhythm of fasting and feeding without reducing caloric intake on cardiac function and metabolism against simulated microgravity. Male rats under ad libitum feeding or time-restricted feeding (TRF; food access limited to 8 hours every day) were subjected to hindlimb unloading (HU) to simulate microgravity. HU for 6 weeks led to left ventricular dyssynchrony and declined cardiac function. HU also lowered pyruvate dehydrogenase (PDH) activity and impaired glucose utilization in the heart. All these were largely preserved by TRF. TRF showed no effects on HU-induced loss of cardiac mass, but significantly improved contractile function of cardiomyocytes. Interestingly, TRF raised liver-derived fibroblast growth factor 21 (FGF21) level and enhanced cardiac FGF21 signaling as manifested by upregulation of FGF receptor-1 (FGFR1) expression and its downstream markers in HU rats. In isolated cardiomyocytes, FGF21 treatment improved PDH activity and glucose utilization, consequently enhancing cell contractile function. Finally, both liver-specific knockdown (KD) of FGF21 and cardiac-specific FGFR1 KD abrogated the cardioprotective effects of TRF in HU rats. These data demonstrate that TRF improves cardiac glucose utilization and ameliorates cardiac dysfunction induced by simulated microgravity, at least partially, through restoring cardiac FGF21 signaling, suggesting TRF as a potential countermeasure for cardioprotection in long-term spaceflight.
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Affiliation(s)
- Xin-Pei Wang
- School of Aerospace Medicine, Fourth Military Medical University, Xi'an, China
| | - Chang-Yang Xing
- School of Aerospace Medicine, Fourth Military Medical University, Xi'an, China.,Department of Ultrasound Medicine, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Jia-Xin Zhang
- School of Aerospace Medicine, Fourth Military Medical University, Xi'an, China
| | - Jia-Heng Zhou
- School of Aerospace Medicine, Fourth Military Medical University, Xi'an, China
| | - Yun-Chu Li
- School of Aerospace Medicine, Fourth Military Medical University, Xi'an, China
| | - Hong-Yan Yang
- School of Aerospace Medicine, Fourth Military Medical University, Xi'an, China
| | - Peng-Fei Zhang
- School of Aerospace Medicine, Fourth Military Medical University, Xi'an, China
| | - Wei Zhang
- Department of Cardiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Yin Huang
- Key Laboratory of Drug Quality Control and Pharmacovigilance, China Pharmaceutical University, Nanjing, China
| | - Jian-Gang Long
- Center for Mitochondrial Biology and Medicine, Center for Translational Medicine, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Feng Gao
- School of Aerospace Medicine, Fourth Military Medical University, Xi'an, China
| | - Xing Zhang
- School of Aerospace Medicine, Fourth Military Medical University, Xi'an, China
| | - Jia Li
- School of Aerospace Medicine, Fourth Military Medical University, Xi'an, China
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11
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Pranata R, Yonas E, Vania R, Tondas AE, Yuniadi Y. Fragmented QRS is associated with intraventricular dyssynchrony and independently predicts nonresponse to cardiac resynchronization therapy—Systematic review and meta‐analysis. Ann Noninvasive Electrocardiol 2020; 25:e12750. [PMID: 32187770 PMCID: PMC7358826 DOI: 10.1111/anec.12750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/26/2019] [Accepted: 01/08/2020] [Indexed: 11/30/2022] Open
Abstract
Background Fragmented QRS (fQRS) is postulated to be associated with ventricular dyssynchrony and might be able to predict a nonresponse to cardiac resynchronization therapy (CRT) implantation. In this systematic review and meta‐analysis, we aim to assess whether fQRS can be a marker of intraventricular dyssynchronies in patients with ischemic and nonischemic cardiomyopathy and whether it is an independent predictor of nonresponse in patients receiving CRT. Methods We performed a comprehensive search on topics that assesses fQRS and its association with intraventricular dyssynchrony and nonresponse to CRT up until September 2019. Results Fragmented QRS is associated with intraventricular dyssynchrony (OR 10.34 [3.39, 31.54], p < .001; I2: 80% with sensitivity 76.8%, specificity 77%, LR+ 3.3, and LR− 0.3). Subgroup analysis showed that fQRS is associated with intraventricular dyssynchrony in patients with narrow QRS complex (OR 20.92 [12.24, 35.73], p < .001; I2: 0%) and nonischemic cardiomyopathy (OR of 19.97 [12.12, 32.92], p < .001; I2: 0%). Fragmented QRS was also associated with a higher time‐to‐peak myocardial sustained systolic (Ts‐SD) (OR 15.19 [12.58, 17.80], p < .001; I2: 0% and positive Yu index (OR 15.61 [9.07, 26.86], p < .001; I2: 0%). Fragmented QRS has a pooled adjusted OR of OR of 1.70 [1.35, 2.14], p < .001; I2: 62% for association with a nonresponse to CRT. QRS duration is found to be higher in nonresponders group mean difference −8.54 [−13.38, −3.70], p < .001; I2: 70%. Conclusion Fragmented QRS is associated with intraventricular dyssynchrony and is independently associated with nonresponse to cardiac resynchronization therapy.
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Affiliation(s)
- Raymond Pranata
- Faculty of Medicine Universitas Pelita Harapan Tangerang Indonesia
| | - Emir Yonas
- Faculty of Medicine Universitas YARSI Jakarta Indonesia
| | - Rachel Vania
- Faculty of Medicine Universitas Pelita Harapan Tangerang Indonesia
| | - Alexander Edo Tondas
- Department of Cardiology and Vascular Medicine Faculty of Medicine Universitas Sriwijaya Dr. Mohammad Hoesin General Hospital Palembang Indonesia
| | - Yoga Yuniadi
- Department of Cardiology and Vascular Medicine Faculty of Medicine Universitas Indonesia National Cardiovascular Center Harapan Kita Jakarta Indonesia
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Left ventricular systolic dyssynchrony in patients with Kawasaki disease: a real-time three-dimensional echocardiography study. Int J Cardiovasc Imaging 2020; 36:1941-1951. [PMID: 32529348 DOI: 10.1007/s10554-020-01909-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 06/01/2020] [Indexed: 12/17/2022]
Abstract
The left ventricular (LV) systolic dyssynchrony index (SDI) is an important prognostic indicator for many cardiovascular diseases; however, the characteristics of the SDI in patients with Kawasaki disease (KD) are unknown. In this study, we aimed to identify and quantify the SDI using real-time three-dimensional echocardiography (RT3DE) in KD patients during different phases. In addition, we intended to explore whether the SDI is associated with systolic dysfunction. Seventy consecutive KD patients and seventy age- and sex-matched controls were enrolled. The SDIs (percent of cardiac cycle) of 16 segments (16-SDI%) and 12 segments (12-SDI%) were calculated based on the defined standard deviation of each segment time from end diastole to the minimal systolic volume according to the 17-segment model (apex excluded). In the acute phase, the 16-SDI% and 12-SDI% were significantly higher in KD patients than in controls (4.40 ± 0.14 vs. 1.98 ± 0.12, P = 0.000; 3.55 ± 1.21 vs. 1.67 ± 0.93, P = 0.009, respectively), and patients with coronary artery aneurysm (CAA) exhibited higher 16-SDI% (P = 0.021) and 12-SDI% (P = 0.034) than patients without CAA. In the convalescent phase, patients with CAA still had higher 16-SDI% (P = 0.002) and 12-SDI% (P = 0.031) than controls, while the SDI in patients without CAA recovered to normal. The 16-SDI% was negatively correlated with the LV ejection fraction obtained from RT3DE (r = - 0.845, P = 0.000). Mechanical dyssynchrony is prevalent in KD patients during the acute phase and transient in patients without CAA, while patients with CAA still have impaired synchrony even in the convalescent phase. LV systolic dysfunction is associated with increased dyssynchrony. RT3DE is a valuable modality for identifying and quantifying dyssynchrony in KD patients.
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Le Rolle V, Galli E, Danan D, El Houari K, Hubert A, Donal E, Hernández AI. Sensitivity Analysis of a Left Ventricle Model in the Context of Intraventricular Dyssynchrony. Acta Biotheor 2020; 68:45-59. [PMID: 31506833 DOI: 10.1007/s10441-019-09362-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 08/29/2019] [Indexed: 10/26/2022]
Abstract
The objective of the current study was to propose a sensitivity analysis of a 3D left ventricle model in order to assess the influence of parameters on myocardial mechanical dispersion. A finite element model of LV electro-mechanical activity was proposed and a screening method was used to evaluate the sensitivity of model parameters on the standard deviation of time to peak strain. Results highlight the importance of propagation parameters associated with septal and lateral segments activation. Simulated curves were compared to myocardial strains, obtained from echocardiography of one healthy subject and one patient diagnosed with intraventricular dyssynchrony and coronary artery disease. Results show a close match between simulation and clinical strains and illustrate the model ability to reproduce myocardial strains in the context of intraventricular dyssynchrony.
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Wang J, Liang Y, Chen H, Wang W, Bai J, Chen X, Qin S, Su Y, Ge J. Patient-tailored SyncAV algorithm: A novel strategy to improve synchrony and acute hemodynamic response in heart failure patients treated by cardiac resynchronization therapy. J Cardiovasc Electrophysiol 2019; 31:512-520. [PMID: 31828904 DOI: 10.1111/jce.14315] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 11/06/2019] [Accepted: 12/03/2019] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Several automatic algorithms have developed to optimize the timing cycle setting in cardiac resynchronization therapy (CRT). The present study aims to investigate whether the novel device-based SyncAV algorithm could elicit better synchrony and acute hemodynamic response. METHODS AND RESULTS Thirty five patients undergoing CRT implantation were prospectively studied. The device was programmed to three biventricular (BiV) pacing modes sequentially after the procedure: QuickOpt algorithm (mode I), SyncAV algorithm with default 50 ms offset (mode II), and SyncAV algorithm with optimized offset minimizing QRS duration (QRSd) (mode III). After each setting, electrocardiographic and echocardiographic data were collected. As a result, QRSd was reduced from 172.8 ± 17.9 ms during intrinsic conduction to 153.1 ± 15.9 ms in mode I, further narrowed to 140.5 ± 16.7 ms in mode II, and reached shortest (134.8 ± 16.1 ms) in mode III (P < .01 for all). Besides, significantly shorter QT intervals were observed in mode I (453.2 ± 45.5 ms), mode II (443.9 ± 34.2 ms) and mode III (444.1 ± 28.7 ms), compared with native condition (472.5 ± 51.2 ms) (P < .01). All three BiV modes exhibited comparable Tp Te interval and Tp Te /QT ratio (P > .05). Mode I presented significantly higher aortic velocity time integral than intrinsic conduction (21.0 ± 6.4 cm vs 18.4 ± 5.5 cm; P < .01), which was even higher in mode II (22.0 ± 6.5 cm) and mode III (23.7 ± 6.5 cm). All three BiV modes significantly reduced standard deviation of time to peak contraction of 12-LV segments (Ts-SD) (Mode I: 55.2 ± 16.5 ms, Mode II: 50.2 ± 14.7 ms, Mode III: 45.4 ± 14.4 ms) compared with intrinsic conduction (66.3 ± 18.4 ms) (P < .01), with Mode III demonstrating the smallest (P < .01). CONCLUSION SyncAV CRT ameliorated electrical and mechanical synchrony as well as acute hemodynamic response beyond conventional QuickOpt optimization. An additional individualized adjustment to the SyncAV offset added to its advantage.
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Affiliation(s)
- Jingfeng Wang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yixiu Liang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Haiyan Chen
- Department of Echocardiography, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Wang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jin Bai
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xueying Chen
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shengmei Qin
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yangang Su
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
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Celikyurt U, Acar B, Hidayet S, Karauzum İ, Karauzum K, Vural A, Agacdiken A. Systolic aortic root motion predicts response to cardiac resynchronization therapy. Pacing Clin Electrophysiol 2019; 42:1471-1476. [DOI: 10.1111/pace.13792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 08/20/2019] [Accepted: 08/25/2019] [Indexed: 12/07/2022]
Affiliation(s)
- Umut Celikyurt
- Department of CardiologyKocaeli University Medical Faculty Kocaeli Turkey
| | - Burak Acar
- Department of CardiologyKocaeli University Medical Faculty Kocaeli Turkey
| | - Siho Hidayet
- Department of Cardiologyİnönü University Medical Faculty Malatya Turkey
| | - İrem Karauzum
- Department of CardiologyKocaeli University Medical Faculty Kocaeli Turkey
| | - Kurtulus Karauzum
- Department of CardiologyKocaeli University Medical Faculty Kocaeli Turkey
| | - Ahmet Vural
- Department of CardiologyKocaeli University Medical Faculty Kocaeli Turkey
| | - Aysen Agacdiken
- Department of CardiologyKocaeli University Medical Faculty Kocaeli Turkey
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Celikyurt U, Açar B, Karauzum I, Karauzum K, Ural D, Agir A, Vural A. Shorter time to begin of QRS fragmentation predicts non-response to cardiac resynchronization therapy in non-ischemic heart failure patients. Rev Clin Esp 2019. [DOI: 10.1016/j.rceng.2019.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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17
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Celikyurt U, Açar B, Karauzum I, Karauzum K, Ural D, Agir A, Vural A. El inicio rápido de la fragmentación del QRS predice la no respuesta a la terapia de resincronización cardíaca en pacientes con insuficiencia cardíaca no isquémica. Rev Clin Esp 2019; 219:243-250. [DOI: 10.1016/j.rce.2018.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 11/24/2018] [Accepted: 11/26/2018] [Indexed: 11/30/2022]
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Askari IV, Osipova OA. Influence of beta-blockers on mechanical dyssynchrony and cardiac remodeling in patients with ischemic chronic heart failure in the setting of revascularization. RESEARCH RESULTS IN PHARMACOLOGY 2019. [DOI: 10.3897/rrpharmacology.5.34073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Introduction: Diastolic dysfunction (DD) and cardiac dyssynchrony (DS) are involved in the progression of chronic heart failure (CHF). A comparative analysis was conducted of the effect of a 6-month course of nebivolol and bisoprolol on DD, DS and metalloproteinase-9 (MMP-9) level in patients with ischemic chronic heart failure with preserved ejection fraction (HFpEF) and with midrange ejection fraction (HFmrEF), as well as in patients with comorbid type 2 diabetes mellitus (T2DM) in the setting of coronary artery bypass grafting (CABG) after 6 months of therapy.
Materials and methods: The study included 308 patients with CHFFC I-II, left ventricular ejection fraction (LVEF) >40%, who had undergone CABG. The average dose of nebivolol in patients with DS 6 months later was 5.1±2.6 mg/day, and bisoprolol – 4.9±2.4 mg/day. Echocardiography (EchoCG) and evaluation of MMP-9 in blood plasma were performed. Mechanical myocardial asynchrony was determined by calculating the standard deviation of time to peak systolic myocardial velocity (TS-SD) and maximum segment delay (TS12) using a 6-basal and-midsegment model.
Results and discussion: MMP-9 level in patients with CHF before CABG was 4.7 times higher (p<0.001). MMP-9 correlated with LVEF (r=-0.60, p<0.001), E/A (r=-0.49, p<0.001), DT (r=0.43, p<0.001), E` (r=-0.58, p<0.001) and DS: TS12 (r=0.54, p<0.001), TS-SD (r=0.49, p<0.001). The six-month course of nebivolol improved the values of DS: TS12 – by 30% (p<0.001), TS-SD – by 32% (p<0.01) and reduced the MMP-9 level by 11% (p<0.001). In patients with HFmrEF without DSnebivolol increased E/A by 19% (p<0.01), E` – by 16% (P<0.05), and decreased E/E’ by 9% (p<0.05), DT – by 12% (p<0.05). In patients with HFpEF and DM2, nebivolol reduced TS12 by 37% (p<0.01), TS-SD – by 29% (p<0.05) and MMP-9 – by 13% (p<0.05).
Conclusion: The positive effect of nebivolol on the DS, DD of the LV in patients with HFpEF, HFmrEF and with comorbid type 2 diabetes mellitus. The six-month course of nebivolol decreased the MMP-9 level in patients with ischemic CHF after CABG, including patients with T2DM.
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Abstract
Cardiac resynchronization therapy (CRT) is an electrical therapy to resolve an electrical problem. Any method to predict CRT response must specifically reflect the electrical substrate. Time-to-peak dyssynchrony is too unspecific for prediction of response because dyssynchrony by this approach may reflect the presence of scar or fibrosis even in the absence of conduction delay. New methods are based on the actual physiology of activation delay-induced heart failure (HF) and are superior to time-to-peak methods in predicting CRT response. Time-to-peak dyssynchrony may be used for prognosis in HF patients without signs of delayed ventricular activation and for monitoring CRT response.
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Affiliation(s)
- Bhupendar Tayal
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, Aalborg 9100, Denmark
| | - Peter Sogaard
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, Aalborg 9100, Denmark.
| | - Niels Risum
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen 2100, Denmark
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Rodrigues I, Abreu A, Oliveira M, Cunha PS, Clara HS, Osório P, Lousinha A, Valente B, Portugal G, Rio P, Morais LA, Santos V, Carmo MM, Ferreira RC. Impact on long-term cardiovascular outcomes of different cardiac resynchronization therapy response criteria. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2018.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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21
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Rodrigues I, Abreu A, Oliveira M, Cunha PS, Clara HS, Osório P, Lousinha A, Valente B, Portugal G, Rio P, Morais LA, Santos V, Carmo MM, Ferreira RC. Impact on long-term cardiovascular outcomes of different cardiac resynchronization therapy response criteria. Rev Port Cardiol 2018; 37:961-969. [DOI: 10.1016/j.repc.2018.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 02/03/2018] [Accepted: 02/18/2018] [Indexed: 12/31/2022] Open
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22
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Naya M, Manabe O, Koyanagawa K, Tamaki N. The role of nuclear medicine in assessments of cardiac dyssynchrony. J Nucl Cardiol 2018; 25:1980-1987. [PMID: 28956317 DOI: 10.1007/s12350-017-1072-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 08/29/2017] [Indexed: 12/30/2022]
Abstract
Radionuclide imaging has an advantage for quantitative analyses of the tracer concentration and its temporal changes. Myocardial perfusion and function have been adapted for synchrony analyses. Extracted parameters have been demonstrated to measure ventricular synchrony and even to predict CRT outcomes. ERNA has the advantages of higher temporal resolution, greater reproducibility, and the volumetric analysis of both ventricles that can be applied for analyses of intraventricular synchrony and interventricular synchrony. Several software packages such as Quantitative Gated SPECT, the Emory Cardiac Toolbox, cardioREPO, and Heart Function View are available to assess the LV dyssynchrony parameters from GSPECT. A count-based method is applied to extract the amplitude and phase from each of the reconstructed GSPECT short-axis datasets throughout the cardiac cycle and then subjected to a Fourier analysis, the results of which are displayed on a polar map and histogram. Some of the parameters such as the bandwidth (expressed as the 95% width of the phase histogram) and the standard deviation of the phase are obtained by the phase histogram to assess the intraventricular synchrony. This review paper focuses on the application of the LV dyssynchrony parameters estimated by cardiac SPECT in patients with a heart disease.
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Affiliation(s)
- Masanao Naya
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.
| | - Osamu Manabe
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kazuhiro Koyanagawa
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Nagara Tamaki
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
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23
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Fulati Z, Liu Y, Sun N, Kang Y, Su Y, Chen H, Shu X. Speckle tracking echocardiography analyses of myocardial contraction efficiency predict response for cardiac resynchronization therapy. Cardiovasc Ultrasound 2018; 16:30. [PMID: 30453975 PMCID: PMC6245808 DOI: 10.1186/s12947-018-0148-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 10/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In patients with left ventricular (LV) dysssynchrony, contraction that doesn't fall into ejection period (LVEj) results in a waste of energy due to inappropriate contraction timing, which was now widely treated by cardiac resynchronization therapy(CRT). Myocardial Contraction Efficiency was defined as the ratio of Efficient Contraction Time (ECTR) and amplitude of efficient contraction (ECR) during LVEj against that in the entire cardiac cycle. This study prospectively investigated whether efficiency indexes could predict CRT outcome. METHODS Our prospective pilot study including 70 CRT candidates, parameters of myocardial contraction timing and contractility were measured by speckle tracking echocardiography (STE) and efficiency indexes were calculated accordingly at baseline and at 6-month follow-up. Primary outcome events were predefined as death or HF hospitalization, and secondary outcome events were defined as all-cause death during the follow-up. 16-segement Standard deviation of time to onset strain (TTO-16SD) and time to peak strain (TTP-16SD) were included as the dyssynchrony indexes. RESULTS According to LV end systolic volume (LVESV) and LV eject fraction(LVEF) values at 6-month follow-up, subjects were classified into responder and non-responder groups, ECR (OR 0.87, 95%CI 0.78-0.97, P < 0.05) and maximum longitudinal strain (MLS) (OR 2.22, 95%CI 1.36-3.61, P < 0.01) were the two independent predictors for CRT response, Both TTO-16SD and TTP-16SD failed to predict outcome. Patients with poorer myocardial contraction efficiency and better contractility are more likely to benefit from CRT. CONCLUSIONS STE can evaluate left ventricular contraction efficiency and contractility to predict CRT response. When analyzing myocardial strain by STE, contraction during LVEj should be highlighted.
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Affiliation(s)
- Zibire Fulati
- Department of Echocardiography, Shanghai Institute of Medical Imaging; Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Yang Liu
- Department of Echocardiography, Shanghai Institute of Medical Imaging; Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Ning Sun
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Yu Kang
- Department of Cardiology, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Yangang Su
- Department of Cardiology; Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Haiyan Chen
- Department of Echocardiography, Shanghai Institute of Medical Imaging; Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
| | - Xianhong Shu
- Department of Echocardiography, Shanghai Institute of Medical Imaging; Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
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24
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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.
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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
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Zajac J, Eriksson J, Alehagen U, Ebbers T, Bolger AF, Carlhäll CJ. Mechanical dyssynchrony alters left ventricular flow energetics in failing hearts with LBBB: a 4D flow CMR pilot study. Int J Cardiovasc Imaging 2017; 34:587-596. [PMID: 29098524 PMCID: PMC5859696 DOI: 10.1007/s10554-017-1261-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 10/19/2017] [Indexed: 11/23/2022]
Abstract
The impact of left bundle branch block (LBBB) related mechanical dyssynchrony on left ventricular (LV) diastolic function remains unclear. 4D flow cardiovascular magnetic resonance (CMR) has provided reliable markers of LV dysfunction: reduced volume and kinetic energy (KE) of the portion of LV inflow which passes directly to outflow (Direct Flow) has been demonstrated in failing hearts compared to normal hearts. We sought to investigate the impact of mechanical dyssynchrony on diastolic function by comparing 4D flow in myopathic LVs with and without LBBB. CMR data were acquired at 3 T in 22 heart failure patients; 11 with LBBB and 11 without LBBB matched according to several demographic and clinical parameters. An established 4D flow analysis method was used to separate the LV end-diastolic (ED) volume into functional flow components based on the blood’s timing and route through the heart cavities. While the Direct Flow volume was not different between the groups, the KE possessed at ED was lower in LBBB patients (P = 0.018). Direct Flow entering the LV during early diastolic filling possessed less KE at ED in LBBB patients compared to non-LBBB patients, whereas no intergroup difference was observed during late filling. Pre-systolic KE of LV Direct Flow was reduced in patients with LBBB compared to matched patients with normal conduction. These intriguing findings propose that 4D flow specific measures can serve as markers of LV mechanical dyssynchrony in heart failure patients, and could possibly be investigated as predictors of response to cardiac resynchronization therapy.
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Affiliation(s)
- Jakub Zajac
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, 581 85, Linköping, Sweden. .,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden. .,Department of Clinical Physiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
| | - Jonatan Eriksson
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, 581 85, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Urban Alehagen
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, 581 85, Linköping, Sweden.,Department of Cardiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Tino Ebbers
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, 581 85, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Ann F Bolger
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, 581 85, Linköping, Sweden.,Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Carl-Johan Carlhäll
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, 581 85, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Clinical Physiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Mahfouz RA, Alawady WS, Salem A. Ventricular dyssynchrony as a marker of latent carditis in children with acute rheumatic fever: A tissue Doppler imaging. Echocardiography 2017; 34:1667-1673. [DOI: 10.1111/echo.13720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Ragab A. Mahfouz
- Department of Cardiology; Zagazig University Hospital; Zagazig Egypt
| | - Waleed S. Alawady
- Department of Cardiology; Zagazig University Hospital; Zagazig Egypt
| | - Abdelhakeem Salem
- Department of Cardiology; Zagazig University Hospital; Zagazig Egypt
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Muser D, Tioni C, Shah R, Selvanayagam JB, Nucifora G. Prevalence, Correlates, and Prognostic Relevance of Myocardial Mechanical Dispersion as Assessed by Feature-Tracking Cardiac Magnetic Resonance After a First ST-Segment Elevation Myocardial Infarction. Am J Cardiol 2017. [PMID: 28648394 DOI: 10.1016/j.amjcard.2017.05.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Postinfarction mechanical dispersion (MD), that is, the regional heterogeneity of myocardial contraction throughout the cardiac cycle, has detrimental effects on left ventricular (LV) function and is related to the occurrence of heart failure and ventricular arrhythmias. However, its prevalence, pathophysiological determinants, and clinical utility are still unknown. The aim of the present study is to clarify these issues. In total, 130 consecutive patients (mean age 60 ± 12 years, 75% male) with a first ST-segment elevation myocardial infarction (STEMI) were included. Cardiac magnetic resonance (CMR) with late gadolinium enhancement imaging was performed to assess LV function, infarct size, and microvascular obstruction. Feature-tracking analysis was applied to cine-CMR short-axis images to assess MD, defined as the SD of the time-to-peak circumferential strain of the LV segments expressed as percent cardiac cycle. For comparison purpose, 40 control subjects similar in age and gender to the STEMI group were also included. Patients were followed-up for a median of 95 months; the outcome event was defined as a composite of cardiovascular death, aborted sudden cardiac death, and hospitalization for heart failure. STEMI patients had significantly higher MD compared with controls (12.0 ± 5.35% vs 3.85 ± 0.99%, p <0.001). At multivariate analysis, heart rate (β = 0.20, p = 0.008), LV end-systolic volume index (β = 0.37, p <0.001), and infarct size (β = 0.23, p = 0.017) were significantly and independently related to MD. The outcome event occurred in 26 (20%) patients. At multivariate Cox proportional hazards analysis, MD was significantly and independently related to the outcome event (p <0.001). MD provided significant incremental value over the other clinical and CMR variables in predicting the outcome event (p <0.001 for the chi-square change). In conclusion, MD after STEMI is a marker of the extent of myocardial damage; its assessment by feature-tracking CMR provides significant, independent, and incremental long-term prognostic information.
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Affiliation(s)
- Daniele Muser
- Cardiothoracic Department, University Hospital "Santa Maria della Misericordia", Udine, Italy
| | - Chiara Tioni
- Cardiothoracic Department, University Hospital "Santa Maria della Misericordia", Udine, Italy; Postgraduate School of Cardiovascular Sciences, University of Trieste, Trieste, Italy
| | - Ranjit Shah
- Department of Heart Health, South Australian Health & Medical Research Institute, Adelaide, South Australia, Australia; School of Medicine, Flinders University, Bedford Park, Adelaide, South Australia, Australia; Department of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia
| | - Joseph B Selvanayagam
- Department of Heart Health, South Australian Health & Medical Research Institute, Adelaide, South Australia, Australia; School of Medicine, Flinders University, Bedford Park, Adelaide, South Australia, Australia; Department of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia
| | - Gaetano Nucifora
- Department of Heart Health, South Australian Health & Medical Research Institute, Adelaide, South Australia, Australia; School of Medicine, Flinders University, Bedford Park, Adelaide, South Australia, Australia; Northwest Heart Centre, Wythenshawe Hospital, University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom.
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Mahfouz RA, El-Awady WS, Dewedar A. Ventricular dyssynchrony in pregnant women: A tissue Doppler study. Echocardiography 2017; 34:968-972. [PMID: 28692143 DOI: 10.1111/echo.13579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The aim of the study was to assess the left ventricular (LV) synchronicity in pregnant women and to identify the main determinants of LV dyssynchrony in asymptomatic pregnant women. METHODS One hundred sixty-seven pregnant women consecutively and 48 age-matched nonpregnant controls were enrolled. For the assessment of LV systolic dyssynchrony, the standard deviation of the time from QRS onset to peak systolic (Tps-LV- standard deviation [SD]) velocity and the maximal difference of the time from QRS onset to peak systolic velocity (Tps-LV) from 12 segments at the apical views. For the LV diastolic dyssynchrony, the standard deviation of the time from QRS onset to peak diastolic (Tpe-LV-SD) velocity and the maximal difference of the time from QRS onset to peak diastolic velocity (Tpe-LV) were calculated. RESULTS Both systolic and diastolic dyssynchrony indexes were significantly higher in pregnant women than in the normal controls (Tps-LV; P<.01, Tps-LV-SD; P<.03, Tpe-LV, P<.05 and Tpe-LV-SD; P<.02). A total of 28 (16.8%) of the pregnant women had a dyssynchrony index above the accepted value for LV dyssynchrony (>34.4 msec). There was a significant correlation between LV dyssynchrony indexes with, multiparty, multifetal pregnancies, systolic blood pressure in pregnant women with LV dyssynchrony. Additionally LV dyssynchrony was significantly associated with elevated E/e" and brain natriuretic peptide (BNP). CONCLUSIONS Both systolic synchronicity and diastolic synchronicity were affected in pregnant women compared to nonpregnant women. LV dyssynchrony was significantly correlated with age, multiparity, and BNP level. Early detectable changes in systolic and diastolic synchrony may be present in pregnant women at higher risk of peripartum cardiomyopathy.
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Affiliation(s)
- Ragab A Mahfouz
- Cardiology Department, Zagazig University Hospital, Zagazig, Egypt
| | | | - Ashraf Dewedar
- Cardiology Department, Zagazig University Hospital, Zagazig, Egypt
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WANG JINGFENG, GONG XUE, CHEN HAIYAN, QIN SHENGMEI, ZHOU NIANWEI, SU YANGANG, GE JUNBO. Effect of Cardiac Resynchronization Therapy on Myocardial Fibrosis and Relevant Cytokines in a Canine Model With Experimental Heart Failure. J Cardiovasc Electrophysiol 2017; 28:438-445. [PMID: 28127817 DOI: 10.1111/jce.13171] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 01/15/2017] [Accepted: 01/18/2017] [Indexed: 02/06/2023]
Affiliation(s)
- JINGFENG WANG
- Department of Cardiology; Shanghai Institute of Medical Imaging, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University; Shanghai China
| | - XUE GONG
- Department of Echocardiography; Shanghai Institute of Medical Imaging, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University; Shanghai China
| | - HAIYAN CHEN
- Department of Echocardiography; Shanghai Institute of Medical Imaging, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University; Shanghai China
| | - SHENGMEI QIN
- Department of Cardiology; Shanghai Institute of Medical Imaging, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University; Shanghai China
| | - NIANWEI ZHOU
- Department of Echocardiography; Shanghai Institute of Medical Imaging, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University; Shanghai China
| | - YANGANG SU
- Department of Cardiology; Shanghai Institute of Medical Imaging, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University; Shanghai China
| | - JUNBO GE
- Department of Cardiology; Shanghai Institute of Medical Imaging, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University; Shanghai China
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Gendre R, Lairez O, Mondoly P, Duparc A, Carrié D, Galinier M, Berry I, Cognet T. Research of predictive factors for cardiac resynchronization therapy: a prospective study comparing data from phase-analysis of gated myocardial perfusion single-photon computed tomography and echocardiography. Ann Nucl Med 2017; 31:218-226. [DOI: 10.1007/s12149-017-1148-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 12/28/2016] [Indexed: 11/28/2022]
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31
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Erdem FH, Ozturk S, Öztürk S, Erdem A, Ayhan S, Öztürk M, Dönmez İ, Baltacı D, Yazıcı M. The Effects of Ivabradine on Left Ventricular Synchronization and Tei Index in Patients with Systolic Heart Failure. ACTA CARDIOLOGICA SINICA 2017; 33:58-65. [PMID: 28115808 PMCID: PMC5241437 DOI: 10.6515/acs20160205b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 02/05/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND The aim of our study was to evaluate in stable outpatients with systolic heart failure (HF) the 3 months effect of ivabradine on LV synchronization and Tei index in stable outpatients with systolic HF. METHODS We evaluated prospectively 40 (30 males, 10 females) patients with HF. All patients were evaluated before and after treatment by transthoracic M mode, two dimensional (2D), pulsed-wave (PW), continuous wave (CW), color flow and tissue Doppler imaging (TDI) and tissue synchronization imaging (TSI). Standard deviation of Ts of the 12 LV segments (Ts-SD-12) is the most widely used parameter of intra-LV asynchrony. RESULTS Thirty men and 10 women with mean ± SD age of 64.7 ± 9.9 years were included in this study. Most of the patients benefitted from some degree of clinical improvement, 12/16 (75.0%) from NYHA III to II and 18/24 (75.0%) from II to I, respectively. Resting heart rate was significantly reduced after ivabradine treatment (84.3 ± 11.4 vs. 66.5 ± 11.5 bpm, p < 0.001). E/E' and Tei index were significantly changed after ivabradine treatment (17.3 ± 9.0 vs. 14.8 ± 7.1, p = 0.02 and 0.86 ± 0.74 vs. 0.81 ± 0.69, p = 0.02). Intra-LV synchrony parameters Ts-SD-12 and Ts-12 were significantly reduced after ivabradine (46.8 ± 13.6 vs. 42.7 ± 13.1, p = 0.01 and 142.5 ± 44.0 vs. 128.5 ± 45.2, p = 0.009). CONCLUSIONS The present study demonstrated that adding ivabradine to the standard therapy reduced HR and significantly improved LV ventricular asynchrony and Tei index in systolic HF patients.
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Affiliation(s)
- Fatma Hizal Erdem
- Department of Cardiology, Faculty of Medicine, Abant Izzet Baysal University, Bolu
| | - Serkan Ozturk
- Department of Cardiology, Faculty of Medicine, Abant Izzet Baysal University, Bolu
| | - Selçuk Öztürk
- Department of Cardiology, Faculty of Medicine, Abant Izzet Baysal University, Bolu
| | - Alim Erdem
- Department of Cardiology, Faculty of Medicine, Abant Izzet Baysal University, Bolu
| | - Selim Ayhan
- Department of Cardiology, Faculty of Medicine, Abant Izzet Baysal University, Bolu
| | | | - İbrahim Dönmez
- Department of Cardiology, Faculty of Medicine, Abant Izzet Baysal University, Bolu
| | - Davut Baltacı
- Family Medicine, Faculty of Medicine, Duzce University, Duzce, Turkey
| | - Mehmet Yazıcı
- Department of Cardiology, Faculty of Medicine, Abant Izzet Baysal University, Bolu
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Behar JM, Claridge S, Jackson T, Sieniewicz B, Porter B, Webb J, Rajani R, Kapetanakis S, Carr-White G, Rinaldi CA. The role of multi modality imaging in selecting patients and guiding lead placement for the delivery of cardiac resynchronization therapy. Expert Rev Cardiovasc Ther 2016; 15:93-107. [DOI: 10.1080/14779072.2016.1252674] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Jonathan M Behar
- Department of Imaging Sciences & Biomedical Engineering, King’s College London, London, UK
- Department of Cardiology, St. Thomas’ Hospital, London, UK
| | - Simon Claridge
- Department of Imaging Sciences & Biomedical Engineering, King’s College London, London, UK
- Department of Cardiology, St. Thomas’ Hospital, London, UK
| | - Tom Jackson
- Department of Imaging Sciences & Biomedical Engineering, King’s College London, London, UK
- Department of Cardiology, St. Thomas’ Hospital, London, UK
| | - Ben Sieniewicz
- Department of Imaging Sciences & Biomedical Engineering, King’s College London, London, UK
- Department of Cardiology, St. Thomas’ Hospital, London, UK
| | - Bradley Porter
- Department of Imaging Sciences & Biomedical Engineering, King’s College London, London, UK
- Department of Cardiology, St. Thomas’ Hospital, London, UK
| | - Jessica Webb
- Department of Imaging Sciences & Biomedical Engineering, King’s College London, London, UK
- Department of Cardiology, St. Thomas’ Hospital, London, UK
| | - Ronak Rajani
- Department of Cardiology, St. Thomas’ Hospital, London, UK
| | | | | | - Christopher A Rinaldi
- Department of Imaging Sciences & Biomedical Engineering, King’s College London, London, UK
- Department of Cardiology, St. Thomas’ Hospital, London, UK
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Karaca O, Gunes HM, Omaygenc MO, Cakal B, Cakal SD, Demir GG, Kizilirmak F, Gokdeniz T, Barutcu I, Boztosun B, Kilicaslan F. Predicting Ventricular Arrhythmias in Cardiac Resynchronization Therapy: The Impact of Persistent Electrical Dyssynchrony. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:969-77. [PMID: 27333978 DOI: 10.1111/pace.12908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 05/03/2016] [Accepted: 06/09/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although response to cardiac resynchronization therapy (CRT) has been conventionally assessed with left ventricular volume reduction, ventricular arrhythmias (ventricular tachycardia/ventricular fibrillation [VT/VF]) are of critical importance associated with unfavorable outcomes even in the "superresponders" to therapy. We evaluated the predictors of VT/VF and the association of residual dyssynchrony during follow-up. METHODS Ninety-five patients receiving CRT were followed-up for 9 ± 3 months. Post-CRT dyssynchrony was defined as a prolonged QRS duration (QRSd) for persistent electrical dyssynchrony (ED), and a Yu index ≥ 33 ms for persistent mechanical dyssynchrony. The first VT/VF episode, including nonsustained VT detected on device interrogation and/or appropriate antitachycardia pacing or shock for VT/VF, were the end points of the study. RESULTS Forty-five patients who reached the study end points had significantly lower mean ΔQRS (baseline QRSd - post-CRT QRSd) values than those without VT/VF (-20.8 ± 28.9 ms vs -6.6 ± 30.7 ms, P = 0.022). Both the baseline and post-CRT QRSds, along with the Yu index values, were not different in two groups. Patients with VT/VF were statistically more likely to have persistent ED (38% vs 9%, P = 0.021). Kaplan-Meier curves showed that a negative ΔQRS was associated with a higher incidence of VT/VF during follow-up (P = 0.016). A multivariate Cox model revealed that QRS prolongation was an independent predictor of VT/VF after CRT (P = 0.029). CONCLUSIONS A negative ΔQRS, also called persistent ED, is associated with VT/VF. Narrowest possible QRSd might be a reliable goal of both implantation and optimization of devices to reduce arrhythmic events after CRT.
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Affiliation(s)
- Oguz Karaca
- Cardiology Department, Medipol University Faculty of Medicine, Istanbul, Turkey.
| | - Haci M Gunes
- Cardiology Department, Medipol University Faculty of Medicine, Istanbul, Turkey
| | | | - Beytullah Cakal
- Cardiology Department, Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Sinem Deniz Cakal
- Cardiology Department, Medipol University Faculty of Medicine, Istanbul, Turkey
| | | | - Filiz Kizilirmak
- Cardiology Department, Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Tayyar Gokdeniz
- Cardiology Department, Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Irfan Barutcu
- Cardiology Department, Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Bilal Boztosun
- Cardiology Department, Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Fethi Kilicaslan
- Cardiac Electrophysiology, Medipol University Faculty of Medicine, Istanbul, Turkey
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Steelant B, Stankovic I, Roijakkers I, Aarones M, Bogaert J, Desmet W, Aakhus S, Voigt JU. The Impact of Infarct Location and Extent on LV Motion Patterns. JACC Cardiovasc Imaging 2016; 9:655-64. [DOI: 10.1016/j.jcmg.2015.07.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 06/25/2015] [Accepted: 07/15/2015] [Indexed: 12/14/2022]
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Effect of QRS Narrowing After Cardiac Resynchronization Therapy on Functional Mitral Regurgitation in Patients With Systolic Heart Failure. Am J Cardiol 2016; 117:412-9. [PMID: 26721652 DOI: 10.1016/j.amjcard.2015.11.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 11/09/2015] [Accepted: 11/09/2015] [Indexed: 12/26/2022]
Abstract
The determinants of improvement in functional mitral regurgitation (FMR) after cardiac resynchronization therapy (CRT) remain unclear. We evaluated the predictors of FMR improvement and hypothesized that CRT-induced change in QRS duration (ΔQRS) might have an impact on FMR response after CRT. One hundred ten CRT recipients were enrolled. CRT response (≥ 15 reduction in left ventricular end-systolic volume) and FMR response (absolute reduction in FMR volume) were assessed with echocardiography before and 6 months after CRT. The study end points included all-cause death or hospitalization assessed in 12 ± 3 months (range 1 to 18). A total of 71 patients (65%) responded to CRT at 6 months. FMR response was observed in 49 (69%) of the CRT responders and 8 (20%) of the CRT nonresponders (p <0.001). Although the baseline QRS durations were similar, the paced QRS durations were shorter (p = 0.012) and the ΔQRS values were greater (p = 0.003) in FMR responders compared with FMR nonresponders. There was a linear correlation between ΔQRS and change in regurgitant volume (r = 0.49, p <0.001). At multivariate analysis, baseline tenting area (p = 0.012) and ΔQRS (p = 0.028) independently predicted FMR response. A ΔQRS ≥ 20 ms was related to CRT response, FMR improvement, and lower rates of death or hospitalization during follow-up (p values <0.05). In conclusion, QRS narrowing after CRT independently predicts FMR response. A ΔQRS ≥ 20 ms after CRT is associated with a favorable outcome in all clinical end points.
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QRS prolongation after cardiac resynchronization therapy is a predictor of persistent mechanical dyssynchrony. J Interv Card Electrophysiol 2015; 46:105-13. [DOI: 10.1007/s10840-015-0080-7] [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: 07/18/2015] [Accepted: 11/25/2015] [Indexed: 10/22/2022]
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Sharma RK, Donekal S, Rosen BD, Tattersall MC, Volpe GJ, Ambale-Venkatesh B, Nasir K, Wu CO, Polak JF, Korcarz CE, Stein JH, Carr J, Watson KE, Bluemke DA, Lima JAC. Association of subclinical atherosclerosis using carotid intima-media thickness, carotid plaque, and coronary calcium score with left ventricular dyssynchrony: the multi-ethnic Study of Atherosclerosis. Atherosclerosis 2015; 239:412-8. [PMID: 25682041 PMCID: PMC4361257 DOI: 10.1016/j.atherosclerosis.2015.01.041] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 01/22/2015] [Accepted: 01/30/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND The role of atherosclerosis in the progression of global left ventricular dysfunction and cardiovascular events has been well recognized. Left ventricular (LV) dyssynchrony is a measure of regional myocardial dysfunction. Our objective was to investigate the relationship of subclinical atherosclerosis with mechanical LV dyssynchrony in a population-based asymptomatic multi-ethnic cohort. METHODS AND RESULTS Participants of the Multi-Ethnic Study of Atherosclerosis (MESA) at exam 5 were evaluated using 1.5T cardiac magnetic resonance (CMR) imaging, carotid ultrasound (n = 2062) for common carotid artery (CCA) and internal carotid artery (ICA) intima-media thickness (IMT), and cardiac computed tomography (n = 2039) for coronary artery calcium (CAC) assessment (Agatston method). Dyssynchrony indices were defined as the standard deviation of time to peak systolic circumferential strain (SD-TPS) and the difference between maximum and minimum (max-min) time to peak strain using harmonic phase imaging in 12 segments (3-slices × 4 segments). Multivariable regression analyses were performed to assess associations after adjusting for participant demographics, cardiovascular risk factors, LV mass, and ejection fraction. In multivariable analyses, SD-TPS was significantly related to measures of atherosclerosis, including CCA-IMT (8.7 ms/mm change in IMT, p = 0.020), ICA-IMT (19.2 ms/mm change in IMT, p < 0.001), carotid plaque score (1.2 ms/unit change in score, p < 0.001), and log transformed CAC+1 (0.66 ms/unit log-CAC+1, p = 0.018). These findings were consistent with other parameter of LV dyssynchrony i.e. max-min. CONCLUSION In the MESA cohort, measures of atherosclerosis are associated with parameters of subclinical LV dyssynchrony in the absence of clinical coronary event and left-bundle-branch block.
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Affiliation(s)
- Ravi K Sharma
- Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Sirisha Donekal
- Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Boaz D Rosen
- Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Matthew C Tattersall
- Division of Cardiology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Gustavo J Volpe
- Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Khurram Nasir
- Centers for Prevention and Wellness, Baptist Health South Florida, Miami, FL, USA
| | - Colin O Wu
- Office of Biostatistics Research, National Heart Lung and Blood Institute, Bethesda, MD, USA
| | - Joseph F Polak
- Department of Radiology, Tufts Medical Center, Boston, MA, USA
| | - Claudia E Korcarz
- Division of Cardiology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - James H Stein
- Division of Cardiology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - James Carr
- Division of Radiology, Northwestern University, Chicago, IL, USA
| | - Karol E Watson
- Department of Medicine, University of California, Los Angeles, CA, USA
| | - David A Bluemke
- Radiology and Imaging Sciences, National Institutes of Health (NIH), Bethesda, MD, USA; Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
| | - João A C Lima
- Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA; Department of Radiology, Johns Hopkins University, Baltimore, MD, USA.
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Left bundle branch block and echocardiography in the era of CRT. J Echocardiogr 2014; 13:6-14. [DOI: 10.1007/s12574-014-0233-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 11/11/2014] [Accepted: 11/11/2014] [Indexed: 10/24/2022]
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Bulbul Sen B, Rifaioglu EN, Ekiz O, Buyukkaya E, Kurt M, Karakas MF, Buyukkaya S, Bilen P, Akcay AB, Sen N. Assessment of left ventricular dyssynchrony in patients with psoriasis. Int J Dermatol 2014; 53:1221-7. [PMID: 25219512 DOI: 10.1111/ijd.12192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Psoriasis is an inflammatory disorder, which has been reported to be associated with cardiovascular (CV) risks. Although increased CV risks in psoriasis are well established, there are no data about changes of contraction synchrony in psoriasis. Therefore, we aimed to study the left ventricular (LV) contraction synchrony in patients with psoriasis with narrow QRS and normal ejection fraction. METHODS Fifty patients with psoriasis and 50 age- and sex-matched control subjects were included in the study. LV dyssynchrony was investigated by color-coded tissue Doppler imaging. RESULTS In the psoriasis group, the mean high-sensitive C-reactive protein values were significantly higher compared with the controls. Peak A velocity, deceleration time, isovolumetric relaxation time, and E/E' values were higher in the psoriasis group; however, E/A ratio and average Em were higher in the control group. LV systolic dyssynchrony parameters [including standard deviation of Ts of the 12 LV segments (Ts-SD-12), maximal difference in Ts between any two of the 12 LV segments, standard deviation of Ts of the six basal LV segments, and maximal difference in Ts between any two of the six basal LV segments] were found to be higher in the psoriasis group. The patients with ventricular dyssynchrony (a Ts-SD-12 >34.4 ms) were higher in the psoriasis group than the control group (34% vs. 6%, P < 0.01). CONCLUSION In patients with psoriasis with normal ejection fractions and narrow QRS, LV systolic dyssynchrony is an early manifestation of heart involvement and may coexist with diastolic dysfunction.
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Affiliation(s)
- Bilge Bulbul Sen
- Department of Dermatology, Mustafa Kemal University, School of Medicine, Hatay, Turkey
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Yanagisawa S, Inden Y, Shimano M, Yoshida N, Fujita M, Ohguchi S, Ishikawa S, Kato H, Okumura S, Miyoshi A, Nagao T, Yamamoto T, Hirai M, Murohara T. Clinical characteristics and predictors of super-response to cardiac resynchronization therapy: a combination of predictive factors. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 37:1553-64. [PMID: 25223930 DOI: 10.1111/pace.12506] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 06/16/2014] [Accepted: 08/04/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients with greater improvement of cardiac function after cardiac resynchronization therapy (CRT) implantation are identified as "super-responders." However, it remains unclear which kind of preimplant assessments could accurately predict outcomes after CRT. Thus, we aimed to examine the essential predicting factors for super-response to CRT, and to construct an accurate predictable model. METHODS We retrospectively analyzed the CRT patients who underwent implantation at Nagoya University Hospital. Super-responders are defined as those who show a relative reduction in left ventricular end-systolic volume ≥30% after 6 months of CRT. RESULTS Eighty patients (mean age, 67.8 ± 10.2 years) were included. Twenty-two patients received upgrading procedure to CRT implantation. Six months after the implantation, 29 patients (36%) were super-responders. Multiple logistic regression analysis shows that consistent right ventricular pacing with a previous device (odds ratio [OR] 7.28, 95% confidence interval [CI] 1.52-34.9; P = 0.013), lack of prior history of ventricular arrhythmia (OR 5.32, 95% CI 1.52-18.6; P = 0.009), and smaller left atrial diameter (LAD) (OR 0.92, 95% CI 0.86-0.98; P = 0.014) are independent predictors for CRT super-responders. The use of a combination of these predictive factors could increase the certainty with which a greater response to CRT is predicted and the presence of such a combination could improve prognosis. CONCLUSION Greater response to biventricular pacing occurs more frequently in patients with consistent right ventricular pacing, lack of prior history of ventricular arrhythmia, and smaller LAD. An association between patient background characteristics and a super-response to CRT was also identified.
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Affiliation(s)
- Satoshi Yanagisawa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Cardiology, Chunichi Hospital, Aichi, Japan
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Sharma RK, Volpe G, Rosen BD, Ambale-Venkatesh B, Donekal S, Fernandes V, Wu CO, Carr J, Bluemke DA, Lima JAC. Prognostic implications of left ventricular dyssynchrony for major adverse cardiovascular events in asymptomatic women and men: the Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc 2014; 3:jah3624. [PMID: 25092789 PMCID: PMC4310386 DOI: 10.1161/jaha.114.000975] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Left ventricular (LV) dyssynchrony is related to adverse outcomes in systolic heart failure, but its prognostic importance in asymptomatic population is not known. Our objective was to assess the prognostic implications of LV mechanical dyssynchrony in a large multiethnic population before the occurrence of global LV dysfunction. Methods and Results A total of 1392 participants in the Multi‐Ethnic Study of Atherosclerosis (MESA; mean age: 64.7 years; 46% were women) with cardiac magnetic resonance imaging at baseline were followed for a median duration of 8.3 years. Harmonic phase imaging analysis was used to derive systolic circumferential strain. Greater standard deviation of time to peak systolic strain (SD‐TPS) indicates greater dyssynchrony. With SD‐TPS as a continuous variable, Cox proportional hazards analysis was used to assess hazards ratio after adjusting for demographics, cardiovascular risk factors, LV mass‐to‐volume ratio, and ejection fraction. Using the 75th percentile of SD‐TPS as a cutoff, Kaplan–Meier analysis was performed between 2 categorical groups for each gender. Higher values of dyssynchrony in women predicted major adverse cardiovascular events, defined as myocardial infarction, heart failure, stroke, and death (hazard ratio: 1.01 per 1‐ms increment in SD‐TPS, P=0.015), hard coronary events (hazard ratio: 1.05 per 1‐ms increment in SD‐TPS, P=0.026), and cerebrovascular events (hazard ratio: 1.03 per 1‐ms increment in SD‐TPS, P=0.013). In contrast, dyssynchrony in men was not predictive of events. Kaplan–Meier analyses in women revealed increased event occurrence in the higher dyssynchrony group, but this was not the case in men. Conclusions In an asymptomatic cohort, greater LV dyssynchrony determined by cardiac magnetic resonance imaging predicts adverse cardiovascular outcome in women but not in men. Clinical Trial Registration URL: http://clinicaltrials.gov. Unique identifier: NCT00005487.
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Affiliation(s)
- Ravi K Sharma
- Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland (R.K.S., G.V., B.D.R., B.A.V., S.D., D.A.B., J.L.)
| | - Gustavo Volpe
- Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland (R.K.S., G.V., B.D.R., B.A.V., S.D., D.A.B., J.L.)
| | - Boaz D Rosen
- Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland (R.K.S., G.V., B.D.R., B.A.V., S.D., D.A.B., J.L.)
| | - Bharat Ambale-Venkatesh
- Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland (R.K.S., G.V., B.D.R., B.A.V., S.D., D.A.B., J.L.)
| | - Sirisha Donekal
- Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland (R.K.S., G.V., B.D.R., B.A.V., S.D., D.A.B., J.L.)
| | - Veronica Fernandes
- Department of Medicine, Mount Sinai Hospital, New York City, New York (V.F.)
| | - Colin O Wu
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland (C.O.W.)
| | - Jeffrey Carr
- Department of Medicine, Vanderbilt University, Nashville, Tennessee (J.C.)
| | - David A Bluemke
- Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland (R.K.S., G.V., B.D.R., B.A.V., S.D., D.A.B., J.L.) Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland (D.A.B., J.L.) Radiology and Imaging Sciences, National Institutes of Health (NIH), Bethesda, Maryland (D.A.B.)
| | - João A C Lima
- Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland (R.K.S., G.V., B.D.R., B.A.V., S.D., D.A.B., J.L.) Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland (D.A.B., J.L.)
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Liu Y, Liu P, Hou L, Li L, Zhang Y, Wu J, Xie J, Jin G, Yang X. Analysis of the effects of electroacupuncture at the pericardium 6 acupoint on heart function in patients with angina using equilibrium radionuclide angiocardiography quantity analysis technique. J Altern Complement Med 2014; 20:466-71. [PMID: 24720785 DOI: 10.1089/acm.2013.0433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To analyze changes in cardiac function indices after electroacupuncture (EA) at the pericardium 6 (PC-6) acupoint using the equilibrium radionuclide angiocardiography (ERNA) quantity analysis technique. DESIGN Analysis of clinical outcomes after EA at PC-6 measured by ERNA. SETTING The study was conducted in a hospital. PARTICIPANTS 31 participants (17 patients with angina and 14 healthy volunteers). INTERVENTION The study used ERNA to study outcomes of EA at PC-6 on heart function. OUTCOME MEASURE ERNA images were taken before the treatment (T0), at the end of the treatment (T1), and 20 minutes after the treatment (T2) and then processed. RESULTS Regional left ventricular ejection fraction (REF) increased after EA in the angina and control groups. REF at T2 was significantly higher than at T1 in the angina group (p<.01). In the control group, REF was higher at T1 than at T0 (p<.01) but did not differ between T1 and T2 (p=.08). The REF deviation among ventricular regions in the angina group was significantly greater than that in the control group at T0 (p<.01) but was reduced to the level of that in control group after EA (p=.52). Peak filling rate was lower in the angina group than in controls at all three time points (all p<.01). After EA, peak filling rate increased markedly in the angina group but not in the control group. The cardiac cycle was shorter in the angina group than in the control group at T0 (p<.01) and increased after EA. The cardiac cycle of the control group did not change. CONCLUSION Effects of EA at PC-6 on heart function can be detected and quantified by ENRA.
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Affiliation(s)
- Yuting Liu
- 1 The Second Affiliated Hospital of Harbin Medical University , Harbin, China
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Introduction to indexes for cardiac resynchronization therapy (CRT) indication. J Med Ultrason (2001) 2014; 41:261-74. [PMID: 27277786 DOI: 10.1007/s10396-013-0499-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Klimusina J, De Boeck BW, Leenders GE, Faletra FF, Prinzen F, Averaimo M, Pasotti E, Klersy C, Moccetti T, Auricchio A. Redistribution of left ventricular strain by cardiac resynchronization therapy in heart failure patients. Eur J Heart Fail 2014; 13:186-94. [DOI: 10.1093/eurjhf/hfq197] [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] [Indexed: 11/12/2022] Open
Affiliation(s)
- Julija Klimusina
- Division of Cardiology; Fondazione Cardiocentro Ticino; Via Tesserete 48, CH-6900 Lugano Switzerland
| | | | | | - Francesco F. Faletra
- Division of Cardiology; Fondazione Cardiocentro Ticino; Via Tesserete 48, CH-6900 Lugano Switzerland
| | - Frits Prinzen
- Department of Physiology; Cardiovascular Research Institute Maastricht; Maastricht The Netherlands
| | - Manuela Averaimo
- Division of Cardiology; Fondazione Cardiocentro Ticino; Via Tesserete 48, CH-6900 Lugano Switzerland
| | - Elena Pasotti
- Division of Cardiology; Fondazione Cardiocentro Ticino; Via Tesserete 48, CH-6900 Lugano Switzerland
| | - Catherine Klersy
- Service of Biometry and Statistics, Research Department; IRCCS Fondazione Policlinico San Matteo; Pavia Italy
| | - Tiziano Moccetti
- Division of Cardiology; Fondazione Cardiocentro Ticino; Via Tesserete 48, CH-6900 Lugano Switzerland
| | - Angelo Auricchio
- Division of Cardiology; Fondazione Cardiocentro Ticino; Via Tesserete 48, CH-6900 Lugano Switzerland
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Yuan LJ, Takenaka K, Uno K, Ebihara A, Sasaki K, Komuro T, Sonoda M, Nagai R. Normal and shear strains of the left ventricle in healthy human subjects measured by two-dimensional speckle tracking echocardiography. Cardiovasc Ultrasound 2014; 12:7. [PMID: 24517641 PMCID: PMC4016487 DOI: 10.1186/1476-7120-12-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 12/08/2013] [Indexed: 11/18/2022] Open
Abstract
Background Animal studies have shown that shear deformation of myocardial sheets in transmural planes of left ventricular (LV) wall is an important mechanism for systolic wall thickening, and normal and shear strains of the LV free wall differ from those of the interventricular septum (IVS). We sought to test whether these also hold for human hearts. Methods Thirty healthy volunteers (male 23 and female 7, aged 34 ± 6 years) from Outpatient Department of the University of Tokyo Hospital were included. Echocardiographic images were obtained in the left decubitus position using a commercially available system (Aloka SSD-6500, Japan) equipped with a 3.5-MHz transducer. The ECG was recorded simultaneously. The peak systolic radial normal strain (length change), shear strain (angle change) and time to peak systolic radial normal strain were obtained non-invasively by two-dimensional speckle tracking echocardiography. Results The peak systolic radial normal strain in both IVS and LV posterior wall (LVPW) showed a trend to increase progressively from the apical level to the basal level, especially at short axis views, and the peak systolic radial normal strain of LVPW was significantly greater than that of IVS at all three levels. The time to peak systolic radial normal strain was the shortest at the basal IVS, and increased progressively from the base to the apical IVS. It gradually increased from the apical to the basal LVPW in sequence, especially at short axis views. The peak of radial normal strain of LVPW occurred much later than the peak of IVS at all three levels. For IVS, the shear deformation was clockwise at basal level, and counterclockwise at mid and apical levels in LV long-axis view. For LVPW, the shear deformations were all counterclockwise in LV long-axis view and increased slightly from base to the apex. LVPW showed larger shear strains than IVS at all three levels. Bland-Altman analysis shows very good agreement between measurements taken by the same observer and by two independent observers. Conclusion “Myocardial sheets” theory also holds true for intact human LV. Moreover, dyssynchrony exists even in healthy human subjects, which should be considered when evaluating the diseased hearts.
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Affiliation(s)
- Li-Jun Yuan
- Department of Ultrasound Diagnostics, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China.
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Practical and conceptual limitations of tissue Doppler imaging to predict reverse remodelling in cardiac resynchronisation therapy. Eur J Heart Fail 2014; 10:281-90. [DOI: 10.1016/j.ejheart.2008.02.003] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2007] [Revised: 01/02/2008] [Accepted: 02/04/2008] [Indexed: 11/23/2022] Open
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El-Menyar AA, Abdou SM. Impact of left bundle branch block and activation pattern on the heart. Expert Rev Cardiovasc Ther 2014; 6:843-57. [DOI: 10.1586/14779072.6.6.843] [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] [Indexed: 01/22/2023]
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Zoroufian A, Razmi T, Savandroomi Z, Tokaldany ML, Sadeghian H, Sahebjam M, Jalali A. Correlation between systolic deformation and dyssynchrony indices and the grade of left ventricular hypertrophy in hypertensive patients with a preserved systolic ejection fraction undergoing coronary angiography, based on tissue Doppler imaging. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:119-128. [PMID: 24371106 DOI: 10.7863/ultra.33.1.119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES The purpose of this study was to investigate whether systolic mechanical dyssynchrony occurs in hypertensive patients with a normal coronary artery and a normal ejection fraction and its relationship with different degrees of left ventricular (LV) hypertrophy. METHODS A total of 125 angiographically normal coronary patients (42.4% male; mean age ± SD, 57.16 ± 8.26 years) with an ejection fraction greater than 50% were included, of which 84 were hypertensive and 41 normotensive. The hypertensive patients were categorized into 3 groups: no, mild, and moderate LV hypertrophy. Tissue Doppler and deformation imaging parameters were measured in the 6 LV basal segments at peak systole. RESULTS The frequency of dyssynchrony was 40.5% in the hypertensive patients compared to 19.5% in the control patients (P = .020). Among the hypertensive patients, LV dyssynchrony was found in 5 patients (20%) with no hypertrophy, 20 (42.6%) with mild hypertrophy, and 9 (75%) with moderate hypertrophy. There was a moderate correlation between the grade of hypertrophy and septal-lateral wall delay (r = 0.497), 6-basal segment delay (r = 0.454), overall strain (r = 0.453), overall peak systolic velocity (r = -0.430), and standard deviation of the time to peak systolic velocity in the basal segments (r = 0.429). After adjustment for the LV end-systolic diameter and body surface area, overall strain was the best correlate of the hypertrophy grade (odds ratio, 7.043; 95% confidence interval, 1.839-26.980; P = .0044). CONCLUSIONS Among tissue Doppler and deformation indices, overall peak systolic strain was the strongest correlate of the LV hypertrophy grade. Therefore, in hypertensive patients with normal cardiac systolic function, a reduction in overall strain in the 6 basal LV segments may be a good indicator of progression of the LV hypertrophy grade and systolic dysfunction.
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Affiliation(s)
- Arezoo Zoroufian
- Department of Echocardiography, Tehran Heart Center, North Kargar Street, Tehran 14117 13138, Iran.
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Örem C, Kazaz Z, Yaylı S, Çevik OÇ, Kırış A, Öztürk M, Arslan B, Örem A. Left ventricular systolic asynchrony: an important sign for cardiac involvement in plaque-type psoriasis. Int J Dermatol 2013; 53:369-75. [DOI: 10.1111/ijd.12276] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Cihan Örem
- Department of Cardiology; Faculty of Medicine; Karadeniz Technical University; Trabzon Turkey
| | - Zeynep Kazaz
- Cardiology Department; Of State Hospital; Trabzon Turkey
| | - Savaş Yaylı
- Department of Dermatology; Faculty of Medicine; Karadeniz Technical University; Trabzon Turkey
| | - Osman Çağlar Çevik
- Department of Dermatology; Kanuni Education and Training Hospital; Trabzon Turkey
| | - Abdulkadir Kırış
- Department of Cardiology; Faculty of Medicine; Karadeniz Technical University; Trabzon Turkey
| | - Mustafa Öztürk
- Department of Cardiology; Faculty of Medicine; Karadeniz Technical University; Trabzon Turkey
| | - Bilgihan Arslan
- Department of Cardiology; Faculty of Medicine; Karadeniz Technical University; Trabzon Turkey
| | - Asım Örem
- Department of Biochemistry; Faculty of Medicine; Karadeniz Technical University; Trabzon Turkey
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Calibration of the Normal Cutoff Values of Systolic Dyssynchrony of the Left Ventricular Synchronicity in Normal Subjects Using Real-Time 3-Dimensional Echocardiography and the Effects of Age and Heart Rate. Cell Biochem Biophys 2013; 69:115-21. [DOI: 10.1007/s12013-013-9777-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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