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Bertelli M, Ziacchi M, van Slochteren F, Rondanina E, Lazzeri M, Carecci A, Biffi M. LV cathode position in CRT recipients: How can we benefit from CMR? Int J Cardiol 2024; 412:132321. [PMID: 38977225 DOI: 10.1016/j.ijcard.2024.132321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/24/2024] [Accepted: 07/01/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND Left ventricular lead positioning represents a key step in CRT optimization. However, evidence for its guidance based on specific topographical factors and related imaging techniques is sparse. OBJECTIVE To analyze reverse remodeling (RR) and clinical events in CRT recipients based on LV cathode (LVC) position relative to latest mechanical activation (LMA) and scar as determined by cardiac magnetic resonance (CMR). METHODS This is a retrospective single-center study of 68 consecutive Q-LV-guided CRT-D and CRT-P recipients. Through CMR-based 3D reconstructions overlayed on fluoroscopy images, LVCs were stratified as concordant, adjacent, or discordant to LMA (3 segments with latest and greatest radial strain) and scar (segments with >50% scar transmurality). The primary endpoint of RR (expressed as percentage ESV change) and secondary composite endpoint of HF hospitalizations, LVAD/heart transplant, or cardiovascular death were compared across categories. RESULTS LVC proximity to LMA was associated with a progressive increase in RR (percentage ESV change: concordant -47.0 ± 5.9%, adjacent -31.4 ± 3.1%, discordant +0.4 ± 3.7%), while proximity to scar was associated with sharply decreasing RR (concordant +10.7 ± 12.9%, adjacent +0.3 ± 5.3%, discordant -31.3 ± 4.4%, no scar -35.4 ± 4.8%). 4 integrated classes of LVC position demonstrated a significant positive RR gradient the more optimal the category (class I -47.0 ± 5.9%, class II -34.9 ± 2.8%, class III -5.5 ± 4.3%, class IV + 3.4 ± 5.2%). Freedom from composite secondary endpoint of HF hospitalization, LVAD/heart transplant, or cardiovascular death confirmed these trends demonstrating significant differences across both integrated as well as individual LMA and scar categories. CONCLUSION Integrated CMR-determined LVC position relative to LMA and scar stratifies response to CRT.
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Affiliation(s)
- Michele Bertelli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Department of Cardiology, 40122 Bologna, Italy.
| | - Matteo Ziacchi
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Department of Cardiology, 40122 Bologna, Italy
| | | | | | - Mirco Lazzeri
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Department of Cardiology, 40122 Bologna, Italy
| | - Alessandro Carecci
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Department of Cardiology, 40122 Bologna, Italy
| | - Mauro Biffi
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Department of Cardiology, 40122 Bologna, Italy
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Zou JH, Hua BT, Shao XX, Wang C, Li H, Lu YN, Tian X, Li ZX, Pu LJ, Wang J. Redefining left bundle branch block from high-density electroanatomical mapping. Int J Cardiol 2024; 402:131830. [PMID: 38320669 DOI: 10.1016/j.ijcard.2024.131830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/13/2024] [Accepted: 02/01/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND The existing ECG criteria for diagnosing left bundle branch block (LBBB) are insufficient to distinguish between true and false blocks accurately. METHODS We hypothesized that the notch width of the QRS complex in the lateral leads (I, avL, V5, V6) on the LBBB-like ECG could further confirm the diagnosis of true complete left bundle branch block (t-LBBB). We conducted high-density, three-dimensional electroanatomical mapping in the cardiac chambers of 37 patients scheduled to undergo CRT. These patients' preoperative electrocardiograms met the ACC/AHA/HRS guidelines for the diagnosis of complete LBBB. If the left bundle branch potential could be mapped from the base of the heart to the apex on the left ventricular septum, it was defined as a false complete left bundle branch block (f-LBBB). Otherwise, it was categorized as a t-LBBB. We conducted a comparative analysis between the two groups, considering the clinical characteristics, real-time correspondence between the spread of ventricular electrical excitation and the QRS wave, QRS notch width of the lateral leads (I, avL, V5, V6), and the notch width/left ventricular end-diastolic diameter (Nw/LVd) ratio. We performed the ROC correlation analysis of Nw/LVd and t-LBBB to determine the sensitivity and specificity for diagnostic authenticity. RESULTS Twenty-five patients were included in the t-LBBB group, while 12 patients were assigned to the f-LBBB group. Within the t-LBBB group, the first peak of the QRS notch correlated with the depolarization of the right ventricle and septum, the trough corresponded to the depolarization of the left ventricle across the left ventricle, and the second peak aligned with the depolarization of the left ventricular free wall. In contrast, within the f-LBBB group, the first peak coincided with the depolarization of the right ventricle and a majority of the left ventricle, the second peak occurred due to the depolarization of the latest, locally-activated myocardium in the left ventricle, and the trough was a result of delayed activation of the left ventricle that did not align with the usual peak timing. The QRS notch width (45.2 ± 12.3 ms vs. 52.5 ± 9.2 ms, P < 0.05) and the Nw/LVd ratio (0.65 ± 0.19 ms/mm vs. 0.81 ± 0.17 ms/mm, P < 0.05) were compared between the two groups. After conducting the ROC correlation analysis, a sensitivity of 56% and a specificity of 91.7% for diagnosing t-LBBB using Nw/LVd were obtained. CONCLUSION By utilizing the current diagnostic criteria for LBBB, an increased Nw/LVd value can enhance the effectiveness of diagnosing LBBB.
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Affiliation(s)
- Jun-Hua Zou
- The first Department of Cardiology, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Bao-Tong Hua
- The third Department of Cardiology, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Xiao-Xia Shao
- The third Department of Cardiology, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Chao Wang
- The first Department of Cardiology, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Hao Li
- The third Department of Cardiology, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Ya-Nan Lu
- The first Department of Cardiology, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Xin Tian
- The first Department of Cardiology, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Zhi-Xuan Li
- The first Department of Cardiology, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Li-Jin Pu
- The first Department of Cardiology, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.
| | - Jing Wang
- The first Department of Cardiology, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.
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3
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Calvieri C, Riva A, Sturla F, Dominici L, Conia L, Gaudio C, Miraldi F, Secchi F, Galea N. Left Ventricular Adverse Remodeling in Ischemic Heart Disease: Emerging Cardiac Magnetic Resonance Imaging Biomarkers. J Clin Med 2023; 12:jcm12010334. [PMID: 36615133 PMCID: PMC9820966 DOI: 10.3390/jcm12010334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/10/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
Post-ischemic left ventricular (LV) remodeling is a biologically complex process involving myocardial structure, LV shape, and function, beginning early after myocardial infarction (MI) and lasting until 1 year. Adverse remodeling is a post-MI maladaptive process that has been associated with long-term poor clinical outcomes. Cardiac Magnetic Resonance (CMR) is the best tool to define adverse remodeling because of its ability to accurately measure LV end-diastolic and end-systolic volumes and their variation over time and to characterize the underlying myocardial changes. Therefore, CMR is the gold standard method to assess in vivo myocardial infarction extension and to detect the presence of microvascular obstruction and intramyocardial hemorrhage, both associated with adverse remodeling. In recent times, new CMR quantitative biomarkers emerged as predictive of post-ischemic adverse remodeling, such as T1 mapping, myocardial strain, and 4D flow. Additionally, CMR T1 mapping imaging may depict infarcted tissue and assess diffuse myocardial fibrosis by using surrogate markers such as extracellular volume fraction, which may predict functional recovery or risk stratification of remodeling. Finally, there is emerging evidence supporting the utility of intracavitary blood flow kinetic energy and hemodynamic features assessed by the 4D flow CMR technique as early predictors of remodeling.
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Affiliation(s)
- Camilla Calvieri
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, 00100 Rome, Italy
- Correspondence:
| | - Alessandra Riva
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20129 Milan, Italy
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, 20097 Milan, Italy
| | - Francesco Sturla
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20129 Milan, Italy
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, 20097 Milan, Italy
| | - Lorenzo Dominici
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00100 Rome, Italy
| | - Luca Conia
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00100 Rome, Italy
| | - Carlo Gaudio
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, 00100 Rome, Italy
| | - Fabio Miraldi
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, 00100 Rome, Italy
| | - Francesco Secchi
- Unit of Radiology, IRCCS Policlinico San Donato, 20097 Milan, Italy
- Department of Biomedical Sciences for Health, Università Degli Studi di Milano, 20129 Milan, Italy
| | - Nicola Galea
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00100 Rome, Italy
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Green PG, Herring N, Betts TR. What Have We Learned in the Last 20 Years About CRT Non-Responders? Card Electrophysiol Clin 2022; 14:283-296. [PMID: 35715086 DOI: 10.1016/j.ccep.2021.12.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Although cardiac resynchronization therapy (CRT) has become well established in the treatment of heart failure, the management of patients who do not respond after CRT remains a key challenge. This review will summarize what we have learned about non-responders over the last 20 years and discuss methods for optimizing response, including the introduction of novel therapies.
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Affiliation(s)
- Peregrine G Green
- Department of Physiology, Anatomy and Genetics, University of Oxford, Sherrington Building, Parks Road, Oxford, OX1 3PT, UK; Oxford Centre for Clinical Magnetic Resonance Research (OCMR), University of Oxford, Level 0 John Radcliffe Hospital, Oxford, OX3 9DU, UK; Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK
| | - Neil Herring
- Department of Physiology, Anatomy and Genetics, University of Oxford, Sherrington Building, Parks Road, Oxford, OX1 3PT, UK; Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK
| | - Timothy R Betts
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK; Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
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5
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Lopes BBC, Kwon DH, Shah DJ, Lesser JR, Bapat V, Enriquez-Sarano M, Sorajja P, Cavalcante JL. Importance of Myocardial Fibrosis in Functional Mitral Regurgitation: From Outcomes to Decision-Making. JACC Cardiovasc Imaging 2021; 14:867-878. [PMID: 33582069 DOI: 10.1016/j.jcmg.2020.10.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/19/2020] [Accepted: 10/08/2020] [Indexed: 12/27/2022]
Abstract
Functional mitral regurgitation (FMR) is a common and complex valve disease, in which severity and risk stratification is still a conundrum. Although risk increases with FMR severity, it is modulated by subjacent left ventricular (LV) disease. The extent of LV remodeling and dysfunction is traditionally evaluated by echocardiography, but a growing body of evidence shows that myocardial fibrosis (MF) assessment by cardiac magnetic resonance (CMR) may complement risk stratification and inform treatment decisions. This review summarizes the current knowledge on the comprehensive evaluation that CMR can provide for patients with FMR, in particular for the assessment of MF and its potential impact in clinical decision-making.
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Affiliation(s)
- Bernardo B C Lopes
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Deborah H Kwon
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Dipan J Shah
- Houston Methodist Debakey Heart & Vascular Center, Houston, Texas, USA
| | - John R Lesser
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Vinayak Bapat
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Maurice Enriquez-Sarano
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - João L Cavalcante
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
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6
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Loring Z, Friedman DJ, Emerek K, Graff C, Sørensen PL, Hansen SM, Wieslander B, Ugander M, Søgaard P, Atwater BD. Lead one ratio in left bundle branch block predicts poor cardiac resynchronization therapy response. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:503-510. [PMID: 32285950 DOI: 10.1111/pace.13916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 02/27/2020] [Accepted: 03/29/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND A low electrocardiogram (ECG) lead one ratio (LOR) of the maximum positive/negative QRS amplitudes is associated with lower left ventricular ejection fraction (LVEF) and worse outcomes in left bundle branch block (LBBB); however, the impact of LOR on cardiac resynchronization therapy (CRT) outcomes is unknown. We compared clinical outcomes and echocardiographic changes after CRT implantation by LOR. METHODS Consecutive CRT-defibrillator recipients with LBBB implanted between 2006 and 2015 at Duke University Medical Center were included (N = 496). Time to heart transplant, left ventricular assist device (LVAD) implantation, or death was compared among patients with LOR <12 vs ≥12 using Cox-proportional hazard models. Changes in LVEF and LV volumes after CRT were compared by LOR. RESULTS Baseline ECG LOR <12 was associated with an adjusted hazard ratio (HR) of 1.69 (95% CI: 1.12-2.40, P = .01) for heart transplant, LVAD, or death. Patients with LOR <12 had less reduction of LV end diastolic volume (ΔLVEDV -4 ± 21 vs -13 ± 23%, P = .04) and LV end systolic volume (ΔLVESV -9 ± 27 vs -22 ± 26%, P = .03) after CRT. In patients with QRS duration (QRSd) ≥150 ms, LOR <12 was associated with an adjusted HR of 2.01 (95% CI 1.21-3.35, P = .008) for heart transplant, LVAD, or death, compared with LOR ≥12. CONCLUSIONS Baseline ECG LOR <12 portends worse outcomes after CRT implantation in patients with LBBB, specifically among those with QRSd ≥150 ms. This ECG ratio may identify patients with a class I indication for CRT implantation at high risk for poor postimplantation outcomes.
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Affiliation(s)
- Zak Loring
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina.,Duke Clinical Research Institute, Durham, North Carolina
| | - Daniel J Friedman
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina.,Duke Clinical Research Institute, Durham, North Carolina
| | - Kasper Emerek
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Claus Graff
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Peter L Sørensen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Steen M Hansen
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Bjorn Wieslander
- Department of Clinical Physiology, Karolinska Institute, and Karolinska University Hospital, Stockholm, Sweden
| | - Martin Ugander
- Department of Clinical Physiology, Karolinska Institute, and Karolinska University Hospital, Stockholm, Sweden
| | - Peter Søgaard
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Brett D Atwater
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
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8
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Sengupta PP, Kramer CM, Narula J, Dilsizian V. The Potential of Clinical Phenotyping of Heart Failure With Imaging Biomarkers for Guiding Therapies: A Focused Update. JACC Cardiovasc Imaging 2018; 10:1056-1071. [PMID: 28882290 DOI: 10.1016/j.jcmg.2017.07.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 06/28/2017] [Accepted: 07/05/2017] [Indexed: 02/07/2023]
Abstract
The need for noninvasive assessment of cardiac volumes and ejection fraction (EF) ushered in the use of cardiac imaging techniques in heart failure (HF) trials that investigated the roles of pharmacological and device-based therapies. However, in contrast to HF with reduced EF (HFrEF), modern HF pharmacotherapy has not improved outcomes in HF with preserved EF (HFpEF), largely attributed to patient heterogeneity and incomplete understanding of pathophysiological insights underlying the clinical presentations of HFpEF. Modern cardiac imaging methods offer insights into many sets of changes in cardiac tissue structure and function that can precisely link cause with cardiac remodeling at organ and tissue levels to clinical presentations in HF. This has inspired investigators to seek a more comprehensive understanding of HF presentations using imaging techniques. This article summarizes the available evidence regarding the role of cardiac imaging in HF. Furthermore, we discuss the value of cardiac imaging techniques in identifying HF patient subtypes who share similar causes and mechanistic pathways that can be targeted using specific HF therapies.
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Affiliation(s)
- Partho P Sengupta
- Section of Cardiology, West Virginia University Heart and Vascular Institute, West Virginia University, Morgantown, West Virginia.
| | - Christopher M Kramer
- Departments of Medicine and Radiology and Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, Virginia
| | - Jagat Narula
- Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
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9
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Zhang B, Guo J, Zhang G. Comparison of triple-site ventricular pacing versus conventional cardiac resynchronization therapy in patients with systolic heart failure: A meta-analysis of randomized and observational studies. J Arrhythm 2018; 34:55-64. [PMID: 29721114 PMCID: PMC5828262 DOI: 10.1002/joa3.12018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 11/08/2017] [Indexed: 12/03/2022] Open
Abstract
Background Conventional cardiac resynchronization therapy (CRT, Bi‐V) is associated with no response in about 40% patients due to an insufficient resynchronization. Some studies showed triple‐site ventricular (Tri‐V) pacing had greater benefits compared with Bi‐V pacing, but the results of these studies were conflicting. We hypothesized that Tri‐V pacing had greater benefits on long‐term outcomes compared with Bi‐V pacing in patients with heart failure. Methods PubMed, EMBASE, and the Cochrane Library were searched for clinical studies with related outcomes. Weighted mean differences (WMD) and 95% confidence intervals (CIs) were calculated to compare the change in left ventricular ejection fraction (LVEF), left ventricular geometry, functional capacity, and quality of life between Tri‐V pacing group and control group. Results Five trials with 251 patients were included in the analysis. Patients in the Tri‐V pacing group had a greater improvement in LVEF (WMD 4.04; 95% CI 2.15‐5.92, P < .001) and NYHA classes (WMD −0.27; 95% CI −0.42 to −0.11, P = .001) compared with control group. However, there were no significant differences in left ventricular geometry, six‐min walk distance, or Minnesota Living With Heart Failure Questionnaire score between the two groups. The subgroup analyses showed there might be a greater improvement in LVEF in the Tri‐V pacing group in patients with QRS duration ≥ 155 ms (WMD 5.60; 95% CI 3.09‐8.10, P < .001). Conclusions The present analysis suggests that Tri‐V pacing has greater benefits in terms of an improvement in LVEF and functional capacity in patients with systolic heart failure, especially in patients with the duration of QRS ≥ 155 ms.
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Affiliation(s)
- Baowei Zhang
- Department of Cardiology The affiliated People's Hospital of Jiangsu University Zhenjiang China
| | - Junfang Guo
- Department of Cardiology The affiliated People's Hospital of Jiangsu University Zhenjiang China
| | - Guohui Zhang
- Department of Cardiology The affiliated People's Hospital of Jiangsu University Zhenjiang China
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10
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Lee AWC, Costa CM, Strocchi M, Rinaldi CA, Niederer SA. Computational Modeling for Cardiac Resynchronization Therapy. J Cardiovasc Transl Res 2018; 11:92-108. [PMID: 29327314 PMCID: PMC5908824 DOI: 10.1007/s12265-017-9779-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 12/18/2017] [Indexed: 11/21/2022]
Abstract
Cardiac resynchronization therapy (CRT) is an effective treatment for heart failure (HF) patients with an electrical substrate pathology causing ventricular dyssynchrony. However 40-50% of patients do not respond to treatment. Cardiac modeling of the electrophysiology, electromechanics, and hemodynamics of the heart has been used to study mechanisms behind HF pathology and CRT response. Recently, multi-scale dyssynchronous HF models have been used to study optimal device settings and optimal lead locations, investigate the underlying cardiac pathophysiology, as well as investigate emerging technologies proposed to treat cardiac dyssynchrony. However the breadth of patient and experimental data required to create and parameterize these models and the computational resources required currently limits the use of these models to small patient numbers. In the future, once these technical challenges are overcome, biophysically based models of the heart have the potential to become a clinical tool to aid in the diagnosis and treatment of HF.
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Affiliation(s)
- Angela W C Lee
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
| | | | - Marina Strocchi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | | | - Steven A Niederer
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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11
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Mihos CG, Yucel E, Capoulade R, Orencole MP, Upadhyay GA, Santana O, Singh JP, Picard MH. Effects of cardiac resynchronization therapy after inferior myocardial infarction on secondary mitral regurgitation and mitral valve geometry. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:114-121. [DOI: 10.1111/pace.13255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 11/06/2017] [Accepted: 11/28/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Christos G. Mihos
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital; Harvard Medical School; Boston MA USA
- Echocardiography Laboratory, Columbia University Division of Cardiology; Mount Sinai Heart Institute; Miami Beach FL USA
| | - Evin Yucel
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital; Harvard Medical School; Boston MA USA
| | - Romain Capoulade
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital; Harvard Medical School; Boston MA USA
| | - Mary P. Orencole
- Cardiac Arrhythmia Service, Massachusetts General Hospital; Harvard Medical School; Boston MA USA
| | | | - Orlando Santana
- Echocardiography Laboratory, Columbia University Division of Cardiology; Mount Sinai Heart Institute; Miami Beach FL USA
| | - Jagmeet P. Singh
- Cardiac Arrhythmia Service, Massachusetts General Hospital; Harvard Medical School; Boston MA USA
| | - Michael H. Picard
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital; Harvard Medical School; Boston MA USA
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12
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Adam RD, Shambrook J, Flett AS. The Prognostic Role of Tissue Characterisation using Cardiovascular Magnetic Resonance in Heart Failure. Card Fail Rev 2017; 3:86-96. [PMID: 29387459 DOI: 10.15420/cfr.2017:19:1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Despite significant advances in heart failure diagnostics and therapy, the prognosis remains poor, with one in three dying within a year of hospital admission. This is at least in part due to the difficulties in risk stratification and personalisation of therapy. The use of left ventricular systolic function as the main arbiter for entrance into clinical trials for drugs and advanced therapy, such as implantable defibrillators, grossly simplifies the complex heterogeneous nature of the syndrome. Cardiovascular magnetic resonance offers a wealth of data to aid in diagnosis and prognostication. The advent of novel cardiovascular magnetic resonance mapping techniques allows us to glimpse some of the pathophysiological mechanisms underpinning heart failure. We review the growing prognostic evidence base using these techniques.
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Affiliation(s)
- Robert D Adam
- Department of Cardiology, University Hospital Southampton,Southampton, UK
| | - James Shambrook
- Department of Cardiology, University Hospital Southampton,Southampton, UK
| | - Andrew S Flett
- Department of Cardiology, University Hospital Southampton,Southampton, UK
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