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Doğan Z, Erden EÇ, Erden İ, Bektaşoğlu G. Assessment of subtle cardiac dysfunction induced by premature ventricular contraction using two-dimensional strain echocardiography and the effects of successful ablation. Rev Port Cardiol 2024; 43:25-32. [PMID: 37473913 DOI: 10.1016/j.repc.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/30/2023] [Accepted: 04/25/2023] [Indexed: 07/22/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES We aimed to assess the effects of successful ablation on impaired left ventricular global longitudinal strain (LV-GLS) in patients with frequent premature ventricular contractions (PVCs). We also evaluated the potential risk factors of impaired LV-GLS. METHODS Thirty-six consecutive patients without any structural heart disease, who were treated with radiofrequency (RF) ablation due to frequent PVCs, were included in the study. All patients were evaluated with standard transthoracic and two-dimensional speckle tracking echocardiography. RESULTS Mean LV-GLS before ablation was 17.3±3.7 and 20.5±2.6 after ablation; the difference was statistically significant (p<0.01). Patients were categorized into two groups: those with LV-GLS value >-16% and those ≤16%. Low PVC E flow/post-PVC E flow and PVC SV/post-PVC SV ratios were associated with impaired LV-GLS. CONCLUSION In symptomatic patients with frequent PVCs and normal left ventricular ejection fraction, we observed significant improvement in LV-GLS value following successful RF ablation. Patients with impaired LV-GLS more often display non-ejecting PVCs and post-extrasystolic potentiation (PEP) compared to patients with normal LV-GLS.
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Affiliation(s)
- Zeki Doğan
- Department of Cardiology, Atlas University Medical Faculty Medicine Hospital, Istanbul, Turkey
| | - Emine Çakcak Erden
- Department of Cardiology, Atlas University Medical Faculty Medicine Hospital, Istanbul, Turkey
| | - İsmail Erden
- Department of Cardiology, Atlas University Medical Faculty Medicine Hospital, Istanbul, Turkey.
| | - Gökhan Bektaşoğlu
- Department of Cardiology, Atlas University Medical Faculty Medicine Hospital, Istanbul, Turkey
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Zhu Z, Gao Z, Chen B, Hall DD, Minerath R, Koval O, Sierra A, Subbotina E, Zhu X, Kim YR, Yang J, Grumbach I, Irani K, Grueter C, Song LS, Hodgson-Zingman DM, Zingman LV. Atrial-paced, exercise-similar heart rate envelope induces myocardial protection from ischaemic injury. Europace 2022; 24:1025-1035. [PMID: 34792112 PMCID: PMC9282913 DOI: 10.1093/europace/euab273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 10/19/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS The study investigates the role and mechanisms of clinically translatable exercise heart rate (HR) envelope effects, without dyssynchrony, on myocardial ischaemia tolerance compared to standard preconditioning methods. Since the magnitude and duration of exercise HR acceleration are tightly correlated with beneficial cardiac outcomes, it is hypothesized that a paced exercise-similar HR envelope, delivered in a maximally physiologic way that avoids the toxic effects of chamber dyssynchrony, may be more than simply a readout, but rather also a significant trigger of myocardial conditioning and stress resistance. METHODS AND RESULTS For 8 days over 2 weeks, sedated mice were atrial-paced once daily via an oesophageal electrode to deliver an exercise-similar HR pattern with preserved atrioventricular and interventricular synchrony. Effects on cardiac calcium handling, protein expression/modification, and tolerance to ischaemia-reperfusion (IR) injury were assessed and compared to those in sham-paced mice and to the effects of exercise and ischaemic preconditioning (IPC). The paced cohort displayed improved myocardial IR injury tolerance vs. sham controls with an effect size similar to that afforded by treadmill exercise or IPC. Hearts from paced mice displayed changes in Ca2+ handling, coupled with changes in phosphorylation of calcium/calmodulin protein kinase II, phospholamban and ryanodine receptor channel, and transcriptional remodelling associated with a cardioprotective paradigm. CONCLUSIONS The HR pattern of exercise, delivered by atrial pacing that preserves intracardiac synchrony, induces cardiac conditioning and enhances ischaemic stress resistance. This identifies the HR pattern as a signal for conditioning and suggests the potential to repurpose atrial pacing for cardioprotection.
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Affiliation(s)
- Zhiyong Zhu
- Department of Medicine, University of Iowa, 200 Hawkins Drive, CBRB 2270B, Iowa City, IA 52242, USA
- Department of Medicine, Veterans Affairs Medical Center, 601 Hwy 6 West, Iowa City, IA 52246, USA
| | - Zhan Gao
- Department of Medicine, University of Iowa, 200 Hawkins Drive, CBRB 2270B, Iowa City, IA 52242, USA
| | - Biyi Chen
- Department of Medicine, University of Iowa, 200 Hawkins Drive, CBRB 2270B, Iowa City, IA 52242, USA
| | - Duane D Hall
- Department of Medicine, University of Iowa, 200 Hawkins Drive, CBRB 2270B, Iowa City, IA 52242, USA
| | - Rachel Minerath
- Department of Medicine, University of Iowa, 200 Hawkins Drive, CBRB 2270B, Iowa City, IA 52242, USA
| | - Olha Koval
- Department of Medicine, University of Iowa, 200 Hawkins Drive, CBRB 2270B, Iowa City, IA 52242, USA
| | - Ana Sierra
- Department of Medicine, University of Iowa, 200 Hawkins Drive, CBRB 2270B, Iowa City, IA 52242, USA
| | - Ekaterina Subbotina
- Department of Medicine, University of Iowa, 200 Hawkins Drive, CBRB 2270B, Iowa City, IA 52242, USA
| | - Xiaoyi Zhu
- Department of Medicine, University of Iowa, 200 Hawkins Drive, CBRB 2270B, Iowa City, IA 52242, USA
| | - Young Rae Kim
- Department of Medicine, University of Iowa, 200 Hawkins Drive, CBRB 2270B, Iowa City, IA 52242, USA
| | - Jun Yang
- Department of Medicine, University of Iowa, 200 Hawkins Drive, CBRB 2270B, Iowa City, IA 52242, USA
| | - Isabella Grumbach
- Department of Medicine, University of Iowa, 200 Hawkins Drive, CBRB 2270B, Iowa City, IA 52242, USA
| | - Kaikobad Irani
- Department of Medicine, University of Iowa, 200 Hawkins Drive, CBRB 2270B, Iowa City, IA 52242, USA
| | - Chad Grueter
- Department of Medicine, University of Iowa, 200 Hawkins Drive, CBRB 2270B, Iowa City, IA 52242, USA
| | - Long Sheng Song
- Department of Medicine, University of Iowa, 200 Hawkins Drive, CBRB 2270B, Iowa City, IA 52242, USA
| | - Denice M Hodgson-Zingman
- Department of Medicine, University of Iowa, 200 Hawkins Drive, CBRB 2270B, Iowa City, IA 52242, USA
| | - Leonid V Zingman
- Department of Medicine, University of Iowa, 200 Hawkins Drive, CBRB 2270B, Iowa City, IA 52242, USA
- Department of Medicine, Veterans Affairs Medical Center, 601 Hwy 6 West, Iowa City, IA 52246, USA
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Cooper BL, Gloschat C, Swift LM, Prudencio T, McCullough D, Jaimes R, Posnack NG. KairoSight: Open-Source Software for the Analysis of Cardiac Optical Data Collected From Multiple Species. Front Physiol 2021; 12:752940. [PMID: 34777017 PMCID: PMC8586513 DOI: 10.3389/fphys.2021.752940] [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] [Received: 08/03/2021] [Accepted: 09/27/2021] [Indexed: 01/09/2023] Open
Abstract
Cardiac optical mapping, also known as optocardiography, employs parameter-sensitive fluorescence dye(s) to image cardiac tissue and resolve the electrical and calcium oscillations that underly cardiac function. This technique is increasingly being used in conjunction with, or even as a replacement for, traditional electrocardiography. Over the last several decades, optical mapping has matured into a “gold standard” for cardiac research applications, yet the analysis of optical signals can be challenging. Despite the refinement of software tools and algorithms, significant programming expertise is often required to analyze large optical data sets, and data analysis can be laborious and time-consuming. To address this challenge, we developed an accessible, open-source software script that is untethered from any subscription-based programming language. The described software, written in python, is aptly named “KairoSight” in reference to the Greek word for “opportune time” (Kairos) and the ability to “see” voltage and calcium signals acquired from cardiac tissue. To demonstrate analysis features and highlight species differences, we employed experimental datasets collected from mammalian hearts (Langendorff-perfused rat, guinea pig, and swine) dyed with RH237 (transmembrane voltage) and Rhod-2, AM (intracellular calcium), as well as human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CM) dyed with FluoVolt (membrane potential), and Fluo-4, AM (calcium indicator). We also demonstrate cardiac responsiveness to ryanodine (ryanodine receptor modulator) and isoproterenol (beta-adrenergic agonist) and highlight regional differences after an ablation injury. KairoSight can be employed by both basic and clinical scientists to analyze complex cardiac optical mapping datasets without requiring dedicated computer science expertise or proprietary software.
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Affiliation(s)
- Blake L Cooper
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, United States.,Children's National Heart Institute, Children's National Hospital, Washington, DC, United States.,Department of Pharmacology and Physiology, George Washington University, Washington, DC, United States
| | - Chris Gloschat
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, United States.,Children's National Heart Institute, Children's National Hospital, Washington, DC, United States
| | - Luther M Swift
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, United States.,Children's National Heart Institute, Children's National Hospital, Washington, DC, United States
| | - Tomas Prudencio
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, United States.,Children's National Heart Institute, Children's National Hospital, Washington, DC, United States
| | - Damon McCullough
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, United States.,Children's National Heart Institute, Children's National Hospital, Washington, DC, United States
| | - Rafael Jaimes
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, United States.,Children's National Heart Institute, Children's National Hospital, Washington, DC, United States
| | - Nikki G Posnack
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, United States.,Children's National Heart Institute, Children's National Hospital, Washington, DC, United States.,Department of Pharmacology and Physiology, George Washington University, Washington, DC, United States.,Department of Pediatrics, George Washington University, Washington, DC, United States
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Role of Two-Dimensional Speckle-Tracking Echocardiography in Early Detection of Left Ventricular Dysfunction in Dogs. Animals (Basel) 2021; 11:ani11082361. [PMID: 34438818 PMCID: PMC8388726 DOI: 10.3390/ani11082361] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/24/2021] [Accepted: 08/07/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary Two-dimensional speckle-tracking echocardiography represents an advanced imaging technique that allows the analysis of global and regional myocardial function, cardiac rotation and synchronicity using deformation imaging. It has gained growing importance over the last decade, especially in human medicine as a method of evaluating myocardial function. This review aims to give an overview of the current understanding of this technique and its clinical applicability in the field of veterinary medicine with a focus on early detection of left ventricular dysfunction in dogs. Abstract Two-dimensional speckle-tracking echocardiography (2D–STE) is an advanced echocardiographic technique based on deformation imaging that allows comprehensive evaluation of the myocardial function. Clinical application of 2D–STE holds great potential for its ability to provide valuable information on both global and regional myocardial function and to quantify cardiac rotation and synchronicity, which are not readily possible with the conventional echocardiography. It has gained growing importance over the past decade, especially in human medicine, and its application includes assessment of myocardial function, detection of subclinical myocardial dysfunction and serving as a prognostic indicator. This review illustrates the fundamental concepts of deformation analysis and gives an overview of the current understanding and its clinical application of this technique in veterinary medicine, with a focus on early detection of left ventricular (LV) dysfunction in dogs.
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Norby FL, Alonso A, Rooney MR, Maheshwari A, Koene RJ, Zhang M, Soliman EZ, Loehr LR, Mosley T, Gottesman RF, Coresh J, Chen LY. Association of Ventricular Arrhythmias With Dementia: The Atherosclerosis Risk in Communities (ARIC) Study. Neurology 2020; 96:e926-e936. [PMID: 33106393 DOI: 10.1212/wnl.0000000000011122] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 10/12/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE We performed a cross-sectional analysis to determine whether nonsustained ventricular tachycardia (NSVT) and premature ventricular contractions (PVCs) were associated with dementia in a population-based study. METHODS We included 2,517 (mean age 79 years, 26% Black) participants who wore a 2-week ambulatory continuous ECG recording device in 2016 to 2017. NSVT was defined as a wide-complex tachycardia ≥4 beats with a rate >100 bpm. We calculated NSVT and PVC burden as the number of episodes per day. Dementia was adjudicated by experts. We used logistic regression to assess the associations of NSVT and PVCs with dementia. RESULTS The mean recording time of the Zio XT Patch was 12.6 ± 2.6 days. There were 768 (31%) participants with NSVT; prevalence was similar in White and Black participants. There were 134 (6.5%) dementia cases (5% in White, 10% in Black participants). After multivariable adjustment, there was no overall association between NSVT and dementia; however, there was a significant race interaction (p < 0.001). In Black participants, NSVT was associated with a 3.67 times higher adjusted odds of dementia (95% confidence interval [CI] 1.92-7.02) compared to those without NSVT, whereas in White participants NSVT was not associated with dementia (odds ratio [95% CI] 0.64 [0.37-1.10]). In Black participants only, a higher burden of PVCs was associated with dementia. CONCLUSIONS Presence of NSVT and a higher burden of NSVT and PVCs are associated with dementia in elderly Black people. Further research to confirm this novel finding and to elucidate the underlying mechanisms is warranted.
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Affiliation(s)
- Faye L Norby
- From the Division of Epidemiology and Community Health (F.L.N.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Epidemiology (M.R.R., J.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Penn State Heart and Vascular Institute (A.M.), Penn State College of Medicine, Hershey, PA; Aultman Medical Group (R.J.K.), Aultman Hospital, Canton, OH; Cardiac Arrhythmia Center (M.Z., L.Y.C.), Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis; Department of Epidemiology (E.Z.S.), Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (L.R.L.), School of Medicine, University of North Carolina at Chapel Hill; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Departments of Neurology and Epidemiology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Alvaro Alonso
- From the Division of Epidemiology and Community Health (F.L.N.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Epidemiology (M.R.R., J.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Penn State Heart and Vascular Institute (A.M.), Penn State College of Medicine, Hershey, PA; Aultman Medical Group (R.J.K.), Aultman Hospital, Canton, OH; Cardiac Arrhythmia Center (M.Z., L.Y.C.), Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis; Department of Epidemiology (E.Z.S.), Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (L.R.L.), School of Medicine, University of North Carolina at Chapel Hill; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Departments of Neurology and Epidemiology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Mary R Rooney
- From the Division of Epidemiology and Community Health (F.L.N.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Epidemiology (M.R.R., J.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Penn State Heart and Vascular Institute (A.M.), Penn State College of Medicine, Hershey, PA; Aultman Medical Group (R.J.K.), Aultman Hospital, Canton, OH; Cardiac Arrhythmia Center (M.Z., L.Y.C.), Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis; Department of Epidemiology (E.Z.S.), Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (L.R.L.), School of Medicine, University of North Carolina at Chapel Hill; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Departments of Neurology and Epidemiology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Ankit Maheshwari
- From the Division of Epidemiology and Community Health (F.L.N.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Epidemiology (M.R.R., J.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Penn State Heart and Vascular Institute (A.M.), Penn State College of Medicine, Hershey, PA; Aultman Medical Group (R.J.K.), Aultman Hospital, Canton, OH; Cardiac Arrhythmia Center (M.Z., L.Y.C.), Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis; Department of Epidemiology (E.Z.S.), Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (L.R.L.), School of Medicine, University of North Carolina at Chapel Hill; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Departments of Neurology and Epidemiology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Ryan J Koene
- From the Division of Epidemiology and Community Health (F.L.N.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Epidemiology (M.R.R., J.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Penn State Heart and Vascular Institute (A.M.), Penn State College of Medicine, Hershey, PA; Aultman Medical Group (R.J.K.), Aultman Hospital, Canton, OH; Cardiac Arrhythmia Center (M.Z., L.Y.C.), Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis; Department of Epidemiology (E.Z.S.), Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (L.R.L.), School of Medicine, University of North Carolina at Chapel Hill; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Departments of Neurology and Epidemiology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Michael Zhang
- From the Division of Epidemiology and Community Health (F.L.N.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Epidemiology (M.R.R., J.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Penn State Heart and Vascular Institute (A.M.), Penn State College of Medicine, Hershey, PA; Aultman Medical Group (R.J.K.), Aultman Hospital, Canton, OH; Cardiac Arrhythmia Center (M.Z., L.Y.C.), Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis; Department of Epidemiology (E.Z.S.), Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (L.R.L.), School of Medicine, University of North Carolina at Chapel Hill; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Departments of Neurology and Epidemiology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Elsayed Z Soliman
- From the Division of Epidemiology and Community Health (F.L.N.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Epidemiology (M.R.R., J.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Penn State Heart and Vascular Institute (A.M.), Penn State College of Medicine, Hershey, PA; Aultman Medical Group (R.J.K.), Aultman Hospital, Canton, OH; Cardiac Arrhythmia Center (M.Z., L.Y.C.), Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis; Department of Epidemiology (E.Z.S.), Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (L.R.L.), School of Medicine, University of North Carolina at Chapel Hill; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Departments of Neurology and Epidemiology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Laura R Loehr
- From the Division of Epidemiology and Community Health (F.L.N.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Epidemiology (M.R.R., J.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Penn State Heart and Vascular Institute (A.M.), Penn State College of Medicine, Hershey, PA; Aultman Medical Group (R.J.K.), Aultman Hospital, Canton, OH; Cardiac Arrhythmia Center (M.Z., L.Y.C.), Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis; Department of Epidemiology (E.Z.S.), Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (L.R.L.), School of Medicine, University of North Carolina at Chapel Hill; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Departments of Neurology and Epidemiology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Thomas Mosley
- From the Division of Epidemiology and Community Health (F.L.N.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Epidemiology (M.R.R., J.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Penn State Heart and Vascular Institute (A.M.), Penn State College of Medicine, Hershey, PA; Aultman Medical Group (R.J.K.), Aultman Hospital, Canton, OH; Cardiac Arrhythmia Center (M.Z., L.Y.C.), Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis; Department of Epidemiology (E.Z.S.), Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (L.R.L.), School of Medicine, University of North Carolina at Chapel Hill; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Departments of Neurology and Epidemiology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Rebecca F Gottesman
- From the Division of Epidemiology and Community Health (F.L.N.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Epidemiology (M.R.R., J.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Penn State Heart and Vascular Institute (A.M.), Penn State College of Medicine, Hershey, PA; Aultman Medical Group (R.J.K.), Aultman Hospital, Canton, OH; Cardiac Arrhythmia Center (M.Z., L.Y.C.), Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis; Department of Epidemiology (E.Z.S.), Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (L.R.L.), School of Medicine, University of North Carolina at Chapel Hill; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Departments of Neurology and Epidemiology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Josef Coresh
- From the Division of Epidemiology and Community Health (F.L.N.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Epidemiology (M.R.R., J.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Penn State Heart and Vascular Institute (A.M.), Penn State College of Medicine, Hershey, PA; Aultman Medical Group (R.J.K.), Aultman Hospital, Canton, OH; Cardiac Arrhythmia Center (M.Z., L.Y.C.), Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis; Department of Epidemiology (E.Z.S.), Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (L.R.L.), School of Medicine, University of North Carolina at Chapel Hill; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Departments of Neurology and Epidemiology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Lin Y Chen
- From the Division of Epidemiology and Community Health (F.L.N.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Epidemiology (M.R.R., J.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Penn State Heart and Vascular Institute (A.M.), Penn State College of Medicine, Hershey, PA; Aultman Medical Group (R.J.K.), Aultman Hospital, Canton, OH; Cardiac Arrhythmia Center (M.Z., L.Y.C.), Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis; Department of Epidemiology (E.Z.S.), Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (L.R.L.), School of Medicine, University of North Carolina at Chapel Hill; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Departments of Neurology and Epidemiology (R.F.G.), Johns Hopkins University, Baltimore, MD
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Mahfouz RA, Seaoud EA, Elbelbesy RA, Shehata IE. Resting Left Ventricular Dyssynchrony and Mechanical Reserve in Asymptomatic Normotensive Subjects with Early Type 2 Diabetes Mellitus. Pulse (Basel) 2020; 8:47-56. [PMID: 32999878 DOI: 10.1159/000506712] [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: 12/08/2019] [Accepted: 02/14/2020] [Indexed: 11/19/2022] Open
Abstract
Background Most diabetic patients have silent ischemia and cardiac dysfunction that is usually observed in the late phase of the disease when it becomes clinically obvious. We hypothesized that left ventricular dyssynchrony (LVdys) (or dispersion) is an early marker of myocardial involvement in asymptomatic early type 2 diabetes mellitus (T2DM) patients. Therefore, we aimed to detect early markers of myocardial dysfunction in early T2DM using LVdys and left ventricular mechanical reserve (LVMR). Methods We examined 91 consecutive subjects with early T2DM with speckle tracking imaging to evaluate LVdys and with dobutamine stress to evaluate LVMR (defined as left ventricular mechanical reserve global longitudinal strain [LVMRGLS] ≥2%). Our patients were divided into two groups according to LVdys: group 1 with LVdys (n = 49), and group 2 without LVdys (n = 42). Results We found that 49 (54%) subjects in our cohort had resting LVdys (standard deviation of tissue synchronization of the 12 left ventricular segments [Ts-SD-12] ≥34.2 ms). GLS and strain rate were comparable at rest between patients with and without LVdys. On the other hand, LVMR was blunted in those with LVdys (p < 0.001). We found that HbA1c, high-sensitivity C-reactive protein, and left atrial volume index were inversely correlated with LVMR. Multivariate analysis showed that LVdys was the strongest predictor (p < 0.001) of blunted LVMR. Using receiver operating characteristic curve analysis, we found that a Ts-SD-12 ≥36.5 ms was the best cutoff value to predict blunted LVMR (area under the curve = 0.89, p < 0.001). Conclusion The LVdys (Ts-SD-12) cutoff ≥36.5 ms was the optimal value for prediction of impaired LVMR and might be an early marker of subclinical cardiac dysfunction and risk stratification of subjects with asymptomatic early T2DM with preserved left ventricular ejection fraction.
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Affiliation(s)
- Ragab A Mahfouz
- Department of Cardiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Elshaimaa A Seaoud
- Department of Cardiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Radwa A Elbelbesy
- Department of Cardiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Islam E Shehata
- Department of Cardiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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7
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Koester C, Ibrahim AM, Cancel M, Labedi MR. The Ubiquitous Premature Ventricular Complex. Cureus 2020; 12:e6585. [PMID: 32051798 PMCID: PMC7001138 DOI: 10.7759/cureus.6585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 01/06/2020] [Indexed: 12/17/2022] Open
Abstract
Premature ventricular complexes (PVCs) are one of the most commonly encountered arrhythmias and are ubiquitous in clinical practice, both in the outpatient and inpatient settings. They are often discovered incidentally in asymptomatic patients, however, can cause myriad symptoms acutely and chronically. Long thought to be completely benign, PVCs have been historically disregarded without pursuing any further evaluation. Newer data have revealed that a high burden of PVCs with specific characteristics can significantly increase a patient's risk of developing PVC-induced cardiomyopathy. The aim of this literature review is to provide further clarification on the identification of high-risk PVCs, subsequent workup, and the currently available treatment options. PVCs arise from an ectopic focus within the ventricles. Patients with PVCs can be either asymptomatic or have severe disabling symptoms. The diagnostic workup for PVCs includes electrocardiogram (ECG) and 24-h Holter monitor to assess the QRS morphology and its frequency. A transthoracic echocardiogram (TTE) is done to look for structural heart disease and cardiomyopathy. Management of PVCs should be focused on identifying and treating the underlying causes, such as electrolyte abnormalities, substance use, and underlying structural heart disease. Beta-blockers are first-line therapy for symptomatic PVCs. Nondihydropyridine calcium channel blockers, classic antiarrhythmic agents, and amiodarone can be considered as second-line agents. Patients who are unable to tolerate medical therapy should undergo catheter ablation of the PVC focus to prevent PVC-induced cardiomyopathy. PVCs are common in clinical practice, and it is vital to identify patients at higher risk for PVC-induced cardiomyopathy to facilitate early intervention. Patients with no evidence of structural heart disease and infrequent PVCs should be monitored closely, while those who are symptomatic should be treated medically. For those who have failed medical therapy, catheter ablation of the PVCs focus is recommended. Catheter ablation has been shown to reduce PVCs burden and improve left ventricular ejection fraction (LVEF) in those with PVC-induced cardiomyopathy.
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Affiliation(s)
- Cameron Koester
- Internal Medicine, Southern Illinois University School of Medicine, Springfield, USA
| | - Abdisamad M Ibrahim
- Internal Medicine, Southern Illinois University School of Medicine, Springfield, USA
| | - Michelle Cancel
- Internal Medicine, Southern Illinois University School of Medicine, Springfield, USA
| | - Mohamed R Labedi
- Internal Medicine: Cardiology, Southern Illinois University School of Medicine, Springfield, USA
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8
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Singh JP, Solomon SD, Fradley MG, Barac A, Kremer KA, Beck CA, Brown MW, McNitt S, Schleede S, Zareba W, Goldenberg I, Kutyifa V. Association of Cardiac Resynchronization Therapy With Change in Left Ventricular Ejection Fraction in Patients With Chemotherapy-Induced Cardiomyopathy. JAMA 2019; 322:1799-1805. [PMID: 31714987 PMCID: PMC6865289 DOI: 10.1001/jama.2019.16658] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
IMPORTANCE The incidence of chemotherapy-induced cardiomyopathy is increasing and is associated with poor clinical outcomes. OBJECTIVE To assess the association of cardiac resynchronization therapy (CRT) with improvement in cardiac function, as well as clinical improvement in patients with chemotherapy-induced cardiomyopathy. DESIGN, SETTING, AND PARTICIPANTS The Multicenter Automatic Defibrillator Implantation Trial-Chemotherapy-Induced Cardiomyopathy was an uncontrolled, prospective, cohort study conducted between November 21, 2014, and June 21, 2018, at 12 tertiary centers with cardio-oncology programs in the United States. Thirty patients were implanted with CRT owing to reduced left ventricular ejection fraction (LVEF≤35%), New York Heart Association class II-IV heart failure symptoms, and wide QRS complex, with established chemotherapy-induced cardiomyopathy and were followed up for 6 months after CRT implantation. The date of final follow-up was February 6, 2019. EXPOSURES CRT implantation according to standard of care. MAIN OUTCOMES AND MEASURES The primary end point was change in LVEF from baseline to 6 months after initiating CRT. Secondary outcomes included all-cause mortality and change in left ventricular end-systolic volume and end-diastolic volume. RESULTS Among 30 patients who were enrolled (mean [SD] age, 64 [11] years; 26 women [87%]; 73% had a history of breast cancer; 20% had a history of lymphoma or leukemia), primary end point data were available for 26 patients and secondary end point data were available for 23 patients. Patients had nonischemic cardiomyopathy with left bundle branch block, median LVEF of 29%, and a mean QRS duration of 152 ms. Patients with CRT experienced a statistically significant improvement in mean LVEF at 6 months from 28% to 39% (difference, 10.6% [95% CI, 8.0%-13.3%]; P < .001). This was accompanied by a reduction in LV end-systolic volume from 122.7 to 89.0 mL (difference, 37.0 mL [95% CI, 28.2-45.8]) and reduction in LV end-diastolic volume from 171.0 to 143.2 mL (difference, 31.9 mL [95% CI, 22.1-41.6]) (both P < .001). Adverse events included a procedure-related pneumothorax (1 patient), a device pocket infection (1 patient), and heart failure requiring hospitalization during follow-up (1 patient). CONCLUSIONS AND RELEVANCE In this preliminary study of patients with chemotherapy-induced cardiomyopathy, CRT was associated with improvement in LVEF after 6 months. The findings are limited by the small sample size, short follow-up, and absence of a control group. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02164721.
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Affiliation(s)
| | | | | | - Ana Barac
- MedStar Washington Hospital Center & MedStar Heart and Vascular Institute, Washington, DC
| | - Kristina A. Kremer
- Clinical Cardiovascular Research Center, Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Christopher A. Beck
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York
| | - Mary W. Brown
- Clinical Cardiovascular Research Center, Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Scott McNitt
- Clinical Cardiovascular Research Center, Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Susan Schleede
- Clinical Cardiovascular Research Center, Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Wojciech Zareba
- Clinical Cardiovascular Research Center, Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Ilan Goldenberg
- Clinical Cardiovascular Research Center, Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Valentina Kutyifa
- Clinical Cardiovascular Research Center, Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, New York
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Al Saikhan L, Park C, Hughes AD. Reproducibility of Left Ventricular Dyssynchrony Indices by Three-Dimensional Speckle-Tracking Echocardiography: The Impact of Sub-optimal Image Quality. Front Cardiovasc Med 2019; 6:149. [PMID: 31649937 PMCID: PMC6795682 DOI: 10.3389/fcvm.2019.00149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 09/26/2019] [Indexed: 11/13/2022] Open
Abstract
Background: 3D speckle-tracking echocardiography (3D-STE) is a novel method to quantify left ventricular (LV) mechanical dyssynchrony. 3D-STE is influenced by image quality, but studies on the magnitude of its effect on 3D-STE derived LV systolic dyssynchrony indices (SDIs) and their test-retest reproducibility are limited. Methods: 3D-STE was performed in two groups, each comprising 18 healthy volunteers with good echocardiographic windows. In study 1, optimal and inferior-quality images, by intentionally poor echocardiographic technique, were acquired. In study 2, sub-optimal quality images were acquired by impairing ultrasound propagation using neoprene rubber sheets (thickness 2, 3, and 4 mm) mimicking mildly, moderately, and severely impaired images, respectively. Measures (normalized to cardiac cycle duration) were volume- and strain-based SDIs defined as the standard deviation of time to minimum segmental values, and volume- and strain-derived dispersion indices. For both studies test-retest reproducibility was assessed. Results: Test-retest reproducibility was better for most indices when restricting the analysis to good quality images; nevertheless, only volume-, circumferential strain-, and principal tangential strain-derived LV dyssynchrony indices achieved fair to good reliability. There was no evidence of systematic bias due to sub-optimal quality image. Volume-, circumferential strain-, and principal tangential strain-derived SDIs correlated closely. Radial strain- and longitudinal strain-SDI correlated moderately or weakly with volume-SDI, respectively. Conclusions: Sub-optimal image quality compromised the reliability of 3D-STE derived dyssynchrony indices but did not introduce systematic bias in healthy individuals. Even with optimal quality images, only 3D-STE indices based on volume, circumferential strain and principal tangential strain showed acceptable test-retest reliability.
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Affiliation(s)
- Lamia Al Saikhan
- Department of Cardiac Technology, College of Applied Medial Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Chloe Park
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science and Experimental Medicine, UCL Institute of Cardiovascular Science, London, United Kingdom
| | - Alun D. Hughes
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science and Experimental Medicine, UCL Institute of Cardiovascular Science, London, United Kingdom
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Thomas E, Toth D, Kurzendorfer T, Rhode K, Mountney P. Mechanical Activation Computation from Fluoroscopy for Guided Cardiac Resynchronization Therapy. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:592-595. [PMID: 30440466 DOI: 10.1109/embc.2018.8512434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Congestive heart failure is associated with significant morbidity and mortality, as first line treatments are not always effective in improving symptoms and quality of life. Furthermore, 30-50% of patients who are treated with cardiac resynchronization therapy (CRT), a minimally invasive intervention, do not respond when assessed by objective criteria such as cardiac remodeling. Positioning of the left ventricular lead in the latest activating myocardial region is associated with the best outcome. Cardiac magnetic resonance (CMR) imaging can detect scar tissue and interventricular dyssynchrony; improving the outcome of CRT. However, MR is currently not standard modality for CRT due to its cost and limited availability. This paper explores a novel method to exploit interventional X-ray fluoroscopy set up in CRT procedures to gain information on mechanical activation of the myocardium by tracking the movement of vessels overlying to left ventricular myocardium. Fluoroscopic images were labelled, to track branch movement and determine the motion along the main principal component associated with cardiac motion, to optimize lead placement in CRT. A comparison between MR- and fluoroscopy-derived mechanical activation was performed on 9 datasets, showing more than 66% agreement in 8 cases.
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11
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Wang J, Nie Z, Chen H, Shu X, Yang Z, Yao R, Su Y, Ge J. Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing. J Vis Exp 2017. [PMID: 29286395 DOI: 10.3791/56439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
It is now well recognized that heart failure (HF) patients with left bundle branch block (LBBB) derive substantial clinical benefits from cardiac resynchronization therapy (CRT), and LBBB has become one of the important predictors for CRT response. The conventional tachypacing-induced HF model has several major limitations, including absence of stable LBBB and rapid reversal of left ventricular (LV) dysfunction after cessation of pacing. Hence, it is essential to establish an optimal model of chronic HF with isolated LBBB for studying CRT benefits. In the present study, a canine model of asynchronous HF induced by left bundle branch (LBB) ablation and 4 weeks of rapid right ventricular (RV) pacing is established. The RV and right atrial (RA) pacing electrodes via the jugular vein approach, together with an epicardial LV pacing electrode, were implanted for CRT performance. Presented here are the detailed protocols of radiofrequency (RF) catheter ablation, pacing leads implantation, and rapid pacing strategy. Intracardiac and surface electrograms during operation were also provided for a better understanding of LBB ablation. Two-dimensional speckle tracking imaging and aortic velocity time integral (aVTI) were acquired to validate the chronic stable HF model with LV asynchrony and CRT benefits. By coordinating ventricular activation and contraction, CRT uniformed the LV mechanical work and restored LV pump function, which was followed by reversal of LV dilation. Moreover, the histopathological study revealed a significant restoration of cardiomyocyte diameter and collagen volume fraction (CVF) after CRT performance, indicating a histologic and cellular reverse remodeling elicited by CRT. In this report, we described a feasible and valid method to develop a chronic asynchronous HF model, which was suitable for studying structural and biologic reverse remodeling following CRT.
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Affiliation(s)
- Jingfeng Wang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University
| | - Zhenning Nie
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University
| | - Haiyan Chen
- Department of Echocardiography, Shanghai Institute of Medical imaging, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University
| | - Xianhong Shu
- Department of Echocardiography, Shanghai Institute of Medical imaging, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University
| | - Zhaohua Yang
- Department of Cardiac surgery, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University
| | - Ruiming Yao
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University
| | - Yangang Su
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University;
| | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University
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12
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Ling Y, Wan Q, Chen Q, Zhu W. Assessment of subtle cardiac dysfunction in patients with frequent premature ventricular complexes by real-time three-dimensional speckle tracking echocardiography. Clin Cardiol 2017; 40:554-558. [PMID: 28471536 DOI: 10.1002/clc.22697] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 01/18/2017] [Accepted: 01/31/2017] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND To evaluate subtle and early premature ventricular complex (PVC)-induced ventricular impairment in patients with frequent PVCs and without structural heart disease by real-time 3-dimensional (3D) speckle tracking echocardiography (RT3D-STE). HYPOTHESIS Patients with frequent premature ventricular complexes with normal left ventricular ejection fraction have subtle left ventricular dysfunction. METHODS Forty patients (22 male) with a single source of frequent PVCs and 40 healthy controls (24 male) underwent assessment by conventional 2-dimensional (2D) echocardiography and RT3D-STE. Left ventricular ejection fraction (LVEF), and global longitudinal, circumferential, radial, and area strain (GLS, GCS, GRS, and GAS, respectively) and individual segment strain were calculated using off-line analysis software and compared between the 2 groups. RESULTS There were no significant differences in baseline clinical or 2D echocardiographic variables including LVEF between groups. However, all RT3D-STE assessed variables, including GLS, GCS, GRS, GAS, and individual segment strain, were significantly lower (P < 0.05) in the PVC group than the control group, and showed strong correlations, most prominently GCS (r = -0.84, P = 0.020), with LV function as assessed by LVEF. 3D-STE measurements showed good intraobserver, interobserver, and test-retest agreement. CONCLUSIONS In patients with frequent PVCs and normal LVEF, 3D -STE revealed lower global and regional strain values than in healthy controls. RT3D-STE is a novel, feasible and reproducible method to assess cardiac function and appears suitable to detect subtle left ventricular dysfunction.
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Affiliation(s)
- Yunlong Ling
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Quan Wan
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qingxing Chen
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wenqing Zhu
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
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13
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Abstract
Dyssynchronous contraction of the ventricle significantly worsens morbidity and mortality in patients with heart failure (HF). Approximately one-third of patients with HF have cardiac dyssynchrony and are candidates for cardiac resynchronization therapy (CRT). The initial understanding of dyssynchrony and CRT was in terms of global mechanics and hemodynamics, but lack of clinical benefit in a sizable subgroup of recipients who appear otherwise appropriate has challenged this paradigm. This article reviews current understanding of these cellular and subcellular mechanisms, arguing that these aspects are key to improving CRT use, as well as translating its benefits to a wider HF population.
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Affiliation(s)
- Jonathan A Kirk
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Ross Research Building, Room 858, 720 Rutland Avenue, Baltimore, MD 21205, USA.
| | - David A Kass
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Ross Research Building, Room 858, 720 Rutland Avenue, Baltimore, MD 21205, USA
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14
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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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15
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Recovery of renal dysfunction after catheter ablation of outflow tract ventricular arrhythmias in patients with ventricular premature depolarization-mediated cardiomyopathy. J Interv Card Electrophysiol 2016; 48:43-50. [DOI: 10.1007/s10840-016-0190-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 09/16/2016] [Indexed: 11/25/2022]
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16
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Luebbert J, Auberson D, Marchlinski F. Premature Ventricular Complexes in Apparently Normal Hearts. Card Electrophysiol Clin 2016; 8:503-514. [PMID: 27521085 DOI: 10.1016/j.ccep.2016.04.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Premature ventricular complexes (PVCs) are consistently associated with worse prognosis and higher morbidity and mortality. This article reviews PVCs and their presentation in patients with an apparently normal heart. Patients with PVCs may be completely asymptomatic, whereas others may note severely disabling symptoms. Cardiomyopathy may occur with frequent PVCs. Diagnostic work-up is directed at obtaining 12-lead ECG to characterize QRS morphology, Holter monitor to assess frequency, and echo and advanced imaging to assess for early cardiomyopathy and exclude structural heart disease. Options for management include watchful waiting, medical therapy, or catheter ablation. Malignant variants of PVCs may induce ventricular fibrillation even in a normal heart.
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Affiliation(s)
- Jeffrey Luebbert
- Department of Medicine, Pennsylvania Hospital, University of Pennsylvania Health System, 230 West Washington Square, Philadelphia, PA 19106, USA
| | - Denise Auberson
- Department of Medicine, Pennsylvania Hospital, University of Pennsylvania Health System, 230 West Washington Square, Philadelphia, PA 19106, USA
| | - Francis Marchlinski
- Perelman Center for Advanced Medicine, East Pavilion, 2nd Floor, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA.
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17
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Lin CY, Chang SL, Chung FP, Chen YY, Lin YJ, Lo LW, Hu YF, Tuan TC, Chao TF, Liao JN, Chang YT, Lin CH, Allamsetty S, Walia R, Te ALD, Yamada S, Chiang SJ, Tsao HM, Chen SA. Long-Term Outcome of Non-Sustained Ventricular Tachycardia in Structurally Normal Hearts. PLoS One 2016; 11:e0160181. [PMID: 27548469 PMCID: PMC4993359 DOI: 10.1371/journal.pone.0160181] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 07/14/2016] [Indexed: 01/09/2023] Open
Abstract
Background The impact of non-sustained ventricular tachycardia (NSVT) on the risk of thromboembolic event and clinical outcomes in patients without structural heart disease remains undetermined. This study aimed to evaluate the association between NSVT and clinical outcomes. Methods The study population of 5903 patients was culled from the “Registry of 24-hour ECG monitoring at Taipei Veterans General Hospital” (REMOTE database) between January 1, 2002 and December 31, 2004. Of that total, we enrolled 3767 patients without sustained ventricular tachycardia, structural heart disease, and permanent pacemaker. For purposes of this study, NSVT was defined as 3 or more consecutive beats arising below the atrioventricular node with an RR interval of <600 ms (>100 beats/min) and lasting < 30 seconds. Result There were 776 deaths, 2042 hospitalizations for any reason, 638 cardiovascular (CV)-related hospitalizations, 350 ischemic strokes, 409 transient ischemic accident (TIA), 368 new-onset heart failure (HF), and 260 new-onset atrial fibrillation (AF) with a mean follow-up duration of 10 ± 1 years. In multivariate analysis, the presence of NSVT was independently associated with death (hazard ratio [HR]: 1.362, 95% confidence interval [CI]: 1.071–1.731), CV hospitalization (HR: 1.527, 95% CI: 1.171–1.992), ischemic stroke (HR: 1.436, 95% CI: 1.014–2.032), TIA (HR 1.483, 95% CI: 1.069–2.057), and new-onset HF (HR: 1.716, 95% CI: 1.243–2.368). There was no significant association between the presence of NSVT and all-cause hospitalization or new-onset AF. Conclusion In patients without structural heart disease, presence of NSVT on 24-hour monitoring was independently associated with death, CV hospitalization, ischemic stroke, TIA, and new onset heart failure.
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Affiliation(s)
- Chin-Yu Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Shih-Lin Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Fa-Po Chung
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yun-Yu Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Epidemiology and Preventive Medicine College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Li-Wei Lo
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yu-Feng Hu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Ta-Chuan Tuan
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Jo-Nan Liao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yao-Ting Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Chung-Hsing Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Suresh Allamsetty
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Rohit Walia
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Abigail Louise D. Te
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shinya Yamada
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shuo-Ju Chiang
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsuan-Ming Tsao
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Division of Cardiology, National Yang-Ming University Hospital, Yi-Lan, Taiwan
- * E-mail:
| | - Shih-Ann Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
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18
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Hsu YL, Huang HP. Two-dimensional speckle-tracking echocardiographic assessment of left ventricular mechanical synchrony in clinically normal cats. VETERINARY MEDICINE-RESEARCH AND REPORTS 2016; 7:33-40. [PMID: 30050835 PMCID: PMC6042560 DOI: 10.2147/vmrr.s97634] [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] [Indexed: 11/23/2022]
Abstract
Ventricular heterogeneity and synchrony are associated with hypertrophic cardiomyopathy in humans. Hypertrophic cardiomyopathy is commonly observed in cats. The aim of this study was to determine the presence and normal range of left ventricular mechanical heterogeneity and synchrony in clinically healthy cats using two-dimensional speckle-tracking echocardiography. Thirty-four clinically healthy cats were included in this prospective study. Two-dimensional echocardiography and two-dimensional speckle-tracking echocardiography were performed on all cats. Echocardiographic parameters, including circumferential, radial, and longitudinal strain and strain rate, heterogeneity, and synchrony, were measured. Segmental heterogeneity values in the circumferential, radial, and longitudinal directions were 13.1%±5.9%, 19.1%±10.3%, and 15.4%±6.8%, respectively. Transmural heterogeneity was -14.3%±4.6% in the circumferential direction. Left ventricular synchrony values in the circumferential, radial, and longitudinal directions were 11.7±4.2, 16.5±13.4, and 19.4±8.5 ms, respectively. Inter-ventricular synchrony was -3.9±13.2 ms. Left ventricular heterogeneity and synchrony were noted in clinically healthy cats; segmental heterogeneity, which is characterized as longitudinal, progressively increased from the apical to the basal segments, while transmural heterogeneity, which is characterized as circumferential, progressively decreased from the endocardium to the epicardium.
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Affiliation(s)
- Yueh-Lun Hsu
- Institute of Veterinary Clinical Science, Veterinary School, National Taiwan University, Taipei, Taiwan,
| | - Hui-Pi Huang
- Institute of Veterinary Clinical Science, Veterinary School, National Taiwan University, Taipei, Taiwan,
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Entz M, George SA, Zeitz MJ, Raisch T, Smyth JW, Poelzing S. Heart Rate and Extracellular Sodium and Potassium Modulation of Gap Junction Mediated Conduction in Guinea Pigs. Front Physiol 2016; 7:16. [PMID: 26869934 PMCID: PMC4735342 DOI: 10.3389/fphys.2016.00016] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 01/12/2016] [Indexed: 11/29/2022] Open
Abstract
Background: Recent studies suggested that cardiac conduction in murine hearts with narrow perinexi and 50% reduced connexin43 (Cx43) expression is more sensitive to relatively physiological changes of extracellular potassium ([K+]o) and sodium ([Na+]o). Purpose: Determine whether similar [K+]o and [Na+]o changes alter conduction velocity (CV) sensitivity to pharmacologic gap junction (GJ) uncoupling in guinea pigs. Methods: [K+]o and [Na+]o were varied in Langendorff perfused guinea pig ventricles (Solution A: [K+]o = 4.56 and [Na+]o = 153.3 mM. Solution B: [K+]o = 6.95 and [Na+]o = 145.5 mM). Gap junctions were inhibited with carbenoxolone (CBX) (15 and 30 μM). Epicardial CV was quantified by optical mapping. Perinexal width was measured with transmission electron microscopy. Total and phosphorylated Cx43 were evaluated by western blotting. Results: Solution composition did not alter CV under control conditions or with 15μM CBX. Decreasing the basic cycle length (BCL) of pacing from 300 to 160 ms decreased CV uniformly with both solutions. At 30 μM CBX, a change in solution did not alter CV either longitudinally or transversely at BCL = 300 ms. However, reducing BCL to 160 ms caused CV to decrease more in hearts perfused with Solution B than A. Solution composition did not alter perinexal width, nor did it change total or phosphorylated serine 368 Cx43 expression. These data suggest that the solution dependent CV changes were independent of altered perinexal width or GJ coupling. Action potential duration was always shorter in hearts perfused with Solution B than A, independent of pacing rate and/or CBX concentration. Conclusions: Increased heart rate and GJ uncoupling can unmask small CV differences caused by changing [K+]o and [Na+]o. These data suggest that modulating extracellular ionic composition may be a novel anti-arrhythmic target in diseases with abnormal GJ coupling, particularly when heart rate cannot be controlled.
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Affiliation(s)
- Michael Entz
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State UniversityBlacksburg, VA, USA; Virginia Tech Carilion Research Institute and Center for Heart and Regenerative Medicine, Virginia Polytechnic Institute and State UniversityRoanoke, VA, USA
| | - Sharon A George
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State UniversityBlacksburg, VA, USA; Virginia Tech Carilion Research Institute and Center for Heart and Regenerative Medicine, Virginia Polytechnic Institute and State UniversityRoanoke, VA, USA
| | - Michael J Zeitz
- Virginia Tech Carilion Research Institute and Center for Heart and Regenerative Medicine, Virginia Polytechnic Institute and State University Roanoke, VA, USA
| | - Tristan Raisch
- Virginia Tech Carilion Research Institute and Center for Heart and Regenerative Medicine, Virginia Polytechnic Institute and State UniversityRoanoke, VA, USA; Translational Biology, Medicine, and Health, Virginia Polytechnic Institute and State UniversityBlacksburg, VA, USA
| | - James W Smyth
- Virginia Tech Carilion Research Institute and Center for Heart and Regenerative Medicine, Virginia Polytechnic Institute and State UniversityRoanoke, VA, USA; Department of Biological Sciences, College of Science, Virginia Polytechnic Institute and State UniversityBlacksburg, VA, USA
| | - Steven Poelzing
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State UniversityBlacksburg, VA, USA; Virginia Tech Carilion Research Institute and Center for Heart and Regenerative Medicine, Virginia Polytechnic Institute and State UniversityRoanoke, VA, USA; Department of Biological Sciences, College of Science, Virginia Polytechnic Institute and State UniversityBlacksburg, VA, USA
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20
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Global longitudinal strain is an independent predictor of cardiovascular events in patients with maintenance hemodialysis: a prospective study using three-dimensional speckle tracking echocardiography. Int J Cardiovasc Imaging 2016; 32:757-66. [DOI: 10.1007/s10554-016-0836-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 01/08/2016] [Indexed: 01/08/2023]
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21
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Abstract
Dyssynchronous contraction of the ventricle significantly worsens morbidity and mortality in patients with heart failure (HF). Approximately one-third of patients with HF have cardiac dyssynchrony and are candidates for cardiac resynchronization therapy (CRT). The initial understanding of dyssynchrony and CRT was in terms of global mechanics and hemodynamics, but lack of clinical benefit in a sizable subgroup of recipients who appear otherwise appropriate has challenged this paradigm. This article reviews current understanding of these cellular and subcellular mechanisms, arguing that these aspects are key to improving CRT use, as well as translating its benefits to a wider HF population.
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Affiliation(s)
- Jonathan A Kirk
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Ross Research Building, Room 858, 720 Rutland Avenue, Baltimore, MD 21205, USA.
| | - David A Kass
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Ross Research Building, Room 858, 720 Rutland Avenue, Baltimore, MD 21205, USA
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22
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Singleton MJ, Spragg DD. Pre-Implant Assessment For Optimal LV Lead Placement In CRT: ECG, ECHO, or MRI? J Atr Fibrillation 2015; 8:1280. [PMID: 27957193 DOI: 10.4022/jafib.1280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 08/30/2015] [Accepted: 08/31/2015] [Indexed: 01/08/2023]
Abstract
Cardiac resynchronization therapy (CRT) improves cardiac function in many patients with ventricular dyssynchrony. The optimal use of imaging for pre-implantation assessment remains a subject of debate. Here, we review the literature to date on the utility of echocardiography and cardiac MR, as well as conventional ECG, in choosing the best site for LV lead implantation. Prior to the use of imaging for pre-implantation evaluation, LV leads were placed empirically, based on average responses from population-level studies. Subsequently, patient-specific approaches have been used to maximize response. Both echocardiography and cardiac MR allow determination of areas of latest mechanical activation. Some studies have found improved response when pacing is applied at or near the site of latest mechanical activation. Similarly, both echocardiography and cardiac MR provide information about the location of any myocardial scar, which should be avoided when placing the LV lead due to variable conduction and high capture thresholds. Alternative approaches include targeting the region of latest electrical activation via measurement of the QLV interval and methods based on intraoperative hemodynamic measurements. Each of these modalities offers complementary insights into LV lead placement, so future directions include multimodality pre-implantation evaluation, studies of which are ongoing. Emerging technologies such as leadless implantable pacemakers may free implanting electrophysiologists from the constraints of the coronary sinus, making this information more useful and making non-response to CRT increasingly rare.
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Affiliation(s)
- Matthew J Singleton
- Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center, Baltimore, MD
| | - David D Spragg
- Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center, Baltimore, MD
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23
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Affiliation(s)
- Stanley F Fernandez
- From the Departments of Medicine, Biomedical Engineering, Physiology and Biophysics, VA WNY Health Care System, and Clinical and Translational Research Center, University at Buffalo, NY
| | - John M Canty
- From the Departments of Medicine, Biomedical Engineering, Physiology and Biophysics, VA WNY Health Care System, and Clinical and Translational Research Center, University at Buffalo, NY.
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24
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Kim SA, Kim MN, Shim WJ, Park SM. Layer-specific dyssynchrony and its relationship to the change of left ventricular function in hypertensive patients. Heart Vessels 2015; 31:528-34. [PMID: 25573260 DOI: 10.1007/s00380-014-0626-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 12/26/2014] [Indexed: 10/24/2022]
Abstract
Left ventricular (LV) remodeling in systemic arterial hypertension causes electrical conduction delay and impairs synchronous contraction, which may contribute to the development of heart failure. This study aimed to assess the change of LV mechanics in hypertension by layer-specific dyssynchrony. One hundred and twenty-one patients with primary hypertension and LV ejection fraction >50 % (mean age, 62 ± 10 years) and 31 normotensive controls (mean age, 63 ± 9 years) were prospectively included. Layer-specific dyssynchrony index (DI) was defined as standard deviation of time interval (TI) from the onset of Q wave to peak longitudinal strain obtained from 18 segments in each endocardial, myocardial, and epicardial layer. The global TI between the onset of Q wave to peak global longitudinal strain in each layer was obtained and the time difference (TD) of global TI between layers was calculated. DIs were significantly different in three layers (P < 0.001 in both groups), and were significantly greater in hypertensive patients than in controls except epicardial DI. End diastolic filling pressure and LV global longitudinal strain were related with endocardial DI. TD between endocardium and myocardium was greater in hypertensive patients than in controls (P = 0.001). Layer-specific DI revealed delayed contraction in each layer and between layers in hypertensive patients, which were apparent in endocardium and between endocardium and myocardium. Increased layer-specific DIs were associated with subclinical LV dysfunction, although LV ejection fraction was preserved. These may be helpful to understand layer-specific mechanical property of LV myocardium and for early detection of subclinical impairment of myocardial function.
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Affiliation(s)
- Su-A Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, 126-1, Anam-dong 5 ga, Seongbuk-gu, Seoul, 136-705, Republic of Korea
| | - Mi-Na Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, 126-1, Anam-dong 5 ga, Seongbuk-gu, Seoul, 136-705, Republic of Korea
| | - Wan-Joo Shim
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, 126-1, Anam-dong 5 ga, Seongbuk-gu, Seoul, 136-705, Republic of Korea
| | - Seong-Mi Park
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, 126-1, Anam-dong 5 ga, Seongbuk-gu, Seoul, 136-705, Republic of Korea.
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25
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Yang S, Chen L, Sun S, Shah P, Yang W, Zhang B, Zhang Z, Chan DW, Kass DA, van Eyk JE, Zhang H. Glycoproteins identified from heart failure and treatment models. Proteomics 2015; 15:567-79. [PMID: 25141849 PMCID: PMC4492696 DOI: 10.1002/pmic.201400151] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Revised: 07/28/2014] [Accepted: 08/15/2014] [Indexed: 01/12/2023]
Abstract
Conduction abnormalities can lead to dyssynchronous contraction, which significantly worsens morbidity and mortality of heart failure. Cardiac resynchronization therapy (CRT) can reverse ventricular remodeling and improve cardiac function. Although the underlying molecular changes are unknown, the use of a canine model of dyssynchronous heart failure (DHF) and CRT has shown that there are global changes across the cardiac proteome. This study determines changes in serum glycoprotein concentration from DHF and CRT compared to normal. We hypothesize that CRT invokes protective or advantageous pathways that can be reflected in the circulating proteome. Two prong discovery approaches were carried out on pooled normal, DHF, and CRT samples composed of individual canine serum to determine the overall protein concentration and the N-linked glycosites of circulating glycoproteins. The level of the glycoproteins was altered in DHF and CRT compared to control sera, with 63 glycopeptides substantially increased in DHF and/or CRT. Among the 32 elevated glycosite-containing peptides in DHF, 13 glycopeptides were reverted to normal level after CRT therapy. We further verify the changes of glycopeptides using label-free LC-MS from individual canine serum. Circulating glycoproteins such as alpha-fetoprotein, alpha-2-macroglobulin, galectin-3-binding protein, and collectin-10 show association to failing heart and CRT treatment model.
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Affiliation(s)
- Shuang Yang
- Department of Pathology, Johns Hopkins University, Baltimore, 21231
| | - Lijun Chen
- Department of Pathology, Johns Hopkins University, Baltimore, 21231
| | - Shisheng Sun
- Department of Pathology, Johns Hopkins University, Baltimore, 21231
| | - Punit Shah
- Department of Pathology, Johns Hopkins University, Baltimore, 21231
| | - Weiming Yang
- Department of Pathology, Johns Hopkins University, Baltimore, 21231
| | - Bai Zhang
- Department of Pathology, Johns Hopkins University, Baltimore, 21231
| | - Zhen Zhang
- Department of Pathology, Johns Hopkins University, Baltimore, 21231
| | - Daniel W. Chan
- Department of Pathology, Johns Hopkins University, Baltimore, 21231
| | - David A. Kass
- Cellular and Molecular Medicine, Johns Hopkins University, Baltimore, 21205
| | - Jennifer E. van Eyk
- Department of Medicine, Johns Hopkins University, Baltimore, 21224
- Advanced Clinical Biosystems Research Institute, Cedar Sinai Medical Center, Los Angeles
| | - Hui Zhang
- Department of Pathology, Johns Hopkins University, Baltimore, 21231
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26
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Gopalamurugan AB, Ganesha Babu G, Rogers DP, Simpson AL, Ahsan SY, Lambiase PD, Chow AW, Lowe MD, Rowland E, Segal OR. Is CRT pro-arrhythmic? A comparative analysis of the occurrence of ventricular arrhythmias between patients implanted with CRTs and ICDs. Front Physiol 2014; 5:334. [PMID: 25278901 PMCID: PMC4166112 DOI: 10.3389/fphys.2014.00334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 08/14/2014] [Indexed: 11/13/2022] Open
Abstract
Aim and Hypothesis: Despite the proven symptomatic and mortality benefit of cardiac resynchronization therapy (CRT), there is anecdotal evidence it may be pro-arrhythmic in some patients. We aimed to identify if there were significant differences in the incidence of ventricular arrhythmias (VAs) in patients undergoing CRT-D and implantable cardioverter-defibrillators (ICD) implantation for primary prevention indication. We hypothesized that CRT is unlikely to be pro-arrhythmic based on the positive mortality and morbidity data from large randomized trials. Methods and Results: A retrospective analysis of device therapies for VA in a primary prevention device cohort was performed. Patients with ischemic (IHD) and non-ischemic (DCM) cardiomyopathy and ICD or CRT+ICD devices (CRT-D) implanted between 2005 and 2007 without prior history of sustained VA were included for analysis. VA episodes were identified from stored electrograms and defined as sustained (VT/VF) if therapy [anti-tachycardia pacing (ATP) or shocks] was delivered or non-sustained (NSVT) if not. Of a total of 180 patients, 117 (68% male) were in the CRT-D group, 42% IHD, ejection fraction (EF) 24.5 ± 8.2% and mean follow-up 23.9 ± 9.8 months. 63 patients (84% male) were in the ICD group, 60% IHD, EF 27.7 ± 7.2% and mean follow-up 24.6 ± 10.8 months. Overall, there was no significant difference in the incidence of VA (35.0 vs. 38.1%, p = 0.74), sustained VT (21.3 vs. 28.5%, p = 0.36) or NSVT (12.8 vs. 9.5%, p = 0.63) and no significant difference in type of therapy received for VT/VF: ATP (68 vs. 66.6%, p = 0.73) and shocks (32 vs. 33.3%, p = 0.71) between the CRT-D and ICD groups, respectively. Conclusion: In patients with cardiomyopathy receiving CRT-D and ICDs for primary prophylaxis, there was no significant difference in the incidence of VA. From this single center retrospective analysis, there is no evidence to support cardiac resynchronization causing pro-arrhythmia.
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Affiliation(s)
- A B Gopalamurugan
- Department of Cardiac Electrophysiology, The Heart Hospital, Institute of Cardiovascular Sciences, University College London UK
| | - G Ganesha Babu
- Department of Cardiac Electrophysiology, The Heart Hospital, Institute of Cardiovascular Sciences, University College London UK
| | - Dominic P Rogers
- Department of Cardiac Electrophysiology, The Heart Hospital, Institute of Cardiovascular Sciences, University College London UK
| | - Adam L Simpson
- Department of Cardiac Electrophysiology, The Heart Hospital, Institute of Cardiovascular Sciences, University College London UK
| | - Syed Y Ahsan
- Department of Cardiac Electrophysiology, The Heart Hospital, Institute of Cardiovascular Sciences, University College London UK
| | - Pier D Lambiase
- Department of Cardiac Electrophysiology, The Heart Hospital, Institute of Cardiovascular Sciences, University College London UK
| | - Anthony W Chow
- Department of Cardiac Electrophysiology, The Heart Hospital, Institute of Cardiovascular Sciences, University College London UK
| | - Martin D Lowe
- Department of Cardiac Electrophysiology, The Heart Hospital, Institute of Cardiovascular Sciences, University College London UK
| | - Edward Rowland
- Department of Cardiac Electrophysiology, The Heart Hospital, Institute of Cardiovascular Sciences, University College London UK
| | - Oliver R Segal
- Department of Cardiac Electrophysiology, The Heart Hospital, Institute of Cardiovascular Sciences, University College London UK
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27
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Vernooy K, van Deursen CJM, Strik M, Prinzen FW. Strategies to improve cardiac resynchronization therapy. Nat Rev Cardiol 2014; 11:481-93. [PMID: 24839977 DOI: 10.1038/nrcardio.2014.67] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cardiac resynchronization therapy (CRT) emerged 2 decades ago as a useful form of device therapy for heart failure associated with abnormal ventricular conduction, indicated by a wide QRS complex. In this Review, we present insights into how to achieve the greatest benefits with this pacemaker therapy. Outcomes from CRT can be improved by appropriate patient selection, careful positioning of right and left ventricular pacing electrodes, and optimal timing of electrode stimulation. Left bundle branch block (LBBB), which can be detected on an electrocardiogram, is the predominant substrate for CRT, and patients with this conduction abnormality yield the most benefit. However, other features, such as QRS morphology, mechanical dyssynchrony, myocardial scarring, and the aetiology of heart failure, might also determine the benefit of CRT. No single left ventricular pacing site suits all patients, but a late-activated site, during either the intrinsic LBBB rhythm or right ventricular pacing, should be selected. Positioning the lead inside a scarred region substantially impairs outcomes. Optimization of stimulation intervals improves cardiac pump function in the short term, but CRT procedures must become easier and more reliable, perhaps with the use of electrocardiographic measures, to improve long-term outcomes.
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Affiliation(s)
- Kevin Vernooy
- Department of Cardiology, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, Netherlands
| | | | - Marc Strik
- Department of Cardiology, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, Netherlands
| | - Frits W Prinzen
- Department of Physiology, Maastricht University, PO Box 616, 6200 MD Maastricht, Netherlands
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28
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Chiu DYY, Green D, Abidin N, Sinha S, Kalra PA. Echocardiography in hemodialysis patients: uses and challenges. Am J Kidney Dis 2014; 64:804-16. [PMID: 24751169 DOI: 10.1053/j.ajkd.2014.01.450] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 01/23/2014] [Indexed: 11/11/2022]
Abstract
Patients with end-stage renal disease undergoing hemodialysis have high rates of morbidity and mortality. Cardiovascular disease accounts for almost half of this mortality, with the single most common cause being sudden cardiac death. Early detection of abnormalities in cardiac structure and function may be important to allow timely and appropriate cardiac interventions. Echocardiography is noninvasive cardiac imaging that is widely available and provides invaluable information on cardiac morphology and function. However, it has limitations. Echocardiography is operator dependent, and image quality can vary depending on the operator's experience and the patient's acoustic window. Hemodialysis patients undergo regular hemodynamic changes that also may affect echocardiographic findings. An understanding of the prognostic significance and interpretation of echocardiographic results in this setting is important for patient care. There are some emerging techniques in echocardiographic imaging that can provide more detailed and accurate information compared with conventional 2-dimensional echocardiography. Use of these novel tools may further our understanding of the pathophysiology of cardiac disease in patients with end-stage renal disease undergoing hemodialysis.
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Affiliation(s)
- Diana Y Y Chiu
- Vascular Research Group, Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford; Institute of Population Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester
| | - Darren Green
- Vascular Research Group, Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford; Institute of Population Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester
| | - Nik Abidin
- Department of Cardiology, Salford Royal Hospital, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Smeeta Sinha
- Vascular Research Group, Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford; Institute of Population Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester
| | - Philip A Kalra
- Vascular Research Group, Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford; Institute of Population Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester.
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29
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Almomani A, Siddiqui K, Ahmad M. Echocardiography in patients with complications related to pacemakers and cardiac defibrillators. Echocardiography 2014; 31:388-99. [PMID: 24341293 DOI: 10.1111/echo.12483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
The evolving indications and uses for implantable cardiac devices have led to a significant increase in the number of implanted devices each year. Implantation of endocardial leads for permanent pacemakers and cardiac defibrillators can cause many delayed complications. Complications may be mechanical and related to the interaction of the device leads with the valves and endomyocardium, e.g., perforation, infection, and thrombosis, or due to the electrical pacing of the myocardium and conduction abnormalities, e.g., left ventricular dyssynchrony. Tricuspid regurgitation, another delayed complication in these patients, may be secondary to both mechanical and pacing effects of the device leads. Echocardiography plays an important role in the diagnosis of these device-related complications. Both two-dimensional transthoracic echocardiography and transesophageal echocardiography provide useful diagnostic information. Real time three-dimensional echocardiography is a novel technique that can further enhance the detection of lead-related complications.
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Affiliation(s)
- Ahmed Almomani
- Division of Cardiology, Department of Medicine, University of Texas Medical Branch, Galveston, Texas
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30
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Gupta S, Figueredo VM. Tachycardia mediated cardiomyopathy: Pathophysiology, mechanisms, clinical features and management. Int J Cardiol 2014; 172:40-6. [DOI: 10.1016/j.ijcard.2013.12.180] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 12/23/2013] [Accepted: 12/30/2013] [Indexed: 11/25/2022]
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31
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Limongelli G, Roselli T, Pacileo G, Calabró P, Maddaloni V, Masarone D, Riegler L, Gravino R, Scarafile R, Salerno G, Miele T, D'Andrea A, Santangelo L, Romano M, Di Salvo G, Russo MG, Calabró R. Effect of cardiac resynchronization therapy on cardiotrophin-1 circulating levels in patients with heart failure. Intern Emerg Med 2014; 9:43-50. [PMID: 22179744 DOI: 10.1007/s11739-011-0740-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 11/28/2011] [Indexed: 10/14/2022]
Abstract
Cardiotrophin-1 (CT-1) is a member of the interleukin (IL-6) family of cytokines. Plasma CT-1 levels correlate with the left ventricle mass index in patients with dilatated cardiomyopathy and congestive heart failure (CHF). The aim of this paper was to evaluate CT-1 plasma levels, before and after cardiac resynchronization therapy CRT, and to characterizeits prognostic role in patients with CHF. Fifty-two consecutive patients (M/F = 39/13; 56 ± 11 years old) underwent clinical and echocardiographic evaluation, and blood sample collection at baseline. The same evaluation was repeated 6.4 ± 0.79 months after CRT. Patients with a decreased LV end-systolic volume by at least 15% (reverse remodeling) were considered echo responders to CRT. Twenty-nine patients (56%) were responders to CRT. After CRT, only 15 patients (29%) showed increased CT-1 after CRT. They were all non responders to CRT. A multivariate, logistic model showed CT-1 as an independent predictor of CRT echo response (p = 0.005; OR 0.97). During follow-up (18 ± 7 months), 21 cardiac events in 18 patients occurred. A Cox multivariable model showed plasma BNP pre-CRT (p = 0.02; CI 1.2-5.6; OR 3.1) and CT1 post-CRT (p = 0.01; CI 1.4-4.3; OR 2.7) as independent predictors of cardiac events. Analysis of CT-1 plasma levels deserves future consideration for larger, longitudinal studies in patients with CHF.
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Affiliation(s)
- Giuseppe Limongelli
- Department of Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy,
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32
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Kramer SP, Powell DK, Haggerty CM, Binkley CM, Mattingly AC, Cassis LA, Epstein FH, Fornwalt BK. Obesity reduces left ventricular strains, torsion, and synchrony in mouse models: a cine displacement encoding with stimulated echoes (DENSE) cardiovascular magnetic resonance study. J Cardiovasc Magn Reson 2013; 15:109. [PMID: 24380567 PMCID: PMC3882783 DOI: 10.1186/1532-429x-15-109] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 12/11/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obesity affects a third of adults in the US and results in an increased risk of cardiovascular mortality. While the mechanisms underlying this increased risk are not well understood, animal models of obesity have shown direct effects on the heart such as steatosis and fibrosis, which may affect cardiac function. However, the effect of obesity on cardiac function in animal models is not well-defined. We hypothesized that diet-induced obesity in mice reduces strain, torsion, and synchrony in the left ventricle (LV). METHODS Ten 12-week-old C57BL/6 J mice were randomized to a high-fat or low-fat diet. After 5 months on the diet, mice were imaged with a 7 T ClinScan using a cine DENSE protocol. Three short-axis and two long-axis slices were acquired for quantification of strains, torsion and synchrony in the left ventricle. RESULTS Left ventricular mass was increased by 15% (p = 0.032) with no change in volumes or ejection fraction. Subepicardial strain was lower in the obese mice with a 40% reduction in circumferential strain (p = 0.008) a 53% reduction in radial strain (p = 0.032) and a trend towards a 19% reduction in longitudinal strain (p = 0.056). By contrast, subendocardial strain was modestly reduced in the obese mice in the circumferential direction by 12% (p = 0.028), and no different in the radial (p = 0.690) or longitudinal (p = 0.602) directions. Peak torsion was reduced by 34% (p = 0.028). Synchrony of contraction was also reduced (p = 0.032) with a time delay in the septal-to-lateral direction. CONCLUSIONS Diet-induced obesity reduces left ventricular strains and torsion in mice. Reductions in cardiac strain are mostly limited to the subepicardium, with relative preservation of function in the subendocardium. Diet-induced obesity also leads to reduced synchrony of contraction and hypertrophy in mouse models.
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MESH Headings
- Animals
- Biomechanical Phenomena
- Diet, High-Fat
- Disease Models, Animal
- Hypertrophy, Left Ventricular/diagnosis
- Hypertrophy, Left Ventricular/etiology
- Hypertrophy, Left Ventricular/physiopathology
- Magnetic Resonance Imaging, Cine
- Mice
- Mice, Inbred C57BL
- Myocardial Contraction
- Obesity/complications
- Obesity/diagnosis
- Obesity/physiopathology
- Predictive Value of Tests
- Stress, Mechanical
- Stroke Volume
- Time Factors
- Torsion, Mechanical
- Ventricular Dysfunction, Left/diagnosis
- Ventricular Dysfunction, Left/etiology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Function, Left
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Affiliation(s)
- Sage P Kramer
- Departments of Pediatrics, Physiology and Medicine, University of Kentucky, 800 Rose St, MN-150, Lexington, KY 40536, USA
| | - David K Powell
- Departments of Pediatrics, Physiology and Medicine, University of Kentucky, 800 Rose St, MN-150, Lexington, KY 40536, USA
| | - Christopher M Haggerty
- Departments of Pediatrics, Physiology and Medicine, University of Kentucky, 800 Rose St, MN-150, Lexington, KY 40536, USA
| | - Cassi M Binkley
- Departments of Pediatrics, Physiology and Medicine, University of Kentucky, 800 Rose St, MN-150, Lexington, KY 40536, USA
| | - Andrea C Mattingly
- Departments of Pediatrics, Physiology and Medicine, University of Kentucky, 800 Rose St, MN-150, Lexington, KY 40536, USA
| | - Lisa A Cassis
- Department of Molecular and Biomedical Pharmacology, University of Kentucky, Lexington, KY, USA
| | - Frederick H Epstein
- Departments of Biomedical Engineering and Radiology, University of Virginia, Charlottesville, VA, USA
| | - Brandon K Fornwalt
- Departments of Pediatrics, Physiology and Medicine, University of Kentucky, 800 Rose St, MN-150, Lexington, KY 40536, USA
- Graduate Center for Biomedical Engineering, University of Kentucky, Lexington, KY, USA
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Carballeira Pol L, Deyell MW, Frankel DS, Benhayon D, Squara F, Chik W, Kohari M, Deo R, Marchlinski FE. Ventricular premature depolarization QRS duration as a new marker of risk for the development of ventricular premature depolarization-induced cardiomyopathy. Heart Rhythm 2013; 11:299-306. [PMID: 24184787 DOI: 10.1016/j.hrthm.2013.10.055] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Frequent ventricular premature depolarizations (VPDs) can cause cardiomyopathy (CMP). The mechanisms underlying its development remain unclear, with VPD burden being only a weak predictor of risk. OBJECTIVE To determine whether VPD QRS duration at the time of initial presentation could predict risk for the subsequent development of CMP in patients with normal left ventricular ejection fraction (LVEF). METHODS From consecutive patients referred for ablation between January 1, 2006, and April 2, 2013, with ≥10% VPDs on 24-hour Holter monitoring, we identified 45 patients with normal LVEF and an electrocardiogram of the targeted VPD, who were then followed for at least 6 months (median 14 months; interquartile range [IQR] 8-32 months) before intervention. We excluded patients with structural or genetic heart disease. RESULTS Of the 45 patients, 28 (62%) maintained normal LVEF and 17(38%) developed VPD-induced CMP. VPD burden was similar (26.5% [IQR 19.3%-39.5%] vs 26.0% [IQR 16.4%-41.0%]; P = 0.4) between the 2 groups. Patients who developed VPD-induced CMP had significantly longer VPD QRS duration (159 ms vs 142 ms; P < .001) and a longer sinus QRS duration (97 ms vs 89 ms; P = .04). A VPD QRS duration of ≥153 ms best predicted development of VPD CMP (82% sensitivity and 75% specificity). Longer VPD QRS duration and a non-outflow tract site of VPD origin were independent risk factors for left ventricular dysfunction after multivariate analysis. CONCLUSION VPD QRS duration longer than 153 ms and a non-outflow tract site of origin might be useful predictors of the subsequent development of VPD-induced CMP.
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Affiliation(s)
- Lidia Carballeira Pol
- Electrophysiology Section, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Marc W Deyell
- Electrophysiology Section, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David S Frankel
- Electrophysiology Section, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel Benhayon
- Cardiology Department, Pasteur University Hospital, Nice, France
| | - Fabien Squara
- Electrophysiology Section, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Cardiology Department, Pasteur University Hospital, Nice, France
| | - William Chik
- Electrophysiology Section, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Maria Kohari
- Electrophysiology Section, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rajat Deo
- Electrophysiology Section, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Francis E Marchlinski
- Electrophysiology Section, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
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Abstract
Patients with heart failure and decreased function frequently develop discoordinate contraction because of electric activation delay. Often termed dyssynchrony, this further decreases systolic function and chamber efficiency and worsens morbidity and mortality. In the mid- 1990s, a pacemaker-based treatment termed cardiac resynchronization therapy (CRT) was developed to restore mechanical synchrony by electrically activating both right and left sides of the heart. It is a major therapeutic advance for the new millennium. Acute chamber effects of CRT include increased cardiac output and mechanical efficiency and reduced mitral regurgitation, whereas reduction in chamber volumes ensues more chronically. Patient candidates for CRT have a prolonged QRS duration and discoordinate wall motion, although other factors may also be important because ≈30% of such selected subjects do not respond to the treatment. In contrast to existing pharmacological inotropes, CRT both acutely and chronically increases cardiac systolic function and work, yet it also reduces long-term mortality. Recent studies reveal unique molecular and cellular changes from CRT that may also contribute to this success. Heart failure with dyssynchrony displays decreased myocyte and myofilament function, calcium handling, β-adrenergic responsiveness, mitochondrial ATP synthase activity, cell survival signaling, and other changes. CRT reverses many of these abnormalities often by triggering entirely new pathways. In this review, we discuss chamber, circulatory, and basic myocardial effects of dyssynchrony and CRT in the failing heart, and we highlight new research aiming to better target and implement CRT, as well as leverage its molecular effects.
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Affiliation(s)
- Jonathan A Kirk
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Turak O, Özcan F, Kadife İ, İşleyen A, Cebeci M, Başar FN, Selçuk MT, Gölbaşi Z, Aras D, Aydoğdu S. The effect of different circadian blood pressure rhythms on left ventricular systolic dyssynchrony in patients with newly diagnosed essential hypertension. Echocardiography 2013; 31:34-40. [PMID: 23889460 DOI: 10.1111/echo.12305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES Left ventricular (LV) synchronous contraction is impaired in patients with hypertension (HT). The deleterious effects of HT on cardiovascular system are more evident in patients with nondipper HT than dippers. In this study, we aimed to investigate the effect of nondipping HT on LV systolic synchronicity compared with dippers and controls. METHODS One hundred patients with newly diagnosed essential HT and 50 normotensive subjects were enrolled in this study. The hypertensive patients were assigned 2 groups comprising 55 dippers and 45 nondippers. Each subject underwent a comprehensive transthoracic echocardiographic examination. The evaluation of systolic dyssynchrony was performed by tissue synchronization imaging, and the time to regional peak systolic tissue velocity (Ts) in LV was measured on the basis of 12 segmental models. The standard deviation (SD) of the 12 LV segments (Ts-SD-12) and maximal difference in Ts between any two of the 12 LV segments (Ts-12) were calculated. RESULTS Compared with the control group, the synchronicity indexes were significantly prolonged in the hypertensive patients. Furthermore, Ts-SD-12 and Ts-12 values were found to be significantly impaired in patients with nondipper HT, compared with dippers: Ts-SD-12 (38.1 ± 18.7 vs. 31.8 ± 15.4, P ≤ 0.001); Ts-12 (123.0 ± 50.6 vs. 98.4 ± 42.3, P ≤ 0.001). Stepwise multivariate logistic regression analysis revealed a significant negative association between LV dyssynchrony indices and percentage decline in BP level from day to night. CONCLUSION Synchronous systolic contraction of LV is found to be significantly impaired in patients with nondipping circadian pattern of HT compared with dippers and the controls.
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Affiliation(s)
- Osman Turak
- Department of Cardiology, Türkiye Yüksek Ihtisas Education and Research Hospital, Ankara, Turkey
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Hayashi SY, Nowak J, Lindholm B, Nascimento MMD, Lind B, Bjällmark A, Larsson M, Pachaly MA, Seeberger A, Riella MC, Brodin L. Left ventricular mechanical dyssynchrony in patients with different stages of chronic kidney disease and the effects of hemodialysis. Hemodial Int 2013; 17:346-58. [DOI: 10.1111/hdi.12017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Shirley Yumi Hayashi
- Department of Medical Engineering, School of Technology and HealthRoyal Institute of Technology Stockholm Sweden
- Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and TechnologyKarolinska InstitutetKarolinska University Hospital Huddinge Stockholm Sweden
| | - Jacek Nowak
- Department of Laboratory Medicine, Division of Clinical PhysiologyKarolinska InstitutetKarolinska University Hospital Huddinge Stockholm Sweden
| | - Bengt Lindholm
- Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and TechnologyKarolinska InstitutetKarolinska University Hospital Huddinge Stockholm Sweden
| | - Marcelo Mazza do Nascimento
- Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and TechnologyKarolinska InstitutetKarolinska University Hospital Huddinge Stockholm Sweden
- Pro‐renal Foundation Curitiba Parana Brazil
| | - Britta Lind
- Department of Medical Engineering, School of Technology and HealthRoyal Institute of Technology Stockholm Sweden
| | - Anna Bjällmark
- Department of Medical Engineering, School of Technology and HealthRoyal Institute of Technology Stockholm Sweden
| | - Matilda Larsson
- Department of Medical Engineering, School of Technology and HealthRoyal Institute of Technology Stockholm Sweden
| | | | - Astrid Seeberger
- Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and TechnologyKarolinska InstitutetKarolinska University Hospital Huddinge Stockholm Sweden
| | | | - Lars‐Åke Brodin
- Department of Medical Engineering, School of Technology and HealthRoyal Institute of Technology Stockholm Sweden
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The impact of change in volume and left-ventricular hypertrophy on left-ventricular mechanical dyssynchrony in children with end-stage renal disease. Pediatr Cardiol 2012; 33:1124-30. [PMID: 22441563 DOI: 10.1007/s00246-012-0266-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Accepted: 02/21/2012] [Indexed: 10/28/2022]
Abstract
Left-ventricular dyssynchrony (LVD) adversely affects systolic performance and has not been previously evaluated in children with end-stage renal disease (ESRD). We hypothesized (1) that LVD in children with ESRD would be significantly increased compared with controls and (2) that volume load and left-ventricular hypertrophy (LVH) would be associated with increased LVD. This was a prospective observational study in which real-time three-dimensional echocardiographic data were acquired in 27 stable children with ESRD (13 peritoneal dialysis [PD] and 14 hemodialysis [HD]) and 29 normal controls. Data were acquired before and after an HD session. Dyssynchrony index (SDI) was defined per standard formulae and was normalized to cardiac cycle duration (SDIp). Left-ventricular mass (LVM) was obtained from M-mode echocardiography and was normalized to height(2.7) (LVM index). The mean age (13.8 vs. 11.3 years) and SDI, SDIp, LVM, and LVM index were significantly greater among children with ESRD than among controls (p < 0.05). Demographics and heart rates were comparable between HD and PD subgroups, whereas SDI 16 and 12 segments, SDIp 16 segments, and LVM were significantly greater in the HD group. SDI and SDIp 16 segments improved after an HD session (p < 0.05); LVM and LVM index remained unchanged. LVD was significantly greater in patients with LVH compared with those without LVH. Children with ESRD had significant LVD and increased LVM compared with controls. Increased LVD in those undergoing HD rather than PD, as well as the improvement in synchrony after HD, suggest that volume may modulate LVD. LVD was increased in children with LVH. LVD in children with ESRD may have pathogenic implications.
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Kuznetsova T, Bogaert P, Kloch-Badelek M, Thijs D, Thijs L, Staessen JA. Association of left ventricular diastolic function with systolic dyssynchrony: a population study. Eur Heart J Cardiovasc Imaging 2012; 14:471-9. [PMID: 23002213 DOI: 10.1093/ehjci/jes189] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Left ventricular (LV) (dys)synchrony has an important impact on LV function and structure. Our study aimed to describe the distribution and determinants of LV mechanical delay indexes in the general population and to assess an association of different Doppler indexes reflecting LV diastolic function with LV mechanical delay indexes. METHODS AND RESULTS In 200 subjects enrolled in a family-based population study (46.5% women; mean age, 57.9; 48% hypertensive), we performed echocardiography with tissue synchronization imaging (TSI) and two-dimensional speckle tracking. We measured the maximum difference in time to peak systolic velocity between any 2 of 12 LV segments (Ts-max); the standard deviation of time to peak systolic velocity of 12 segments (Ts-sd); the difference in time to peak systolic velocity and strain between septal and lateral LV walls and the strain delay index in septal and lateral walls [septal and lateral (SDI)]. In univariable and multivariable regression analyses, TSI indexes and lateral SDI independently increased with age (P ≤ 0.027) and body mass index (P ≤ 0.010). Ts-max and Ts-sd also increased with female sex (P ≤ 0.0002) and decreased with heart rate (P ≤ 0.0004). Septal SDI only increased with female sex (P < 0.0001). Among the Doppler indexes of LV diastolic function, only E/e' was significantly and positively associated with TSI indexes (P ≤ 0.037) and lateral SDI (P = 0.0026), but not with septal SDI (P = 0.69). In participants with advanced stage of LV diastolic dysfunction, TSI indexes were prolonged compare with subjects with normal LV diastolic function (P ≤ 0.002). CONCLUSION We demonstrated that in unselected subjects LV diastolic dysfunction was associated with mechanical LV dyssynchrony as assessed by echocardiography.
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Affiliation(s)
- Tatiana Kuznetsova
- Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Science, University of Leuven, Campus Sint Rafaël, Kapucijnenvoer 35, block d, level 00, Box 7001, B-3000 Leuven, Belgium.
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Cheung YF, Yu W, Li SN, Lam WWM, Ho YC, Wong SJ, Chan GCF, Ha SY. Dynamic dyssynchrony and impaired contractile reserve of the left ventricle in beta-thalassaemia major: an exercise echocardiographic study. PLoS One 2012; 7:e45265. [PMID: 23028894 PMCID: PMC3445473 DOI: 10.1371/journal.pone.0045265] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 08/17/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Performance of the left ventricle during exercise stress in thalassaemia patients is uncertain. We aimed to explore the phenomenon of dynamic dyssynchrony and assess contractile reserve in patients with beta-thalassaemia major and determine their relationships with myocardial iron load. METHODS AND RESULTS Thirty-two thalassaemia patients (16 males), aged 26.8 ± 6.9 years, without heart failure and 17 healthy controls were studied. Their left ventricular (LV) volumes, ejection fraction, systolic dyssynchrony index (SDI), and myocardial acceleration during isovolumic LV contraction (IVA) were determined at rest and during submaximal bicycle exercise testing using 3-dimensional and tissue Doppler echocardiography. Myocardial iron load as assessed by T2* cardiac magnetic resonance in patients were further related to indices of LV dyssynchrony and contractile reserve. At rest, patients had significantly greater LV SDI (p<0.001) but similar IVA (p = 0.22) compared with controls. With exercise stress, the prevalence of mechanical dyssynchrony (SDI>4.6%, control+2SD) increased from baseline 25% to 84% in patients. Δ SDI(exercise-baseline) correlated with exercise-baseline differences in LV ejection fraction (p<0.001) and stroke volume (p = 0.006). Compared with controls, patients had significantly less exercise-induced increase in LV ejection fraction, cardiac index, and IVA (interaction, all p<0.05) and had impaired contractile reserve as reflected by the gentler IVA-heart rate slope (p = 0.018). Cardiac T2* in patients correlated with baseline LV SDI (r = -0.44, p = 0.011) and IVA-heart rate slope (r = 0.36, p = 0.044). CONCLUSIONS Resting LV dyssynchrony is associated with myocardial iron load. Exercise stress further unveils LV dynamic dyssynchrony and impaired contractile reserve in patients with beta-thalassaemia major.
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Affiliation(s)
- Yiu-fai Cheung
- Division of Paediatric Cardiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
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Leenders GE, De Boeck BW, Teske AJ, Meine M, Bogaard MD, Prinzen FW, Doevendans PA, Cramer MJ. Septal Rebound Stretch is a Strong Predictor of Outcome After Cardiac Resynchronization Therapy. J Card Fail 2012; 18:404-12. [DOI: 10.1016/j.cardfail.2012.02.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 01/31/2012] [Accepted: 02/01/2012] [Indexed: 10/28/2022]
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O'Mara JE, Fruechte EM, Palac RT, Costa SP. Regional Patterns of Dyssynchrony: Lateral Wall Delay Is Desirable but Not Essential for Left Ventricular Remodeling in Biventricular Pacing. Echocardiography 2012; 29:554-9. [DOI: 10.1111/j.1540-8175.2011.01656.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Cha YM, Lee GK, Klarich KW, Grogan M. Premature Ventricular Contraction-Induced Cardiomyopathy. Circ Arrhythm Electrophysiol 2012; 5:229-36. [DOI: 10.1161/circep.111.963348] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Yong-Mei Cha
- From the Division of Cardiovascular Diseases (Y.-M.C., K.W.K., M.G.), Mayo Clinic, Rochester, MN; and the Department of Medicine (G.K.L.), National University Health System, Singapore
| | - Glenn K. Lee
- From the Division of Cardiovascular Diseases (Y.-M.C., K.W.K., M.G.), Mayo Clinic, Rochester, MN; and the Department of Medicine (G.K.L.), National University Health System, Singapore
| | - Kyle W. Klarich
- From the Division of Cardiovascular Diseases (Y.-M.C., K.W.K., M.G.), Mayo Clinic, Rochester, MN; and the Department of Medicine (G.K.L.), National University Health System, Singapore
| | - Martha Grogan
- From the Division of Cardiovascular Diseases (Y.-M.C., K.W.K., M.G.), Mayo Clinic, Rochester, MN; and the Department of Medicine (G.K.L.), National University Health System, Singapore
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Yamazaki KG, Ihm SH, Thomas RL, Roth D, Villarreal F. Cell adhesion molecule mediation of myocardial inflammatory responses associated with ventricular pacing. Am J Physiol Heart Circ Physiol 2012; 302:H1387-93. [PMID: 22268115 DOI: 10.1152/ajpheart.00496.2011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Poorly synchronized activation of the ventricles can lead to impairment of normal cardiac structure/function. We reported previously that short term (4 h) left ventricular (LV) pacing-induced ventricular dyskinesis led to an inflammatory response localized to the epicardium. Results from this study demonstrated that neutrophils may play a major role in this inflammatory process. Neutrophil recruitment to a site of injury is a process that is highly dependent on an upregulation of cell adhesion molecules (CAM). The dependence of ventricular dysynchrony-induced inflammatory responses on CAM upregulation has not been explored. To gain further insight, we used a mouse model of LV pacing to evaluate the role of CAM in mediating the inflammatory response associated with ventricular dyskinesis. We first examined the effects of LV pacing in wild-type mice. Results demonstrate that 40 min of LV pacing increases ICAM-1 immunostaining as well as myeloperoxidase activity and tissue oxidative stress by twofold in early-activated myocardium. Matrix metalloproteinase-9 activity also increased in the same region by ∼3.5-fold. To determine the role of CAM, mice null for ICAM-1 or p-selectin were subjected to 40 min LV pacing. Results demonstrate that the inflammatory response seen in the wild-type mice was significantly mitigated in the ICAM-1 and p-selectin null mice. In conclusion, results demonstrate that CAM expression plays a critical role in the triggering of LV pacing-induced inflammation, thus providing evidence of a vascular mechanism underlying this response. The mechanisms that trigger an upregulation of myocardial CAM expression and, therefore, inflammation await further investigation since they suggest a specific involvement of vascular events.
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Affiliation(s)
- Katrina Go Yamazaki
- Department of Biological Sciences, California State University Los Angeles, 90032, USA.
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Vanderheyden M, Penicka M, Bartunek J. Cellular Electrophysiological Abnormalities in Dyssynchronous Hearts and During CRT. J Cardiovasc Transl Res 2011; 5:127-34. [DOI: 10.1007/s12265-011-9335-6] [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: 10/10/2011] [Accepted: 11/16/2011] [Indexed: 01/19/2023]
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Abstract
Heart failure (HF) involves changes in cardiac structure, myocardial composition, myocyte deformation, and multiple biochemical and molecular alterations that impact heart function and reserve capacity. Collectively, these changes have been referred to as 'cardiac remodeling'. Understanding the components of this process with the goal of stopping or reversing its progression has become a major objective. This concept is often termed 'reverse remodeling', and is successfully achieved by inhibitors of the renin-angiotensin-aldosterone system, β-blockers, and device therapies such as cardiac resynchronization or ventricular assist devices. Not every method of reverse remodeling has long-lasting clinical efficacy. However, thus far, every successful clinical treatment with long-term benefits on the morbidity and mortality of patients with HF reverses remodeling. Reverse remodeling is defined by lower chamber volumes (particularly end-systolic volume) and is often accompanied by improved β-adrenergic and heart-rate responsiveness. At the cellular level, reverse remodeling impacts on myocyte size, function, excitation-contraction coupling, bioenergetics, and a host of molecular pathways that regulate contraction, cell survival, mitochondrial function, oxidative stress, and other features. Here, we review the current evidence for reverse remodeling by existing therapies, and discuss novel approaches that are rapidly moving from preclinical to clinical trials.
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Echocardiographic assessment of interventricular and intraventricular mechanical synchrony in normal dogs. J Vet Cardiol 2011; 13:115-26. [PMID: 21641290 DOI: 10.1016/j.jvc.2011.02.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Revised: 02/08/2011] [Accepted: 02/12/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The aims of this prospective study are to (1) generate normal ranges for interventricular and intraventricular mechanical synchrony in dogs, and (2) generate normal ranges for tissue Doppler imaging (TDI) velocity imaging and speckle tracking strain imaging assessment of segmental intraventricular mechanical synchrony in dogs. ANIMALS 10 prospectively recruited healthy dogs. METHODS Dogs were excluded if they had abnormal historical, physical examination, echocardiographic, ECG or systolic blood pressure findings. Interventricular mechanical synchrony was assessed using time difference between left and right ventricular pre-ejection periods. Intraventricular mechanical synchrony was assessed using both M-mode and color M-mode septal to posterior wall mechanical delay (SPWMD). Intraventricular segmental mechanical synchrony was assessed using both color TDI and speckle tracking strain analysis of segmental myocardial motion during systole and diastole. RESULTS All synchrony measures were found to be independent of age or body weight. Normal range for mechanical interventricular synchrony was found to be -10.2 to 12.6 ms. Assessment of mechanical intraventricular synchrony using either M-mode or color M-mode SPWMD was found to be associated with an extremely wide normal range, limiting clinical applicability. Normal ranges for segmental intraventricular mechanical synchrony assessed using either color TDI or speckle tracking were found to be comparable to those published for human subjects. CONCLUSIONS Interventricular and intraventricular mechanical synchrony in dogs is independent of age and body weight. The normal ranges identified in this study form a basis for assessment of normal versus abnormal mechanical synchrony in canine cardiovascular disease patients.
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Abstract
The heart is a remarkably adaptive organ, capable of increasing its minute output and overcoming short-term or prolonged pressure overload. The structural response, in addition to the foregoing functional demands, is that of myocardial hypertrophy. Then, why should an adaptive response increase cardiovascular risk in hypertensive patients with left ventricular hypertrophy (LVH)? Evidence shows that the functional performance of hypertrophied cardiomyocytes is impaired, and that additional alterations develop in cardiomyocytes themselves, the extracellular matrix and the intramyocardial vasculature, leading to myocardial remodelling and providing the basis for the adverse prognosis associated with pathological LVH in hypertensive patients (i.e., hypertensive heart disease, HHD). As molecular information accumulates, the pathophysiological understanding and the clinical approach to HHD are changing. The time has come to develop novel diagnostic and therapeutic strategies aimed at improving the prognosis of HHD on the basis of reversing or even preventing the aforementioned changes in the ventricular myocardium.
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Clements IP, Christenson S, Hodge DO, Mullan BP, Redfield MM, Hayes DL. Symptom improvement after upgrade from right ventricular apical to biventricular pacing: Role of right and left ventricular volumes assessed with single-photon emission computed tomographic equilibrium radionuclide angiocardiography. J Nucl Cardiol 2011; 18:43-51. [PMID: 21128041 DOI: 10.1007/s12350-010-9287-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Accepted: 08/11/2010] [Indexed: 01/26/2023]
Abstract
BACKGROUND In patients with heart failure and reduced left ventricular ejection fraction (LVEF), the effect of upgrading from right ventricular (RV) apical to biventricular pacing on RV and left ventricular (LV) volumes and ejection fraction (EF) is unknown. Also, the relationship of symptom improvement after biventricular upgrade to RV and LV volumes and EF has not been clarified. METHODS AND RESULTS Nineteen patients with long-standing persistent RV apical pacing who had heart failure symptoms and echocardiographic LVEF of 0.40 or less underwent upgrade to biventricular pacing. Patients had single-photon emission computed tomographic equilibrium radionuclide angiocardiography immediately before and at 3-6 months after the upgrade procedure, to measure RV and LV volumes and EF. Biventricular upgrade was associated with increase in LVEF and decrease in LV end-diastolic and end-systolic volumes; right ventricular ejection fraction (RVEF) and end-diastolic and end-systolic volumes were unaltered. Patients with improvement in New York Heart Association heart failure class of I or more had larger initial LV end-diastolic volumes than patients without an improvement and had decreased LV end-diastolic and end-systolic volumes comparatively. Symptom improvement was not associated with RVEF and volume change. CONCLUSION Symptom improvement with LV remodeling, but not RV remodeling, occurs 3-6 months after biventricular upgrade in patients with heart failure.
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Affiliation(s)
- Ian P Clements
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, 55905, USA.
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Heinzel FR, MacQuaide N, Biesmans L, Sipido K. Dyssynchrony of Ca2+ release from the sarcoplasmic reticulum as subcellular mechanism of cardiac contractile dysfunction. J Mol Cell Cardiol 2010; 50:390-400. [PMID: 21075114 DOI: 10.1016/j.yjmcc.2010.11.008] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Revised: 09/30/2010] [Accepted: 11/05/2010] [Indexed: 02/05/2023]
Abstract
Cardiac contractile function depends on coordinated electrical activation throughout the heart. Dyssynchronous electrical activation of the ventricles has been shown to contribute to contractile dysfunction in heart failure, and resynchronization therapy has emerged as a therapeutic concept. At the cellular level, coupling of membrane excitation to myofilament contraction is facilitated by highly organized intracellular structures which coordinate Ca(2+) release. The cytosolic [Ca(2+)] transient triggered by depolarization-induced Ca(2+) influx is the result of a gradable and robust high gain process, Ca(2+)-induced Ca(2+) release (CICR), which integrates subcellular localized Ca(2+) release events. Lack of synchronization of these localized release events can contribute to contractile dysfunction in myocardial hypertrophy and heart failure. Different underlying mechanisms relate to functional and structural changes in sarcolemmal Ca(2+) channels, the sarcoplasmic Ca(2+) release channel or ryanodine receptor, RyR, their intracellular arrangement in close proximity in couplons and the loss of t-tubules. Dyssynchrony at the subcellular level translates in a reduction of the overall gain of CICR at the cellular level and forms an important determinant of myocyte contractility in heart failure.
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