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Tersalvi G, Beltrani V, Grübler MR, Molteni A, Cristoforetti Y, Pedrazzini G, Treglia G, Biasco L. Positron Emission Tomography in Heart Failure: From Pathophysiology to Clinical Application. J Cardiovasc Dev Dis 2023; 10:220. [PMID: 37233187 PMCID: PMC10218989 DOI: 10.3390/jcdd10050220] [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: 03/31/2023] [Revised: 05/13/2023] [Accepted: 05/15/2023] [Indexed: 05/27/2023] Open
Abstract
Imaging modalities are increasingly being used to evaluate the underlying pathophysiology of heart failure. Positron emission tomography (PET) is a non-invasive imaging technique that uses radioactive tracers to visualize and measure biological processes in vivo. PET imaging of the heart uses different radiopharmaceuticals to provide information on myocardial metabolism, perfusion, inflammation, fibrosis, and sympathetic nervous system activity, which are all important contributors to the development and progression of heart failure. This narrative review provides an overview of the use of PET imaging in heart failure, highlighting the different PET tracers and modalities, and discussing fields of present and future clinical application.
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Affiliation(s)
- Gregorio Tersalvi
- Department of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
- Department of Internal Medicine, Ente Ospedaliero Cantonale, 6850 Mendrisio, Switzerland
| | - Vittorio Beltrani
- Department of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
- Department of Internal Medicine, Ente Ospedaliero Cantonale, 6850 Mendrisio, Switzerland
| | - Martin R. Grübler
- Department of Cardiology, Regional Hospital Neustadt, 2700 Wiener Neustadt, Austria
- Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Alessandra Molteni
- Department of Internal Medicine, Ente Ospedaliero Cantonale, 6850 Mendrisio, Switzerland
| | - Yvonne Cristoforetti
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
| | - Giovanni Pedrazzini
- Department of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
| | - Giorgio Treglia
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
- Clinic of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
- Faculty of Biology and Medicine, University of Lausanne (UNIL), 1015 Lausanne, Switzerland
| | - Luigi Biasco
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
- Division of Cardiology, Azienda Sanitaria Locale Torino 4, 10073 Ospedale di Ciriè, Italy
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Sorensen J. PET imaging of heart diseases by Acetate. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00209-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Liu S, Lin X, Shi X, Fang L, Huo L, Shang F, Knuuti J, Han C, Wu X, Guo R, Ding H, Zhang R, Duan H, Ding J, Xing H, Zhao X. Myocardial tissue and metabolism characterization in men with alcohol consumption by cardiovascular magnetic resonance and 11C-acetate PET/CT. J Cardiovasc Magn Reson 2020; 22:23. [PMID: 32299425 PMCID: PMC7161264 DOI: 10.1186/s12968-020-00614-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 03/03/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Chronic alcohol consumption initially leads to asymptomatic left ventricular dysfunction, but can result in myocardial impairment and heart failure if ongoing. This study sought to characterize myocardial tissues and oxidative metabolism in asymptomatic subjects with chronic alcohol consumption by quantitative cardiovascular magnetic resonance (CMR) and 11C-acetate positron emission tomography (PET)/computed tomography (CT). METHODS Thirty-four male subjects (48.8 ± 9.1 years) with alcohol consumption > 28 g/day for > 10 years and 35 age-matched healthy male subjects (49.5 ± 9.7 years) underwent CMR and 11C-acetate PET/CT. Native and post T1 values and extracellular volume (ECV) from CMR and Kmono and K1 from PET imaging were measured. Quantitative measurements by CMR and PET imaging were compared between subjects with moderate to heavy alcohol consumption and healthy controls, and their correlations were also analyzed. RESULTS Compared to healthy controls, subjects with alcohol consumption showed significantly shorter native T1 (1133 ± 65 ms vs. 1186 ± 31 ms, p < 0.001) and post T1 (477 ± 42 ms vs. 501 ± 38 ms, p = 0.008) values, greater ECV (28.2 ± 2.2% vs. 26.9 ± 1.3%, p = 0.003), marginally lower Kmono (57.6 ± 12.1 min- 1 × 10- 3 vs. 63.0 ± 11.7 min- 1 × 10- 3, p = 0.055), and similar K1 (0.82 ± 0.13 min- 1 vs. 0.83 ± 0.15 min- 1, p = 0.548) after adjusting for confounding factors. There were no significant differences in CMR measurements and K1 between subjects with heavy and moderate alcohol consumption (all p > 0.05). In contrast, subjects with heavy alcohol consumption showed significantly lower Kmono values compared to those with moderate alcohol consumption (52.9 ± 12.1 min- 1 × 10- 3 vs. 63.7 ± 9.2 min- 1 × 10- 3, p = 0.012). Strong and moderate correlations were found between K1 and ECV in healthy controls (r = 0.689, p = 0.013) and subjects with moderate alcohol consumption (r = 0.518, p = 0.048), respectively. CONCLUSION Asymptomatic men with heavy alcohol consumption have detectable structural and metabolic changes in myocardium on CMR and 11C-acetate PET/CT. Compared with quantitative CMR, 11C-acetate PET/CT imaging may be more sensitive for detecting differences in myocardial damage among subjects with moderate to heavy alcohol consumption.
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Affiliation(s)
- Shuai Liu
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Haidian District, Beijing, 100084, China
| | - Xue Lin
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Ximin Shi
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science, 1# Shuaifuyuan, Dongcheng District, Beijing, 100730, China
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, China
| | - Ligang Fang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Li Huo
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science, 1# Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, China.
| | - Fei Shang
- Department of Biomedical Engineering, Beijing Institute of Technology School of Life Science, Beijing, China
| | - Juhani Knuuti
- Turku PET Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Chunlei Han
- Turku PET Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Xiaomeng Wu
- Department of Biomedical Engineering, Beijing Institute of Technology School of Life Science, Beijing, China
| | - Rui Guo
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Haidian District, Beijing, 100084, China
| | - Haiyan Ding
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Haidian District, Beijing, 100084, China
| | - Runhua Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Huimin Duan
- Department of Medical Engineering, First Affiliated Hospital of PLA General Hospital, Beijing, China
| | - Jie Ding
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science, 1# Shuaifuyuan, Dongcheng District, Beijing, 100730, China
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, China
| | - Haiqun Xing
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science, 1# Shuaifuyuan, Dongcheng District, Beijing, 100730, China
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Haidian District, Beijing, 100084, China.
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Lee R, Shah RV, Murthy VL. Assessment of dyssynchrony by gated myocardial perfusion imaging does not improve patient management. J Nucl Cardiol 2018; 25:526-531. [PMID: 28791621 PMCID: PMC6312556 DOI: 10.1007/s12350-017-1022-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 05/10/2017] [Indexed: 01/14/2023]
Abstract
Clinical trials have demonstrated improved outcomes with cardiac resynchronization therapy in patients with heart failure and electrical evidence of dyssynchrony. There has been intense effort at developing imaging markers of dyssynchrony with the aim of improved risk stratification. However, these efforts have not been fruitful to date. This article discusses mechanisms of cardiac dyssynchrony, reviews clinical data supporting resynchronization therapy, and addresses the lack of convincing evidence to support the use of noninvasive imaging measures of dyssynchrony in improving patient management.
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Affiliation(s)
- Ran Lee
- Frankel Cardiovascular Center, Michigan Medicine, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109-5873, USA.
| | - Ravi V Shah
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Venkatesh L Murthy
- Frankel Cardiovascular Center, Michigan Medicine, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109-5873, USA
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Martens P, Nijst P, Verbrugge FH, Dupont M, Tang WW, Mullens W. Profound differences in prognostic impact of left ventricular reverse remodeling after cardiac resynchronization therapy relate to heart failure etiology. Heart Rhythm 2018; 15:130-136. [DOI: 10.1016/j.hrthm.2017.08.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Indexed: 11/25/2022]
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Xu YZ, Chen CF, Chen B, Gao XF, Hua W, Cha YM, Dzeja PP. The Modulating Effects of Cardiac Resynchronization Therapy on Myocardial Metabolism in Heart Failure. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:1404-1409. [PMID: 27807872 DOI: 10.1111/pace.12971] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 10/25/2016] [Indexed: 11/28/2022]
Abstract
Heart failure (HF) is associated with changes in cardiac substrate utilization and energy metabolism, including a decline in high-energy phosphate content, mitochondrial dysfunction, and phosphotransfer enzyme deficiency. A shift toward glucose metabolism was noted in the end stage of HF in animals, although HF in humans may not be associated with a shift toward predominant glucose utilization. Deficiencies of micronutrients are well-established causes of cardiomyopathy. Correction of these deficits can improve heart function. The genes governing the energy metabolism were predominantly underexpressed in nonischemic cardiomyopathy and hypertrophic cardiomyopathy but were overexpressed in ischemic cardiomyopathy. Cardiac resynchronization therapy (CRT) has been proven to increase cardiac efficiency without increasing myocardial oxygen consumption. Altered myocardial metabolism is normalized by CRT to improve ventricular function.
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Affiliation(s)
- Yi-Zhou Xu
- Department of Cardiology, Hangzhou First People's Hospital and Hangzhou Hospital of Nanjing Medical University, Hangzhou, China
| | - Chao-Feng Chen
- Department of Cardiology, Hangzhou First People's Hospital and Hangzhou Hospital of Nanjing Medical University, Hangzhou, China
| | - Bin Chen
- Department of Cardiology, Hangzhou First People's Hospital and Hangzhou Hospital of Nanjing Medical University, Hangzhou, China
| | - Xiao-Fei Gao
- Department of Cardiology, Hangzhou First People's Hospital and Hangzhou Hospital of Nanjing Medical University, Hangzhou, China
| | - Wei Hua
- The Cardiac Arrhythmia Center, Fu Wai Hospital of the Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yong-Mei Cha
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Petras P Dzeja
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
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Ståhlberg M, Braunschweig F, Gadler F, Mortensen L, Lund LH, Linde C. Cardiac resynchronization therapy: results, challenges and perspectives for the future. SCAND CARDIOVASC J 2016; 50:282-292. [PMID: 27577107 DOI: 10.1080/14017431.2016.1221530] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Heart failure (HF) is considered as an epidemic and affects 2% of the population in the Western world. About 15-30% of patients with HF and reduced ejection fraction (HFrEF) also have prolonged QRS duration on the surface ECG, most commonly as a result of left-bundle branch block (LBBB). Increased QRS duration is a marker of a dyssynchronous activation, and subsequent contraction, pattern in the left ventricle (LV). When dyssynchrony is superimposed on the failing heart it further reduced systolic function and ultimately worsens outcome. During the past 15 years several randomized controlled clinical trials have documented that resynchronization of the dyssynchronous failing heart with a biventricular pacemaker - cardiac resynchronization therapy (CRT) - which can restore a more synchronous activation and contraction pattern. This translates in halted or reversed disease progression and improved clinical outcome, including reduced mortality. In this review, we will discuss several aspects of CRT including mechanisms of dyssynchrony and resynchronization in the failing heart, evidence of CRT efficacy derived from clinical trials and current challenges in CRT including patient selection and optimization of therapy delivery. Last, we will discuss future perspectives including the role of CRT to prevent adverse events in patients with an indication for antibradycardia pacing, the role of leadless pacing in the CRT setting as well as a new clinical arena where dyssynchrony and resynchronization may be important.
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Affiliation(s)
- Marcus Ståhlberg
- a Department of Medicine, Karolinska Institutet , Solna , Stockholm , Sweden.,b Department of Cardiology , Karolinska University Hospital , Solna , Stockholm , Sweden
| | - Frieder Braunschweig
- a Department of Medicine, Karolinska Institutet , Solna , Stockholm , Sweden.,b Department of Cardiology , Karolinska University Hospital , Solna , Stockholm , Sweden
| | - Fredrik Gadler
- a Department of Medicine, Karolinska Institutet , Solna , Stockholm , Sweden.,b Department of Cardiology , Karolinska University Hospital , Solna , Stockholm , Sweden
| | - Lars Mortensen
- a Department of Medicine, Karolinska Institutet , Solna , Stockholm , Sweden.,b Department of Cardiology , Karolinska University Hospital , Solna , Stockholm , Sweden
| | - Lars H Lund
- a Department of Medicine, Karolinska Institutet , Solna , Stockholm , Sweden.,b Department of Cardiology , Karolinska University Hospital , Solna , Stockholm , Sweden
| | - Cecilia Linde
- a Department of Medicine, Karolinska Institutet , Solna , Stockholm , Sweden.,b Department of Cardiology , Karolinska University Hospital , Solna , Stockholm , Sweden
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Nemutlu E, Zhang S, Xu YZ, Terzic A, Zhong L, Dzeja PD, Cha YM. Cardiac resynchronization therapy induces adaptive metabolic transitions in the metabolomic profile of heart failure. J Card Fail 2015; 21:460-9. [PMID: 25911126 DOI: 10.1016/j.cardfail.2015.04.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 01/20/2015] [Accepted: 04/10/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Heart failure (HF) is associated with ventricular dyssynchrony and energetic inefficiency, which can be alleviated by cardiac resynchronization therapy (CRT). The aim of this study was to determine the metabolomic signature in HF and its prognostic value regarding the response to CRT. METHODS AND RESULTS This prospective study consisted of 24 patients undergoing CRT for advanced HF and 10 control patients who underwent catheter ablation for supraventricular arrhythmia but not CRT. Blood samples were collected before and 3 months after CRT. Metabolomic profiling of plasma samples was performed with the use of gas chromatography-mass spectrometry and nuclear magnetic resonance. The plasma metabolomic profile was altered in the HF patients, with a distinct panel of metabolites, including Krebs cycle and lipid, amino acid, and nucleotide metabolism. CRT improved the metabolomic profile. The succinate-glutamate ratio, an index of Krebs cycle activity, improved from 0.58 ± 0.13 to 2.84 ± 0.60 (P < .05). The glucose-palmitate ratio, an indicator of the balance between glycolytic and fatty acid metabolism, increased from 0.96 ± 0.05 to 1.54 ± 0.09 (P < .01). Compared with nonresponders to CRT, responders had a distinct baseline plasma metabolomic profile, including higher isoleucine, phenylalanine, leucine, glucose, and valine levels and lower glutamate levels at baseline (P < .05). CONCLUSIONS CRT improves the plasma metabolomic profile of HF patients, indicating harmonization of myocardial energy substrate metabolism. CRT responders may have a favorable metabolomic profile as a potential biomarker for predicting CRT outcome.
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Affiliation(s)
- Emirhan Nemutlu
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota; Departments of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota; Department of Analytical Chemistry, Faculty of Pharmacy, University of Hacettepe, Ankara, Turkey
| | - Song Zhang
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota; Departments of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota
| | - Yi-Zhou Xu
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Andre Terzic
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota; Departments of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota
| | - Li Zhong
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Petras D Dzeja
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota; Departments of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota
| | - Yong-Mei Cha
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
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Gabrielli L, Sitges M, Mont L. Assessing reverse remodeling in heart failure patients treated with cardiac resynchronization therapy and its impact on prognosis. Expert Rev Cardiovasc Ther 2014; 10:1437-48. [DOI: 10.1586/erc.12.137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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10
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Boogers MM, Chen J, Bax JJ. Role of nuclear imaging in cardiac resynchronization therapy. Expert Rev Cardiovasc Ther 2014; 7:65-72. [DOI: 10.1586/14779072.7.1.65] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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11
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Ståhlberg M, Lund LH, Zabarovskaja S, Gadler F, Braunschweig F, Linde C. Cardiac resynchronization therapy: a breakthrough in heart failure management. J Intern Med 2012; 272:330-43. [PMID: 22882554 DOI: 10.1111/j.1365-2796.2012.02580.x] [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: 02/05/2023]
Abstract
Heart failure is now considered an epidemic. In patients with heart failure, electrical and mechanical dyssynchrony, evident primarily as prolongation of the QRS-complex on the surface electrocardiogram, is associated with detrimental effects on the cardiovascular system at several levels. In the past 10 years, studies have demonstrated that by stimulating both cardiac ventricles simultaneously, or almost simultaneously [cardiac resynchronization therapy (CRT)], the adverse effects of dyssynchrony can be overcome. Here, we provide a comprehensive overview of different aspects of CRT including the rationale behind and evidence for efficacy of the therapy. Issues with regard to gender effects and patient follow-up as well as a number of unresolved concerns will also be discussed.
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Affiliation(s)
- M Ståhlberg
- Department of Cardiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
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AKAR JOSEPHG. Response to Cardiac Resynchronization in Heart Failure: Just Go With the Myocardial Blood Flow? J Cardiovasc Electrophysiol 2010; 21:1240-1. [DOI: 10.1111/j.1540-8167.2010.01840.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Sahlén A, Shahgaldi K, Aminoff A, Aagaard P, Manouras A, Winter R, Ehrenborg E, Braunschweig F. Effects of Prolonged Exercise on Left Ventricular Mechanical Synchrony in Long-Distance Runners: Importance of Previous Exposure to Endurance Races. J Am Soc Echocardiogr 2010; 23:977-84. [DOI: 10.1016/j.echo.2010.06.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Indexed: 11/26/2022]
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Knaapen P, Götte MJ, van Dijk J, De Cock CC, Allart CP, Lammertsma CC, Visser FC. Cardiac resynchronization therapy: assessment of dyssynchrony and effects on metabolism. Future Cardiol 2010; 1:245-55. [PMID: 19804169 DOI: 10.1517/14796678.1.2.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
In recent years cardiac resynchronization therapy has emerged as a promising new treatment strategy in a subgroup of patients with congestive heart failure and an asynchronous contraction pattern. By simultaneously pacing both right ventricular apex and lateral side of the left ventricle, ventricular synchrony can be partially restored and beneficial effects on cardiac performance can be observed. This review discusses the principles of ventricular dyssynchrony, and the acute and chronic effects of cardiac resynchronization therapy on systolic function, cardiac metabolism, and clinical parameters. Furthermore, the issue of identifying patients who do not respond to this therapy is addressed.
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Affiliation(s)
- P Knaapen
- VU University Medical Center , Department of Cardiology, 6D 120, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
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Abstract
Cardiac resynchronization has emerged as a highly effective therapy for heart failure. However, up to 40% of patients do not benefit from this treatment. In this Review, we discuss the potential role of MRI and nuclear molecular imaging in providing additional insights into the response to cardiac resynchronization therapy. Variables with potential prognostic and therapeutic values include the evaluation of cardiac dyssynchrony, scar, cardiac sympathetic function, myocardial blood flow, myocardial glucose and oxidative metabolism. Other molecular targets to characterize apoptosis, fatty acid metabolism, angiogenesis and angiotensin-converting enzyme activity will also be described. The potential use of these techniques in identifying and measuring responses to cardiac resynchronization therapy and future areas of research will be explored.
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Wikstrom G, Blomström-Lundqvist C, Andren B, Lönnerholm S, Blomström P, Freemantle N, Remp T, Cleland JGF. The effects of aetiology on outcome in patients treated with cardiac resynchronization therapy in the CARE-HF trial. Eur Heart J 2009; 30:782-8. [PMID: 19168870 PMCID: PMC2663726 DOI: 10.1093/eurheartj/ehn577] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Revised: 11/06/2008] [Accepted: 12/04/2008] [Indexed: 01/08/2023] Open
Abstract
AIMS Cardiac dyssynchrony is common in patients with heart failure, whether or not they have ischaemic heart disease (IHD). The effect of the underlying cause of cardiac dysfunction on the response to cardiac resynchronization therapy (CRT) is unknown. This issue was addressed using data from the CARE-HF trial. METHODS AND RESULTS Patients (n = 813) were grouped by heart failure aetiology (IHD n = 339 vs. non-IHD n = 473), and the primary composite (all-cause mortality or unplanned hospitalization for a major cardiovascular event) and principal secondary (all-cause mortality) endpoints analysed. Heart failure severity and the degree of dyssynchrony were compared between the groups by analysing baseline clinical and echocardiographic variables. Patients with IHD were more likely to be in NYHA class IV (7.5 vs. 4.0%; P = 0.03) and to have higher NT-proBNP levels (2182 vs. 1725 pg/L), indicating more advanced heart failure. The degree of dyssynchrony was more pronounced in patients without IHD (assessed using mean QRS duration, interventricular mechanical delay, and aorta-pulmonary pre-ejection time). Left ventricular ejection fraction and left ventricular end-systolic volume improved to a lesser extent in the IHD group (4.53 vs. 8.50% and -35.68 vs. -58.52 cm(3)). Despite these differences, CRT improved all-cause mortality, NYHA class, and hospitalization rates to a similar extent in patients with or without IHD. CONCLUSION The benefits of CRT in patients with or without IHD were similar in relative terms in the CARE-HF study but as patients with IHD had a worse prognosis, the benefit in absolute terms may be greater.
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Affiliation(s)
- Gerhard Wikstrom
- Department of Cardiology, Institute of Medical Sciences, Akademiska Hospital, University of Uppsala, Uppsala, Sweden.
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Schlosshan D, Barker D, Lewis N, Pepper C, Tan LB. A mechanistic investigation into how long-term resynchronization therapy confers ongoing cardiac functional benefits and improved exercise capacity. Am J Cardiol 2009; 103:701-8. [PMID: 19231337 DOI: 10.1016/j.amjcard.2008.10.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Revised: 10/25/2008] [Accepted: 10/25/2008] [Indexed: 11/27/2022]
Abstract
The exact mechanisms underpinning the longer term benefits of cardiac resynchronization therapy (CRT) were not fully understood. It was still unclear whether there was any ongoing functional benefit conferred by the partial resynchronization of ventricular contraction. To resolve this, a randomized controlled double-blind crossover trial was conducted to investigate the impact of temporary cessation of CRT on cardiac function both at rest and during peak exercise. Fifteen patients with severe heart failure and a CRT device implanted at least 3 months previously were randomly assigned to have the CRT mode switched to either off or on during exercise tests with central hemodynamic measurements (including noninvasive cardiac output measured using rebreathing methods), then crossed over on separate days to the opposite CRT mode. There were no significant changes in hemodynamic variables at rest with either mode of CRT. When CRT was acutely turned off, there was 19% lower peak exercise cardiac power (2.10 +/- 0.46 vs 2.59 +/- 0.75 W; p <0.005), 6% lower mean arterial pressure (92 +/- 12 vs 98 +/- 13 mm Hg; p <0.05), and 11.5% lower peak cardiac output (10.4 +/- 1.9 vs 11.8 +/- 2.5 L/min; p <0.05). Exercise capacity was also diminished with lower peak oxygen uptake (15.7 +/- 4.3 vs 17.2 +/- 4.9 ml/kg/min; p <0.01) and shorter exercise duration (542 +/- 204 vs 587 +/- 212 seconds; p <0.05). These changes were seen without differences in peak respiratory exchange ratio and peak systemic vascular resistance. In conclusion, these observations provided evidence that after CRT, left ventricular resynchronization continued to confer cardiac functional benefits manifest during peak exercise, but imperceptible at rest.
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Affiliation(s)
- Dominik Schlosshan
- Academic Unit of Molecular Cardiovascular Medicine, University of Leeds, Leeds, United Kingdom
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18
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YPENBURG CLAUDIA, VAN DE VEIRE NICO, WESTENBERG JOSJ, BLEEKER GABEB, MARSAN NINAAJMONE, HENNEMAN MAUREENM, VAN DER WALL ERNSTE, SCHALIJ MARTINJ, ABRAHAM THEODOREP, BAROLD SSERGE, BAX JEROENJ. Noninvasive Imaging in Cardiac Resynchronization Therapy-Part 2: Follow-up and Optimization of Settings. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2008; 31:1628-39. [DOI: 10.1111/j.1540-8159.2008.01237.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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19
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Ukkonen H, Sundell J, Knuuti J. Effects of CRT on myocardial innervation, perfusion and metabolism. Europace 2008; 10 Suppl 3:iii114-7. [DOI: 10.1093/europace/eun228] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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20
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Valzania C, Gadler F, Winter R, Braunschweig F, Brodin LA, Gudmundsson P, Boriani G, Eriksson MJ. Effects of cardiac resynchronization therapy on coronary blood flow: evaluation by transthoracic Doppler echocardiography. Eur J Heart Fail 2008; 10:514-20. [PMID: 18436475 DOI: 10.1016/j.ejheart.2008.03.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2007] [Revised: 02/15/2008] [Accepted: 03/27/2008] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Relatively limited and conflicting data are available on the effects of cardiac resynchronization therapy (CRT) on coronary blood flow (CBF). AIMS To investigate changes in the left anterior descending coronary artery (LAD) flow under different CRT pacing modes by means of transthoracic Doppler echocardiography (TTE). METHODS Twenty-two responders to CRT (67+/-11 years) with idiopathic dilated cardiomyopathy underwent TTE assessment of LAD flow and Tissue Velocity Imaging during 4 programming modes: intrinsic conduction (IC), right ventricular pacing (RV), simultaneous biventricular pacing (BVP), BVP with left ventricular (LV) pre-activation. RESULTS Mean coronary flow velocity (CFV) was increased by simultaneous BVP (p=0.0063 vs. IC) and BVP with LV pre-activation (p<0.0001 vs. IC; p=0.027 vs. simultaneous BVP). Peak CFV and LAD flow velocity/time integral were highest during BVP with LV pre-activation. A reduction in septal-to-lateral delay and an increase in peak systolic velocity in the basal septum were observed during simultaneous BVP and BVP with LV pre-activation. CONCLUSIONS In CRT responders with idiopathic dilated cardiomyopathy, an increase in LAD flow, assessed by TTE, was observed during simultaneous BVP and BVP with LV pre-activation. This was associated with an improvement in regional myocardial contraction and a decrease in intraventricular dyssynchrony.
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Affiliation(s)
- Cinzia Valzania
- Department of Medicine, Division of Cardiology, Karolinska Institutet, Stockholm, Sweden.
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21
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YPENBURG CLAUDIA, BAX JEROENJ. The Role of Positron Emission Tomography in Evaluation of Alterations in Cardiac Efficiency after Cardiac Resynchronization Therapy. J Cardiovasc Electrophysiol 2008; 19:133-5. [DOI: 10.1111/j.1540-8167.2007.01032.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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22
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CHRISTENSON STUARTD, CHAREONTHAITAWEE PANITHAYA, BURNES JOHNE, HILL MICHAELR, KEMP BRADJ, KHANDHERIA BIJOYK, HAYES DAVIDL, GIBBONS RAYMONDJ. Effects of Simultaneous and Optimized Sequential Cardiac Resynchronization Therapy on Myocardial Oxidative Metabolism and Efficiency. J Cardiovasc Electrophysiol 2008; 19:125-32. [DOI: 10.1111/j.1540-8167.2007.00996.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Valzania C, Gadler F, Eriksson MJ, Olsson A, Boriani G, Braunschweig F. Electromechanical effects of cardiac resynchronization therapy during rest and stress in patients with heart failure. Eur J Heart Fail 2007; 9:644-50. [DOI: 10.1016/j.ejheart.2007.01.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2006] [Revised: 11/21/2006] [Accepted: 01/11/2007] [Indexed: 11/25/2022] Open
Affiliation(s)
- Cinzia Valzania
- Institute of Cardiology of the University of Bologna; Bologna Italy
| | - Fredrik Gadler
- Department of Cardiology; Karolinska University Hospital, Karolinska Institute; Stockholm Sweden
| | - Maria J. Eriksson
- Department of Clinical Physiology; Karolinska University Hospital, Karolinska Institute; Stockholm Sweden
| | - Arne Olsson
- Department of Clinical Physiology; Karolinska University Hospital, Karolinska Institute; Stockholm Sweden
| | - Giuseppe Boriani
- Institute of Cardiology of the University of Bologna; Bologna Italy
| | - Frieder Braunschweig
- Department of Cardiology; Karolinska University Hospital, Karolinska Institute; Stockholm Sweden
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24
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Yildirim A, Soylu O, Dagdeviren B, Ergelen M, Celik S, Zencirci E, Tezel T. Cardiac Resynchronization Improves Coronary Blood Flow. TOHOKU J EXP MED 2007; 211:43-7. [PMID: 17202771 DOI: 10.1620/tjem.211.43] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Asynchronous ventricular activation, induced by left bundle branch block, is known to have deleterious effects on the systolic and diastolic functions of the left ventricle (LV). Cardiac resynchronization therapy (CRT) has been proposed as a complementary method to improve the LV systolic performance by restoring the synchronized contraction patterns in patients with advanced heart failure and left bundle branch block. However, the effect of CRT on myocardial blood flow is not well established. In the present study, we therefore examined the coronary blood flow in 20 patients with idiopathic dilated cardiomyopathy, implanted with a biventricular pacemaker according to the established CRT criteria. Color Doppler settings were adjusted for the optimal coronary flow imaging, and coronary flow velocities were obtained in all patients. Typical diastolic predominant phasic Doppler spectrum of the distal left anterior descending coronary artery (LAD) was recorded. Conventional echocardiographic variables, peak values of the diastolic and systolic LAD velocities, and the velocity time integrals were measured for three or five consecutive beats during CRT with pacemaker on and off. Successful CRT with biventricular pacing increased coronary blood flow velocities of the distal LAD in addition to its well-known benefits on the systolic and diastolic LV performance in patients with significant dyssynchrony. CRT decreased duration of mitral regurgitation and increased diastolic filling time. Peak diastolic velocities and velocity time integral of the distal LAD were increased significantly. In conclusion, successful CRT with biventricular pacing improves coronary blood flow velocities of the distal LAD.
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Affiliation(s)
- Aydin Yildirim
- Cardiology Department, Siyami Ersek Thoracic and Cardiovascular Surgery Center, 21 Acibadem, Istanbul, Turkey.
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25
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Bax JJ, Abraham T, Barold SS, Breithardt OA, Fung JWH, Garrigue S, Gorcsan J, Hayes DL, Kass DA, Knuuti J, Leclercq C, Linde C, Mark DB, Monaghan MJ, Nihoyannopoulos P, Schalij MJ, Stellbrink C, Yu CM. Cardiac Resynchronization Therapy. J Am Coll Cardiol 2005; 46:2168-82. [PMID: 16360043 DOI: 10.1016/j.jacc.2005.09.020] [Citation(s) in RCA: 163] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2005] [Revised: 09/19/2005] [Accepted: 09/19/2005] [Indexed: 11/19/2022]
Abstract
Encouraged by the clinical success of cardiac resynchronization therapy (CRT), the implantation rate has increased exponentially, although several limitations and unresolved issues of CRT have been identified. This review concerns issues that are encountered during implantation of CRT devices, including the role of electroanatomical mapping, whether CRT implantation should be accompanied by simultaneous atrioventricular nodal ablation in patients with atrial fibrillation, procedural complications, and when to consider surgical left ventricular lead positioning. Furthermore, (echocardiographic) CRT optimization and assessment of CRT benefits after implantation are highlighted. Also, controversial issues such as the potential value of CRT in patients with mild heart failure or narrow QRS complex are addressed. Finally, open questions concerning when to combine CRT with implantable cardioverter-defibrillator therapy and the cost-effectiveness of CRT are discussed.
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Affiliation(s)
- Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
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26
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Lindner O, Vogt J, Kammeier A, Wielepp P, Holzinger J, Baller D, Lamp B, Hansky B, Körfer R, Horstkotte D, Burchert W. Effect of cardiac resynchronization therapy on global and regional oxygen consumption and myocardial blood flow in patients with non-ischaemic and ischaemic cardiomyopathy. Eur Heart J 2004; 26:70-6. [PMID: 15615802 DOI: 10.1093/eurheartj/ehi046] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS We studied the effects of cardiac resynchronization therapy (CRT) on global and regional myocardial oxygen consumption (MVO2) and myocardial blood flow (MBF) in non-ischaemic (NICM) and ischaemic dilated cardiomyopathy (ICM). METHODS AND RESULTS Thirty-one NICM and 11 ICM patients, all of them acute responders, were investigated. MVO2 and MBF were obtained by 11C-acetate PET before and after 4 months of CRT. In NICM global MVO2 and MBF did not change during CRT, while the rate pressure product (RPP) normalized MVO2 increased (P=0.03). Before CRT regional MVO2 and MBF were highest in the lateral wall and lowest in the septum. Under therapy, MVO2 and MBF decreased in the lateral wall (P=0.045) and increased in the septum (P=0.045) resulting in a more uniform distribution. In ICM, global MVO2, MBF, and RPP did not change under CRT. Regional MVO2 and MBF showed no significant changes but a similar tendency in the lateral and septal wall to that in NICM. CONCLUSION CRT induces changes of MVO2 and MBF on a regional level with a more uniform distribution between the myocardial walls and improved ventricular efficiency in NICM. Based on the investigated parameters, CRT appears to be more effective in NICM than in ICM.
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Affiliation(s)
- Oliver Lindner
- Institute of Molecular Biophysics, Radiopharmacy, and Nuclear Medicine, Heart and Diabetes Center North Rhine-Westphalia, Georgstr. 11, D-32545 Bad Oeynhausen, Germany.
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27
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Gibbons RJ, Araoz PA. The year in cardiac imaging. J Am Coll Cardiol 2004; 44:1937-44. [DOI: 10.1016/j.jacc.2004.08.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2004] [Accepted: 08/04/2004] [Indexed: 10/26/2022]
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28
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Knaapen P, van Campen LMC, de Cock CC, Götte MJW, Visser CA, Lammertsma AA, Visser FC. Effects of Cardiac Resynchronization Therapy on Myocardial Perfusion Reserve. Circulation 2004; 110:646-51. [PMID: 15302806 DOI: 10.1161/01.cir.0000138108.68719.c1] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Cardiac resynchronization therapy (CRT) is a relatively new treatment strategy for patients with heart failure and mechanical asynchrony. Reported effects of CRT on regional myocardial blood flow (MBF) are conflicting, and effects on hyperemic MBF are scarce. The aim of the present study was to assess serial changes of MBF and MBF reserve in patients receiving a biventricular pacemaker.
Methods and Results—
Fourteen patients with heart failure (NYHA class III or IV; left ventricular ejection fraction <35%), QRS width >120 ms, and sinus rhythm were studied (mean age, 58±10 years; 8 men). MBF and hyperemic MBF were measured at baseline, 3 months after biventricular pacing (CRT on), and after cessation of pacing (CRT off) with PET and H
2
15
O. CRT had no significant effect on resting MBF (baseline versus CRT on versus CRT off: 0.82±0.25 versus 0.69±0.24 versus 0.74±0.24 mL · min
−1
· mL
−1
;
P
=NS). Hyperemic MBF increased during CRT (1.91±1.03 versus 2.66±1.66 versus 1.92±1.06 mL · min
−1
· mL
−1
;
P
=0.01 by MANOVA), as did MBF reserve (2.25±1.00 versus 3.76±2.38 versus 2.49±0.94 mL · min
−1
· mL
−1
;
P
=0.023). CRT (reversibly) resulted in a more homogeneous distribution of regional resting MBF as demonstrated by the septal-to-lateral ratio. The decrease in the ratio of left ventricular end-diastolic volume to left ventricular mass, as a reflection of wall stress, was related to the increase in hyperemic MBF (
r
=0.53,
P
<0.05). Left ventricular ejection fraction increased from 25±7% to 37±9% (
P
<0.01).
Conclusions—
Resting MBF is unaltered by CRT despite an increase in left ventricular function. However, the distribution pattern of resting MBF becomes more homogeneous. Hyperemic MBF and consequently MBF reserve are enhanced by CRT.
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Affiliation(s)
- Paul Knaapen
- Department of Cardiology, 6D Room 120, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
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29
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Knuuti J, Sundell J, Naum A, Engblom E, Koistinen J, Ylitalo A, Stolen KQ, Kalliokoski R, Nekolla SG, Bax KEJJ, Airaksinen KEJ. Assessment of right ventricular oxidative metabolism by PET in patients with idiopathic dilated cardiomyopathy undergoing cardiac resynchronisation therapy. Eur J Nucl Med Mol Imaging 2004; 31:1592-8. [PMID: 15290120 DOI: 10.1007/s00259-004-1631-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2004] [Accepted: 06/16/2004] [Indexed: 10/26/2022]
Abstract
PURPOSE Right ventricular (RV) performance is known to have prognostic value in patients with congestive heart failure (CHF). Cardiac resynchronization therapy (CRT) has been found to enhance left ventricular (LV) energetics and metabolic reserve in patients with heart failure. The interplay between the LV and RV may play an important role in CRT response. The purpose of the study was to investigate RV oxidative metabolism, metabolic reserve and the effects of CRT in patients with CHF and left bundle brach block. In addition, the role of the RV in the response to CRT was evaluated. METHODS Ten patients with idiopathic dilated cardiomyopathy who had undergone implantation of a biventricular pacemaker 8+/-5 months earlier were studied under two conditions: CRT ON and after CRT had been switched OFF for 24 h. Oxidative metabolism was measured using [11C]acetate positron emission tomography (Kmono). The measurements were performed at rest and during dobutamine-induced stress (5 microg/kg per minute). LV performance and interventricular mechanical delay (interventricular asynchrony) were measured using echocardiography. RESULTS CRT had no effect on RV Kmono at rest (ON: 0.052+/-0.014, OFF: 0.047+/-0.018, NS). Dobutamine-induced stress increased RV Kmono significantly under both conditions but oxidative metabolism was more enhanced when CRT was ON (0.076+/-0.026 vs 0.065+/-0.027, p=0.003). CRT shortened interventricular delay significantly (45+/-33 vs 19+/-35 ms, p=0.05). In five patients the response to CRT was striking (32% increase in mean LV stroke volume, range 18-36%), while in the other five patients no response was observed (mean change +2%, range -6% to +4%). RV Kmono and LV stroke volume response to CRT correlated inversely (r=-0.66, p=0.034). None of the other measured parameters, including all LV parameters and electromechanical parameters, were associated with the response to CRT. In responders, RV Kmono with CRT OFF was significantly lower than in non-responders (0.036+/-0.01 vs 0.058+/-0.02, p=0.047). CONCLUSION CRT appears to enhance RV oxidative metabolism and metabolic reserve during stress. Patients responding to CRT appear to have lower RV oxidative metabolism at rest, suggesting that the RV plays a significant role in the response to CRT.
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Affiliation(s)
- Juhani Knuuti
- Turku PET Centre, University of Turku, Turku, Finland.
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30
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Nowak B, Stellbrink C, Sinha AM, Kaiser HJ, Reinartz P, Koos R, Markus K, Hanrath P, Buell U, Schaefer WM. Effects of cardiac resynchronization therapy on myocardial blood flow measured by oxygen-15 water positron emission tomography in idiopathic-dilated cardiomyopathy and left bundle branch block. Am J Cardiol 2004; 93:496-9. [PMID: 14969635 DOI: 10.1016/j.amjcard.2003.10.055] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2003] [Revised: 10/10/2003] [Accepted: 10/10/2003] [Indexed: 10/26/2022]
Abstract
Regional and global myocardial blood flow and coronary vascular resistance were determined in patients with idiopathic-dilated cardiomyopathy and left bundle branch block before and during cardiac resynchronization therapy (CRT) using oxygen-15 water positron emission tomography. The investigated parameters did not exhibit regional heterogeneity and were not influenced by CRT. This implies that the beneficial effects of CRT do not require additional oxygen demand or regional reallocation of oxidative metabolism.
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Affiliation(s)
- Bernd Nowak
- Department of Nuclear Medicine, University Hospital, Aachen University of Technology, Aachen, Germany.
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