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Bilikundi P, Alphonce B, Nyundo A, Meda JR. Predictors and outcomes of cardiac dyssynchrony among patients with heart failure attending Benjamin Mkapa Hospital in Dodoma, central Tanzania: A protocol of prospective-longitudinal study. PLoS One 2023; 18:e0287813. [PMID: 37976266 PMCID: PMC10655995 DOI: 10.1371/journal.pone.0287813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/26/2023] [Indexed: 11/19/2023] Open
Abstract
INTRODUCTION Cardiac Dyssynchrony is prevalent among patients with heart failure with high cost of care and potentially poor outcomes. Nevertheless, little is known about cardiac dyssynchrony among heart failure patients, especially in developing countries. This study aims at assessing the predictors and outcomes of cardiac dyssynchrony among heart failure patients attending the cardiology department at Benjamin Mkapa Referral Hospital in Dodoma, central Tanzania. METHODS The study will follow a prospective longitudinal design involving participants aged 18 years and above with heart failure attending the Cardiology Department at Benjamin Mkapa Hospital. Heart failure will be identified based on Framingham's score and patients will be enrolled and followed up for six months. Baseline socio-demographic and clinical characteristics will be taken during enrollment. Outcomes of interest at six months include worsening of heart failure, readmission and death. Continuous data will be summarized as Mean (SD) or Median (IQR), and categorical data will be summarized using proportions and frequencies. Binary logistic regression will be used to determine predictors and outcomes of Cardiac Dyssynchrony among patients with heart failure.
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Affiliation(s)
- Patrick Bilikundi
- Department of Internal Medicine, School of Medicine & Dentistry, The University Dodoma, Dodoma, Tanzania
- Department of Cardiology, The Benjamin Mkapa Hospital, Dodoma, Tanzania
| | - Baraka Alphonce
- Department of Internal Medicine, School of Medicine & Dentistry, The University Dodoma, Dodoma, Tanzania
| | - Azan Nyundo
- Department of Internal Medicine, School of Medicine & Dentistry, The University Dodoma, Dodoma, Tanzania
- Department of Psychiatry and Mental Health, School of Medicine and Dentistry, The University of Dodoma, Dodoma, Tanzania
- Mirembe National Mental Hospital, Dodoma, Tanzania
| | - John Robson Meda
- Department of Internal Medicine, School of Medicine & Dentistry, The University Dodoma, Dodoma, Tanzania
- Department of Cardiology, The Benjamin Mkapa Hospital, Dodoma, Tanzania
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Doi T, Nakata T, Noto T, Mita T, Yuda S, Hashimoto A. Improved risk-stratification in heart failure patients with mid-range to severe abnormalities of QRS duration and systolic function using mechanical dyssynchrony assessed by myocardial perfusion-gated SPECT. J Nucl Cardiol 2022; 29:1611-1625. [PMID: 33629244 DOI: 10.1007/s12350-021-02554-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 12/15/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The use of left ventricular mechanical dyssynchrony (LVMD), which has been reported to be responsible for unfavorable outcomes, might improve conventional risk-stratification by clinical indices including QRS duration (QRSd) and systolic dysfunction in patients with heart failure (HF). METHODS AND RESULTS Following measurements of 12-lead QRSd and left ventricular ejection fraction (LVEF), three-dimensional (3-D) LVMD was evaluated as a standard deviation (phase SD) of regional mechanical systolic phase angles by gated myocardial perfusion imaging in 829 HF patients. Patients were followed up for a mean period of 37 months with a primary endpoint of lethal cardiac events (CEs). In an overall multivariate Cox proportional hazards model, phase SDs were identified as significant prognostic determinants independently. The patients were divided into 4 groups by combining with the cut-off values of LVEF (35% and 50%) and QRSd (130 ms and 150 ms). The groups with lower LVEF and prolonged QRSd more frequently had CEs than did the other groups. Patient groups with LVEF < 35% and with 35% ≦ LVEF < 50% were differentiated into low-risk and high-risk categories by using an optimal phase SD cut-off value of both QRSd thresholds. CONCLUSIONS 3-D LVMD can risk-stratify HF patients with mid-range as well as severe abnormalities of QRSd and systolic dysfunction.
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Affiliation(s)
- Takahiro Doi
- Department of Cardiology, Teine Kijinkai Hospital, Sapporo, Hokkaido, Japan.
| | - Tomoaki Nakata
- Department of Cardiology, Hakodate Goryokaku Hospital, Hakodate, Japan
| | - Takahiro Noto
- Department of Cardiology, Teine Kijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Tomohiro Mita
- Department of Cardiology, Teine Kijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Satoshi Yuda
- Department of Cardiology, Teine Kijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Akiyoshi Hashimoto
- Department of Cardiology, Renal and Metabolic Medicine, Sapporo Medical University, Sapporo, Japan
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Zhang F, Wang Y. Left ventricular mechanical dyssynchrony in patients with heart failure: What is the next step? J Nucl Cardiol 2022; 29:1629-1631. [PMID: 33709331 DOI: 10.1007/s12350-021-02578-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 02/10/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Feifei Zhang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No. 185, Juqian Street, Changzhou, Jiangsu Province, 213003, China
- Changzhou Key Laboratory of Molecular Imaging, Changzhou, Jiangsu Province, China
| | - Yuetao Wang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No. 185, Juqian Street, Changzhou, Jiangsu Province, 213003, China.
- Changzhou Key Laboratory of Molecular Imaging, Changzhou, Jiangsu Province, China.
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Wang M, Xu Y, Wang S, Zhao T, Cai H, Wang Y, Zou R, Wang C. Predictive value of electrocardiographic markers in children with dilated cardiomyopathy. Front Pediatr 2022; 10:917730. [PMID: 36081634 PMCID: PMC9445218 DOI: 10.3389/fped.2022.917730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Dilated cardiomyopathy (DCM) refers to a heterogeneous group of cardiomyopathies characterized by ventricular dilatation and myocardial systolic dysfunction, which can lead to serious consequences such as malign arrhythmia, sudden death, heart failure, and thromboembolism. With its economical, non-invasive, simple and reproducible advantages, electrocardiogram (ECG) has become an important indicator for assessing the prognosis of cardiovascular diseases. In recent years, more and more studies of electrocardiography on DCM have been carried out, but there is still a lack of a comprehensive summary of its prognostic value. This article reviews the prognostic value of electrocardiographic markers in children with DCM.
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Affiliation(s)
- Miao Wang
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yi Xu
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shuo Wang
- Department of Neonatology, Xiangya Hospital, Central South University, Changsha, China
| | - Ting Zhao
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Hong Cai
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yuwen Wang
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Runmei Zou
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Cheng Wang
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
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Athayde GAT, Borges BCC, Pinheiro AO, Souza AL, Oliveira CP, Martins SAM, Teixeira RA, Siqueira SF, Porter TR, Mathias Junior W, Martinelli Filho M. Myocardial function reclassification: Echocardiographic strain patterns in patients with chronic Chagas cardiomyopathy and intraventricular dyssynchrony. Int J Cardiol 2021; 348:102-107. [PMID: 34890764 DOI: 10.1016/j.ijcard.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/03/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND We aimed to identify, among Chronic Chagas Cardiomyopathy (CCC) patients with left ventricular dysfunction (LVD) and non-left bundle branch block (non-LBBB), subgroups with different functional and mechanical patterns of global longitudinal strain (GLS) and intraventricular dyssynchrony (IVD) at rest and after exercise stress test, and reclassify them using a new echocardiographic approach. METHODOLOGY In this single-center cross-sectional study, 40 patients with CCC, left ventricular ejection fraction (LVEF) ≤ 35% and non-LBBB underwent rest echocardiography and then treadmill exercise stress echocardiography with GLS and IVD analysis. The sample was divided into four groups, based on GLS and IVD significant variation between rest and exercise: GLS + IVD+ (9 patients); GLS + IVD- (9 patients); GLS-IVD+ (10 patients); GLS-IVD- (10 patients). RESULTS At rest, median LVEF was 28% (21.3%-33%) and GLS (-7% (-5%/-9.3%), were not different among groups. The average response of GLS was an increase of 0.74% over rest values, and the average response of IVD was a decrease of 6.9 ms. Group GLS-IVD+ presented more dyssynchrony at rest (p = 0.01). Left atrial (LA) volume (higher in GLS-IVD-) (p = 0.022) and TAPSE (higher in GLS + IVD+) (p = 0.015) were also different among groups at baseline. Of the 40 patients evaluated, 27 (67.5%) had very severe LVD (GLS < -8%). In addition, among these patients, 11 patients had contractile reserve after undergoing stress echocardiography. CONCLUSIONS In patients with CCC, severe LVD and non-LBBB, the evaluation of GLS and IVD between rest and exercise was able to reclassify myocardial function and to identify subgroups with contractile reserve and significant dyssynchronopathy.
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Affiliation(s)
- Guilherme A T Athayde
- Cardiac Stimulation Clinical Unit, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Bruno C C Borges
- Echocardiography Unit, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Andreia O Pinheiro
- Cardiac Stimulation Clinical Unit, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Aline L Souza
- Cardiac Stimulation Clinical Unit, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Camila P Oliveira
- Cardiac Stimulation Clinical Unit, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Sergio A M Martins
- Cardiac Stimulation Clinical Unit, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ricardo A Teixeira
- Cardiac Stimulation Clinical Unit, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Sergio F Siqueira
- Cardiac Stimulation Clinical Unit, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.
| | - Thomas Richard Porter
- Echocardiography Laboratory of the University of Nebraska Medical Center, Omaha, NE, USA.
| | - Wilson Mathias Junior
- Echocardiography Unit, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Martino Martinelli Filho
- Cardiac Stimulation Clinical Unit, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.
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Li Y, Liu X, Xu Y, Li W, Tang S, Zhou X, Sun J, Zhang Q, Han Y, Chen Y. The Prognostic Value of Left Ventricular Mechanical Dyssynchrony Derived from Cardiac MRI in Patients with Idiopathic Dilated Cardiomyopathy. Radiol Cardiothorac Imaging 2021; 3:e200536. [PMID: 34498001 DOI: 10.1148/ryct.2021200536] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 05/12/2021] [Accepted: 06/08/2021] [Indexed: 02/05/2023]
Abstract
Purpose To investigate the prognostic value of mechanical dyssynchrony evaluated by deformable registration algorithm (DRA) analysis of cardiac MRI (CMR) in patients with idiopathic dilated cardiomyopathy (DCM). Materials and Methods This secondary analysis of a prospective study (clinical trial no. ChiCTR1800017058) enrolled 409 patients (mean age, 48 years ± 14:300 men) with idiopathic DCM who underwent CMR between June 2012 and September 2018. Mechanical dyssynchrony was measured as standard deviation of time-to-peak (sdTTP) and uniformity ratio estimate (URE) indexes by DRA strain analysis. The primary endpoint included all-cause mortality and heart transplantation. The secondary endpoint included primary endpoint, aborted sudden cardiac death, and heart failure readmission. Cox regression analyses and Kaplan-Meier survival analysis were performed to identify the association between variables and outcomes. Results During a median follow-up of 25.1 months, 57 and 132 patients reached primary and secondary endpoints, respectively. Most URE indexes were significantly lower in patients reaching primary endpoint. In multivariable analysis, circumferential URE (CURE) at apical level was independently associated with primary endpoints (hazard ratio, 0.307 [95% CI: 0.106, 0.883]; P = .03) and secondary endpoints (hazard ratio, 0.452 [95% CI: 0.209, 0.979]; P = .04), whereas most sdTTP measures were not. Furthermore, among patients with left ventricular ejection fraction of less than 35% or presence of late gadolinium enhancement, those with CURE at apical level of less than 0.917 had a significantly higher rate of adverse outcomes. Conclusion URE indexes were more predictive of prognostic outcomes compared with sdTTP measurements; the CURE at apical level was an independent predictor of adverse cardiac events in patients with DCM.Keywords: Heart, Outcomes Analysis, MR-ImagingClinical trial registration no. ChiCTR1800017058 Supplemental material is available for this article. See also commentary by Rajiah and François in this issue.© RSNA, 2021.
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Affiliation(s)
- Yangjie Li
- Departments of Cardiology (Y.L., Y.X., W.L., S.T., Q.Z., Y.C.) and Radiology (X.L., J.S.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China; Siemens Healthcare, Shanghai, China (X.Z.); and Cardiovascular Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Xiumin Liu
- Departments of Cardiology (Y.L., Y.X., W.L., S.T., Q.Z., Y.C.) and Radiology (X.L., J.S.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China; Siemens Healthcare, Shanghai, China (X.Z.); and Cardiovascular Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Yuanwei Xu
- Departments of Cardiology (Y.L., Y.X., W.L., S.T., Q.Z., Y.C.) and Radiology (X.L., J.S.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China; Siemens Healthcare, Shanghai, China (X.Z.); and Cardiovascular Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Weihao Li
- Departments of Cardiology (Y.L., Y.X., W.L., S.T., Q.Z., Y.C.) and Radiology (X.L., J.S.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China; Siemens Healthcare, Shanghai, China (X.Z.); and Cardiovascular Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Siqi Tang
- Departments of Cardiology (Y.L., Y.X., W.L., S.T., Q.Z., Y.C.) and Radiology (X.L., J.S.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China; Siemens Healthcare, Shanghai, China (X.Z.); and Cardiovascular Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Xiaoyue Zhou
- Departments of Cardiology (Y.L., Y.X., W.L., S.T., Q.Z., Y.C.) and Radiology (X.L., J.S.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China; Siemens Healthcare, Shanghai, China (X.Z.); and Cardiovascular Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Jiayu Sun
- Departments of Cardiology (Y.L., Y.X., W.L., S.T., Q.Z., Y.C.) and Radiology (X.L., J.S.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China; Siemens Healthcare, Shanghai, China (X.Z.); and Cardiovascular Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Qing Zhang
- Departments of Cardiology (Y.L., Y.X., W.L., S.T., Q.Z., Y.C.) and Radiology (X.L., J.S.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China; Siemens Healthcare, Shanghai, China (X.Z.); and Cardiovascular Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Yuchi Han
- Departments of Cardiology (Y.L., Y.X., W.L., S.T., Q.Z., Y.C.) and Radiology (X.L., J.S.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China; Siemens Healthcare, Shanghai, China (X.Z.); and Cardiovascular Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Yucheng Chen
- Departments of Cardiology (Y.L., Y.X., W.L., S.T., Q.Z., Y.C.) and Radiology (X.L., J.S.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China; Siemens Healthcare, Shanghai, China (X.Z.); and Cardiovascular Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pa (Y.H.)
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Rajiah P, François CJ. Cardiac MRI for Left Ventricular Dyssynchrony: Time for Coordinated Response. Radiol Cardiothorac Imaging 2021; 3:e210193. [PMID: 34498012 PMCID: PMC8415138 DOI: 10.1148/ryct.2021210193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/12/2021] [Accepted: 08/12/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Prabhakar Rajiah
- From the Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905
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Mele D, Trevisan F, Fiorencis A, Smarrazzo V, Bertini M, Ferrari R. Current Role of Echocardiography in Cardiac Resynchronization Therapy: from Cardiac Mechanics to Flow Dynamics Analysis. Curr Heart Fail Rep 2021; 17:384-396. [PMID: 32979151 DOI: 10.1007/s11897-020-00484-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW The aim of this review is to summarily explain what LV synchrony, coordination, myocardial work, and flow dynamics are, trying to clarify their advantages and limitations in the treatment of heart failure patients undergoing or with implanted cardiac resynchronization therapy (CRT). RECENT FINDINGS CRT is an established treatment for patients with heart failure and left ventricular systolic dysfunction. In the current guidelines, CRT implant indications rely only on electrical dyssynchrony, but in the last years, many aspects of cardiac mechanics (including contractile synchrony, coordination, propagation, and myocardial work) and flow dynamics have been studied using echocardiographic techniques to better characterize patients undergoing or with implanted CRT. However, the concepts, limits, and potential applications of all these echocardiographic evaluations are unclear to most clinicians. The use of left ventricular dyssynchrony and discoordination indices may help to identify those significant mechanical alterations whose correction may increase the probability of a favorable CRT response. Assessment of myocardial work and intracardiac flow dynamics may overcome some limitations of the conventional evaluation of cardiac mechanics but more investigations are needed before extensive clinical application.
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Affiliation(s)
- Donato Mele
- Cardiac Unit, Azienda Ospedaliero-Universitaria, Via Aldo Moro 8, 44124, Cona (Ferrara), Italy.
| | - Filippo Trevisan
- Cardiac Unit, Azienda Ospedaliero-Universitaria, Via Aldo Moro 8, 44124, Cona (Ferrara), Italy
| | - Andrea Fiorencis
- Cardiac Unit, Azienda Ospedaliero-Universitaria, Via Aldo Moro 8, 44124, Cona (Ferrara), Italy
| | - Vittorio Smarrazzo
- Cardiac Unit, Azienda Ospedaliero-Universitaria, Via Aldo Moro 8, 44124, Cona (Ferrara), Italy
| | - Matteo Bertini
- Cardiac Unit, Azienda Ospedaliero-Universitaria, Via Aldo Moro 8, 44124, Cona (Ferrara), Italy
| | - Roberto Ferrari
- Cardiac Unit, Azienda Ospedaliero-Universitaria, Via Aldo Moro 8, 44124, Cona (Ferrara), Italy
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Legallois D, Marie PY, Franken PR, Djaballah W, Agostini D, Manrique A. Comparison of the dyssynchrony parameters recorded with gated SPECT in ischemic cardiomyopathy according to their repeatability at rest and to their ability to detect a synchrony reserve under dobutamine infusion. J Nucl Cardiol 2020; 27:2247-2257. [PMID: 30515748 DOI: 10.1007/s12350-018-01546-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 11/10/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study aimed to determine whether the repeatability of dyssynchrony assessment using gated myocardial perfusion SPECT (GSPECT) allows the detection of synchrony reserve during low-dose dobutamine infusion. METHODS AND RESULTS Sixty-one patients with ischemic cardiomyopathy and LV ejection fraction < 50% were prospectively included in 10 centers. Each patient underwent two consecutive rest GSPECT with 99mTc-labeled tracer (either tetrofosmin or sestamibi) to assess the repeatability of LV function and dyssynchrony parameters, followed by a GSECT acquisition during low-dose dobutamine infusion. LV dyssynchrony was assessed using QGS software through histogram bandwidth (BW), standard deviation of the phase (SD), and entropy. Repeatability was assessed with Lin's concordance correlation coefficient (CCC). Entropy showed a higher CCC (0.80) compared to BW (0.68) and SD (0.75). On average, dobutamine infusion yielded to improve both BW (P = .049) and entropy (P = .04) although significant improvements, setting outside the 95% confidence interval of the repeatability analysis, were documented in only 6 and 4 patients for BW and entropy, respectively. CONCLUSIONS A synchrony reserve may be documented in patients with ischemic cardiomyopathy through the recording of BW and entropy with low-dose dobutamine GSPECT, with the additional advantage of a higher repeatability for entropy.
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Affiliation(s)
- Damien Legallois
- Normandie Université, UNICAEN, Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, FHU REMOD-VHF, 14000, Caen, France
- Department of Cardiology, CHU de Caen, 14000, Caen, France
| | | | | | | | - Denis Agostini
- Normandie Université, UNICAEN, Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, FHU REMOD-VHF, 14000, Caen, France
- Department of Nuclear Medicine, CHU de Caen, 14000, Caen, France
| | - Alain Manrique
- Normandie Université, UNICAEN, Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, FHU REMOD-VHF, 14000, Caen, France.
- Department of Nuclear Medicine, CHU de Caen, 14000, Caen, France.
- Investigations chez l'Homme, GIP Cyceron PET Center, Campus Jules Horowitz, BP 5229, 14074, Caen, France.
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Salimian S. Left ventricular mechanical dyssynchrony under stress: Isn't it time to conduct a prospective multicenter study? J Nucl Cardiol 2020; 27:2258-2260. [PMID: 30656574 DOI: 10.1007/s12350-019-01599-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 12/28/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Samaneh Salimian
- Department of Biomedical Sciences, University of Montreal, Montreal, QC, Canada.
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Quantitative mechanical dyssynchrony in dilated cardiomyopathy measured by deformable registration algorithm. Eur Radiol 2020; 30:2010-2020. [PMID: 31953665 DOI: 10.1007/s00330-019-06578-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/04/2019] [Accepted: 11/07/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To investigate the diagnostic value and reproducibility of deformable registration algorithm (DRA)-derived mechanical dyssynchrony parameters in dilated cardiomyopathy (DCM) patients. METHODS The present study included 80 DCM patients (40 with normal QRS duration (NQRS-DCM); 40 with left bundle branch block (LBBB-DCM)) and 20 healthy volunteers. The balanced steady-state free-precession (bSSFP) cine images were acquired using a 3.0T scanner. Mechanical dyssynchrony parameters were calculated based on DRA-derived segmental strain, including uniformity ratio estimate (URE) and standard derivation of time-to-peak (T2Psd) parameters in circumferential, radial, and longitudinal orientations. RESULTS DCM patients showed significant mechanical dyssynchrony reflected by both URE and T2Psd parameters compared with controls. Among DCM patients, LBBB-DCM showed decreased CURE (0.78 ± 0.21 vs. 0.93 ± 0.05, p < 0.001) and RURE (0.69 ± 0.14 vs. 0.83 ± 0.15, p = 0.001), and increased T2Psd-Ecc (median with interquartile range, 94.1 (54.4-123.2) ms vs. 63.7 (44.9-80.4) ms, p = 0.003) and T2Psd-Err (91.1 (61.1-103.2) ms vs. 62.3 (46.3-104.5) ms, p = 0.041) compared with NQRS-DCM patients. CURE showed a strong correlation with QRS duration (r = - 0.54, p < 0.001), with maximum AUC (0.791) to differentiate LBBB-DCM from NQRS-DCM patients. Improved intra- and inter-observer reproducibility was found using URE indices (coefficient of variation (CoV), 1.20-3.17%) than T2Psd parameters (CoV, 15.28-41.18%). CONCLUSIONS The DRA-based CURE showed significant correlation with QRS duration and the highest discriminatory value between LBBB-DCM and NQRS-DCM patients. URE indices showed greater reproducibility compared with T2Psd parameters for assessing myocardial dyssynchrony in DCM patients. KEY POINTS • The strain analyses based on DRA suggested that DCM patients have varying degrees of mechanical dyssynchrony and there is a significant difference from normal controls. • CURE showed the strongest correlation with QRS duration and was the best parameter for differentiating DCM patients with normal QRS duration from patients with LBBB, and with normal controls. • URE indices showed improved reproducibility compared with T2Psd parameters in all three orientations (circumferential, radial, and longitudinal).
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Scolari FL, Silveira AD, Menegazzo WR, Mendes APC, Pimentel M, Clausell N, Goldraich LA. Expanding benefits from cardiac resynchronization therapy to exercise-induced left bundle branch block in advanced heart failure. ESC Heart Fail 2020; 7:329-333. [PMID: 31923352 PMCID: PMC7083438 DOI: 10.1002/ehf2.12580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/20/2019] [Accepted: 11/11/2019] [Indexed: 01/09/2023] Open
Abstract
Indications of cardiac resynchronization therapy (CRT) do not include exercise‐induced left bundle branch block, but functional impairment could be improved with CRT in such cases. A 57‐year‐old woman with idiopathic dilated cardiomyopathy (ejection fraction 23%) presented with New York Heart Association Class IV and recurrent hospitalizations. During heart transplant evaluation, a new onset of intermittent left bundle branch block was observed on the cardiopulmonary exercise test. CRT was implanted, and 97% resynchronization rate was achieved. In 12 month follow‐up, both clinical and prognostic exercise parameters improved. In patients with heart failure with reduced ejection fraction and no left bundle branch block at rest, exercise test can uncover electromechanical dyssynchrony that may benefit from CRT.
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Affiliation(s)
- Fernando L Scolari
- Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rua Ramiro Barcelos, 2350, room 2060, Porto Alegre, RS, 90035-903, Brazil
| | - Anderson D Silveira
- Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rua Ramiro Barcelos, 2350, room 2060, Porto Alegre, RS, 90035-903, Brazil.,Post-Graduate Program in Cardiology and Cardiovascular Sciences, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Willian R Menegazzo
- Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rua Ramiro Barcelos, 2350, room 2060, Porto Alegre, RS, 90035-903, Brazil
| | - Ana Paula Chedid Mendes
- Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rua Ramiro Barcelos, 2350, room 2060, Porto Alegre, RS, 90035-903, Brazil
| | - Maurício Pimentel
- Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rua Ramiro Barcelos, 2350, room 2060, Porto Alegre, RS, 90035-903, Brazil.,Post-Graduate Program in Cardiology and Cardiovascular Sciences, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Nadine Clausell
- Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rua Ramiro Barcelos, 2350, room 2060, Porto Alegre, RS, 90035-903, Brazil.,Post-Graduate Program in Cardiology and Cardiovascular Sciences, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Livia A Goldraich
- Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rua Ramiro Barcelos, 2350, room 2060, Porto Alegre, RS, 90035-903, Brazil
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Affiliation(s)
- Prem Soman
- Division of Cardiology and The Heart and Vascular Institute, University of Pittsburgh Medical Center, PA
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Mele D, Luisi GA, Malagù M, Laterza A, Ferrari R, Bertini M. Echocardiographic evaluation of cardiac dyssynchrony: Does it still matter? Echocardiography 2018; 35:707-715. [PMID: 29719067 DOI: 10.1111/echo.13902] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Cardiac resynchronization therapy (CRT) is an established treatment for patients with heart failure and left ventricular systolic dysfunction. For many years, cardiac mechanical dyssynchrony assessed by echocardiography has been considered as a key evaluation to characterize CRT candidates and predict CRT response. In current guidelines, however, CRT implant indications rely only on electrical dyssynchrony. The aim of this article was to clarify whether and how the evaluation of cardiac mechanical dyssynchrony should be performed today by echocardiography.
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Affiliation(s)
- Donato Mele
- Cardiology Unit and LTTA Center, University of Ferrara, Ferrara, Italy
| | | | - Michele Malagù
- Cardiology Unit and LTTA Center, University of Ferrara, Ferrara, Italy
| | - Anna Laterza
- Cardiology Unit and LTTA Center, University of Ferrara, Ferrara, Italy
| | - Roberto Ferrari
- Cardiology Unit and LTTA Center, University of Ferrara, Ferrara, Italy.,Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, Italy
| | - Matteo Bertini
- Cardiology Unit and LTTA Center, University of Ferrara, Ferrara, Italy
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Salimian S, Thibault B, Finnerty V, Grégoire J, Harel F. Phase analysis of gated blood pool SPECT for multiple stress testing assessments of ventricular mechanical dyssynchrony in a tachycardia-induced dilated cardiomyopathy canine model. J Nucl Cardiol 2017; 24:145-157. [PMID: 26686363 DOI: 10.1007/s12350-015-0338-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 11/06/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Stress-induced dyssynchrony has been shown to be independently correlated with clinical outcomes in patients with dilated cardiomyopathy (DCM) and narrow QRS complexes. However, the extent to which stress levels affect inter- and intraventricular dyssynchrony parameters remains unknown. METHODS Ten large dogs were submitted to tachycardia-induced DCM by pacing the right ventricular apex for 3-4 weeks to reach a target ejection fraction (EF) of 35% or less. Stress was then induced in DCM dogs by administering intravenous dobutamine up to a maximum of 20 μg·kg-1·min-1. Hemodynamic and ventricular dyssynchrony data were analyzed by left ventricular (LV) pressure measurements and gated blood pool SPECT (GBPS) imaging. In order to assess mechanical dyssynchrony in DCM subjects and compare it with that of 8 normal counterparts, we extracted the following data: count-based indices of LV contraction homogeneity index (CHI), entropy and phase standard deviation, and interventricular dyssynchrony index. RESULTS A significant LV intraventricular dyssynchrony (CHI: 96.4 ± 1.3% in control vs 78.6% ± 10.9% in DCM subjects) resulted in an intense LV dysfunction in DCM subjects (EF: 49.5% ± 8.4% in control vs 22.6% ± 6.0% in DCM), compared to control subjects. However, interventricular dyssynchrony did not vary significantly between the two groups. Under stress, DCM subjects showed a significant improvement in ventricular functional parameters at each level (EF: 22.6% ± 6.0% at rest vs 48.1% ± 5.8% at maximum stress). All intraventricular dyssynchrony indices showed a significant increase in magnitude of synchrony from baseline to stress levels of greater than or equal to 5 μg·kg-1·min-1 dobutamine. There were individual differences in the magnitude and pattern of change in interventricular dyssynchrony during the various levels of stress. CONCLUSIONS Based on GBPS analyses, different levels of functional stress, even in close intervals, can have a significant impact on hemodynamic and intraventricular dyssynchrony parameters in a DCM model with narrow QRS complex.
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MESH Headings
- Animals
- Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography/methods
- Cardiomyopathy, Dilated/diagnostic imaging
- Cardiomyopathy, Dilated/etiology
- Cardiomyopathy, Dilated/physiopathology
- Dogs
- Exercise Test/methods
- Gated Blood-Pool Imaging/methods
- Image Interpretation, Computer-Assisted/methods
- Reproducibility of Results
- Sensitivity and Specificity
- Tachycardia, Ventricular/complications
- Tachycardia, Ventricular/diagnostic imaging
- Tachycardia, Ventricular/physiopathology
- Ventricular Dysfunction, Left/diagnostic imaging
- Ventricular Dysfunction, Left/etiology
- Ventricular Dysfunction, Left/physiopathology
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Affiliation(s)
- Samaneh Salimian
- Department of Nuclear Medicine, Montreal Heart Institute and University of Montreal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada
| | - Bernard Thibault
- Department of Medicine, Montreal Heart Institute and University of Montreal, Montreal, QC, Canada
| | - Vincent Finnerty
- Department of Nuclear Medicine, Montreal Heart Institute and University of Montreal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada
| | - Jean Grégoire
- Department of Nuclear Medicine, Montreal Heart Institute and University of Montreal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada
| | - François Harel
- Department of Nuclear Medicine, Montreal Heart Institute and University of Montreal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada.
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Germano G, Van Kriekinge SD. Measuring mechanical cardiac dyssynchrony in the 3-D era. J Nucl Cardiol 2017; 24:158-161. [PMID: 26719153 DOI: 10.1007/s12350-015-0379-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 12/11/2015] [Indexed: 12/25/2022]
Affiliation(s)
- Guido Germano
- Cedars-Sinai Medical Center, 8700 Beverly Blvd A047 N, Los Angeles, CA, USA.
- UCLA, David Geffen School of Medicine, Los Angeles, CA, USA.
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Spartera M, Galderisi M, Mele D, Cameli M, D'Andrea A, Rossi A, Mondillo S, Novo G, Esposito R, D'Ascenzi F, Montisci R, Gallina S, Margonato A, Agricola E. Role of cardiac dyssynchrony and resynchronization therapy in functional mitral regurgitation. Eur Heart J Cardiovasc Imaging 2016; 17:471-80. [DOI: 10.1093/ehjci/jev352] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 12/14/2015] [Indexed: 12/28/2022] Open
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Plein S, Edvardsen T, Pierard LA, Saraste A, Knuuti J, Maurer G, Lancellotti P. The year 2013 in the European Heart Journal - Cardiovascular Imaging: Part II. Eur Heart J Cardiovasc Imaging 2014; 15:837-41. [DOI: 10.1093/ehjci/jeu088] [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: 01/08/2023] Open
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Nombela-Franco L, Ribeiro HB, Urena M, Allende R, Amat-Santos I, DeLarochellière R, Dumont E, Doyle D, DeLarochellière H, Laflamme J, Laflamme L, García E, Macaya C, Jiménez-Quevedo P, Côté M, Bergeron S, Beaudoin J, Pibarot P, Rodés-Cabau J. Significant mitral regurgitation left untreated at the time of aortic valve replacement: a comprehensive review of a frequent entity in the transcatheter aortic valve replacement era. J Am Coll Cardiol 2014; 63:2643-58. [PMID: 24681140 DOI: 10.1016/j.jacc.2014.02.573] [Citation(s) in RCA: 129] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Revised: 02/18/2014] [Accepted: 02/25/2014] [Indexed: 12/12/2022]
Abstract
Significant mitral regurgitation (MR) is frequent in patients with severe aortic stenosis (AS). In these cases, concomitant mitral valve repair or replacement is usually performed at the time of surgical aortic valve replacement (SAVR). Transcatheter aortic valve replacement (TAVR) has recently been considered as an alternative for patients at high or prohibitive surgical risk. However, concomitant significant MR in this setting is typically left untreated. Moderate to severe MR after aortic valve replacement is therefore a relevant entity in the TAVR era. The purpose of this review is to present the current knowledge on the clinical impact and post-procedural evolution of concomitant significant MR in patients with severe AS who have undergone aortic valve replacement (SAVR and TAVR). This information could contribute to improving both the clinical decision-making process in and management of this challenging group of patients.
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Affiliation(s)
- Luis Nombela-Franco
- Quebec Heart & Lung Institute, Quebec City, Quebec, Canada; Cardiovascular Institute, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
| | | | - Marina Urena
- Quebec Heart & Lung Institute, Quebec City, Quebec, Canada
| | | | | | | | - Eric Dumont
- Quebec Heart & Lung Institute, Quebec City, Quebec, Canada
| | - Daniel Doyle
- Quebec Heart & Lung Institute, Quebec City, Quebec, Canada
| | | | | | - Louis Laflamme
- Quebec Heart & Lung Institute, Quebec City, Quebec, Canada
| | - Eulogio García
- Cardiovascular Institute, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
| | - Carlos Macaya
- Cardiovascular Institute, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
| | - Pilar Jiménez-Quevedo
- Cardiovascular Institute, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
| | - Mélanie Côté
- Quebec Heart & Lung Institute, Quebec City, Quebec, Canada
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Yamada S, Arrell DK, Kane GC, Nelson TJ, Perez-Terzic CM, Behfar A, Purushothaman S, Prinzen FW, Auricchio A, Terzic A. Mechanical dyssynchrony precedes QRS widening in ATP-sensitive K⁺ channel-deficient dilated cardiomyopathy. J Am Heart Assoc 2013; 2:e000410. [PMID: 24308936 PMCID: PMC3886734 DOI: 10.1161/jaha.113.000410] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Contractile discordance exacerbates cardiac dysfunction, aggravating heart failure outcome. Dissecting the genesis of mechanical dyssynchrony would enable an early diagnosis before advanced disease. Methods and Results High‐resolution speckle‐tracking echocardiography was applied in a knockout murine surrogate of adult‐onset human cardiomyopathy caused by mutations in cardioprotective ATP‐sensitive K+ (KATP) channels. Preceding the established criteria of cardiac dyssynchrony, multiparametric speckle‐based strain resolved nascent erosion of dysfunctional regions within cardiomyopathic ventricles of the KATP channel–null mutant exposed to hemodynamic stress. Not observed in wild‐type counterparts, intraventricular disparity in wall motion, validated by the degree, direction, and delay of myocardial speckle patterns, unmasked the disease substrate from asymptomatic to overt heart failure. Mechanical dyssynchrony preceded widening of the QRS complex and exercise intolerance and progressed into global myocardial discoordination and decompensated cardiac pump function, precipitating a low output syndrome. Conclusions The present study, with the use of high‐resolution imaging, prospectively resolved the origin and extent of intraventricular motion disparity in a KATP channel–knockout model of dilated cardiomyopathy. Mechanical dyssynchrony established as an early marker of cardiomyopathic disease offers novel insight into the pathodynamics of dyssynchronous heart failure.
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Affiliation(s)
- Satsuki Yamada
- Center for Regenerative Medicine, Marriott Heart Disease Research Program, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
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Calibration of the Normal Cutoff Values of Systolic Dyssynchrony of the Left Ventricular Synchronicity in Normal Subjects Using Real-Time 3-Dimensional Echocardiography and the Effects of Age and Heart Rate. Cell Biochem Biophys 2013; 69:115-21. [DOI: 10.1007/s12013-013-9777-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Donal E, Bernard A, Daubert JC. Will mechanical dyssynchrony one day impact our management of chronic heart failure patients? Eur Heart J Cardiovasc Imaging 2012; 14:93-4. [PMID: 22918404 DOI: 10.1093/ehjci/jes170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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