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Wang X, Ge B, Miao C, Lee C, Romero JE, Li P, Wang F, Xu D, Chen M, Li D, Li D, Li M, Xu F, Li Y, Gong C, Taub CC, Yao J. Beyond conduction impairment: Unveiling the profound myocardial injury in left bundle branch block. Heart Rhythm 2024; 21:1370-1379. [PMID: 38490601 DOI: 10.1016/j.hrthm.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/09/2024] [Accepted: 03/05/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Left bundle branch block (LBBB) represents a frequently encountered conduction system disorder. Despite its widespread occurrence, a continual dilemma persists regarding its intricate association with underlying cardiomyopathy and its pivotal role in the initiation of dilated cardiomyopathy. The pathologic alterations linked to LBBB-induced cardiomyopathy (LBBB-CM) have remained elusive. OBJECTIVE This study sought to investigate the chronologic dynamics of LBBB to left ventricular dysfunction and the pathologic mechanism of LBBB-CM. METHODS LBBB model was established through main left bundle branch trunk ablation in 14 canines. All LBBB dogs underwent transesophageal echocardiography and electrocardiography before ablation and at 1 month, 3 months, 6 months, and 12 months after LBBB induction. Single-photon emission computed tomography imaging was performed at 12 months. We then harvested the heart from all LBBB dogs and 14 healthy adult dogs as normal controls for anatomic observation, Purkinje fiber staining, histologic staining, and connexin43 protein expression quantitation. RESULTS LBBB induction caused significant fibrotic changes in the endocardium and mid-myocardium. Purkinje fibers exhibited fatty degeneration, vacuolization, and fibrosis along with downregulated connexin43 protein expression. During a 12-month follow-up, left ventricular dysfunction progressively worsened, peaking at the end of the observation period. The association between myocardial dysfunction, hypoperfusion, and fibrosis was observed in the LBBB-afflicted canines. CONCLUSION LBBB may lead to profound myocardial injury beyond its conduction impairment effects. The temporal progression of left ventricular dysfunction and the pathologic alterations observed shed light on the complex relationship between LBBB and cardiomyopathy. These findings offer insights into potential mechanisms and clinical implications of LBBB-CM.
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Affiliation(s)
- Xiaoxian Wang
- Department of Ultrasound Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, People's Republic of China
| | - Beibei Ge
- Department of Ultrasound Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, People's Republic of China
| | - Changqing Miao
- Department of Cardiology, Jiangyin People's Hospital, Jiangyin, People's Republic of China
| | - Christopher Lee
- Department of Cardiology, University of California, San Francisco, California
| | - Jorge E Romero
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Peng Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Fang Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Di Xu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Minglong Chen
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Dianfu Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Dong Li
- Harbor-UCLA Medical Center, Torrance, California
| | - Mingxia Li
- Department of Ultrasound Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, People's Republic of China
| | - Fang Xu
- Department of Ultrasound Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, People's Republic of China
| | - Yan Li
- Department of Anesthesiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Chanjuan Gong
- Department of Anesthesiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Cynthia C Taub
- Department of Medicine, Upstate Medical University, Norton College of Medicine, Syracuse, New York
| | - Jing Yao
- Department of Ultrasound Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, People's Republic of China; Medical Imaging Center, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, People's Republic of China.
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2
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Cheng S, Li H, Hu Y, Jin H, Weng S, He P, Huang H, Liu X, Gu M, Niu H, Cai M, Pei J, Chen L, Ding L, Hua W. Left Bundle Branch Area Pacing With or Without Conduction System Capture in Heart Failure Models. JACC Clin Electrophysiol 2024:S2405-500X(24)00366-9. [PMID: 38970598 DOI: 10.1016/j.jacep.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 04/10/2024] [Accepted: 05/01/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND Left bundle branch area pacing includes left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP), which is effective in patients with dyssynchronous heart failure (DHF). However, the basic mechanisms are unknown. OBJECTIVES This study aimed to compare LBBP with LVSP and explore potential mechanisms underlying the better clinical outcomes of LBBP. METHODS A total of 24 beagles were assigned to the following groups: 1) control group; 2) DHF group, left bundle branch ablation followed by 6 weeks of AOO pacing at 200 ppm; 3) LBBP group, DHF for 3 weeks followed by 3 weeks of DOO pacing at 200 ppm; and 4) LVSP with the same interventions in the LBBP group. Metrics of electrocardiogram, echocardiography, hemodynamics, and expression of left ventricular proteins were evaluated. RESULTS Compared with LVSP, LBBP had better peak strain dispersion (44.67 ± 1.75 ms vs 55.50 ± 4.85 ms; P < 0.001) and hemodynamic effect (dP/dtmax improvement: 27.16% ± 7.79% vs 11.37% ± 4.73%; P < 0.001), whereas no significant differences in cardiac function were shown. The altered expressions of proteins in the lateral wall vs septum in the DHF group were partially reversed by LBBP and LVSP, which was associated with the contraction and adhesion process, separately. CONCLUSIONS The animal study demonstrated that LBBP offered better mechanical synchrony and improved hemodynamics than LVSP, which might be explained by the reversed expression of contraction proteins. These results supported the potential superiority of left bundle branch area pacing with the capture of the conduction system in DHF model.
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Affiliation(s)
- Sijing Cheng
- Department of Cardiology, The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui Li
- Department of Ultrasound, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yiran Hu
- Department of Cardiology, The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Cardiology and Macrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Han Jin
- Cardiology department, Peking University First Hospital, Beijing, China
| | - Sixian Weng
- Department of Cardiology, The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Pengkang He
- Cardiology department, Peking University First Hospital, Beijing, China
| | - Hao Huang
- Department of Cardiology, The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xi Liu
- Department of Cardiology, The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Min Gu
- Department of Cardiology, The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongxia Niu
- Department of Cardiology, The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Minsi Cai
- Department of Cardiology, The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianqiu Pei
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Capital Medical University, Beijing, China
| | - Liang Chen
- Department of Cardiac Surgery, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College. Beijing, China
| | - Ligang Ding
- Department of Cardiology, The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Hua
- Department of Cardiology, The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Lazăr-Höcher AI, Cozma D, Cirin L, Cozgarea A, Faur-Grigori AA, Catană R, Tudose DG, Târtea G, Crișan S, Gaiță D, Luca CT, Văcărescu C. A Comparative Analysis of Apical Rocking and Septal Flash: Two Views of the Same Systole? J Clin Med 2024; 13:3109. [PMID: 38892820 PMCID: PMC11172686 DOI: 10.3390/jcm13113109] [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: 03/28/2024] [Revised: 05/11/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024] Open
Abstract
Heart failure (HF) is a complex medical condition characterized by both electrical and mechanical dyssynchrony. Both dyssynchrony mechanisms are intricately linked together, but the current guidelines for cardiac resynchronization therapy (CRT) rely only on the electrical dyssynchrony criteria, such as the QRS complex duration. This possible inconsistency may result in undertreating eligible individuals who could benefit from CRT due to their mechanical dyssynchrony, even if they fail to fulfill the electrical criteria. The main objective of this literature review is to provide a comprehensive analysis of the practical value of echocardiography for the assessment of left ventricular (LV) dyssynchrony using parameters such as septal flash and apical rocking, which have proven their relevance in patient selection for CRT. The secondary objectives aim to offer an overview of the relationship between septal flash and apical rocking, to emphasize the primary drawbacks and benefits of using echocardiography for evaluation of septal flash and apical rocking, and to offer insights into potential clinical applications and future research directions in this area. Conclusion: there is an opportunity to render resynchronization therapy more effective for every individual; septal flash and apical rocking could be a very useful and straightforward echocardiography resource.
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Affiliation(s)
- Alexandra-Iulia Lazăr-Höcher
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.-I.L.-H.); (L.C.); (A.C.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania; (A.-A.F.-G.); (S.C.); (D.G.); (C.-T.L.); (C.V.)
| | - Dragoș Cozma
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania; (A.-A.F.-G.); (S.C.); (D.G.); (C.-T.L.); (C.V.)
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania;
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Liviu Cirin
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.-I.L.-H.); (L.C.); (A.C.)
| | - Andreea Cozgarea
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.-I.L.-H.); (L.C.); (A.C.)
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania
| | - Adelina-Andreea Faur-Grigori
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania; (A.-A.F.-G.); (S.C.); (D.G.); (C.-T.L.); (C.V.)
| | - Rafael Catană
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania;
| | - Dănuț George Tudose
- Institute of Cardiovascular Diseases C.C. Iliescu, Fundeni Clinical Institute, 258 Fundeni Street, 022328 Bucharest, Romania;
| | - Georgică Târtea
- Department of Physiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Simina Crișan
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania; (A.-A.F.-G.); (S.C.); (D.G.); (C.-T.L.); (C.V.)
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania;
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Dan Gaiță
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania; (A.-A.F.-G.); (S.C.); (D.G.); (C.-T.L.); (C.V.)
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania;
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Constantin-Tudor Luca
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania; (A.-A.F.-G.); (S.C.); (D.G.); (C.-T.L.); (C.V.)
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania;
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Cristina Văcărescu
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania; (A.-A.F.-G.); (S.C.); (D.G.); (C.-T.L.); (C.V.)
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania;
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
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Craine A, Krishnamurthy A, Villongco CT, Vincent K, Krummen DE, Narayan SM, Kerckhoffs RCP, Omens JH, Contijoch F, McCulloch AD. Successful Cardiac Resynchronization Therapy Reduces Negative Septal Work in Patient-Specific Models of Dyssynchronous Heart Failure. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.13.593804. [PMID: 38798676 PMCID: PMC11118505 DOI: 10.1101/2024.05.13.593804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
In patients with dyssynchronous heart failure (DHF), cardiac conduction abnormalities cause the regional distribution of myocardial work to be non-homogeneous. Cardiac resynchronization therapy (CRT) using an implantable, programmed biventricular pacemaker/defibrillator, can improve the synchrony of contraction between the right and left ventricles in DHF, resulting in reduced morbidity and mortality and increased quality of life. Since regional work depends on wall stress, which cannot be measured in patients, we used computational methods to investigate regional work distributions and their changes after CRT. We used three-dimensional multi-scale patient-specific computational models parameterized by anatomic, functional, hemodynamic, and electrophysiological measurements in eight patients with heart failure and left bundle branch block (LBBB) who received CRT. To increase clinical translatability, we also explored whether streamlined computational methods provide accurate estimates of regional myocardial work. We found that CRT increased global myocardial work efficiency with significant improvements in non-responders. Reverse ventricular remodeling after CRT was greatest in patients with the highest heterogeneity of regional work at baseline, however the efficacy of CRT was not related to the decrease in overall work heterogeneity or to the reduction in late-activated regions of high myocardial work. Rather, decreases in early-activated regions of myocardium performing negative myocardial work following CRT best explained patient variations in reverse remodeling. These findings were also observed when regional myocardial work was estimated using ventricular pressure as a surrogate for myocardial stress and changes in endocardial surface area as a surrogate for strain. These new findings suggest that CRT promotes reverse ventricular remodeling in human dyssynchronous heart failure by increasing regional myocardial work in early-activated regions of the ventricles, where dyssynchrony is specifically associated with hypoperfusion, late systolic stretch, and altered metabolic activity and that measurement of these changes can be performed using streamlined approaches.
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Affiliation(s)
- Amanda Craine
- Department of Bioengineering, University of California San Diego, La Jolla, CA 92093, USA
| | - Adarsh Krishnamurthy
- Department of Bioengineering, University of California San Diego, La Jolla, CA 92093, USA
- Department of Mechanical Engineering, Iowa State University, Ames, IA 50011, USA
| | | | - Kevin Vincent
- Department of Bioengineering, University of California San Diego, La Jolla, CA 92093, USA
| | - David E. Krummen
- Department of Medicine (Cardiology), University of California San Diego, CA 92093, USA
- US Department of Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA
| | | | - Roy C. P. Kerckhoffs
- Department of Bioengineering, University of California San Diego, La Jolla, CA 92093, USA
| | - Jeffrey H. Omens
- Department of Bioengineering, University of California San Diego, La Jolla, CA 92093, USA
- Department of Medicine (Cardiology), University of California San Diego, CA 92093, USA
| | - Francisco Contijoch
- Department of Bioengineering, University of California San Diego, La Jolla, CA 92093, USA
- Department of Radiology, University of California San Diego, CA 92093, USA
| | - Andrew D. McCulloch
- Department of Bioengineering, University of California San Diego, La Jolla, CA 92093, USA
- Department of Medicine (Cardiology), University of California San Diego, CA 92093, USA
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5
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Margulescu AD, Thomas DE, Awadalla M, Shah P, Khurana A, Aldalati O, Obaid DR, Chase AJ, Smith D. Prevalence and progression of LV dysfunction and dyssynchrony in patients with new-onset LBBB post TAVR. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024:S1553-8389(24)00154-4. [PMID: 38604832 DOI: 10.1016/j.carrev.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 04/04/2024] [Accepted: 04/04/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND The impact of new-onset left bundle branch block (N-LBBB) developing after Transcatheter Aortic Valve Replacement (TAVR) on cardiac function and mechanical dyssynchrony is not well defined. METHODS We retrospectively screened all patients who underwent TAVR in our centre between Oct 2018 and Sept 2021 (n = 409). We identified 38 patients with N-LBBB post-operatively (of which 28 were persistent and 10 were transient), and 17 patients with chronic pre-existent LBBB (C-LBBB). We excluded patients requiring pacing post TAVR. For all groups, we retrospectively analysed stored echocardiograms at 3 time points: before TAVR (T0), early after TAVR (T1, 1.2 ± 1.1 days), and late follow-up (T2, 1.5 ± 0.8 years), comparing LV mass and volumes, indices of LV function (LV ejection fraction, LVEF; global longitudinal strain, GLS), and mechanical dyssynchrony indices (systolic stretch index, severity of septal flash). RESULTS At baseline (T0), C-LBBB had worse cardiac function, and larger LV volumes and LV mass, compared with patients with N-LBBB. At T1, N-LBBB resulted in mild dyssynchrony and decreased LVEF and GLS. Dyssynchrony progressed at T2 in persistent N-LBBB but not C-LBBB. In both groups however, LVEF remained stable at T2, although individual response was variable. Patients with better LVEF at baseline demonstrated a higher proportion of developing LBBB-induced LV dysfunction at T2. Lack of improvement of LVEF immediately after TAVR predicted deteriorating LVEF at T2. In transient LBBB, cardiac function and most dyssynchrony indices returned to baseline. CONCLUSIONS N-LBBB after TAVR results in an immediate reduction of cardiac function, in spite of only mild dyssynchrony. When LBBB persists, patients with better cardiac function before TAVR are more likely to have LBBB-induced LV dysfunction after TAVR.
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Affiliation(s)
- Andrei D Margulescu
- Department of Cardiology, Morriston Regional Cardiac Centre, Morriston Hospital, Heol Maes Eglwys, Swansea SA6 6NL, UK.
| | - Dewi E Thomas
- Department of Cardiology, Morriston Regional Cardiac Centre, Morriston Hospital, Heol Maes Eglwys, Swansea SA6 6NL, UK; Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK.
| | - Magid Awadalla
- Mater Private Network Hospital, Eccles Street, Dublin 7 D07 WKW8, Ireland.
| | - Parin Shah
- Department of Cardiology, Morriston Regional Cardiac Centre, Morriston Hospital, Heol Maes Eglwys, Swansea SA6 6NL, UK.
| | - Ayush Khurana
- Department of Cardiology, Morriston Regional Cardiac Centre, Morriston Hospital, Heol Maes Eglwys, Swansea SA6 6NL, UK.
| | - Omar Aldalati
- Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK.
| | - Daniel R Obaid
- Department of Cardiology, Morriston Regional Cardiac Centre, Morriston Hospital, Heol Maes Eglwys, Swansea SA6 6NL, UK; Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK.
| | - Alexander J Chase
- Department of Cardiology, Morriston Regional Cardiac Centre, Morriston Hospital, Heol Maes Eglwys, Swansea SA6 6NL, UK; Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK.
| | - David Smith
- Department of Cardiology, Morriston Regional Cardiac Centre, Morriston Hospital, Heol Maes Eglwys, Swansea SA6 6NL, UK; Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK.
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6
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Athari SS, Mehrabi Nasab E, Jing K, Wang J. Interaction between cardiac resynchronization therapy and cytokines in heart failure patients. Cytokine 2024; 175:156479. [PMID: 38199086 DOI: 10.1016/j.cyto.2023.156479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 12/09/2023] [Accepted: 12/12/2023] [Indexed: 01/12/2024]
Abstract
Congestive heart failure (CHF) is a complex multistage syndrome that has a great financial burden on human societies. It was known that the damaged myocardium sends a signal to stimulate the immune system and proliferation of leukocytes. In continuous, cytokine storm can be initiated and causes the probability of CHF. Persistent inflammation by increasing the levels of pro-inflammatory cytokines, plays an important role in the pathogenesis of CHF and causes remodeling, which is a progressive processs. Although treatment by drugs can reduce mortality and partially control the symptoms of heart failure patients, but complications and mortality are still high. Therefore, other treatment options such as Cardiac Resynchronization Therapy (CRT) are necessary. Today, it is known that CRT can be an effective treatment for many patients with heart failure. CRT is novel, non-pharmacological, and device-based therapy that would be beneficial to know more about its performance in the management of heart failure. In this study, we have reviewed the immunological processes involved in heart failure and the effect of CRT in controlling of the cytokine storm.
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Affiliation(s)
- Seyyed Shamsadin Athari
- Department of Immunology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Entezar Mehrabi Nasab
- Department of Cardiology, School of Medicine, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Cardiology, School of Medicine, Valiasr Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Kai Jing
- Department of Proctology, The People's Hospital of Huaiyin Jinan, 250021 Shandong, China
| | - Jin Wang
- Department of Cardiology, The Fifth People's Hospital of Jinan, 250022 Shandong, China.
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7
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Liu X, Li M, Chen J, Wu J, Zhang L, Hu J, Li F, Fan X, Yang H, Yan L, Liu J. Association between left bundle branch block and ventricular septal mid-wall fibrosis in patients with preserved left ventricular ejection fraction. J Electrocardiol 2024; 83:21-25. [PMID: 38241779 DOI: 10.1016/j.jelectrocard.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 11/29/2023] [Accepted: 01/07/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND The left bundle branch block (LBBB) is associated with ventricular septal mid-wall fibrosis (SMF) in patients with dilated cardiomyopathy (DCM). However, whether LBBB is also associated with SMF in patients with preserved left ventricular ejection fraction (LVEF) remains unclear. METHODS We performed a retrospective study of 210 patients with preserved LVEF (male, n = 116; female, n = 94; mean age, 44 ± 17 years). LBBB was defined as QRS duration ≥140 ms for men or ≥ 130 ms for women, QS or rS in V1-V2, mid-QRS notching or slurring in at least two leads (V1, V2, V5, V6, I, and aVL). SMF determined by late gadolinium-enhancement cardiovascular magnetic resonance was defined as stripe-like or patchy mid-myocardial hyper-enhancement in the interventricular septal segments. RESULTS SMF was detected in 24.8% (52/210) of these patients. The proportion of patients with SMF with LBBB was higher than the proportion of patients with SMF without LBBB (58.3% vs. 20.4%; P < 0.001). In the forward multivariate logistic analysis, LBBB (OR, 4.399; 95% CI, 1.774-10.904; P = 0.001) and age (OR, 1.028; 95% CI, 1.006-1.051; P = 0.011) were independently associated with SMF. The presence of LBBB showed a sensitivity of 27%%, specificity of 94%, positive predictive value of 58%%, and negative predictive value of 80% for the detection of SMF. CONCLUSION LBBB was significantly associated with SMF in hospitalized patients with preserved LVEF. Screening with a resting 12‑lead ECG may help to identify patients who are at a high risk of the presence of SMF.
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Affiliation(s)
- Xiaojie Liu
- Department of Cardiology, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Muzhang Li
- Department of Cardiology, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Jiaying Chen
- Department of Cardiology, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Jintao Wu
- Heart Centre of Henan Provincial People's Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China.
| | - Leiming Zhang
- Heart Centre of Henan Provincial People's Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Juan Hu
- Heart Centre of Henan Provincial People's Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Feifei Li
- Human Resource Department, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xianwei Fan
- Heart Centre of Henan Provincial People's Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Haitao Yang
- Heart Centre of Henan Provincial People's Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Lijie Yan
- Heart Centre of Henan Provincial People's Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Jingjing Liu
- Heart Centre of Henan Provincial People's Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
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8
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Dutta A, Alqabbani RRM, Hagendorff A, Tayal B. Understanding the Application of Mechanical Dyssynchrony in Patients with Heart Failure Considered for CRT. J Cardiovasc Dev Dis 2024; 11:64. [PMID: 38392278 PMCID: PMC10888548 DOI: 10.3390/jcdd11020064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/16/2024] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
Over the past two decades of CRT use, the failure rate has remained around 30-35%, despite several updates in the guidelines based on the understanding from multiple trials. This review article summarizes the role of mechanical dyssynchrony in the selection of heart failure patients for cardiac resynchronization therapy. Understanding the application of mechanical dyssynchrony has also evolved during these past two decades. There is no role of lone mechanical dyssynchrony in the patient selection for CRT. However, mechanical dyssynchrony can complement the electrocardiogram and clinical criteria and improve patient selection by reducing the failure rate. An oversimplified approach to mechanical dyssynchrony assessment, such as just estimating time-to-peak delays between segments, should not be used. Instead, methods that can identify the underlying pathophysiology of HF and are representative of a substrate to CRT should be applied.
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Affiliation(s)
- Abhishek Dutta
- Department of Cardiology, Nazareth Hospital, Philadelphia, PA 19020, USA
| | - Rakan Radwan M Alqabbani
- Department of Internal Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Andreas Hagendorff
- Department of Cardiology, Leipzig University Hospital, 04103 Leipzig, Germany
| | - Bhupendar Tayal
- Harrington and Heart and Vascular Center, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
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9
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Ahmadzadeh M, Rahimi M, Toufan-Tabrizi* M, Mohammadi K. Determining whether LV filling time contributes to HF symptoms in different widths of QRS in LBBB patients: A clinical study. Glob Cardiol Sci Pract 2024; 2024:e202408. [PMID: 38404659 PMCID: PMC10886770 DOI: 10.21542/gcsp.2024.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/11/2023] [Indexed: 02/27/2024] Open
Abstract
OBJECTIVES Accurate assessment of left ventricular (LV) function is essential for managing patients with left bundle branch block (LBBB). This study aimed to evaluate the relationship between LV systolic function, left ventricular diastolic filling time (LVFT), QRS duration, and heart failure symptoms in patients with LBBB. METHODS This study was conducted between June 2021 and June 2022. Patients with LBBB and sinus rhythm who were referred to the echocardiography department were included in the study. All the patients underwent electrocardiogram-gated echocardiography using the same machine. In this study, the LVFT value was measured in absolute terms and as a ratio to the R-R interval (LVFT/RR). RESULTS A total of sixty-five patients were included, forty-two (64.6%) were women, and the mean age was 60.71 ± 8.72. We performed three one-way ANOVA tests that showed that LV filling time/RR ratio, QRS duration, and ejection fraction were significantly different between heart failure classes (p = 0.008, p = 0.001, and p < 0.001, respectively). A weak correlation was observed between LVEF and LVFT/RR (r = 0.349, p = 0.004). Additionally, QRS duration was negatively correlated with LVEF (r = - 0.395, p = 0.004) and LVFT/RR (r = - 0.350, p = 0.004), although these correlations were weak. CONCLUSION We showed that LVFT/RR ratio differed significantly between HF functional classes and was lower in patients with more severe HF symptoms. Additionally, QRS duration was negatively correlated with LVEF and LVFT/RR, and patients with more severe HF symptoms had longer QRS durations.
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Affiliation(s)
| | | | | | - Kamran Mohammadi
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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10
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Tomoaia R, Harrison P, Bevis L, Wahab A, Thompson P, Saunderson CED, Levelt E, Dall’Armellina E, Garg P, Greenwood JP, Plein S, Swoboda PP. CMR characterization of patients with heart failure and left bundle branch block. EUROPEAN HEART JOURNAL. IMAGING METHODS AND PRACTICE 2024; 2:qyae047. [PMID: 38845796 PMCID: PMC11151275 DOI: 10.1093/ehjimp/qyae047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 05/07/2024] [Indexed: 06/09/2024]
Abstract
Aims We aimed to identify the distinctive cardiovascular magnetic resonance (CMR) features of patients with left bundle branch block (LBBB) and heart failure with reduced ejection fraction (HFrEF) of presumed non-ischaemic aetiology. The secondary aim was to determine whether these individuals exhibit characteristics that could potentially serve as predictors of left ventricular ejection fraction (LVEF) recovery as compared with patients without LBBB. Methods and results We prospectively recruited patients with HFrEF (LVEF ≤ 40%) on echocardiography who were referred for early CMR examination. Patients with an established diagnosis of coronary artery disease and known structural or congenital heart disease were excluded. LV recovery was defined as achieving ≥10% absolute improvement to ≥40% in LVEF between baseline evaluation to CMR. A total of 391 patients were recruited including 115 (29.4%) with LBBB. Compared with HF patients without LBBB, those with LBBB exhibited larger left ventricles and smaller right ventricles, but no differences were observed with respect to LVEF (35.8 ± 12 vs. 38 ± 12%, P = 0.105). The overall rate of LV recovery from baseline echocardiogram to CMR (70 [42-128] days) was not significantly different between LBBB and non-LBBB patients (27.8% vs. 31.5%, P = 0.47). Reduced LVEF remained an independent predictor of LV non-recovery only in patients with LBBB. Conclusion Patients presenting with HFrEF and LBBB had larger LV cavities and smaller RV cavities than those without LBBB but no difference in prevalence of scar or ischaemia. The rates of LV recovery were similar between both groups, which supports current guidelines to defer device therapy until 3-6 months of guideline-directed medical therapy, rather than early CMR and device implantation.
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Affiliation(s)
- Raluca Tomoaia
- Biomedical Imaging Sciences Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Woodhouse, Leeds, West Yorkshire LS2 9JT, UK
- Cardiology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Peter Harrison
- Biomedical Imaging Sciences Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Woodhouse, Leeds, West Yorkshire LS2 9JT, UK
| | - Lydia Bevis
- Biomedical Imaging Sciences Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Woodhouse, Leeds, West Yorkshire LS2 9JT, UK
| | - Ali Wahab
- Biomedical Imaging Sciences Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Woodhouse, Leeds, West Yorkshire LS2 9JT, UK
| | - Patrick Thompson
- Biomedical Imaging Sciences Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Woodhouse, Leeds, West Yorkshire LS2 9JT, UK
| | - Christopher E D Saunderson
- Biomedical Imaging Sciences Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Woodhouse, Leeds, West Yorkshire LS2 9JT, UK
| | - Eylem Levelt
- Biomedical Imaging Sciences Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Woodhouse, Leeds, West Yorkshire LS2 9JT, UK
| | - Erica Dall’Armellina
- Biomedical Imaging Sciences Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Woodhouse, Leeds, West Yorkshire LS2 9JT, UK
| | - Pankaj Garg
- Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norfolk, UK
| | - John P Greenwood
- Biomedical Imaging Sciences Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Woodhouse, Leeds, West Yorkshire LS2 9JT, UK
| | - Sven Plein
- Biomedical Imaging Sciences Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Woodhouse, Leeds, West Yorkshire LS2 9JT, UK
| | - Peter P Swoboda
- Biomedical Imaging Sciences Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Woodhouse, Leeds, West Yorkshire LS2 9JT, UK
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11
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Stankovic I, Voigt JU, Burri H, Muraru D, Sade LE, Haugaa KH, Lumens J, Biffi M, Dacher JN, Marsan NA, Bakelants E, Manisty C, Dweck MR, Smiseth OA, Donal E. Imaging in patients with cardiovascular implantable electronic devices: part 1-imaging before and during device implantation. A clinical consensus statement of the European Association of Cardiovascular Imaging (EACVI) and the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J Cardiovasc Imaging 2023; 25:e1-e32. [PMID: 37861372 DOI: 10.1093/ehjci/jead272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 10/15/2023] [Accepted: 10/15/2023] [Indexed: 10/21/2023] Open
Abstract
More than 500 000 cardiovascular implantable electronic devices (CIEDs) are implanted in the European Society of Cardiology countries each year. The role of cardiovascular imaging in patients being considered for CIED is distinctly different from imaging in CIED recipients. In the former group, imaging can help identify specific or potentially reversible causes of heart block, the underlying tissue characteristics associated with malignant arrhythmias, and the mechanical consequences of conduction delays and can also aid challenging lead placements. On the other hand, cardiovascular imaging is required in CIED recipients for standard indications and to assess the response to device implantation, to diagnose immediate and delayed complications after implantation, and to guide device optimization. The present clinical consensus statement (Part 1) from the European Association of Cardiovascular Imaging, in collaboration with the European Heart Rhythm Association, provides comprehensive, up-to-date, and evidence-based guidance to cardiologists, cardiac imagers, and pacing specialists regarding the use of imaging in patients undergoing implantation of conventional pacemakers, cardioverter defibrillators, and resynchronization therapy devices. The document summarizes the existing evidence regarding the use of imaging in patient selection and during the implantation procedure and also underlines gaps in evidence in the field. The role of imaging after CIED implantation is discussed in the second document (Part 2).
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Affiliation(s)
- Ivan Stankovic
- Clinical Hospital Centre Zemun, Department of Cardiology, Faculty of Medicine, University of Belgrade, Vukova 9, 11080 Belgrade, Serbia
| | - Jens-Uwe Voigt
- Department of Cardiovascular Diseases, University Hospitals Leuven/Department of Cardiovascular Sciences, Catholic University of Leuven, Herestraat 49, Leuven 3000, Belgium
| | - Haran Burri
- Cardiac Pacing Unit, Cardiology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Denisa Muraru
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Leyla Elif Sade
- University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, PA, USA
- Department of Cardiology, University of Baskent, Ankara, Turkey
| | - Kristina Hermann Haugaa
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Faculty of Medicine Karolinska Institutet AND Cardiovascular Division, Karolinska University Hospital, StockholmSweden
| | - Joost Lumens
- Cardiovascular Research Center Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Mauro Biffi
- Department of Cardiology, IRCCS, Azienda Ospedaliero Universitaria Di Bologna, Policlinico Di S.Orsola, Bologna, Italy
| | - Jean-Nicolas Dacher
- Department of Radiology, Normandie University, UNIROUEN, INSERM U1096 - Rouen University Hospital, F 76000 Rouen, France
| | - Nina Ajmone Marsan
- Department of Cardiology, Heart and Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Elise Bakelants
- Cardiac Pacing Unit, Cardiology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Charlotte Manisty
- Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Little France Crescent, Edinburgh EH16 4SB, United Kingdom
| | - Otto A Smiseth
- Institute for Surgical Research, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Erwan Donal
- University of Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, Rennes, France
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12
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Larsen CK, Smiseth OA, Duchenne J, Galli E, Aalen JM, Lederlin M, Bogaert J, Kongsgaard E, Linde C, Penicka M, Donal E, Voigt JU, Hopp E. Cardiac Magnetic Resonance Identifies Responders to Cardiac Resynchronization Therapy with an Assessment of Septal Scar and Left Ventricular Dyssynchrony. J Clin Med 2023; 12:7182. [PMID: 38002795 PMCID: PMC10672328 DOI: 10.3390/jcm12227182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/15/2023] [Accepted: 11/18/2023] [Indexed: 11/26/2023] Open
Abstract
Background: The response to cardiac resynchronization therapy (CRT) depends on septal viability and correction of abnormal septal motion. This study investigates if cardiac magnetic resonance (CMR) as a single modality can identify CRT responders with combined imaging of pathological septal motion (septal flash) and septal scar. Methods: In a prospective, multicenter, observational study of 136 CRT recipients, septal scar was assessed using late gadolinium enhancement (LGE) (n = 127) and septal flash visually from cine CMR sequences. The primary endpoint was CRT response, defined as ≥15% reduction in LV end-systolic volume with echocardiography after 6 months. The secondary endpoint was heart transplantation or death of any cause assessed after 39 ± 13 months. Results: Septal scar and septal flash were independent predictors of CRT response in multivariable analysis (both p < 0.001), while QRS duration and morphology were not. The combined approach of septal scar and septal flash predicted CRT response with an area under the curve of 0.86 (95% confidence interval (CI): 0.78-0.94) and was a strong predictor of long-term survival without heart transplantation (hazard ratio 0.27, 95% CI: 0.10-0.79). The accuracy of the approach was similar in the subgroup with intermediate (130-150 ms) QRS duration. The combined approach was superior to septal scar and septal flash alone (p < 0.01). Conclusions: The combined assessment of septal scar and septal flash using CMR as a single-image modality identifies CRT responders with high accuracy and predicts long-term survival.
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Affiliation(s)
- Camilla Kjellstad Larsen
- Institute for Surgical Research and Department of Cardiology, Oslo University Hospital, 0027 Oslo, Norway; (C.K.L.); (O.A.S.); (J.M.A.)
- Institute of Clinical Medicine, University of Oslo, 0316 Oslo, Norway
| | - Otto A. Smiseth
- Institute for Surgical Research and Department of Cardiology, Oslo University Hospital, 0027 Oslo, Norway; (C.K.L.); (O.A.S.); (J.M.A.)
- Institute of Clinical Medicine, University of Oslo, 0316 Oslo, Norway
| | - Jürgen Duchenne
- Department of Cardiovascular Diseases, University Hospitals Leuven, 3000 Leuven, Belgium (J.-U.V.)
- Department of Cardiovascular Sciences, KU Leuven—University of Leuven, 3000 Leuven, Belgium
| | - Elena Galli
- Department of Cardiology, University Hospital of Rennes, 35000 Rennes, France; (E.G.); (E.D.)
| | - John Moene Aalen
- Institute for Surgical Research and Department of Cardiology, Oslo University Hospital, 0027 Oslo, Norway; (C.K.L.); (O.A.S.); (J.M.A.)
- Institute of Clinical Medicine, University of Oslo, 0316 Oslo, Norway
| | - Mathieu Lederlin
- Department of Radiology, University Hospital of Rennes, 35000 Rennes, France;
| | - Jan Bogaert
- Department of Radiology, University Hospitals Leuven, 3000 Leuven, Belgium;
| | - Erik Kongsgaard
- Department of Cardiology, Oslo University Hospital, 0027 Oslo, Norway;
| | - Cecilia Linde
- Department of Cardiology, Karolinska University Hospital, 171 64 Solna, Sweden;
| | | | - Erwan Donal
- Department of Cardiology, University Hospital of Rennes, 35000 Rennes, France; (E.G.); (E.D.)
| | - Jens-Uwe Voigt
- Department of Cardiovascular Diseases, University Hospitals Leuven, 3000 Leuven, Belgium (J.-U.V.)
- Department of Cardiovascular Sciences, KU Leuven—University of Leuven, 3000 Leuven, Belgium
| | - Einar Hopp
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, 0027 Oslo, Norway
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13
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Mesnier J, Ternacle J, Cheema AN, Campelo-Parada F, Urena M, Veiga-Fernandez G, Nombela-Franco L, Munoz-Garcia AJ, Vilalta V, Regueiro A, Del Val D, Asmarats L, Del Trigo M, Serra V, Bonnet G, Jonveaux M, Rezaei E, Matta A, Himbert D, de la Torre Hernandez JM, Tirado-Conte G, Fernandez-Nofrerias E, Vidal P, Alfonso F, Gutierrez-Alonso L, Oteo JF, Belahnech Y, Mohammadi S, Philippon F, Modine T, Rodés-Cabau J. Cardiac Death After Transcatheter Aortic Valve Replacement With Contemporary Devices. JACC Cardiovasc Interv 2023; 16:2277-2290. [PMID: 37758382 DOI: 10.1016/j.jcin.2023.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 06/14/2023] [Accepted: 07/09/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND The burden of cardiac death after transcatheter aortic valve replacement (TAVR), particularly from advanced heart failure (HF) and sudden cardiac death (SCD), remains largely unknown. OBJECTIVES This study sought to evaluate the incidence and predictors of SCD and HF-related death in TAVR recipients treated with newer-generation devices. METHODS This study included a total of 5,421 consecutive patients who underwent TAVR with newer-generation devices using balloon (75.7%) or self-expandable (24.3%) valves. RESULTS After a median follow-up of 2 (IQR: 1-3) years, 976 (18.0%) patients had died, 50.8% from cardiovascular causes. Advanced HF and SCD accounted for 11.6% and 7.5% of deaths, respectively. Independent predictors of HF-related death were atrial fibrillation (HR: 2.17; 95% CI: 1.47-3.22; P < 0.001), prior pacemaker (HR: 1.79; 95% CI: 1.10-2.92; P = 0.01), reduced left ventricular ejection fraction (HR: 1.08 per 5% decrease; 95% CI: 1.01-1.14; P = 0.02), transthoracic approach (HR: 2.50; 95% CI: 1.37-4.55; P = 0.003), and new-onset persistent left bundle branch block (HR: 1.85; 95% CI: 1.14-3.02; P = 0.01). Two baseline characteristics (diabetes, HR: 1.81; 95% CI: 1.13-2.89; P = 0.01; and chronic kidney disease, HR: 1.72; 95% CI: 1.02-2.90; P = 0.04) and 3 procedural findings (valve in valve, HR: 2.17; 95% CI: 1.01-4.64; P = 0.04; transarterial nontransfemoral approach, HR: 2.23; 95% CI: 1.23-4.48; P = 0.01; and periprocedural ventricular arrhythmia, HR: 7.19; 95% CI: 2.61-19.76; P < 0.001) were associated with an increased risk of SCD after TAVR. CONCLUSIONS Advanced HF and SCD accounted for a fifth of deaths after TAVR in contemporary practice. Potentially treatable factors leading to increased risk of HF deaths and SCD were identified, such as arrhythmia/dyssynchrony factors for HF and valve-in-valve TAVR or periprocedural ventricular arrhythmias for SCD.
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Affiliation(s)
- Jules Mesnier
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Julien Ternacle
- Hôpital Cardiologique Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - Asim N Cheema
- Southlake Regional Health Centre, St. Michael's Hospital Toronto, Newmarket, Ontario, Canada
| | | | - Marina Urena
- Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, Spain
| | - Antonio J Munoz-Garcia
- Hospital Universitario Virgen de la Victoria, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Málaga, Spain
| | - Victoria Vilalta
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Ander Regueiro
- Cardiology Department, Instituto Clínic Cardiovascular, Hospital Clínic, Barcelona, Spain and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - David Del Val
- Department of Cardiology, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria La Princesa, CIBER-CV, Madrid, Spain
| | - Lluis Asmarats
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Maria Del Trigo
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Vicenç Serra
- Vall d'Hebron Research Institute, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Guillaume Bonnet
- Hôpital Cardiologique Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - Melchior Jonveaux
- Hôpital Cardiologique Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - Effat Rezaei
- Southlake Regional Health Centre, St. Michael's Hospital Toronto, Newmarket, Ontario, Canada
| | | | - Dominique Himbert
- Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Gabriela Tirado-Conte
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, Spain
| | | | - Pablo Vidal
- Cardiology Department, Instituto Clínic Cardiovascular, Hospital Clínic, Barcelona, Spain and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria La Princesa, CIBER-CV, Madrid, Spain
| | | | - Juan Francisco Oteo
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Yassin Belahnech
- Vall d'Hebron Research Institute, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Siamak Mohammadi
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - François Philippon
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Thomas Modine
- Hôpital Cardiologique Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada; Cardiology Department, Instituto Clínic Cardiovascular, Hospital Clínic, Barcelona, Spain and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
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14
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Munneke AG, Lumens J, Arts T, Prinzen FW, Delhaas T. Myocardial perfusion and flow reserve in the asynchronous heart: mechanistic insight from a computational model. J Appl Physiol (1985) 2023; 135:489-499. [PMID: 37439238 PMCID: PMC10538979 DOI: 10.1152/japplphysiol.00181.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/08/2023] [Accepted: 06/27/2023] [Indexed: 07/14/2023] Open
Abstract
The tight coupling between myocardial oxygen demand and supply has been recognized for decades, but it remains controversial whether this coupling persists under asynchronous activation, such as during left bundle branch block (LBBB). Furthermore, it is unclear whether the amount of local cardiac wall growth, following longer-lasting asynchronous activation, can explain differences in myocardial perfusion distribution between subjects. For a better understanding of these matters, we built upon our existing modeling framework for cardiac mechanics-to-perfusion coupling by incorporating coronary autoregulation. Regional coronary flow was regulated with a vasodilator signal based on regional demand, as estimated from regional fiber stress-strain area. Volume of left ventricular wall segments was adapted with chronic asynchronous activation toward a homogeneous distribution of myocardial oxygen demand per tissue weight. Modeling results show that 1) both myocardial oxygen demand and supply are decreased in early activated regions and increased in late-activated regions; 2) but that regional hyperemic flow remains unaffected; while 3) regional myocardial flow reserve (the ratio of hyperemic to resting myocardial flow) decreases with increases in absolute regional myocardial oxygen demand as well as with decreases in wall thickness. These findings suggest that septal hypoperfusion in LBBB represents an autoregulatory response to reduced myocardial oxygen demand. Furthermore, oxygen demand-driven remodeling of wall mass can explain asymmetric hypertrophy and the related homogenization of myocardial perfusion and flow reserve. Finally, the inconsistent observations of myocardial perfusion distribution can primarily be explained by the degree of dyssynchrony, the degree of asymmetric hypertrophy, and the imaging modality used.NEW & NOTEWORTHY This versatile modeling framework couples myocardial oxygen demand to oxygen supply and myocardial growth, enabling simulation of resting and hyperemic myocardial flow during acute and chronic asynchronous ventricular activation. Model-based findings suggest that reported inconsistencies in myocardial perfusion and flow reserve responses with asynchronous ventricular activation between patients can primarily be explained by the degree of dyssynchrony and wall mass remodeling, which together determine the heterogeneity in regional oxygen demand and, hence, supply with autoregulation.
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Affiliation(s)
- Anneloes G Munneke
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Joost Lumens
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Theo Arts
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Frits W Prinzen
- Department of Physiology, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Tammo Delhaas
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
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15
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Mihailovič PM, Žižek D, Vitez L, Holc P, Klokočovnik T, Bunc M. Case report: A complex case of valve-in-valve TAVI and left bundle branch pacing for severe aortic regurgitation with partially corrected type A aortic dissection and low ejection fraction. Front Cardiovasc Med 2023; 10:1206811. [PMID: 37636302 PMCID: PMC10449538 DOI: 10.3389/fcvm.2023.1206811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 07/21/2023] [Indexed: 08/29/2023] Open
Abstract
Background Aortic regurgitation is a major concern following transcatheter aortic valve implantation (TAVI), as even low-grade regurgitation is associated with increased mortality. This is of particular concern to patients with pre-existing aortic disease who are at increased risk of TAVI valve slippage. Furthermore, conduction system disturbances after TAVI, namely left bundle branch block (LBBB), may have an additional detrimental effect on cardiac function. Case presentation This report documents a successful treatment strategy in a frail patient with a bicuspid aortic valve and aortic disease after valve-sparing surgical repair in 1998, who subsequently developed aortic stenosis and underwent TAVI with an Evolut R self-expanding aortic valve. The progression of aortic disease, aortic root dilatation, and leaflet degeneration over the following years caused aortic regurgitation of the self-expanding aortic valve, resulting in left ventricular dilatation and heart failure along with LBBB and left ventricular (LV) mechanical dyssynchrony. Diagnostic workup of the patient showed persistence of the aneurysm distal to the graft with a dissection spanning the ascending aorta, arch, and terminating proximal to the aortic isthmus. After consideration by the cardiac team, a balloon-expandable valve was chosen for a valve-in-valve (ViV) procedure to provide sufficient radial force to expand the existing valve and correct the regurgitation. Due to the anatomy, a J-wire and pigtail catheter were successfully used for a safe approach and placement of the valve. Following the procedure, intermittent complete atrioventricular block was observed in addition to the pre-existing left bundle branch block, necessitating resynchronization pacing. Due to anatomical considerations, ease of placement, and the expected good level of resynchronization due to the proximal block, we opted for left bundle branch pacing, which showed improvement in left ventricular dyssynchrony and LV function at follow-up. Conclusion Valve-in-valve implantation of a balloon-expandable Myval TAVI device to treat aortic regurgitation caused by slippage and right leaflet disfunction of slef valve is feasible in challenging anatomical scenarios. Left bundle branch pacing is a viable alternative to correct mechanical dyssynchrony in complex patients with LBBB and anatomical challenges necessitating resynchronization.
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Affiliation(s)
| | - David Žižek
- Department of Cardiology, University Medical Center Ljubljana, Slovenia
| | - Luka Vitez
- Department of Cardiology, University Medical Center Ljubljana, Slovenia
| | - Primoz Holc
- Department of Cardiology, University Medical Center Ljubljana, Slovenia
| | - Tomislav Klokočovnik
- Department of Cardiovascular Surgery, University Medical Center Ljubljana, Slovenia
| | - Matjaž Bunc
- Department of Cardiology, University Medical Center Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Slovenia
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16
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Pujol-López M, Tolosana JM, Upadhyay GA, Mont L, Tung R. Left Bundle Branch Block: Characterization, Definitions, and Recent Insights into Conduction System Physiology. Cardiol Clin 2023; 41:379-391. [PMID: 37321688 DOI: 10.1016/j.ccl.2023.03.003] [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] [Indexed: 06/17/2023]
Abstract
Left bundle branch block (LBBB) is not just a simple electrocardiogram alteration. The intricacies of this general terminology go beyond simple conduction block. This review puts together current knowledge on the historical concept of LBBB, clinical significance, and recent insights into the pathophysiology of human LBBB. LBBB is an entity that affects patient diagnosis (primary conduction disease, secondary to underlying pathology or iatrogenic), treatment (cardiac resynchronization therapy or conduction system pacing for heart failure), and prognosis. Recruiting the left bundle branch with conduction system pacing depends on the complex interaction between anatomy, site of pathophysiology, and delivery tools.
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Affiliation(s)
- Margarida Pujol-López
- Arrhythmia Section, Cardiology Department, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, Universitat de Barcelona, C/ Villarroel 170, Barcelona, Catalonia 08036, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain
| | - José M Tolosana
- Arrhythmia Section, Cardiology Department, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, Universitat de Barcelona, C/ Villarroel 170, Barcelona, Catalonia 08036, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Madrid, Spain
| | - Gaurav A Upadhyay
- Center for Arrhythmia Care, Pritzker School of Medicine, University of Chicago, The University of Chicago Medicine, Heart and Vascular Center, 5841 South Maryland Avenue, Chicago, IL 60637, USA
| | - Lluís Mont
- Arrhythmia Section, Cardiology Department, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, Universitat de Barcelona, C/ Villarroel 170, Barcelona, Catalonia 08036, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Madrid, Spain
| | - Roderick Tung
- Center for Arrhythmia Care, Pritzker School of Medicine, University of Chicago, The University of Chicago Medicine, Heart and Vascular Center, 5841 South Maryland Avenue, Chicago, IL 60637, USA.
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17
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Bansal A, Ananthasubramaniam K. Cardiovascular positron emission tomography: established and emerging role in cardiovascular diseases. Heart Fail Rev 2023; 28:387-405. [PMID: 36129644 DOI: 10.1007/s10741-022-10270-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/04/2022] [Indexed: 11/26/2022]
Abstract
Cardiac positron emission tomography (PET) imaging has established themselves firmly as excellent and reliable functional imaging modalities in assessment of the spectrum of coronary artery disease. With the explosion of technology advances and the dream of flow quantification now a reality, the value of PET is now well realized. Cardiac PET has proved itself as precise imaging modality that provides functional imaging of the heart in addition to anatomical imaging. It has established itself as one of the best available techniques for evaluation of myocardial viability. Hybrid PET/computed tomography provides simultaneous integration of coronary anatomy and function with myocardial perfusion and metabolism, thereby improving characterization of the dysfunctional area and chronic coronary artery disease. The availability of quantitative myocardial blood flow evaluation with PET provides additional prognostic information and increases diagnostic accuracy in the management of patients with coronary artery disease. Hybrid imaging seems to hold immense potential in optimizing management of cardiovascular diseases and furthering clinical research.
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Affiliation(s)
- Amit Bansal
- UHS Wilson Medical Center, Johnson City, NY, USA
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18
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Katz M, Meitus A, Arad M, Aizer A, Nof E, Beinart R. Long-Term Outcomes of Tachycardia-Induced Cardiomyopathy Compared with Idiopathic Dilated Cardiomyopathy. J Clin Med 2023; 12:jcm12041412. [PMID: 36835947 PMCID: PMC9960677 DOI: 10.3390/jcm12041412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/05/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND data on the natural course and prognosis of tachycardia-induced cardiomyopathy (TICMP) and comparison with idiopathic dilated cardiomyopathies (IDCM) are scarce. OBJECTIVE To compare the clinical presentation, comorbidities, and long-term outcomes of TICMP patients with IDCM patients. METHODS a retrospective cohort study of patients hospitalized with new-onset TICMP or IDCM. The primary endpoint was a composite of death, myocardial infarction, thromboembolic events, assist device, heart transplantation, and ventricular tachycardia or fibrillation (VT/VF). The secondary endpoint was recurrent hospitalization due to heart failure (HF) exacerbation. RESULTS the cohort was comprised of 64 TICMP and 66 IDCM patients. The primary composite endpoint and all-cause mortality were similar between the groups during a median follow-up of ~6 years (36% versus 29%, p = 0.33 and 22% versus 15%, p = 0.15, respectively). Survival analysis showed no significant difference between TICMP and IDCM groups for the composite endpoint (p = 0.75), all-cause mortality (p = 0.65), and hospitalizations due to heart failure exacerbation. Nonetheless, the incidence of recurrent hospitalization was significantly higher in TICMP patients (incidence rate ratio 1.59; p = 0.009). CONCLUSIONS patients with TICMP have similar long-term outcomes as those with IDCM. However, it portends a higher rate of HF readmissions, mostly due to arrhythmia recurrences.
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Affiliation(s)
- Moshe Katz
- Sheba Medical Center, Ramat Gan 5266202, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel
- NYU Grossman School of Medicine, New York, NY 10016, USA
- Correspondence: ; Tel.: +1-914-893-7914
| | - Amit Meitus
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel
| | - Michael Arad
- Sheba Medical Center, Ramat Gan 5266202, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel
| | - Anthony Aizer
- NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Eyal Nof
- Sheba Medical Center, Ramat Gan 5266202, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel
| | - Roy Beinart
- Sheba Medical Center, Ramat Gan 5266202, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel
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19
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Hu Y, Cheng S, He P, Huang H, Li H, Weng S, Sun XR, Gu M, Niu H, Liu X, Jin H, Zhou X, Hua W. A novel approach for developing left bundle branch pacing and left bundle branch block in a canine model. J Cardiovasc Electrophysiol 2023; 34:997-1005. [PMID: 36758949 DOI: 10.1111/jce.15854] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 01/27/2023] [Accepted: 02/01/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND AND OBJECTIVE Left bundle branch pacing (LBBP) has shown the benefits in the treatment of dyssynchronous heart failure (HF). The purpose of this study was to develop a novel approach for LBBP and left bundle branch block (LBBB) in a canine model. METHODS A "triangle-center" method by tricuspid valve annulus angiography for LBBP implantation was performed in 6 canines. A catheter was then applied for retrograde His potential recording and left bundle branch (LBB) ablation simultaneously. The conduction system was stained to verify the "triangle-center" method for LBBP and assess the locations of the LBB ablation site in relation to the left septal fascicle (LSF). RESULTS The mean LBB potential to ventricular interval and stimulus-peak left ventricular activation time were 11.8 ± 1.2 and 35.7 ± 3.1 ms, respectively. The average intrinsic QRS duration was 44.7 ± 4.7 ms. LBB ablation significantly prolonged the QRS duration (106.3 ± 8.3 ms, p < .001) while LBBP significantly shortened the LBBB-QRS duration to 62.5 ± 5.3 ms (p < .001). After 6 weeks of follow-up, both paced QRS duration (63.0 ± 5.4 ms; p = .203) and LBBB-QRS duration (107.3 ± 7.4 ms; p = .144) were unchanged when comparing to the acute phase, respectively. Anatomical analysis of 6 canine hearts showed that the LBBP lead-tip was all placed in LSF area. CONCLUSION The new approach for LBBP and LBBB canine model was stable and feasible to simulate the clinical dyssynchrony and resynchronization. It provided a useful tool to investigate the basic mechanisms of underlying physiological pacing benefits.
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Affiliation(s)
- Yiran Hu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, The Cardiac Arrhythmia Center, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Cardiology and Macrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Sijing Cheng
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, The Cardiac Arrhythmia Center, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Pengkang He
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Hao Huang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, The Cardiac Arrhythmia Center, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui Li
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, The Cardiac Arrhythmia Center, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sixian Weng
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, The Cardiac Arrhythmia Center, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xue Rong Sun
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, The Cardiac Arrhythmia Center, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Min Gu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, The Cardiac Arrhythmia Center, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongxia Niu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, The Cardiac Arrhythmia Center, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xi Liu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, The Cardiac Arrhythmia Center, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Han Jin
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Xiaohong Zhou
- Department of Cardiology, Cardiac Rhythm Management, Medtronic plc, Mounds View, Minnesota, USA
| | - Wei Hua
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, The Cardiac Arrhythmia Center, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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20
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van Nieuwenhoven FA, Schroen B, Barile L, van Middendorp L, Prinzen FW, Auricchio A. Plasma Extracellular Vesicles as Liquid Biopsy to Unravel the Molecular Mechanisms of Cardiac Reverse Remodeling Following Resynchronization Therapy? J Clin Med 2023; 12:jcm12020665. [PMID: 36675594 PMCID: PMC9862724 DOI: 10.3390/jcm12020665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
Cardiac resynchronization therapy (CRT) has become a valuable addition to the treatment options for heart failure, in particular for patients with disturbances in electrical conduction that lead to regionally different contraction patterns (dyssynchrony). Dyssynchronous hearts show extensive molecular and cellular remodeling, which has primarily been investigated in experimental animals. Evidence showing that at least several miRNAs play a role in this remodeling is increasing. A comparison of results from measurements in plasma and myocardial tissue suggests that plasma levels of miRNAs may reflect the expression of these miRNAs in the heart. Because many miRNAs released in the plasma are included in extracellular vesicles (EVs), which protect them from degradation, measurement of myocardium-derived miRNAs in peripheral blood EVs may open new avenues to investigate and monitor (reverse) remodeling in dyssynchronous and resynchronized hearts of patients.
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Affiliation(s)
- Frans A. van Nieuwenhoven
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Blanche Schroen
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Lucio Barile
- Laboratory for Cardiovascular Theranostics, Istituto Cardiocentro Ticino, 6900 Lugano, Switzerland
| | - Lars van Middendorp
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, 6200 MD Maastricht, The Netherlands
| | - Frits W. Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, 6200 MD Maastricht, The Netherlands
- Correspondence:
| | - Angelo Auricchio
- Department of Cardiology, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
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21
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Kim HM, Hwang I, Yoon YE, Park J, Lee S, Kim H, Kim Y, Lim Y, Cho G. Prediction of Deterioration of Left Ventricular Function Using 3-Dimensional Speckle-Tracking Echocardiography in Patients With Left Bundle-Branch Block. J Am Heart Assoc 2022; 12:e026194. [PMID: 36583438 PMCID: PMC9973573 DOI: 10.1161/jaha.122.026194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Previous studies have demonstrated that 2-dimensional (2D) global longitudinal strain (GLS) is associated with cardiovascular outcomes in patients with left bundle-branch block. However, the predictive value of 3-dimensional (3D) speckle-tracking echocardiography has not yet been investigated in these patients. Methods and Results The authors retrospectively identified 290 patients with left bundle-branch block who underwent echocardiography more than twice. Using speckle-tracking echocardiography, 2D-GLS, 3D-GLS, 3D-global circumferential strain, 3D global radial strain, and 3D global area strain were acquired. The association between 2D and 3D strains and the follow-up left ventricular (LV) ejection fraction (LVEF) was analyzed. The study population was divided into 2 sets: a group with preserved LVEF (baseline LVEF ≥40%) and a group with reduced LVEF (baseline LVEF <40%). After a median follow-up of 29.1 months (interquartile range, 13.1-53.0 months), 14.9% of patients progressed to LV dysfunction in the group with preserved LVEF, and 51.0% of patients showed improved LV function in the group with reduced LVEF. Multivariable analysis of 2D and 3D strains revealed that higher 2D-GLS (odds ratio [OR], 0.65 [95% CI, 0.54-0.78], P<0.001) was highly associated with maintaining LVEF in patients with preserved LVEF. However, a lower 3D-global circumferential strain (OR, 0.61 [95% CI, 0.47-0.78], P<0.001) showed a strong association with persistently reduced LVEF in patients with reduced LVEF. Conclusions Although 2D-GLS showed a powerful predictive value for the deterioration of LV function in the preserved LVEF group, 3D strain, especially 3D-global circumferential strain, can be helpful to predict consistent LV dysfunction in patients with left bundle-branch block who have reduced LVEF.
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Affiliation(s)
- Hyue Mee Kim
- Division of CardiologyDepartment of Internal MedicineChung‐Ang University HospitalChung‐Ang University College of MedicineSeoulSouth Korea
| | - In‐Chang Hwang
- Cardiovascular Center & Department of Internal MedicineCollege of MedicineSeoul National UniversitySeoul National University Bundang HospitalSeongnamGyeonggiSouth Korea
| | - Yeonyee Elizabeth Yoon
- Cardiovascular Center & Department of Internal MedicineCollege of MedicineSeoul National UniversitySeoul National University Bundang HospitalSeongnamGyeonggiSouth Korea
| | - Jun‐Bean Park
- Cardiovascular Center, Department of Internal MedicineCollege of Medicine, Seoul National UniversitySeoul National University HospitalSeoulSouth Korea
| | - Seung‐Pyo Lee
- Cardiovascular Center, Department of Internal MedicineCollege of Medicine, Seoul National UniversitySeoul National University HospitalSeoulSouth Korea
| | - Hyung‐Kwan Kim
- Cardiovascular Center, Department of Internal MedicineCollege of Medicine, Seoul National UniversitySeoul National University HospitalSeoulSouth Korea
| | - Yong‐Jin Kim
- Cardiovascular Center, Department of Internal MedicineCollege of Medicine, Seoul National UniversitySeoul National University HospitalSeoulSouth Korea
| | - Yaeji Lim
- Department of Applied StatisticsChung‐Ang UniversitySeoulSouth Korea
| | - Goo‐Yeong Cho
- Cardiovascular Center & Department of Internal MedicineCollege of MedicineSeoul National UniversitySeoul National University Bundang HospitalSeongnamGyeonggiSouth Korea
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22
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Chen Z, Zhou X, Ma X, Chen K. Recruitment of the cardiac conduction system for optimal resynchronization therapy in failing heart. Front Physiol 2022; 13:1045740. [PMID: 36589433 PMCID: PMC9798297 DOI: 10.3389/fphys.2022.1045740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
Heart failure (HF) is a leading health burden around the world. Although pharmacological development has dramatically advanced medication therapy in the field, hemodynamic disorders or mechanical desynchrony deteriorated by intra or interventricular conduction abnormalities remains a critical target beyond the scope of pharmacotherapy. In the past 2 decades, nonpharmacologic treatment for heart failure, such as cardiac resynchronization therapy (CRT) via biventricular pacing (BVP), has been playing an important role in improving the prognosis of heart failure. However, the response rate of BVP-CRT is variable, leaving one-third of patients not benefiting from the therapy as expected. Considering the non-physiological activation pattern of BVP-CRT, more efforts have been made to optimize resynchronization. The most extensively investigated approach is by stimulating the native conduction system, e.g., His-Purkinje conduction system pacing (CSP), including His bundle pacing (HBP) and left bundle branch area pacing (LBBAP). These emerging CRT approaches provide an alternative to traditional BVP-CRT, with multiple proof-of-concept studies indicating the safety and efficacy of its utilization in dyssynchronous heart failure. In this review, we summarize the mechanisms of dyssynchronous HF mediated by conduction disturbance, the rationale and acute effect of CSP for CRT, the recent advancement in clinical research, and possible future directions of CSP.
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Affiliation(s)
- Zhongli Chen
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | - Xuan Ma
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Keping Chen
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,*Correspondence: Keping Chen,
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23
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van der Velden J, Asselbergs FW, Bakkers J, Batkai S, Bertrand L, Bezzina CR, Bot I, Brundel BJJM, Carrier L, Chamuleau S, Ciccarelli M, Dawson D, Davidson SM, Dendorfer A, Duncker DJ, Eschenhagen T, Fabritz L, Falcão-Pires I, Ferdinandy P, Giacca M, Girao H, Gollmann-Tepeköylü C, Gyongyosi M, Guzik TJ, Hamdani N, Heymans S, Hilfiker A, Hilfiker-Kleiner D, Hoekstra AG, Hulot JS, Kuster DWD, van Laake LW, Lecour S, Leiner T, Linke WA, Lumens J, Lutgens E, Madonna R, Maegdefessel L, Mayr M, van der Meer P, Passier R, Perbellini F, Perrino C, Pesce M, Priori S, Remme CA, Rosenhahn B, Schotten U, Schulz R, Sipido KR, Sluijter JPG, van Steenbeek F, Steffens S, Terracciano CM, Tocchetti CG, Vlasman P, Yeung KK, Zacchigna S, Zwaagman D, Thum T. Animal models and animal-free innovations for cardiovascular research: current status and routes to be explored. Consensus document of the ESC Working Group on Myocardial Function and the ESC Working Group on Cellular Biology of the Heart. Cardiovasc Res 2022; 118:3016-3051. [PMID: 34999816 PMCID: PMC9732557 DOI: 10.1093/cvr/cvab370] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 01/05/2022] [Indexed: 01/09/2023] Open
Abstract
Cardiovascular diseases represent a major cause of morbidity and mortality, necessitating research to improve diagnostics, and to discover and test novel preventive and curative therapies, all of which warrant experimental models that recapitulate human disease. The translation of basic science results to clinical practice is a challenging task, in particular for complex conditions such as cardiovascular diseases, which often result from multiple risk factors and comorbidities. This difficulty might lead some individuals to question the value of animal research, citing the translational 'valley of death', which largely reflects the fact that studies in rodents are difficult to translate to humans. This is also influenced by the fact that new, human-derived in vitro models can recapitulate aspects of disease processes. However, it would be a mistake to think that animal models do not represent a vital step in the translational pathway as they do provide important pathophysiological insights into disease mechanisms particularly on an organ and systemic level. While stem cell-derived human models have the potential to become key in testing toxicity and effectiveness of new drugs, we need to be realistic, and carefully validate all new human-like disease models. In this position paper, we highlight recent advances in trying to reduce the number of animals for cardiovascular research ranging from stem cell-derived models to in situ modelling of heart properties, bioinformatic models based on large datasets, and state-of-the-art animal models, which show clinically relevant characteristics observed in patients with a cardiovascular disease. We aim to provide a guide to help researchers in their experimental design to translate bench findings to clinical routine taking the replacement, reduction, and refinement (3R) as a guiding concept.
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Grants
- R01 HL150359 NHLBI NIH HHS
- RG/16/14/32397 British Heart Foundation
- FS/18/37/33642 British Heart Foundation
- PG/17/64/33205 British Heart Foundation
- PG/15/88/31780 British Heart Foundation
- FS/RTF/20/30009, NH/19/1/34595, PG/18/35/33786, CS/17/4/32960, PG/15/88/31780, and PG/17/64/33205 British Heart Foundation
- NC/T001488/1 National Centre for the Replacement, Refinement and Reduction of Animals in Research
- PG/18/44/33790 British Heart Foundation
- CH/16/3/32406 British Heart Foundation
- FS/RTF/20/30009 British Heart Foundation
- NWO-ZonMW
- ZonMW and Heart Foundation for the translational research program
- Dutch Cardiovascular Alliance (DCVA)
- Leducq Foundation
- Dutch Research Council
- Association of Collaborating Health Foundations (SGF)
- UCL Hospitals NIHR Biomedical Research Centre, and the DCVA
- Netherlands CardioVascular Research Initiative CVON
- Stichting Hartekind and the Dutch Research Counsel (NWO) (OCENW.GROOT.2019.029)
- National Fund for Scientific Research, Belgium and Action de Recherche Concertée de la Communauté Wallonie-Bruxelles, Belgium
- Netherlands CardioVascular Research Initiative CVON (PREDICT2 and CONCOR-genes projects), the Leducq Foundation
- ERA PerMed (PROCEED study)
- Netherlands Cardiovascular Research Initiative
- Dutch Heart Foundation
- German Centre of Cardiovascular Research (DZHH)
- Chest Heart and Stroke Scotland
- Tenovus Scotland
- Friends of Anchor and Grampian NHS-Endowments
- National Institute for Health Research University College London Hospitals Biomedical Research Centre
- German Centre for Cardiovascular Research
- European Research Council (ERC-AG IndivuHeart), the Deutsche Forschungsgemeinschaft
- European Union Horizon 2020 (REANIMA and TRAINHEART)
- German Ministry of Education and Research (BMBF)
- Centre for Cardiovascular Research (DZHK)
- European Union Horizon 2020
- DFG
- National Research, Development and Innovation Office of Hungary
- Research Excellence Program—TKP; National Heart Program
- Austrian Science Fund
- European Union Commission’s Seventh Framework programme
- CVON2016-Early HFPEF
- CVON She-PREDICTS
- CVON Arena-PRIME
- European Union’s Horizon 2020 research and innovation programme
- Deutsche Forschungsgemeinschaft
- Volkswagenstiftung
- French National Research Agency
- ERA-Net-CVD
- Fédération Française de Cardiologie, the Fondation pour la Recherche Médicale
- French PIA Project
- University Research Federation against heart failure
- Netherlands Heart Foundation
- Dekker Senior Clinical Scientist
- Health Holland TKI-LSH
- TUe/UMCU/UU Alliance Fund
- south African National Foundation
- Cancer Association of South Africa and Winetech
- Netherlands Heart Foundation/Applied & Engineering Sciences
- Dutch Technology Foundation
- Pie Medical Imaging
- Netherlands Organisation for Scientific Research
- Dr. Dekker Program
- Netherlands CardioVascular Research Initiative: the Dutch Heart Foundation
- Dutch Federation of University Medical Centres
- Netherlands Organization for Health Research and Development and the Royal Netherlands Academy of Sciences for the GENIUS-II project
- Netherlands Organization for Scientific Research (NWO) (VICI grant); the European Research Council
- Incyte s.r.l. and from Ministero dell’Istruzione, Università e Ricerca Scientifica
- German Center for Cardiovascular Research (Junior Research Group & Translational Research Project), the European Research Council (ERC Starting Grant NORVAS),
- Swedish Heart-Lung-Foundation
- Swedish Research Council
- National Institutes of Health
- Bavarian State Ministry of Health and Care through the research project DigiMed Bayern
- ERC
- ERA-CVD
- Dutch Heart Foundation, ZonMw
- the NWO Gravitation project
- Ministero dell'Istruzione, Università e Ricerca Scientifica
- Regione Lombardia
- Netherlands Organisation for Health Research and Development
- ITN Network Personalize AF: Personalized Therapies for Atrial Fibrillation: a translational network
- MAESTRIA: Machine Learning Artificial Intelligence Early Detection Stroke Atrial Fibrillation
- REPAIR: Restoring cardiac mechanical function by polymeric artificial muscular tissue
- Deutsche Forschungsgemeinschaft (DFG, German Research Foundation)
- European Union H2020 program to the project TECHNOBEAT
- EVICARE
- BRAV3
- ZonMw
- German Centre for Cardiovascular Research (DZHK)
- British Heart Foundation Centre for Cardiac Regeneration
- British Heart Foundation studentship
- NC3Rs
- Interreg ITA-AUS project InCARDIO
- Italian Association for Cancer Research
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Affiliation(s)
- Jolanda van der Velden
- Amsterdam UMC, Vrije Universiteit, Physiology, Amsterdam Cardiovascular Science, Amsterdam, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - Folkert W Asselbergs
- Division Heart & Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Faculty of Population Health Sciences, Institute of Cardiovascular Science and Institute of Health Informatics, University College London, London, UK
| | - Jeroen Bakkers
- Hubrecht Institute-KNAW and University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Sandor Batkai
- Hannover Medical School, Institute of Molecular and Translational Therapeutic Strategies, Hannover, Germany
| | - Luc Bertrand
- Hannover Medical School, Institute of Molecular and Translational Therapeutic Strategies, Hannover, Germany
| | - Connie R Bezzina
- Université catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Pole of Cardiovascular Research, Brussels, Belgium
| | - Ilze Bot
- Heart Center, Department of Experimental Cardiology, Amsterdam UMC, Location Academic Medical Center, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
- Division of BioTherapeutics, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - Bianca J J M Brundel
- Amsterdam UMC, Vrije Universiteit, Physiology, Amsterdam Cardiovascular Science, Amsterdam, The Netherlands
| | - Lucie Carrier
- Institute of Experimental Pharmacology and Toxicology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Steven Chamuleau
- Amsterdam UMC, Heart Center, Cardiology, Amsterdam Cardiovascular Science, Amsterdam, The Netherlands
| | - Michele Ciccarelli
- Department of Medicine, Surgery and Odontology, University of Salerno, Fisciano (SA), Italy
| | - Dana Dawson
- Department of Cardiology, Aberdeen Cardiovascular and Diabetes Centre, Aberdeen Royal Infirmary and University of Aberdeen, Aberdeen, UK
| | - Sean M Davidson
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London WC1E 6HX, UK
| | - Andreas Dendorfer
- Walter-Brendel-Centre of Experimental Medicine, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Dirk J Duncker
- Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Thomas Eschenhagen
- Institute of Experimental Pharmacology and Toxicology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Larissa Fabritz
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
- University Center of Cardiovascular Sciences and Department of Cardiology, University Heart Center Hamburg, Germany and Institute of Cardiovascular Sciences, University of Birmingham, UK
| | - Ines Falcão-Pires
- UnIC - Cardiovascular Research and Development Centre, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal
| | - Péter Ferdinandy
- Cardiometabolic Research Group and MTA-SE System Pharmacology Research Group, Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
- Pharmahungary Group, Szeged, Hungary
| | - Mauro Giacca
- Department of Medicine, Surgery and Health Sciences and Cardiovascular Department, Centre for Translational Cardiology, Azienda Sanitaria Universitaria Integrata Trieste, Trieste, Italy
- International Center for Genetic Engineering and Biotechnology (ICGEB), Trieste, Italy
- King’s British Heart Foundation Centre, King’s College London, London, UK
| | - Henrique Girao
- Univ Coimbra, Center for Innovative Biomedicine and Biotechnology, Faculty of Medicine, Coimbra, Portugal
- Clinical Academic Centre of Coimbra, Coimbra, Portugal
| | | | - Mariann Gyongyosi
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Tomasz J Guzik
- Instutute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Jagiellonian University, Collegium Medicum, Kraków, Poland
| | - Nazha Hamdani
- Division Cardiology, Molecular and Experimental Cardiology, Ruhr University Bochum, Bochum, Germany
- Institute of Physiology, Ruhr University Bochum, Bochum, Germany
| | - Stephane Heymans
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Andres Hilfiker
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Denise Hilfiker-Kleiner
- Department for Cardiology and Angiology, Hannover Medical School, Hannover, Germany
- Department of Cardiovascular Complications in Pregnancy and in Oncologic Therapies, Comprehensive Cancer Centre, Philipps-Universität Marburg, Germany
| | - Alfons G Hoekstra
- Computational Science Lab, Informatics Institute, Faculty of Science, University of Amsterdam, Amsterdam, the Netherlands
| | - Jean-Sébastien Hulot
- Université de Paris, INSERM, PARCC, F-75015 Paris, France
- CIC1418 and DMU CARTE, AP-HP, Hôpital Européen Georges-Pompidou, F-75015 Paris, France
| | - Diederik W D Kuster
- Amsterdam UMC, Vrije Universiteit, Physiology, Amsterdam Cardiovascular Science, Amsterdam, The Netherlands
| | - Linda W van Laake
- Division Heart & Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Sandrine Lecour
- Department of Medicine, Hatter Institute for Cardiovascular Research in Africa and Cape Heart Institute, University of Cape Town, Cape Town, South Africa
| | - Tim Leiner
- Department of Radiology, Utrecht University Medical Center, Utrecht, the Netherlands
| | - Wolfgang A Linke
- Institute of Physiology II, University of Muenster, Robert-Koch-Str. 27B, 48149 Muenster, Germany
| | - Joost Lumens
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - Esther Lutgens
- Experimental Vascular Biology Division, Department of Medical Biochemistry, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Institute for Cardiovascular Prevention, Ludwig-Maximilians-Universität München (LMU), Munich, Germany
- DZHK, Partner Site Munich Heart Alliance, Munich, Germany
| | - Rosalinda Madonna
- Department of Pathology, Cardiology Division, University of Pisa, 56124 Pisa, Italy
- Department of Internal Medicine, Cardiology Division, University of Texas Medical School in Houston, Houston, TX, USA
| | - Lars Maegdefessel
- DZHK, Partner Site Munich Heart Alliance, Munich, Germany
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Manuel Mayr
- King’s British Heart Foundation Centre, King’s College London, London, UK
| | - Peter van der Meer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Robert Passier
- Department of Applied Stem Cell Technologies, TechMed Centre, University of Twente, 7500AE Enschede, The Netherlands
- Department of Anatomy and Embryology, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands
| | - Filippo Perbellini
- Hannover Medical School, Institute of Molecular and Translational Therapeutic Strategies, Hannover, Germany
| | - Cinzia Perrino
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Maurizio Pesce
- Unità di Ingegneria Tissutale Cardiovascolare, Centro cardiologico Monzino, IRCCS, Milan, Italy
| | - Silvia Priori
- Molecular Cardiology, Istituti Clinici Scientifici Maugeri, Pavia, Italy
- University of Pavia, Pavia, Italy
| | - Carol Ann Remme
- Université catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Pole of Cardiovascular Research, Brussels, Belgium
| | - Bodo Rosenhahn
- Institute for information Processing, Leibniz University of Hanover, 30167 Hannover, Germany
| | - Ulrich Schotten
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Rainer Schulz
- Institute of Physiology, Justus Liebig University Giessen, Giessen, Germany
| | - Karin R Sipido
- Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium
| | - Joost P G Sluijter
- Experimental Cardiology Laboratory, Department of Cardiology, Regenerative Medicine Center Utrecht, Circulatory Health Laboratory, Utrecht University, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank van Steenbeek
- Division Heart & Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Sabine Steffens
- Institute for Cardiovascular Prevention, Ludwig-Maximilians-Universität München (LMU), Munich, Germany
- DZHK, Partner Site Munich Heart Alliance, Munich, Germany
| | | | - Carlo Gabriele Tocchetti
- Cardio-Oncology Unit, Department of Translational Medical Sciences, Center for Basic and Clinical Immunology Research (CISI), Interdepartmental Center for Clinical and Translational Research (CIRCET), Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, Naples, Italy
| | - Patricia Vlasman
- Amsterdam UMC, Vrije Universiteit, Physiology, Amsterdam Cardiovascular Science, Amsterdam, The Netherlands
| | - Kak Khee Yeung
- Amsterdam UMC, Vrije Universiteit, Surgery, Amsterdam Cardiovascular Science, Amsterdam, The Netherlands
| | - Serena Zacchigna
- Department of Medicine, Surgery and Health Sciences and Cardiovascular Department, Centre for Translational Cardiology, Azienda Sanitaria Universitaria Integrata Trieste, Trieste, Italy
- International Center for Genetic Engineering and Biotechnology (ICGEB), Trieste, Italy
| | - Dayenne Zwaagman
- Amsterdam UMC, Heart Center, Cardiology, Amsterdam Cardiovascular Science, Amsterdam, The Netherlands
| | - Thomas Thum
- Hannover Medical School, Institute of Molecular and Translational Therapeutic Strategies, Hannover, Germany
- Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover, Germany
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24
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Abstract
PURPOSE OF THE REVIEW Dyssynchrony occurs when portions of the cardiac chambers contract in an uncoordinated fashion. Ventricular dyssynchrony primarily impacts the left ventricle and may result in heart failure. This entity is recognized as a major contributor to the development and progression of heart failure. A hallmark of dyssynchronous heart failure (HFd) is left ventricular recovery after dyssynchrony is corrected. This review discusses the current understanding of pathophysiology of HFd and provides clinical examples and current techniques for treatment. RECENT FINDINGS Data show that HFd responds poorly to medical therapy. Cardiac resynchronization therapy (CRT) in the form of conventional biventricular pacing (BVP) is of proven benefit in HFd, but is limited by a significant non-responder rate. Recently, conduction system pacing (His bundle or left bundle branch area pacing) has also shown promise in correcting HFd. HFd should be recognized as a distinct etiology of heart failure; HFd responds best to CRT.
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Affiliation(s)
- Sean J Dikdan
- Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA
| | | | - Behzad B Pavri
- Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA.
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25
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Toquero Ramos J. Should cardiac resynchronization therapy be prescribed before optimizing medical therapy in patients with left bundle branch block-induced cardiomyopathy? REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 76:220-222. [PMID: 36427789 DOI: 10.1016/j.rec.2022.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Jorge Toquero Ramos
- Unidad de Arritmias y Electrofisiología, Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
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26
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Calle S, Duchenne J, Beela AS, Stankovic I, Puvrez A, Winter S, Fehske W, Aarones M, De Buyzere M, De Pooter J, Voigt JU, Timmermans F. Clinical and Experimental Evidence for a Strain-Based Classification of Left Bundle Branch Block-Induced Cardiac Remodeling. Circ Cardiovasc Imaging 2022; 15:e014296. [PMID: 36330792 DOI: 10.1161/circimaging.122.014296] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Septal strain patterns measured by echocardiography reflect the severity of left bundle branch block (LBBB)-induced left ventricular (LV) dysfunction. We investigated whether these LBBB strain stages predicted the response to cardiac resynchronization therapy in an observational study and developed a sheep model of LBBB-induced cardiomyopathy. METHODS The clinical study enrolled cardiac resynchronization therapy patients who underwent echocardiographic examination with speckle-tracking strain analysis before cardiac resynchronization therapy implant. In an experimental sheep model with pacing-induced dyssynchrony, LV remodeling and strain were assessed at baseline, at 8 and 16 weeks. Septal strain curves were classified into 5 patterns (LBBB-0 to LBBB-4). RESULTS The clinical study involved 250 patients (age 65 [58; 72] years; 79% men; 89% LBBB) with a median LV ejection fraction of 25 [21; 30]%. Across the stages, cardiac resynchronization therapy resulted in a gradual volumetric response, ranging from no response in LBBB-0 patients (ΔLV end-systolic volume 0 [-12; 15]%) to super-response in LBBB-4 patients (ΔLV end-systolic volume -44 [-64; -18]%) (P<0.001). LBBB-0 patients had a less favorable long-term outcome compared with those in stage LBBB≥1 (log-rank P=0.003). In 13 sheep, acute right ventricular pacing resulted in LBBB-1 (23%) and LBBB-2 (77%) patterns. Over the course of 8-16 weeks, continued pacing resulted in progressive LBBB-induced dysfunction, coincident with a transition to advanced strain patterns (92% LBBB-2 and 8% LBBB-3 at week 8; 75% LBBB-3 and 25% LBBB-4 at week 16) (P=0.023). CONCLUSIONS The strain-based LBBB classification reflects a pathophysiological continuum of LBBB-induced remodeling over time and is associated with the extent of reverse remodeling in observational cardiac resynchronization therapy-eligible patients.
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Affiliation(s)
- Simon Calle
- Department of Cardiology, University Hospital Ghent, Belgium (S.C., M.D.B., J.D.P., F.T.)
| | - Jürgen Duchenne
- Department of Cardiovascular Sciences, KU Leuven, Belgium (J.D., A.S.B., I.S., A.P., J.-U.V.).,Department of Cardiovascular Diseases, University Hospital Leuven, Belgium (J.D., A.P., J.-U.V.)
| | - Ahmed S Beela
- Department of Cardiovascular Sciences, KU Leuven, Belgium (J.D., A.S.B., I.S., A.P., J.-U.V.).,Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht, the Netherlands (A.S.B.).,Department of Cardiovascular Diseases, Suez Canal University, Egypt (A.S.B.)
| | - Ivan Stankovic
- Department of Cardiovascular Sciences, KU Leuven, Belgium (J.D., A.S.B., I.S., A.P., J.-U.V.).,Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Serbia (I.S.)
| | - Alexis Puvrez
- Department of Cardiovascular Sciences, KU Leuven, Belgium (J.D., A.S.B., I.S., A.P., J.-U.V.).,Department of Cardiovascular Diseases, University Hospital Leuven, Belgium (J.D., A.P., J.-U.V.)
| | - Stefan Winter
- Department of Cardiology, St. Vinzenz Hospital, Germany (S.W., W.F.)
| | - Wolfgang Fehske
- Department of Cardiology, St. Vinzenz Hospital, Germany (S.W., W.F.)
| | - Marit Aarones
- Department of Medicine, Diakonhjemmet Hospital, Norway (M.A.H.)
| | - Marc De Buyzere
- Department of Cardiology, University Hospital Ghent, Belgium (S.C., M.D.B., J.D.P., F.T.)
| | - Jan De Pooter
- Department of Cardiology, University Hospital Ghent, Belgium (S.C., M.D.B., J.D.P., F.T.)
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, KU Leuven, Belgium (J.D., A.S.B., I.S., A.P., J.-U.V.).,Department of Cardiovascular Diseases, University Hospital Leuven, Belgium (J.D., A.P., J.-U.V.)
| | - Frank Timmermans
- Department of Cardiology, University Hospital Ghent, Belgium (S.C., M.D.B., J.D.P., F.T.)
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27
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Toquero Ramos J. ¿Resincronizar antes de la optimización del tratamiento médico de pacientes con miocardiopatía inducida por bloqueo de rama izquierda? Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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28
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Gillette K, Gsell MAF, Strocchi M, Grandits T, Neic A, Manninger M, Scherr D, Roney CH, Prassl AJ, Augustin CM, Vigmond EJ, Plank G. A personalized real-time virtual model of whole heart electrophysiology. Front Physiol 2022; 13:907190. [PMID: 36213235 PMCID: PMC9539798 DOI: 10.3389/fphys.2022.907190] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 08/15/2022] [Indexed: 01/12/2023] Open
Abstract
Computer models capable of representing the intrinsic personal electrophysiology (EP) of the heart in silico are termed virtual heart technologies. When anatomy and EP are tailored to individual patients within the model, such technologies are promising clinical and industrial tools. Regardless of their vast potential, few virtual technologies simulating the entire organ-scale EP of all four-chambers of the heart have been reported and widespread clinical use is limited due to high computational costs and difficulty in validation. We thus report on the development of a novel virtual technology representing the electrophysiology of all four-chambers of the heart aiming to overcome these limitations. In our previous work, a model of ventricular EP embedded in a torso was constructed from clinical magnetic resonance image (MRI) data and personalized according to the measured 12 lead electrocardiogram (ECG) of a single subject under normal sinus rhythm. This model is then expanded upon to include whole heart EP and a detailed representation of the His-Purkinje system (HPS). To test the capacities of the personalized virtual heart technology to replicate standard clinical morphological ECG features under such conditions, bundle branch blocks within both the right and the left ventricles under two different conduction velocity settings are modeled alongside sinus rhythm. To ensure clinical viability, model generation was completely automated and simulations were performed using an efficient real-time cardiac EP simulator. Close correspondence between the measured and simulated 12 lead ECG was observed under normal sinus conditions and all simulated bundle branch blocks manifested relevant clinical morphological features.
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Affiliation(s)
- Karli Gillette
- Gottfried Schatz Research Center—Biophysics, Medical University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | - Matthias A. F. Gsell
- Gottfried Schatz Research Center—Biophysics, Medical University of Graz, Graz, Austria
- NAWI Graz, Institute of Mathematics and Scientific Computing, University of Graz, Graz, Austria
| | | | - Thomas Grandits
- Gottfried Schatz Research Center—Biophysics, Medical University of Graz, Graz, Austria
- NAWI Graz, Institute of Mathematics and Scientific Computing, University of Graz, Graz, Austria
| | | | - Martin Manninger
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Daniel Scherr
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | | | - Anton J. Prassl
- Gottfried Schatz Research Center—Biophysics, Medical University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | - Christoph M. Augustin
- Gottfried Schatz Research Center—Biophysics, Medical University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | | | - Gernot Plank
- Gottfried Schatz Research Center—Biophysics, Medical University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
- *Correspondence: Gernot Plank,
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29
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Khan Z, Besis G, Tomson J. Worsening Heart Failure and Atrial Flutter in a Patient Secondary to Cardiac Resynchronization Therapy Dyssynchrony: A Case Report. Cureus 2022; 14:e29096. [PMID: 36258951 PMCID: PMC9572945 DOI: 10.7759/cureus.29096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2022] [Indexed: 11/11/2022] Open
Abstract
Cardiac resynchronization therapy-defibrillator (CRT-D) and/or cardiac resynchronization therapy-pacemaker (CRT-P) play an important role in improving cardiac synchronization and reducing the risk of ventricular fibrillation arrest (VFA) in patients with severe left ventricular systolic dysfunction (LVSD). Patients with LVSD may notice worsening symptoms when CRT-D or CRT-P is in dyssynchrony. We present a case of 59-year-old patient who presented with worsening shortness of breath (SOB) and progressive exertional dyspnea for the past few weeks accompanied by pink, frothy sputum, occasional urinary incontinence and urge. He was known to have severe LVSD with an ejection fraction of 10% and had CRT-D in situ. Clinical examination revealed bilateral crepitation and normal heart sounds. A chest radiograph showed pulmonary oedema. An electrocardiogram (ECG) showed atrial fibrillation (AF)/flutter with wide QRS complexes. The patient was treated for acute pulmonary oedema and had CRT-D reprogrammed to achieve biventricular synchrony. He was treated with intravenous furosemide and alternate day metolazone initially. He showed significant subjective and objective improvement and was planned for outpatient synchronized intra-device cardioversion. This case is important because patients with severe LVSD with malfunctioning cardiac resynchronization therapy can result in worsening heart failure (HF) leading to higher morbidity and mortality.
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30
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Incidence of persistent left bundle branch block after rapid-deployment aortic valve replacement. Ann Thorac Surg 2022; 115:1446-1454. [PMID: 35952857 DOI: 10.1016/j.athoracsur.2022.07.038] [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: 10/23/2021] [Revised: 06/24/2022] [Accepted: 07/19/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND We aimed to evaluate the incidence, prognosis and predictive factors of new onset of persistent left bundle branch block(NOP-LBBB) after rapid-deployment aortic valve replacement(RD-AVR). METHODS This study was an observational, retrospective, single-center study of 274 consecutive patients with no baseline ventricular conduction disorder and no previous permanent pacemaker implantation(PPI) who underwent RD-AVR with an INTUITY valve(n=55) and INTUITY Elite Valve(n=219). Twelve-lead electrocardiography and transthoracic echocardiography were performed preoperatively, upon discharge, at 1-month and 1-year intervals. The incidence, prognosis, and predictive factors of NOP-LBBB were evaluated. RESULTS NOP-LBBB occurred in 58 patients(21.2%) upon discharge. In multivariate analysis, age (p <0.01), Intuity valve diameter ≥ 23 mm (p = 0.02) and INTUITY ELITE implantation(p=0.01) were independent predictors of NOP-LBBB. By 1:1 propensity matching analysis between the NOP-LBBB group and the control group, there were no significant differences in one-year overall mortality(p=0.23), hospitalization for CHF(p=0.99) or PPI(p=0.99). NOP-LBBB exposed patients to a high rate of dysrhythmic events(12.1%vs.1.4%,p<0.01) and was associated with a significant decrease in LVEF (62±9.5% vs. 65.2±7.83%, p=0.02) without an impact on NYHA functional status(1.25±0.32 and 1.52±0.70,p=0.32). Seventeen patients(6.2%) had a PPI before discharge, including 14 NOP-LBBB patients. CONCLUSIONS NOP-LBBB after RD-AVR is prevalent in patients with no prior conduction disorders. INTUITY ELITE is associated with a significantly higher rate of NOP-LBBB. The persistence of NOP-LBBB predisposed patients to the occurrence of high-grade conduction disorders and might have led to PPI but did not increase mortality or hospitalization for CHF.
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31
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Bouwmeester S, van Loon T, Ploeg M, Mast TP, Verzaal NJ, van Middendorp LB, Strik M, van Nieuwenhoven FA, Dekker LR, Prinzen FW, Lumens J, Houthuizen P. Left atrial remodeling in mitral regurgitation: A combined experimental-computational study. PLoS One 2022; 17:e0271588. [PMID: 35839240 PMCID: PMC9286246 DOI: 10.1371/journal.pone.0271588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 07/05/2022] [Indexed: 11/18/2022] Open
Abstract
Aims
Progressive changes to left atrial (LA) structure and function following mitral regurgitation (MR) remain incompletely understood. This study aimed to demonstrate potential underlying mechanisms using experimental canine models and computer simulations.
Methods
A canine model of MR was created by cauterization of mitral chordae followed by radiofrequency ablation-induced left bundle-branch block (LBBB) after 4 weeks (MR-LBBB group). Animals with LBBB alone served as control. Echocardiography was performed at baseline, acutely after MR induction, and at 4 and 20 weeks, and correlated with histology and computer simulations.
Results
Acute MR augmented LA reservoir and contractile strain (40±4 to 53±6% and -11±5 to -22±9% respectively, p<0.05). LA fractional area change increased significantly (47±4 to 56±4%, p<0.05) while LA end-systolic area remained unchanged (7.2±1.1 versus 7.9±1.1 cm2 respectively, p = 0.08). LA strain ‘pseudonormalized’ after 4 weeks and decompensated at 20 weeks with both strains decreasing to 25±6% and -3±2% respectively (p<0.05) together with a progressive increase in LA end-systolic area (7.2±1.1 to 14.0±6.3 cm2, p<0.05). In the LBBB-group, LA remodeling was less pronounced. Histology showed a trend towards increased interstitial fibrosis in the LA of the MR-LBBB group. Computer simulations indicated that the progressive changes in LA structure and function are a combination of progressive eccentric remodeling and fibrosis.
Conclusion
MR augmented LA strain acutely to supranormal values without significant LA dilation. However, over time, LA strain gradually decreases (pseudornormal and decompensated) with LA dilation. Histology and computer simulations indicated a correlation to a varying degree of LA eccentric remodeling and fibrosis.
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Affiliation(s)
- Sjoerd Bouwmeester
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
- * E-mail:
| | - Tim van Loon
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Meike Ploeg
- Department of Physiology, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Thomas P. Mast
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Nienke J. Verzaal
- Department of Physiology, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Lars B. van Middendorp
- Department of Physiology, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Marc Strik
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France
| | - Frans A. van Nieuwenhoven
- Department of Physiology, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Lukas R. Dekker
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
- Department of Biomedical Technology, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Frits W. Prinzen
- Department of Physiology, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Joost Lumens
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Patrick Houthuizen
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
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García-Rodeja Arias F, Gómez Otero MI, Bouzas Cruz N, García VEGA D, González Ferrero T, Minguito-Carazo C, Martínez Monzonís A, González Juanatey JR, Rodríguez-Mañero M. Effects of guideline-directed medical therapy in patients with left bundle branch block-induced cardiomyopathy. REVISTA ESPAÑOLA DE CARDIOLOGÍA (ENGLISH EDITION) 2022; 76:238-244. [PMID: 35878779 DOI: 10.1016/j.rec.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/07/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND OBJECTIVES Left bundle branch block (LBBB)-induced cardiomyopathy occurs in patients with long-standing LBBB. These patients characteristically exhibit hyperresponsiveness to cardiac resynchronization therapies (CRT). However, there is scarce information on their response to medical treatment. The aim of this study was to assess the change in left ventricular ejection fraction (LVEF) after a 3-month period following titration of guideline-directed medical therapy for heart failure. METHODS This retrospective analysis included all patients assessed in the heart failure unit of a Spanish University Hospital between 2020 and 2021, who presented with de novo ventricular dysfunction (LVEF <40%) and had a history of long-standing LBBB with no other possible causes of cardiomyopathy. RESULTS A total of 1497 patients were analyzed, of which 21 were finally eligible. Mean time from first diagnosis of LBBB to first consultation was 4.05± 4.1 years. Mean LVEF from first consultation to end of titration improved from 29.5±5.7% to 32.7±8.6% (P = .172), but none had recovered ventricular function at the end of follow-up. New York Heart Association functional class improved from 1.91±0.46 to 1.81±0.53 (P=.542). After CRT device implantation in 8 patients, LVEF improved by 18.1±6.4% (P=.003). CONCLUSIONS Guideline-directed medical therapy seems to be ineffective in improving LVEF and functional class in patients with de novo heart failure and LBBB-induced cardiomyopathy. Based on a positive response to CRT on LVEF improvement, early CRT implantation could be a reasonable strategy for these patients.
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Villegas-Martinez M, Krogh MR, Andersen ØS, Sletten OJ, Wajdan A, Odland HH, Elle OJ, Remme EW. Tracking Early Systolic Motion for Assessing Acute Response to Cardiac Resynchronization Therapy in Real Time. Front Physiol 2022; 13:903784. [PMID: 35721553 PMCID: PMC9201723 DOI: 10.3389/fphys.2022.903784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/13/2022] [Indexed: 11/17/2022] Open
Abstract
An abnormal systolic motion is frequently observed in patients with left bundle branch block (LBBB), and it has been proposed as a predictor of response to cardiac resynchronization therapy (CRT). Our goal was to investigate if this motion can be monitored with miniaturized sensors feasible for clinical use to identify response to CRT in real time. Motion sensors were attached to the septum and the left ventricular (LV) lateral wall of eighteen anesthetized dogs. Recordings were performed during baseline, after induction of LBBB, and during biventricular pacing. The abnormal contraction pattern in LBBB was quantified by the septal flash index (SFI) equal to the early systolic shortening of the LV septal-to-lateral wall diameter divided by the maximum shortening achieved during ejection. In baseline, with normal electrical activation, there was limited early-systolic shortening and SFI was low (9 ± 8%). After induction of LBBB, this shortening and the SFI significantly increased (88 ± 34%, p < 0.001). Subsequently, CRT reduced it approximately back to baseline values (13 ± 13%, p < 0.001 vs. LBBB). The study showed the feasibility of using miniaturized sensors for continuous monitoring of the abnormal systolic motion of the LV in LBBB and how such sensors can be used to assess response to pacing in real time to guide CRT implantation.
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Affiliation(s)
- Manuel Villegas-Martinez
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Magnus Reinsfelt Krogh
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
- Department of Informatics, University of Oslo, Oslo, Norway
| | | | - Ole Jakob Sletten
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Institute for Surgical Research, Oslo University Hospital, Oslo, Norway
- Department of Cardiology and Pediatric Cardiology, Oslo University Hospital, Oslo, Norway
| | - Ali Wajdan
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
- Department of Informatics, University of Oslo, Oslo, Norway
| | - Hans Henrik Odland
- Department of Cardiology and Pediatric Cardiology, Oslo University Hospital, Oslo, Norway
| | - Ole Jakob Elle
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
- Department of Informatics, University of Oslo, Oslo, Norway
| | - Espen W. Remme
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
- Institute for Surgical Research, Oslo University Hospital, Oslo, Norway
- *Correspondence: Espen W. Remme,
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Oomen PJA, Phung TKN, Weinberg SH, Bilchick KC, Holmes JW. A rapid electromechanical model to predict reverse remodeling following cardiac resynchronization therapy. Biomech Model Mechanobiol 2022; 21:231-247. [PMID: 34816336 PMCID: PMC9241386 DOI: 10.1007/s10237-021-01532-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 10/22/2021] [Indexed: 10/19/2022]
Abstract
Cardiac resynchronization therapy (CRT) is an effective therapy for patients who suffer from heart failure and ventricular dyssynchrony such as left bundle branch block (LBBB). When it works, it reverses adverse left ventricular (LV) remodeling and the progression of heart failure. However, CRT response rate is currently as low as 50-65%. In theory, CRT outcome could be improved by allowing clinicians to tailor the therapy through patient-specific lead locations, timing, and/or pacing protocol. However, this also presents a dilemma: there are far too many possible strategies to test during the implantation surgery. Computational models could address this dilemma by predicting remodeling outcomes for each patient before the surgery takes place. Therefore, the goal of this study was to develop a rapid computational model to predict reverse LV remodeling following CRT. We adapted our recently developed computational model of LV remodeling to simulate the mechanics of ventricular dyssynchrony and added a rapid electrical model to predict electrical activation timing. The model was calibrated to quantitatively match changes in hemodynamics and global and local LV wall mass from a canine study of LBBB and CRT. The calibrated model was used to investigate the influence of LV lead location and ischemia on CRT remodeling outcome. Our model results suggest that remodeling outcome varies with both lead location and ischemia location, and does not always correlate with short-term improvement in QRS duration. The results and time frame required to customize and run this model suggest promise for this approach in a clinical setting.
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Affiliation(s)
- Pim J. A. Oomen
- Department of Biomedical Engineering, University of Virginia, Box 800759, Health System, Charlottesville, VA 22903, USA
- Department of Medicine, University of Virginia, Box 800158, Health System, Charlottesville, VA 22903, USA
| | - Thien-Khoi N. Phung
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 665 Huntington Ave, Boston, MA 02115, USA
| | - Seth H. Weinberg
- Department of Biomedical Engineering, The Ohio State University, 140 W 19th Ave Columbus, Columbus, OH 43210, USA
| | - Kenneth C. Bilchick
- Department of Medicine, University of Virginia, Box 800158, Health System, Charlottesville, VA 22903, USA
| | - Jeffrey W. Holmes
- Department of Biomedical Engineering, University of Virginia, Box 800759, Health System, Charlottesville, VA 22903, USA
- School of Engineering, University of Alabama at Birmingham, 1075 13th St S, Birmingham, AL 35233, USA
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Abstract
The role of electromechanical dyssynchrony in heart failure gained prominence in literature with the results of trials of cardiac resynchronization therapy (CRT). CRT has shown to significantly decrease heart failure hospitalization and mortality in heart failure patients with dyssynchrony. Current guidelines recommend the use of electrical dyssynchrony based on a QRS > 150 ms and a left bundle branch block pattern on surface electrocardiogram to identify dyssynchrony in patients who will benefit from CRT implantation. However, predicting response to CRT remains a challenge with nearly one-third of patients gaining no benefit from the device. Multiple echocardiographic measures of mechanical dyssynchrony have been studied over the past two decade. However, trials where mechanical dyssynchrony used as an additional or lone criteria for CRT failed to show any benefit in the response to CRT. This shows that a deeper understanding of cardiac mechanics should be applied in the assessment of dyssynchrony. This review discusses the evolving role of imaging techniques in assessing cardiac dyssynchrony and their application in patients considered for device therapy.
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Abstract
Cardiac resynchronization therapy (CRT) is a good treatment for heart failure accompanied by ventricular conduction abnormalities. Current ECG criteria in international guidelines seem to be suboptimal to select heart failure patients for CRT. The criteria QRS duration and left bundle branch block (LBBB) QRS morphology insufficiently detect left ventricular activation delay, which is required for benefit from CRT. Additionally, there are various definitions for LBBB, in which each one has a different association with CRT benefit and is prone to subjective interpretation. Recent studies have shown that the objectively measured vectorcardiographic QRS area identifies left ventricular activation delay with higher accuracy than any of the current ECG criteria. Indeed, various studies have consistently shown that a high QRS area prior to CRT predicts both echocardiographic and clinical improvement after CRT. The beneficial relation of QRS area with CRT-outcome was largely independent from QRS morphology, QRS duration, and patient characteristics known to affect CRT-outcome including ischemic etiology and sex. On top of QRS area prior to CRT, the reduction in QRS area after CRT further improves benefit. QRS area is easily obtainable from a standard 12-lead ECG though it currently requires off-line analysis. Clinical applicability will be significantly improved when QRS area is automatically determined by ECG equipment.
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37
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Prinzen FW, Auricchio A, Mullens W, Linde C, Huizar JF. OUP accepted manuscript. Eur Heart J 2022; 43:1917-1927. [PMID: 35265992 PMCID: PMC9123241 DOI: 10.1093/eurheartj/ehac088] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/02/2021] [Accepted: 02/22/2022] [Indexed: 11/14/2022] Open
Abstract
Electrical disturbances, such as atrial fibrillation (AF), dyssynchrony, tachycardia, and premature ventricular contractions (PVCs), are present in most patients with heart failure (HF). While these disturbances may be the consequence of HF, increasing evidence suggests that they may also cause or aggravate HF. Animal studies show that longer-lasting left bundle branch block, tachycardia, AF, and PVCs lead to functional derangements at the organ, cellular, and molecular level. Conversely, electrical treatment may reverse or mitigate HF. Clinical studies have shown the superiority of atrial and pulmonary vein ablation for rhythm control and AV nodal ablation for rate control in AF patients when compared with medical treatment. Ablation of PVCs can also improve left ventricular function. Cardiac resynchronization therapy (CRT) is an established adjunct therapy currently undergoing several interesting innovations. The current guideline recommendations reflect the safety and efficacy of these ablation therapies and CRT, but currently, these therapies are heavily underutilized. This review focuses on the electrical treatment of HF with reduced ejection fraction (HFrEF). We believe that the team of specialists treating an HF patient should incorporate an electrophysiologist in order to achieve a more widespread use of electrical therapies in the management of HFrEF and should also include individual conditions of the patient, such as body size and gender in therapy fine-tuning.
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Affiliation(s)
| | - Angelo Auricchio
- Division of Cardiology, Istituto Cardiocentro Ticino, Lugano, Switzerland
| | - Wilfried Mullens
- Ziekenhuis Oost Limburg, Genk, Belgium
- Biomedical Research Institute, Faculty of Medicine and Life Sciences, University Hasselt, Hasselt, Belgium
| | - Cecilia Linde
- Department of Medicine, Karolinska Institutet, Solna, Sweden
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Jose F Huizar
- Cardiology Division, Virginia Commonwealth University/Pauley Heart Center, Richmond, VA, USA
- Cardiology Division, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA, USA
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Hong JA, Lee SE, Kim SO, Kim MS, Lee HY, Cho HJ, Choi JO, Jeon ES, Hwang KK, Chae SC, Baek SH, Kang SM, Choi DJ, Yoo BS, Kim KH, Cho MC, Oh BH, Kim JJ. Determinants of left ventricular function improvement for cardiac resynchronization therapy candidates. ESC Heart Fail 2021; 9:283-292. [PMID: 34964278 PMCID: PMC8787974 DOI: 10.1002/ehf2.13765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 09/24/2021] [Accepted: 12/02/2021] [Indexed: 11/11/2022] Open
Abstract
AIMS A waiting period of more than 3 months is recommended for patients before undergoing cardiac resynchronization therapy (CRT). However, due to an anticipated high mortality rate, early implementation of CRT might be beneficial for some patients. We aimed to evaluate the rate and the probability of left ventricular (LV) function improvement and their predictors in patients with heart failure (HF) with indications for CRT. METHODS AND RESULTS From March 2011 to February 2014, a total of 5625 hospitalized patients for acute HF were consecutively enrolled in 10 tertiary hospitals. Among them, we analysed 1792 patients (mean age 63.96 ± 15.42 years, female 63.1%) with left ventricular ejection fraction (LVEF) ≤ 35% at the baseline echocardiography and divided them into three groups: 144 with left bundle branch block (LBBB), 136 with wide QRS complexes without LBBB, and 1512 not having these findings (control). We compared and analysed these three groups for improvement of LV function at follow-up echocardiography. In patients who met CRT indications (patients with LBBB or wide QRS complexes without LBBB), logistic regression was performed to identify risk factors for no improvement of LV. No improvement of LV was defined as LVEF ≤ 35% at follow-up echocardiography or the composite adverse outcomes: death, heart transplantation, extracorporeal membrane oxygenation, or use of a ventricular assist device before follow-up echocardiography. A classification tree was established using the binary recursive partitioning method to predict the outcome of patients who met CRT indications. In a median follow-up of 11 months, LVEF improvement was observed in 24.3%, 15.4%, and 40.5% of patients with LBBB, wide QRS complexes without LBBB, and control, respectively. Patients meeting CRT indications had higher 3 month mortality rates than the control (24.6% vs. 17.7%, P = 0.002). Multivariable logistic regression analysis revealed that large LV end-systolic dimension [odds ratio (OR) 1.10, 95% confidence interval (CI) 1.05-1.15, P < 0.001], low LVEF (OR 0.92, 95% CI 0.87-0.98, P = 0.006), diabetes requiring insulin (OR 6.49, 95% CI 2.53-19.33, P < 0.001), and suboptimal medical therapy (OR 6.85, 95% CI 3.21-15.87, P < 0.001) were significant factors predictive of no improvement. A decision tree analysis was consistent with these results. CONCLUSIONS Patients with CRT indications had higher mortality during their follow-up compared with control. LV function improvement was rare in this population, especially when they had some risk factors. These results suggest that the uniform waiting period before CRT implantation could be reconsidered and individualized.
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Affiliation(s)
- Jung Ae Hong
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.,Department of Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sang Eun Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Seon-Ok Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Min-Seok Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Hyun-Jai Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Jin Oh Choi
- Sungkyunkwan University College of Medicine, Seoul, South Korea
| | - Eun-Seok Jeon
- Sungkyunkwan University College of Medicine, Seoul, South Korea
| | - Kyung-Kuk Hwang
- Chungbuk National University College of Medicine, Cheongju, South Korea
| | - Shung Chull Chae
- Kyungpook National University College of Medicine, Daegu, South Korea
| | | | - Seok-Min Kang
- Yonsei University College of Medicine, Seoul, South Korea
| | - Dong-Ju Choi
- Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Byung-Su Yoo
- Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Kye Hun Kim
- Heart Research Center of Chonnam National University, Gwangju, South Korea
| | - Myeong-Chan Cho
- Chungbuk National University College of Medicine, Cheongju, South Korea
| | - Byung-Hee Oh
- Division of Cardiology, Cardiovascular Center, Mediplex Sejong Hospital, Incheon, South Korea
| | - Jae-Joong Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
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Prinzen FW, Lumens J, Duchenn J, Vernooy K. Electro-energetics of Biventricular, Septal and Conduction System Pacing. Arrhythm Electrophysiol Rev 2021; 10:250-257. [PMID: 35106177 PMCID: PMC8785089 DOI: 10.15420/aer.2021.30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 10/27/2021] [Indexed: 11/10/2022] Open
Abstract
Abnormal electrical activation of the ventricles creates abnormalities in cardiac mechanics. Local contraction patterns, as reflected by strain, are not only out of phase, but also show opposing length changes in early and late activated regions. Consequently, the efficiency of cardiac pump function (the amount of stroke work generated by a unit of oxygen consumed), is approximately 30% lower in dyssynchronous than in synchronous hearts. Maintaining good cardiac efficiency appears important for long-term outcomes. Biventricular, left ventricular septal, His bundle and left bundle branch pacing may minimise the amount of pacing-induced dyssynchrony and efficiency loss when compared to conventional right ventricular pacing. An extensive animal study indicates maintenance of mechanical synchrony and efficiency during left ventricular septal pacing and data from a few clinical studies support the idea that this is also the case for left bundle branch pacing and His bundle pacing. This review discusses electro-mechanics and mechano-energetics under the various paced conditions and provides suggestions for future research.
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Affiliation(s)
- Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands
| | - Joost Lumens
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands
| | - J�rgen Duchenn
- Department of Cardiovascular Sciences, KU Leuven, Belgium
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+ (MUMC+), the Netherlands
- Department of Cardiology, Radboud University Medical Centre (Radboudumc), Nijmegen, the Netherlands
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40
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Hedeer F, Ostenfeld E, Hedén B, Prinzen FW, Arheden H, Carlsson M, Engblom H. To what extent are perfusion defects seen by myocardial perfusion SPECT in patients with left bundle branch block related to myocardial infarction, ECG characteristics, and myocardial wall motion? J Nucl Cardiol 2021; 28:2910-2922. [PMID: 32451797 PMCID: PMC8709823 DOI: 10.1007/s12350-020-02180-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 04/25/2020] [Indexed: 12/04/2022]
Abstract
INTRODUCTION We investigated if uptake pattern on myocardial perfusion SPECT (MPS) in patients with left bundle branch block (LBBB) is related to myocardial fibrosis, myocardial wall motion, and electrocardiography (ECG) characteristics. METHODS Twenty-three patients (9 women) with LBBB, examined with MPS and cardiac magnetic resonance (CMR), were included. Tracer uptake on MPS was classified by visual interpretation as typical LBBB pattern (Defect+, n = 13) or not (Defect-, n = 10) and quantitatively. CMR images were evaluated for wall thickness and for myocardial wall motion both by visual assessment and by regional myocardial radial strain from feature tracking, and for presence and location of myocardial fibrosis. ECGs were analyzed regarding QRS duration and the presence of strict criteria for LBBB. RESULTS Wall thickness was slightly lower in the septum compared to the lateral wall in Defect+ patients (5.6 ± 1.1 vs 6.0 ± 1.3 mm, P = 0.03) but not in Defect- patients (5.6 ± 1.0 vs 5.6 ± 0.9 mm, P = 0.84). Defect+ patients showed a larger proportion of dyskinetic segments in the septum and hyperkinetic segments in the lateral wall compared to Defect- patients (P = 0.006 and P = 0.004, respectively). Decreased myocardial radial strain was associated with decreased tracer uptake by MPS (R = 0.37, P < 0.001). Areas of fibrosis did not match areas with uptake defect on MPS. No differences in ECG variables were seen. CONCLUSION The heterogeneous regional tracer uptake in some patients with LBBB is related to underlying regional myocardial dyskinesia, wall thickening, and wall thickness rather than stress-induced ischemia, myocardial fibrosis, or specific ECG characteristics.
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Affiliation(s)
- Fredrik Hedeer
- Department of Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Ellen Ostenfeld
- Department of Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Bo Hedén
- Department of Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Håkan Arheden
- Department of Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Marcus Carlsson
- Department of Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Henrik Engblom
- Department of Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden.
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Otaki Y, Miller RJH, Slomka PJ. Elucidating the pathophysiology of left bundle branch block related perfusion defects. J Nucl Cardiol 2021; 28:2923-2926. [PMID: 32557149 DOI: 10.1007/s12350-020-02224-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/02/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Yuka Otaki
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Suite. 1258, Los Angeles, CA, 90048, USA.
| | - Robert J H Miller
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Suite. 1258, Los Angeles, CA, 90048, USA
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Piotr J Slomka
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Suite. 1258, Los Angeles, CA, 90048, USA
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Left Bundle Branch Block: Characterization, Definitions, and Recent Insights into Conduction System Physiology. Card Electrophysiol Clin 2021; 13:671-684. [PMID: 34689894 DOI: 10.1016/j.ccep.2021.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Left bundle branch block (LBBB) is not just a simple electrocardiogram alteration. The intricacies of this general terminology go beyond simple conduction block. This review puts together current knowledge on the historical concept of LBBB, clinical significance, and recent insights into the pathophysiology of human LBBB. LBBB is an entity that affects patient diagnosis (primary conduction disease, secondary to underlying pathology or iatrogenic), treatment (cardiac resynchronization therapy or conduction system pacing for heart failure), and prognosis. Recruiting the left bundle branch with conduction system pacing depends on the complex interaction between anatomy, site of pathophysiology, and delivery tools.
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Miyazaki A, Uemura H. Perspective of preexcitation induced cardiomyopathy; early septal contraction, and subsequent rebound stretch. J Cardiol 2021; 79:30-35. [PMID: 34497028 DOI: 10.1016/j.jjcc.2021.08.017] [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: 06/15/2021] [Revised: 07/08/2021] [Accepted: 08/06/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Preexcitation-induced cardiomyopathy (PIC) is defined as a disease presenting ventricular dyssynchrony because of preexcitation through an accessory pathway (AP), being a cousin of pacing-induced cardiomyopathy. The present review aims at providing perspective of this uncharted subgroup. METHODS In order to determine mechanisms and clinical characteristics of PIC, 63 patients in 29 literature reports were reviewed. RESULTS A median age at onset was 4 (0.1-59) years; 55 patients (87%) under 18 years old including 16 infants. Twenty patients (32%) experienced supraventricular tachycardia prior and subsequent to the PIC onset. Heart failure and left ventricular (LV) dysfunction did not correlate with other clinical features. All the 65 APs identified (duplicated in 2 patients) were located on the right side of the atrioventricular junction; at the septal area (in 55%) or the anterolateral aspect (in 22%). AP conduction was successfully eliminated by medical or interventional treatments where attempted. LV function returned to normal within 6 months in 67% of patients, while recovery took longer than 3 years in 8%. Frequently seen at the basal segments of the interventricular septum were early contraction within the QRS complex, dyskinesis at mid-systole, and aneurysm/bulging or local thinning. CONCLUSIONS Several characteristic factors became clear as described above. Rebound stretch following early shortening of the interventricular septum is seemingly the major mechanism of PIC, and thus a right septal or right anterior/anterolateral AP needs attention as a higher risk for PIC.
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Affiliation(s)
- Aya Miyazaki
- Congenital Heart Disease Center, Nara Medical University, Nara, Japan; Department of Transitional Medicine, Division of Congenital Heart Disease, Shizuoka General Hospital, Shizuoka, Japan; Department of Cardiology, Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan.
| | - Hideki Uemura
- Congenital Heart Disease Center, Nara Medical University, Nara, Japan
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Ko TY, Kao HL, Liu YJ, Yeh CF, Huang CC, Chen YH, Hung CS, Chan CY, Lin LC, Chen YS, Lin MS. Impact of conduction disturbances on left ventricular mass regression and geometry change following transcatheter aortic valve replacement. Sci Rep 2021; 11:16778. [PMID: 34408241 PMCID: PMC8373860 DOI: 10.1038/s41598-021-96297-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 08/09/2021] [Indexed: 11/23/2022] Open
Abstract
Our study aimed to compare the difference of LV mass regression and remodeling in regard of conduction disturbances (CD) following transcatheter aortic valve replacement (TAVR). A prospective analysis of 152 consecutive TAVR patients was performed. 53 patients (34.9%) had CD following TAVR, including 30 (19.7%) permanent pacemaker implantation and 23 (15.2%) new left bundle branch block. In 123 patients with 1-year follow-up, significant improvement of LV ejection fraction (LVEF) (baseline vs 12-month: 65.1 ± 13.2 vs 68.7 ± 9.1, P = 0.017) and reduced LV end-systolic volume (LVESV) (39.8 ± 25.8 vs 34.3 ± 17.1, P = 0.011) was found in non-CD group (N = 85), but not in CD group (N = 38). Both groups had significant decrease in LV mass index (baseline vs 12-month: 148.6 ± 36.9 vs. 136.4 ± 34.7 in CD group, p = 0.023; 153.0 ± 50.5 vs. 125.6 ± 35.1 in non-CD group, p < 0.0001). In 46 patients with 3-year follow-up, only non-CD patients (N = 28) had statistically significant decrease in LV mass index (Baseline vs 36-month: 180.8 ± 58.8 vs 129.8 ± 39.1, p = 0.0001). Our study showed the improvement of LV systolic function, reduced LVESV and LV mass regression at 1 year could be observed in patients without CD after TAVR. Sustained LV mass regression within 3-year was found only in patients without CD.
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Affiliation(s)
- Tsung-Yu Ko
- Department of Internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, Medical College, National Taiwan University, Taipei, Taiwan
| | - Hsien-Li Kao
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan
| | - Ying-Ju Liu
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Fan Yeh
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan
| | - Ching-Chang Huang
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan
| | - Ying-Hsien Chen
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan
| | - Chi-Sheng Hung
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan
| | - Chih-Yang Chan
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Lung-Chun Lin
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan
| | - Yih-Sharng Chen
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Mao-Shin Lin
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan.
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45
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Degtiarova G, Claus P, Duchenne J, Schramm G, Nuyts J, Verberne HJ, Voigt JU, Gheysens O. Impact of left bundle branch block on myocardial perfusion and metabolism: A positron emission tomography study. J Nucl Cardiol 2021; 28:1730-1739. [PMID: 31578659 DOI: 10.1007/s12350-019-01900-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 08/26/2019] [Accepted: 09/10/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Better understanding of pathophysiological changes, induced by left bundle branch block (LBBB), may improve patient selection for cardiac resynchronization therapy (CRT). Therefore, we assessed the effect of LBBB on regional glucose metabolism, 13N-NH3-derived absolute and semiquantitative myocardial blood flow (MBF), and their relation in non-ischemic CRT candidates. METHODS Twenty-five consecutive non-ischemic patients with LBBB underwent 18F-FDG and resting dynamic 13N-NH3 PET/CT prior to CRT implantation. Regional 18F-FDG uptake, absolute MBF, and late 13N-NH3 uptake were analyzed and corresponding septal-to-lateral wall ratios (SLR) were calculated. Segmental analysis was performed to evaluate "reverse mismatch," "mismatch," and "match" patterns, based on late 13N-NH3/18F-FDG uptake ratios. RESULTS A significantly lower 18F-FDG uptake was observed in the septum compared to the lateral wall (SLR 0.53 ± 0.17). A similar pattern was observed for MBF (SLR 0.68 ± 0.18), whereas late 13N-NH3 uptake showed a homogeneous distribution (SLR 0.96 ± 0.13). 13N-NH3/18F-FDG "mismatch" and "reverse mismatch" segments were predominantly present in the lateral (52%) and septal wall (61%), respectively. CONCLUSIONS Non-ischemic CRT candidates with LBBB demonstrate lower glucose uptake and absolute MBF in the septum compared to the lateral wall. However, late static 13N-NH3 uptake showed a homogenous distribution, reflecting a composite measure of altered regional MBF and metabolism, induced by LBBB.
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Affiliation(s)
- Ganna Degtiarova
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.
- Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Piet Claus
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Jürgen Duchenne
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Georg Schramm
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Johan Nuyts
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Hein J Verberne
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Olivier Gheysens
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
- Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
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46
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Larsen CK, Aalen JM, Stokke C, Fjeld JG, Kongsgaard E, Duchenne J, Degtiarova G, Gheysens O, Voigt JU, Smiseth OA, Hopp E. Regional myocardial work by cardiac magnetic resonance and non-invasive left ventricular pressure: a feasibility study in left bundle branch block. Eur Heart J Cardiovasc Imaging 2021; 21:143-153. [PMID: 31599327 DOI: 10.1093/ehjci/jez231] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/08/2019] [Accepted: 09/16/2019] [Indexed: 11/13/2022] Open
Abstract
AIMS Regional myocardial work may be assessed by pressure-strain analysis using a non-invasive estimate of left ventricular pressure (LVP). Strain by speckle tracking echocardiography (STE) is not always accessible due to poor image quality. This study investigated the estimation of regional myocardial work from strain by feature tracking (FT) cardiac magnetic resonance (CMR) and non-invasive LVP. METHODS AND RESULTS Thirty-seven heart failure patients with reduced ejection fraction, left bundle branch block (LBBB), and no myocardial scar were compared to nine controls without LBBB. Circumferential strain was measured by FT-CMR in a mid-ventricular short-axis cine view, and longitudinal strain by STE. Segmental work was calculated by pressure-strain analysis. Twenty-five patients underwent 18F-fluorodeoxyglucose (FDG) positron emission tomography. Segmental values were reported as percentages of the segment with maximum myocardial FDG uptake. In LBBB patients, net CMR-derived work was 51 ± 537 (mean ± standard deviation) in septum vs. 1978 ± 1084 mmHg·% in the left ventricular (LV) lateral wall (P < 0.001). In controls, however, there was homogeneous work distribution with similar values in septum and the LV lateral wall (non-significant). Reproducibility was good. Segmental CMR-derived work correlated with segmental STE-derived work and with segmental FDG uptake (average r = 0.71 and 0.80, respectively). CONCLUSION FT-CMR in combination with non-invasive LVP demonstrated markedly reduced work in septum compared to the LV lateral wall in patients with LBBB. Work distribution correlated with STE-derived work and energy demand as reflected in FDG uptake. These results suggest that FT-CMR in combination with non-invasive LVP is a relevant clinical tool to measure regional myocardial work.
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Affiliation(s)
- Camilla Kjellstad Larsen
- Institute for Surgical Research, Oslo University Hospital, Oslo, Norway.,Center for Cardiological Innovation, Oslo University Hospital, Oslo, Norway.,Department of Cardiology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - John M Aalen
- Institute for Surgical Research, Oslo University Hospital, Oslo, Norway.,Center for Cardiological Innovation, Oslo University Hospital, Oslo, Norway.,Department of Cardiology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Caroline Stokke
- Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway.,Division of Radiology and Nuclear Medicine, Oslo University Hospital, Rikshospitalet, N-0027 Oslo, Norway.,Oslo Metropolitan University, Oslo, Norway
| | - Jan Gunnar Fjeld
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Rikshospitalet, N-0027 Oslo, Norway.,Oslo Metropolitan University, Oslo, Norway
| | - Erik Kongsgaard
- Center for Cardiological Innovation, Oslo University Hospital, Oslo, Norway.,Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Jürgen Duchenne
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Ganna Degtiarova
- Department of Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium.,Department of Imaging and Pathology, KU Leuven - University of Leuven, Leuven, Belgium
| | - Olivier Gheysens
- Department of Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium.,Department of Imaging and Pathology, KU Leuven - University of Leuven, Leuven, Belgium
| | - Jens-Uwe Voigt
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Otto A Smiseth
- Institute for Surgical Research, Oslo University Hospital, Oslo, Norway.,Center for Cardiological Innovation, Oslo University Hospital, Oslo, Norway.,Department of Cardiology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Einar Hopp
- Center for Cardiological Innovation, Oslo University Hospital, Oslo, Norway.,Division of Radiology and Nuclear Medicine, Oslo University Hospital, Rikshospitalet, N-0027 Oslo, Norway
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47
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Impact of Bundle Branch Block on Permanent Pacemaker Implantation after Transcatheter Aortic Valve Implantation: A Meta-Analysis. J Clin Med 2021; 10:jcm10122719. [PMID: 34205478 PMCID: PMC8235153 DOI: 10.3390/jcm10122719] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/10/2021] [Accepted: 06/15/2021] [Indexed: 12/30/2022] Open
Abstract
Data regarding the impact of infra-Hisian conduction disturbances leading to permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI) remain limited. The aim of this study was to determine the impact of right and/or left bundle branch block (RBBB/LBBB) on post-TAVI PPI. We performed a systematic literature review to identify studies reporting on RBBB and/or LBBB status and post-TAVI PPI. Study design, patient characteristics, and the presence of branch block were analyzed. Odds ratios (ORs) with 95% CI were extracted. The final analysis included 36 studies, reporting about 55,851 patients. Data on LBBB were extracted from 33 studies. Among 51,026 patients included, 5503 showed pre-implant LBBB (11.9% (10.4%–13.8%)). The influence of LBBB on post-TAVI PPI was not significant OR 1.1474 (0.9025; 1.4588), p = 0.2618. Data on RBBB were extracted from 28 studies. Among 46,663 patients included, 31,603 showed pre-implant RBBB (9.2% (7.3%–11.6%)). The influence of RBBB on post-TAVI PPI was significant OR 4.8581 (4.1571; 5.6775), p < 0.0001. From this meta-analysis, the presence of RBBB increased the risk for post-TAVI PPI, independent of age or LVEF, while this finding was not confirmed for patients experimenting with LBBB. This result emphasizes the need for pre-operative evaluation strategies in patient selection for TAVI.
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Sletten OJ, Aalen JM, Izci H, Duchenne J, Remme EW, Larsen CK, Hopp E, Galli E, Sirnes PA, Kongsgard E, Donal E, Voigt JU, Smiseth OA, Skulstad H. Lateral Wall Dysfunction Signals Onset of Progressive Heart Failure in Left Bundle Branch Block. JACC Cardiovasc Imaging 2021; 14:2059-2069. [PMID: 34147454 DOI: 10.1016/j.jcmg.2021.04.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/13/2021] [Accepted: 04/19/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study sought to investigate if contractile asymmetry between septum and left ventricular (LV) lateral wall drives heart failure development in patients with left bundle branch block (LBBB) and whether the presence of lateral wall dysfunction affects potential for recovery of LV function with cardiac resynchronization therapy (CRT). BACKGROUND LBBB may induce or aggravate heart failure. Understanding the underlying mechanisms is important to optimize timing of CRT. METHODS In 76 nonischemic patients with LBBB and 11 controls, we measured strain using speckle-tracking echocardiography and regional work using pressure-strain analysis. Patients with LBBB were stratified according to LV ejection fraction (EF) ≥50% (EFpreserved), 36% to 49% (EFmid), and ≤35% (EFlow). Sixty-four patients underwent CRT and were re-examined after 6 months. RESULTS Septal work was successively reduced from controls, through EFpreserved, EFmid, and EFlow (all p < 0.005), and showed a strong correlation to left ventricular ejection fraction (LVEF; r = 0.84; p < 0.005). In contrast, LV lateral wall work was numerically increased in EFpreserved and EFmid versus controls, and did not significantly correlate with LVEF in these groups. In EFlow, however, LV lateral wall work was substantially reduced (p < 0.005). There was a moderate overall correlation between LV lateral wall work and LVEF (r = 0.58; p < 0.005). In CRT recipients, LVEF was normalized (≥50%) in 54% of patients with preserved LV lateral wall work, but only in 13% of patients with reduced LV lateral wall work (p < 0.005). CONCLUSIONS In early stages, LBBB-induced heart failure is associated with impaired septal function but preserved lateral wall function. The advent of LV lateral wall dysfunction may be an optimal time-point for CRT.
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Affiliation(s)
- Ole J Sletten
- Institute for Surgical Research, Rikshospitalet, Oslo University Hospital and University of Oslo, Oslo, Norway; Department of Cardiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - John M Aalen
- Institute for Surgical Research, Rikshospitalet, Oslo University Hospital and University of Oslo, Oslo, Norway; Department of Cardiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hava Izci
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Jürgen Duchenne
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Espen W Remme
- Institute for Surgical Research, Rikshospitalet, Oslo University Hospital and University of Oslo, Oslo, Norway; The Intervention Center, Oslo University Hospital, Oslo, Norway
| | - Camilla K Larsen
- Institute for Surgical Research, Rikshospitalet, Oslo University Hospital and University of Oslo, Oslo, Norway; Department of Cardiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Einar Hopp
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Elena Galli
- Department of Cardiology, Centre Hospitalier Universitaire de Rennes and Inserm, Laboratoire Traitement du Signal et de l'Image, University of Rennes, Rennes, France
| | | | - Erik Kongsgard
- Department of Cardiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Erwan Donal
- Department of Cardiology, Centre Hospitalier Universitaire de Rennes and Inserm, Laboratoire Traitement du Signal et de l'Image, University of Rennes, Rennes, France
| | - Jens U Voigt
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Otto A Smiseth
- Institute for Surgical Research, Rikshospitalet, Oslo University Hospital and University of Oslo, Oslo, Norway; Department of Cardiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Helge Skulstad
- Institute for Surgical Research, Rikshospitalet, Oslo University Hospital and University of Oslo, Oslo, Norway; Department of Cardiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
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49
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Lumens J, Koopsen T, Beela AS. What Do We Gain From Septal Strain? JACC Cardiovasc Imaging 2021; 14:1703-1706. [PMID: 34147452 DOI: 10.1016/j.jcmg.2021.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/12/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Joost Lumens
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Tijmen Koopsen
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Ahmed S Beela
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Cardiovascular diseases, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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50
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Danad I, Knaapen P. Myocardial blood flow imaging in patients with a left bundle branch block or ventricular-paced rhythm: "And therein, as the Bard would tell us, lies the rub". J Nucl Cardiol 2021; 28:989-991. [PMID: 33754301 DOI: 10.1007/s12350-021-02586-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: 02/14/2021] [Accepted: 02/15/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Ibrahim Danad
- Department of Cardiology, Amsterdam University Medical Center, Location VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Paul Knaapen
- Department of Cardiology, Amsterdam University Medical Center, Location VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
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